The military health care program for 9.2 million people is gravely ill and may never get well.
Military doctors say they are so understaffed and overworked that the care provided many patients amounts to medical malpractice.
Pentagon officials, acknowledging the problem, say there simply aren't enough military doctors to go around and no sure way to recruit more in this era of the volunteer army.
"Military health care hangs on the precarious edge of disaster," warns the Association of U.S. Army, a private group with heavy membership of retired military people.
The military spent $3.3 billion on health care in fiscal 1978, but interviews with doctors, active and retired service persons and their dependents indicate dissatisfaction - even alarm - over the quality of that care.
Doctors say they cannot keep up with demand and some quit the military at the first opportunity, making an already bad situation worse.
"We're being forced into malpractice," complained on Army radiologist.
A cardiologist who runs not only the heart center at an Army hospital but the intensive care and caronary care units there as well, complained that he sees so many patients in one day that at night, "I lay in bed and worry about whether I could possibly have been right about all those cases."
Military leaders are resorting to desperate measures to try and fill the gaps in the medical ranks. Doctors say this often results in dangerous matchups of skills and requirements.
At the same time, the military is spending millions of dollars to hire civilian doctors to work at military hospitals.
Fort Benning, Ga., for an example, recently hired four civilian radiologists at $100,000 a year each to work at the base hospital. These radiologists work for an Army doctor who receives about one-third their salary.
Many of the civilian doctors being hired by military commanders, military physicians said, are graduates of foreign medical schools who might have trouble getting jobs at community hospitals because of gaps in their training.
Dependents of active duty military people frequently must travel for miles and wait for hours for military medical treatment. The problem is especially acute at bases located far from major cities.
Even in the Washington area, military dependents complained that medical care is one frustrating experience after another. Said the wife of a Navy enlisted man living in the Maryland suburbs: "At three different Navy bases in Virginia, Florida and Maryland over the last five years I found I had to wait from one to three hours to see a doctor for 15 minutes, if I got see him at all instead of a corpsman or a para-medic.
"Once I got to see military doctor, I was usually was sent to another speciality - meaning waiting all over again. The military specialist usually sent me to a civilian specialist because the military hospital didn't have the needed diagnostic equipment. Then I had to pay 20 percent of the civilian doctor's bill."
"I deny the existence of a crisis but concede we've got a serious problem," Vernon McKenzie, acting assistant secretary of defense for health affairs said in an interview.
Two members of the House Armed Services Committee, Reps. Samuel S. Stratton (D-N.Y.) and Robin Beard (R-Tenn.), have been assailing McKenzie and other Pentagon officials for not taking the medical problem more seriously.
"They're screaming out there," Beard told Charles W. Duncan Jr., deputy secretary of defense, at a recent House Armed Services subcommittee hearing where the congressman relayed the results of his own interviews with military doctors in the field. "I talk to surgeons general behind closed doors and they get emotional" about the military health care problem. "They say it's critical. But then when you come over here it's: 'We're going to solve this problem by the early 1980s.' I just think it's time somebody starts getting emotional."
McKenzie said that Pentagon planners foresaw there would be a shortage of military doctors once the draft ended and vainly tried to persuade Congress to enact generous scholarship programs for students willing to trade free medical education for military duty. He said the Pentagon hopes to improve the scholarship programs belatedly approved by Congress. He said the Pentagon next year will press Congress to make military medical scholarships as generous as those offered by the Department of Health, Education and Welfare.
"I'm reasonably optimistic" that scholarships will attract enough military doctors to ease the present shortages by the early 1980s, McKenzie said.
Doctors interviewed said the Pentagon's figures have been adjusted to make doctor shortages look less severe than they really are. Figures supplied by McKenzie project that there will be 10,552 military doctors on active duty by the end of this fiscal year, assuming some help from Congress. That would leave the services short by about 10 percent of the authorized strength.
Under the most optimistic Pentagon projections, the military services would not have all the physicians they need until 1984. This projection assumes Congress will approve the requested incentives.
Without the incentives, the Pentagon estimates, the doctor shortage will continue indefinitely. The services, under this projection, would have only about 80 percent of the doctors they think they need.
But the Pentagon acknowledges the services will have about half the radiologists and internists they need and only two-thirds of the desired anethesiologists.
One idea being pondered by the White House Office of Management and Budget is subcontracting more of the military's health care to the civilian medical community. Some students of the problem see this as the only long-term solution.
But military traditions, such as taking care of one's own, die hard.