In many ways, the job of top DoD health official is one of the most difficult management posts in the Pentagon, if not the whole US government. That is because health care in general and military health care in particular are at a crossroads. None of the pathways lead outward to a certain future. The population served by military health services is becoming markedly older, as is the nation's general population. Costs are exploding, with the money the US spends on health care predicted to double in the next decade.
Beneficiaries have both greater expectations for and more knowledge about their problems and care.
Given all these forces, the Defense Department is having to restructure its health care system, just as the general US health care system is struggling to adapt to the new realities. Both systems are moving in the direction of much greater reliance on managed care. According to the Pentagon, military medicine is in many ways better than ever. The military is probably ahead of the civilian world in terms of its adaptation to the new forces. DoD also provides more health care choices than many civilian employers, insists Bailey.