Uncle Sam Knows Best?

Based on my personal experiences in the Navy, I have grave concerns about the government’s ability to manage a complicated system like health care.

I learned a lot in the Navy. I was on a Navy scholarship in medical school. In exchange for 24 months of medical school including books, tuition, supplies and a small stipend, I owed the Navy 24 months of service. Not a bad deal at all. There was even a provision that so long as it was continuous, additional residency or fellowship training did not increase my obligation.

After medical school I did two years in pediatrics before doing a residency in radiology in the Navy. During that residency I was offered the chance to do a pediatric radiology fellowship at a civilian institution. As a result, I ended up with board certifications in three specialties but only owed the Navy a two year payback. I bet they closed that loophole.

There were other benefits to Navy training. As a resident we were never burdened with fellows and only occasionally with attendings so we were pretty much free to do or try anything - and did. Six months after returning from my fellowship in pediatric radiology, I received a call on a Saturday morning from the chief of radiology who informed me that on Monday I was leaving my position of pediatric radiologist and becoming the head of special procedures at the National Naval Medical Center. Now mind you, I had no special training in special procedures but I was a quick study and this was the early days. I would read about procedures and then go do them, and fortunately for everyone things seem to go well. I can’t imagine this happening anywhere else.

There were other interesting things about the Navy. Once as a resident, I witnessed an argument over the findings on a chest X-ray between a fellow resident and a staff radiologist. Both happened to be lieutenant commanders. Now in the service, your date of promotion has significance. Someone who was promoted to a given rank before someone else is considered to outrank the other fellow. In an attempt to win the argument, the resident eventually resorted to telling the staff member that he declared himself to be the winner because he outranked the staff radiologist by a few weeks.

Another time the chief of the department frantically told us that we had to figure out how to spend a million dollars before the end of the next month or else we would lose it from our budget. Compare that to the time the bulb in our slide projector burned out in August and we were told that we couldn’t replace it until the new budget year began in October. The residents all chipped in. The Navy really was an adventure!

As a result of my experiences in the Navy, I developed a theory that the purpose of our military was to wreak maximum destruction and chaos on the enemy during wartime. During peacetime without an adversary, the military had no choice but to practice on itself. Based on my personal experiences in a government agency, I have grave concerns about the government’s ability to manage a complicated system like health care.