Subtle Threats to US Combat Readiness Include Healthcare Access on Overseas Bases
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An army may march on its stomach but deployed soldiers will stay focused in the field when they know their families are being cared for at home.
When it comes to the front-line warfighters stationed on forward-deployed United States military bases and ships, concerns about financial and family health issues can be a subtle, but systemic, threat to force readiness.
Those strains can manifest in suicides, such as seven self-induced deaths by enlisted men aboard USS George Washington between April 2021 and April 2022, to poor dependent access and inadequate healthcare on military bases that can cause distractions in the field and shortfalls in retaining high-performing leaders.
During a March 7 hearing before the Senate Appropriations Committee’s Defense Subcommittee on the Defense Health Agency’s (DHA) FY24 spending needs, senators heard from the Pentagon, the agency’s director, and chief medical officers of the three military branches how such strains can impact operational readiness.
In 2018, the Pentagon completed a seven-year transition that established the DHA as a joint, integrated combat support agency rather than each military branch having its own. Its FY23 budget was $773 million and FY24 ask is nearly $800 million within the Biden administration’s $6.9 trillion spending plan’s $885 billion military budget.
March and April are typically when multiple military command officers and the Veterans Administration (VA) officials testify before Congressional panels about their spending requests during the annual budget cycle leading up to Oct. 1, the official start of the federal fiscal year.
Thus far, unit/regional commanders, Defense Department chiefs, and veterans’ affairs officials have discussed in hearings an array of topics and undefined—until Biden’s budget reveal—spending needs. There were 16 hearings on Capitol Hill related to military and veterans’ affairs issues scheduled between March 6-10.
‘Lighten the Load’
During the March 7 hearing before the Senate defense appropriations panel, Assistant Secretary of Defense for Health Affairs Dr. Lester Martínez-López said the military is paying more attention to mental health and dependents’ access to medical services to enhance overall force readiness, especially in addressing the “ongoing cases of suicide by serving members and family members.”
The Pentagon must “reverse the heartbreaking trends we have witnessed,” he said, pointing out while suicide is a national scourge reflected within the military community, in the armed services it is a symptom of those serving on active duty facing operational stresses who are unable, or in some cases, fearful, of seeking mental health counseling.
Sen. Dick Durbin (D-Ill.) said mental health counseling “is so important for all of us—all of us—but especially in the military” but in the past there was a “stigma attached” to doing so.
“There’s movement in the bullpen on that” but it will take time, Martínez-López said. “Mental health is health. Now we can put it on the table.”
Once “on the table,” he said, most of the time the person is not really dealing with a mental health issue but a stress issue related to other matters.
“We need to lighten the load on military members,” he said, alleviate financial crises and concerns about dependents’ quality of life in military housing or it can degrade force readiness.
Sen. Susan Collins (R-Maine) noted that among issues identified in providing expanded mental health services for active-duty military and their families is that it takes DHA a year and a half to hire psychiatrists and a year to hire psychologists. And when it does issue a job offer, it’s often turned down because the applicant found a position elsewhere.
‘Arctic Warrior’ Stresses
Sen. Lisa Murkowski (R-Alaska) said suicide is an issue among active duty personnel and their families at the Fort Wainwright U.S. Army and Eielson Air Force bases.
No wonder, she said, noting that for some Wainwright soldiers its a three-mile trek from their barracks to a “WWII Era dining facility,” which can be an arduous and depressing way to live, especially in the winter.
The situation at Wainwright was identified by the military in its report, which called for replacing old buildings on base.
“We know we’ve got to do something. Doing the studies doesn’t necessarily change lives,” Murkowski said, noting a proposed ‘Arctic Warrior’ bill will provide those stationed in Alaska an additional stipend and allow them to be reimbursed for the cost of a flight home.
These are “financial stressors” that aggravate force readiness, she said. “They need a $2,000-$3,000 for a flight home” and many cannot afford it.
Also, Murkowski said, outdated technologies plague many commands, especially those that are forward-deployed, with active-duty warfighters “not being paid on time.”
She has fielded complaints of some “waiting up to seven months to get paycheck situations straightened out. That kind of financial stress on service members … isn’t right.”
In Japan, a Force Diminisher
Biden’s FY24 budget request states “military families are key to the readiness and well-being of the All-Volunteer Force, and therefore are critical to national security.”
But the lack of medical facilities on bases in Japan is forcing military families to wait for extended periods for appointments and Defense Department civilians to seek “host nation providers” to tend to routine and chronic care issues.
Committee Chair Sen. John Tester (R-Mont.), in addressing the situation in Japan, began his remarks by saying, “I want to talk about China.”
He said the United States has “troops in Japan and in other places” facing off against Chinese forces that require vigilance, which can be imperiled by instability on their bases, such as “a lack of healthcare for dependents and DOD civilians.”
Tester was referring to the 8,000 Defense Department (DOD) U.S. Forces Japan civilian employees being allowed only “space available” appointments at U.S. military base medical facilities for routine health matters beginning Jan. 1. 2023.
In October, the DHA announced DOD civilian employees in the Indo-Pacific region—which spans the globe from the U.S. West Coast to the Arabian Sea—must receive routine medical care from a “local host nation provider” because military hospitals lack capacity to service them beginning Jan. 1.
That policy came down after an assessment of forward-deployed bases determined more space within existing medical facilities needed to be accorded and upgraded to treat active-duty casualties in, say, a war with China.
The USFJ would be a pivotal component—and target—in the event of a war. It has approximately 54,000 active-duty military and 45,000 dependents dispersed among 84 installations primarily on Honshu, Kyushu, and Okinawa islands.
USJF includes the headquarters of the 7th Fleet and the 5th Air Force on Honshu in the Tokyo area, and the 3rd Marine Expeditionary Force on Okinawa.
The restricted access is most acutely an issue for the 8,000 USFJ civilian employees working on bases on mainland Japan, especially on Yokota Air Force Base, Naval Hospital Yokosuka, and Camp Zama, headquarters of U.S. Army Japan.
Many DOD civilian workers are key weapons systems technicians and technology consultants and without access to on-base care, Tester said, “This is going to end up being an incredible recruitment challenge.”
Base commanders have been lobbying for expanded medical facilities for a while, he said, but now, “These reports are …. repeatedly delivered with a sense of urgency from military leaders in Japan.
“The impact on our military readiness is alarming.”
