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Could the ceilings that you referred to be lifted just for medical personnel without creating a lot of wrath among the other functions of the military?

Dr. MAYER. We can handle the wrath, Mr. Ray. As long as it wasn't done at the expense of the other people. I told Bernie Rogers, the former supreme commander in Europe, General Rogers, that I simply had to have more physicians and more nurses and more corpsmen in Europe, and he said, “Bud, I agree with you 100 percent. Who do you want me to send home-the tankers? airplane drivers?" We can't be put in the position of eroding the war fighting machine to give an ideal medical system, and if we are given an exception, sure, we are going to enjoy the wrath of a lot of people who don't get exceptions, but we are willing, as I say.

Mr. Ray. Well, it sure seems to me that we have got an obligation now to look after not only the current military people and their families but the retired folks.

Dr. MAYER. Absolutely.

Mr. Ray. As we try to get a copy of the contract that every retiree says he has, we can't seem to get that, but nevertheless he thinks he has it, or she does, and every current military person right now believes they have one, and I think that this country has got to find a way to deal with this situation.

I know down in Fort Benning, GA, we have two optometrists to look after 55,000 active people and their families and 45,000 retirees. We are entitled to six, which couldn't do the job, but there is no funding for more than two. We have to deal with this. It is a very serious situation, and I think you would have the support of many

of us; you would have from me, anyway. Dr. MAYER. Thank you. Mr. Ray. Thank you, Madam Chairman.

Mrs. BYRON. Dr. Mayer, thank you very much for your appearance here, which we thought would be very short this morning, and, as it turned out, once again it wasn't.

Dr. MAYER. I made the shortest statement ever.
Mrs. BYRON. We have too many questions. Thank you very much.

Dr. MAYER. I would like to thank Ms. Lee and Ms. Heath. We argue, we dispute, we have different ways of approaching things, but they have been an enormous help to us. They have stimulated our thinking.

Mrs. BYRON. They are good.
Dr. MAYER. They are really part of our system.
Mrs. BYRON. They are good.
Dr. MAYER. Yes, I know they are good. Thank you.

Mrs. BYRON. They are very thorough and very competent. We operate on this subcommittee with two hands behind our back, and we come out winning every single time. Thank you very much.

The next panel, if they will bring their chairs back. If you will summarize your statements, we will, as you can tell, get along with our questions. I don't think we have any questions for Admiral Zimble, but we might be able to find a couple.


ARMY General BECKER. Yes, Ma'am. Madam Chairman, I am very pleased to be here this morning, and I would like to submit my statement for the record and make a few brief remarks.

The Army leadership is committed to excellent health care for its soldiers and their families, and they believe that health care is a readiness issue. I know there are some problems with it, but I have to tell you, in the last 3 years since I have been there, they have put their money where their mouth is as far as the budget and the programs that have gone forth.

We have got a little problem right now in 1988 which I would like to address later.

We have had great support both from the Congress and the Army staff for Army health care. We have had excellent growth over the past 3 to 4 years, especially in ancillary personnel. We have gotten some extra money to hire some people to help our physicians.

Now the problem areas: 1988 budget. We were well taken care of in the 1988 budget. However, we have some bills that must be paid, and we are sharing in those bills, and they are enormous, and they are going to cause great problems in the delivery of health care. We have to absorb the civilian pay raise. We have the FERS, which is the retirement pay for civilians. Out of the medical budget, we have to pay for the drug testing of recruits, and now we have a $23 million bill for our share of the CHAMPUS cost overrun, which will come up at the end of the year. This has put us behind nearly $40 million, and out of a budget which is 90 percent fixed, we can't stand that, because we are going to have to begin to lay off temporary employees, put in a hiring freeze, cut down on civilian prescriptions, et cetera.

Now we have not finished all the work of the Army staff, and I am being a little premature on this, but I wanted you to know about it, because you will hear about it about 10 minutes after we do.

Mrs. BYRON. Is there something wrong with the communication line?

General BECKER. I mean about the time it happens.
Mrs. BYRON. Better.

General BECKER. We need to be able to use the CHAMPUS money that we have over there. It has been fenced, as you know. We also need the ability to reprogram some money, and we may come and ask for that. So this is a major problem that is facing us at the moment.

A little more chronic problem is the pay for our physicians. The bonus pays have not been increased in many years. We have had discussions about the ISP and the bonus pay, I know here, and I know you understand that. But that has become critical, and we are now short some of the physicians that we are supposed to have simply because more of them have left than we anticipated.

Those are the major things at the moment that are causing us difficulty in peacetime health care. I would be glad to answer any questions.

[The prepared statement of General Becker follows:)













9 MARCH 1988



Madam Chairman and Members of the Committee, I am Lieutenant General Quinn

H. Becker, The Surgeon General of the Army. It is an honor to have this opportunity to appear before your sub-committee to discuss the Army Medical Department (AMEDD) role in providing peacetime health care to our soldiers and

their families. I value your interest and acknowledge the vital role your

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The AMEDD is tasked with per forming four separate, yet interrelated, health care missions. Our primary mission is to ensure a high state of medical readiness to support combat and contingency operations. This includes support to Army field commanders in maintaining a physically and mentally fit force. Equally important, though, are missions to insure a quality peacetime health care delivery system for all author i zed beneficiaries; provide Graduate iledical Education and other health care training to support both the war time and peacetime mission; and conduct extensive research to protect the lives of soldiers who are deployed world-wide. Our day to day operations support each of these missions.

At the outset, I would like to express my appreciation to the Members of this Committee for several specific actions affecting health care delivery as contained in the 1988 DOD Author ization Act. The permission to pursue expansion of the PRIMUS program will assist in improving access to primary care for our beneficiaries. Additionally, the guidance contained in the Conference Report to exempt medical personnel from participation in the

Officer Reduction in FY 1988 will not only assist in medical readiness but will also contribute to maintaining peacetime health care capabilities.

Although the provision of peacetime health care is not the sole mission of

the AMEDD, it is a significant and highly visible benefit of military service. It is an entitlement established by the Congress to which the AMEDD strives to provide the highest quality of health care services consistent with available resources. Its successful execution is interwoven in the daily accomplishment of our multifaceted mission of maintaining medical readiness, conducting research, and educating health care providers. To this aim, the AMEDD operates 49 hospitals along with numerous health and dental clinics

world-wide. We also provide military staff for the Brooke Army Medical Center

operated under the executive agency of the United States Air Force cs part of

the San Antonio Joint Military Medical Command.

We point with pride to the peacetime health care services provided in our medical treatment facilities. Over the past several years, workload accomplished by these AMEDD facilities has remained relatively constant. On an average day, we admit 1,111 patients, have 6,046 beds occupied, assist with the birth of 115 children, and provide care for some 58,582 outpatients. While the number of admissions has actually risen, Army hospitals continue to exper ience a decline in the average length of patient stay which decreased from 5.8 days to 5.5 days between fiscal years 1986-1987. This decrease is reflective of the national trend which results, in part, from technological advancements, such as the use of lithotripters to non-surgically remove kidney stones, along with changing treatment practices like ambulatory surgery.

In spite of productivity enhancements, the AMEDD has not kept pace with

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