By Donna Hoffmeyer
(original post on Medium, Taking Off The Armor)
My friend stood in my driveway, tears welling up in her eyes, as she tried her hardest to keep it together. I knew it was a futile attempt, and hugged her; encouraging her to cry and let the years of pent-up emotions roll down her cheeks.
I’m not going to get into my friend’s medical details to protect her privacy.
What I am going to focus on is how specifically guard and reserve service members get to this point.
I’ve mentioned in the past my last job in the military started as a clinical case manager and ended up working on policy issues that pertained to the medical care of the guard and reserves. Our office was unique in that it had a bird’s eye view of how policy comes down, and either hits or misses the mark.
Our policy was overall pretty decent. Yes, it needed work, as our program evolved. However, if executed how it read, I believe the majority of people we cared for would have fared rather well. What I found most disturbing was the biased interpretation that led to many people ending up with unnecessary mental health issues, or worsening mental issues, while trying to recover from existing physical and/or mental health issues.
As I talked and collaborated with people from other branches, I realized the problems appeared to be systemic across the services. I will not be so arrogant as to surmise why each service had these issues. I can only discuss what I saw, and post-retirement, have been updated periodically.
Competing Agendas
Giving quality care versus affording quality care. This will be a forever struggle. According to the Congressional Research Service’s summary of the FY22 Medical Health System Budget Request, the overall request was an increase of $2.7 billion (FY21 — $51.3B, FY22 $54B), with the majority in operations and management. Sounds like a lot until you take into consideration that it is for all the services and multitude of specialties, training, and support operations.
For context, the FY21 budget request for 79 F-35s alone was $11.4 billion….approximately 21% of the Medical Health System Budget.
This is further validated by the limited resources. Dental exams only once a year; orthodontists are essentially a luck of the draw and only if you are near a military treatment facility that has one; mental health often cannot handle much more than garden variety PTSD, anxiety, and depression and often will have to lean on the civilian sector for assistance beyond weekly treatment. It can be difficult getting into specialty care (when my husband, initially diagnosed with hypothyroidism, was told only people with thyroid cancer could see the endocrinologists).; and rarely do you get to see your PCM consistently.
I do not blame the medical staff. They are caught in the “some is better than none” game. They either give a smidge to everyone or give full care to only a few…and of course, the latter is not an option. So, a wee bit for everyone it is.
Gatekeepers of the Budget
I learned a ton when I started to engage in policy. I learned the people with altruistic intentions of helping the service members were far exceeded by the number of people who thought they were the personal gatekeepers of the budget.
Let me tell you what this turns into…a shit show. Here’s why…
The gatekeepers love to creatively use words to paint pictures that are more kaleidoscope versus realistic. They will make pretty slideshows with all kinds of charts, graphs, and colors that give a false sense of security. They will show productivity and progress. They will have cost savings.
But it is all smoke and mirrors. These folks seem to feel they have to make the numbers look good enough to not stress Congress out. There seems to be this fear that if the real story was told, Congress wouldn’t fiscally support it. Well, I can imagine after decades of making things look better than they are, they would pass out from the true sticker price.
I witnessed one of my previous bosses discuss in a proposal for expansion, how much money our office had saved since its inception. However, he refused to mention our program was not sustainable in its current state. He was afraid he would turn off the higher-ups by addressing the fact we did not have the appropriate staff to sustain a 100% increase in caseload, but was willing to submit a proposal to expand.
If anyone tries to alter the picture… look out. I watched the Air Force spend millions to hire a contracting company to form and manage a high-level working group to work guard and reserve medical care issues. I was in this working group. We agreed on the course of action (COAs), and we agreed on the prioritization…or so I thought. (I’ll note here the COA chosen was the most aggressive COA that was also the most beneficial for the service member.
When it was rolled out, I was in awe as I listened to those who had agreed to the COAs, and were now accusing the contracting company of making decisions independently without their knowledge. Say what?!? I sat in the meetings and heard no pushback when we discussed the plan. From what I could observe, it appeared to be because their leadership was not a fan of the COA chosen. Instead of defending the position, they jumped ship.
From that moment on, it was an uphill battle. I felt like we were wasting taxpayers’ dollars in meetings that dissolved in fighting and no resolution. I heard, after many battles, that it is being implemented, but I am fearful of what the full execution will look like.
The gatekeeper’s philosophy is simple….there is not enough to go around. I cannot tell you how many times I have heard “Ma’am, we can’t take care of everyone.” Oh really? Funny, because I have yet to read in any federal mandates, or services guidance, where we are to limit the number of people that receive care.
