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Top Pentagon Health Care Official Weighs In On Medical Staffing,
Prisoner Abuse In Health Affairs Interview

Defense Assistant Secretary Discusses Evolution Of Battlefield Treatment,
Health Care For Iraqi Civilians And Combatants


BETHESDA, MD—The U.S. military has “absolutely no need” to draft physicians and other clinicians because it has adequate staffing, according to an interview with the Pentagon’s top health care official published today on the Health Affairs Web site.

In the interview, William Winkenwerder, assistant secretary of defense for health affairs, also says that military physicians and other medical personnel are expected to report any sign of abusive interrogation techniques of prisoners, and any physicians who do so will be protected by commanding officers.

Assistant secretary since 2001, Winkenwerder discusses military health care policies ranging from consolidation of base hospitals and clinics to speeding life-saving care to wounded soldiers in the field in this interview with Robert Galvin, director of global health care for General Electric.

A medical draft is unnecessary, Winkenwerder says, because “in the three and a half years of engagement worldwide with the global war on terrorism, something in the range of one-third of [available medical] personnel have deployed into operations. So we clearly have not even tapped our potential capabilities. The bottom line is, we do not think that there’s any need to consider a draft.”

As for reporting prisoner abuse, Winkenwerder says, “The senior leadership from President Bush on down has made clear that detainees must be treated humanely, that violations of this standard are a discredit to the U.S. Armed Forces, and that violators will be held accountable. I think the overwhelming number of military members—and certainly medical personnel—understand this and want to prevent violations of the long-standing policy of the U.S. government.”

Among Winkenwerder’s other remarks:

— On battlefield care: “We are placing forward surgical resuscitative capabilities—small teams of doctors, nurses, anesthetists, and anesthesiologists—in places where surgery can be performed, ideally within just a few minutes of an injury, to stop hemorrhage or to perform a life-saving procedure.”

— On changes to battlefield treatment: “Today we bring [wounded soldiers] back to the United States very soon. A person could be wounded today in and around the area of Fallujah, in a combat support hospital later this afternoon, on an airplane tomorrow to Landstuhl Regional Medical Center in Germany, and at Walter Reed . . . within three days.”

— On treating Iraqi detainees and civilians: “If an Iraqi civilian or even a combatant is injured because of warfare or violence, and that person comes into our custody, we take care of them, with the same level of care that is offered to our own service members or American civilians. That’s just a basic obligation and I’ve been impressed with the way in which our medical professionals have responded to that challenge. Historically, there hasn’t been much doctrinal guidance about this, and we’re working with the line leadership of the military to assess this issue and to plan for it.”

— On health care costs: “I am quite comfortable in saying that it would be my objective that [the military retiree] benefit always be better than the benefit that individuals would be offered by civilian employers. That’s not the issue. The issue is just how much better, or how different, in terms of the costs that individuals share as part of their health plan, this can be without creating perverse incentives. Frankly, this makes it very difficult for us to manage and sustain our medical benefit over the long term.”

The article can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.353.


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Health Affairs, published by Project HOPE, is the leading journal of health policy. Peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. Health Affairs Web Exclusives are available free of charge to all Web site visitors for a two-week period following posting, after which they will revert to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

 

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