Incredible waste is, of course, natural to Washington, particularly in the trillion dollar national security budget—which includes nuclear bombs, intelligence, and veterans’ costs. Three years ago, when I suggested “16 Ways to Cut Defense Spending,” one of the cost savings I wrote about was duplicative hospital costs, this from a system of separate Army, Navy, and Air Force medical services. They should be combined into a single system, but imagine the screaming about lost jobs.

The system was designed after World War I, when wounded could not be easily transported from one part of America to another and long before helicopters and super highways. It is part of the Tricare network, which takes nearly $50 billion yearly out of the Pentagon budget. It includes 55 hospitals and 373 clinics and gives free treatment to military retirees and their families for the rest of their lives. Then there is also the Veterans Administration hospital network with 152 medical centers and almost 800 outpatient clinics.

Although it has proven politically impossible to cut out almost any Pentagon waste, the often terrible care meted out to soldiers and their families might trigger some reforms and cost savings. The military wants to downsize many of the facilities that treat very few patients. The New York Times reported on some of their problems. Half the beds in military hospitals sit idle. Two thirds served less than 30 patients a day, about a third of a typical civilian hospital. The Pentagon would like to close many and change others into outpatient clinics and birthing centers. Half of the hospitals have higher than expected rates of surgical complications. Other problems reported by the Times included 95 percent higher trauma to infants during birth compared to civilian hospitals. A supplementary Times study reports rates and compares the often high surgical complications at 54 military hospitals.

Other problems are caused by the rigid military rotation system, with hospitals getting a new commander every two years, hurting continuity and institutional memory. Instead of trained administrators, over half of hospitals are run by doctors, nurses and dentists. Other reported problems included “persistent lab errors,” and “the impossibility of judging individual hospital’s re-admission and death rates.”

But, as usual, any proposed cutbacks run into a buzz saw in Congress—which often looks at Pentagon spending as a jobs and welfare program for each congressional district. Out of dozens of hospitals, even closing or downsizing less than half of the 15 that the Pentagon would like to close (out of 54 in the U.S. and overseas) has been prohibited by Congress. Even though, as the Times has detailed, horrendous medical malpractices come especially from the smaller hospitals.

The Wall Street Journal reported that “high-volume surgeons are more proficient, high volume hospitals are safer,” with low numbers of operations per surgeon causing more risk: “74% of Air Force general surgeons cited low case numbers as a threat to their skills retention,” the paper reported. The excessive number of military hospitals mean worse care. The entire system reported only 338 cases of open heart surgery, only enough for a single modern civilian hospital.  

This waste and mismanagement is just one small example of what goes on in the U.S. military, intelligence, and nuclear forces. Yet the Republican presidential candidates and congressional leaders nearly all are instead promising new, vast defense spending without a mention of reforming waste. Only Donald Trump has said that we could defend ourselves at much lower cost, but he passes over the subject quickly. As I wrote some time ago, sequestration is the only way to force Congress to start addressing waste in the budget. Then it needs tough outsider oversight to force the savings into non-essential areas. Otherwise, like any corrupt big-city government that first cuts police and firemen when its spending is threatened, the Pentagon will first cut vital needs. The future solvency and security of America depend upon getting the real waste under control.

Jon Basil Utley is publisher of The American Conservative.