Bias
This is prevalent at every level. It is much easier to blame the service member for the administrative snafus than to actually fix the administrative snafus. I mean if the process is not moving, it clearly must be the service member’s fault.
Airman Snuffy didn’t bring in their medical paperwork on time. So, we will not process the paperwork. (Didn’t matter that the clinic they were seen at, attempted to fax the records 10 times to the broken fax machine at the unit that no one mentioned was broken.)
They are not compliant with care. They didn’t go to their medical appointments. (Doesn’t matter that their appointment was rescheduled three times due to staffing issues.)
This person has become a disciplinary issue. (Doesn’t matter she is an MST (military sexual assault) and has to continue to work with her alleged perpetrator, because leadership cannot believe he is capable of that and did not separate them.)
They are faking the injury/illness/disease. (Oh well thank you Colonel Not A Doctor.)
It’s been xx number of days/weeks/months. They should be better by now. (Is that what Dr. Google told you?)
I could go on and on…you get the picture.
Bias does only one thing…slow processes down.
I get it…you think the guy is a waste of space. No matter, the back is still injured and guidance is written on how to handle it. So there are two options here… #1 Help and get him either healed or medically processed out of the service… #2 Deny and keep a broken body on the books forever.
It is that simple.
It’s Not My Job or It’s Not My Job…But….
This goes in two directions. Either, as it is stated, It’s not my job, and the person does nothing to even assist in facilitating a resolution to the problem. Or, It’s not my job…but…, in the sense that they do not have the authority to make the decisions they are attempting to make.
This was a recurring issue I saw working at every level…from the field to headquarters. It always came across to me, that if it would aid the service member, but was extra work for the person, it became It’s not my job. Okay fine…but who’s it and how can we contact them. More often than not, it was met with I have no idea.
Conversely, it seemed if it would not be beneficial to the service member, the person was ready to “help”. (It’s not my job…but…, ) and would make decisions that were not in their lanes of authority. We saw this constantly at the Wing levels, where the commander would attempt to deny a service member an entitlement, and was always furious when they were told they had no authority to make that decision. Unfortunately, in some cases, I have seen it go as far as reprisal.
When everyone is either claiming it is not their job or making decisions that are not theirs to make, chaos ensues.
And guess who pays…everyone.
First and foremost, the service members pay the heftiest price. I have seen medical care stopped because no one is keeping administrative processes on track. I have watched people stay in administrative purgatory for YEARS because the case was thrown in a drawer. I have seen service members removed from orders because of an administrative mess-up that no one will own. I have watched people denied care because administrative processes were not done properly.
I have watched service members mentally decompensate because their unit has turned their back on them; denied them the ability to get care; and made them feel they were worthless because they were injured.
Currently, service members are collectively being denied care because of an extremely poor policy update. (That will be a whole other blog one day.) The frustrating part is I know more people just accepted the policy that came out, rather than fight it. Because hey, It’s not my job.
Units, squadrons, groups, and wings are all suffering as well. Many are functioning on a shoestring budget and cannot afford to have injured folks. It brings morale down when the other members have to pick up the slack for an undetermined amount of time. The supervisors and leaders watch the added stress on their people, and they become frustrated when they cannot see an end in sight. Eventually, the frustration is targeted toward the injured service member.
The military medical system becomes further strained. People receiving intermittent or inconsistent care end up with a worsened condition; only to need more specialty care, and longer recovery times; or worse, never fully recover from their injury. I have seen people with only a physical injury end up contemplating suicide because they are not coming to grips with their delayed or partial recovery. They are also devalued by their unit/peers/supervisor/leadership for their lack of recovery.
Little insight for all my guard and reserve units…shaming does not speed up the recovery process.
Taxpayers’ dollars are wasted. I am afraid to add up the number of hours of wasted meetings. Imagine how that money could have been put to good use…like actually taking care of the service members.
There is nothing good that comes out of denying it. Nothing at all. What we create is a mistrusting, chaotic, and honestly, I’d surmise, more costly world.
Those in senior and key positions need to be looking down at the base of the pyramid and ensuring the foundation (service members) is as solid as possible. We all know what happens when there is a weak foundation.
We need more people speaking the truth about what it costs to properly care for the service members, and not what they feel Congress can stomach.
Leaders need to hold accountability at all levels for actions based on biased beliefs versus applying guidance consistently across the board.
Commanders need to be given options for temporary assistance when they are struggling to continue the mission.
So when my friend breaks down in tears in my driveway, I hug her and wonder when the military will stop denying and start helping.
