FALLS CHURCH, Virginia – One of George Washington’s many wise aphorisms, “To be prepared for war is one of the most effective means of preserving peace,” is timeless. Teddy Roosevelt updated the maxim for audiences of his time, advising the country to, “Speak softly and carry a big stick.” Today we press for Peace through Strength.
The Military Health System (MHS) is a key element in executing this strategy. With a global network of 700+ hospitals and clinics and more than 130,000 military and civilian healthcare professionals standing the watch, the MHS ensures America possesses a medically ready force that is fit to fight at a moment’s notice. The MHS sees optimizing the human factor as our strategic edge in combat. But the MHS is unlike any health care system in the United States – we go to war.
From keeping service members healthy here at home to mitigating disease overseas, we keep guns in the fight. By bringing operating rooms and ICUs to the front lines, aboard ships, and in the sky, we empower warfighters to take heroic risks, confident that the world’s best doctors, nurses, and medics have their back at each step and upon every acre on earth. There is nothing the MHS won’t do: no research too ambitious, no device too expensive, no distance too far to preserve or restore the health of our warfighters.
As Acting Assistant Secretary of Defense for Health Affairs, I’m proud to be charged with guaranteeing our medical forces provide world-class medical care and deploy rapidly to support any and all American military missions. The responsibility doesn’t end there. The MHS also ensures those who protect hearth and home -family members – also receive world-class medical care. This empowers deployed Service members to remain mission-focused without having to worry about the health of their spouse or child.
We also fulfill the solemn compact to provide health care to those retirees who devoted their life’s work and innumerable sacrifices in the service of this Nation. As a retired Navy physician and a military spouse, I understand the sacrifices Service members and their families make, both what it’s like to deploy and what it’s like to be left behind. This mission is both intensely personal and intensely rewarding.
That’s why the current underperformance of the new TRICARE contract is especially frustrating to me. The TRICARE health plan is a key pillar of the military’s healthcare delivery system. Millions of family members and retirees rely on TRICARE’s network of providers and hospitals for both medical care and mental health services, like autism care that families count on each and every day. The Defense Health Agency
and I are working tirelessly to hold the contractors accountable, to grant waivers to ensure access to specialty care, and to help families navigate this transition. We’re making progress, but not quickly enough. I will continue to work on behalf of military families until this system is fixed, and to ensure this doesn’t happen again.
The garrison mission of the MHS is carried out in military medical treatment facilities across the globe. The mission is best distilled to its essence: readiness. Medical readiness is combat readiness, and while we’re grateful to have the current moment of relative peace, we must remain vigilant. When the enemy strikes, we need our Service members physically fit, mentally aware, and healthy to defend our nation.
Throughout history, interwar periods have had a pernicious effect on medical readiness, so much so that these periods bear the eponym: The Walker Dip. In 2018, Surgeon General of the British Armed Forces Vice Admiral Alasdair Walker described a recurring and troubling pattern dating back to the 19th century. From the Napoleonic War (1803-1815) to Iraq and Afghanistan, hard-earned lessons and experience gained in combat, such as the importance of specialized trauma care and transfusion medicine, are forgotten and must be relearned. Sadly, these skills “dips” diminish survival rates, resulting in greater injury and loss of life. Forewarned is forearmed. It’s my personal mission to ensure that the skills and expertise leading to the historically high battlefield survival rates that we achieved in Iraq and Afghanistan are never forgotten.
In a world of profound geopolitical risk and competing economic priorities, how can military medicine avoid the Walker Dip? How can it successfully compete for resources with modernization and replenishment of our weapons stock? Simply put, we can’t afford not to.
Fortunately, military medicine isn’t in competition with warfighting priorities such as weapons systems. Rather, it potentiates the ultimate weapons system: the American Soldier, Sailor, Airman, Marine, and Guardian. Medically ready forces keep guns in the fight and ready medical forces honor the pact that America makes to its sons and daughters to provide world-class medical care anytime, anywhere, under any conditions.
The strategy to maintain peak readiness, to cheat the Walker Dip, is three pronged: Support, Sustain, and Strengthen.
- We Support our warfighters in battle. This is our raison d’etre.
- We Sustain our skills by doing high volume, high complexity medical care.
- We Strengthen our chain by fortifying our force generation platforms.
These goals are mutually reinforcing, fostering a virtuous cycle of success. These priorities require resources, leadership, and commitment. I have infinite confidence in the commitment, skill, and dedication of our people. The MHS is one of the best healthcare systems in America and the very best military medical system in the world. We are blessed with outstanding and supportive leaders in the Department who I will continue to work with to ensure the MHS has what it needs. I will continue to tell our story to our elected representatives on Capitol Hill and advocate for our warfighters to ensure they have the medical support they deserve.
Military medicine is a no-fail mission. I’m confident that our success will continue to reinforce the strength that sustains the peace. But should the peace be broken… our preparation will ensure we break the Walker Dip streak.
By Dr. Stephen Ferrara, Acting Assistant Secretary of Defense for Health Affairs
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