Senate Armed Services hearing spotlights staffing, supply-chain and surge shortfalls in military health system

The Senate Armed Services Committee convened a hearing on the state of the military health system to examine whether the Defense Department can provide medical care at scale in a future large-scale conflict. Chairman Wicker opened the hearing and called three retired military medical leaders — Lieutenant General Douglas Raab (ret.), Major General Paul Friedrichs (ret.) and Colonel Jeremy Cannon (ret.) — to testify on readiness, staffing, supply chains and partnerships.

The witnesses told senators that reforms enacted after 2017 aimed at refocusing military medicine on combat casualty care have not been fully implemented and that funding, personnel and organizational gaps threaten the U.S. ability to absorb combat casualties. "We must treat the military health system like a part of the military," Major General Paul Friedrichs said, urging statutory clarifications in the next National Defense Authorization Act (NDAA) to make medical readiness a clear, funded priority.

Why it matters: Committee members and witnesses stressed that if the MHS cannot sustain clinical volume and specialty experience in peacetime, the services will lose the combat casualty skills needed in conflict. Colonel Jeremy Cannon, a trauma surgeon, noted that only about 10 percent of military general surgeons met readiness standards in a recent study and urged creation of high-volume military trauma centers and expanded civilian partnerships to maintain proficiency.

Witness proposals and areas of concern: The panel outlined overlapping lines of effort. Douglas Raab, former director of the Defense Health Agency (DHA), recommended clearer authority and organizational linkages between DHA, the Office of the Secretary of Defense and the Joint Staff to prioritize combat casualty care and ensure funding and personnel follow-through. Friedrichs and Cannon called for:

- Statutory clarification in the coming NDAA to reaffirm the MHS as part of the military and to strengthen the Joint Trauma System's authority. - Designation and resourcing of a small number of high-volume military treatment facilities (MTFs) or centers of excellence for trauma and burn care, codified civilian accreditation and deeper military–civilian training partnerships. - Reauthorization and expansion of surge frameworks such as the National Disaster Medical System (NDMS), and codified agreements with civilian hospitals and industry to guarantee surge capacity and reimbursement during conflicts. - Greater investment in combat-casualty research (pre-hospital care, battlefield blood, regenerative medicine) and data linkages between DOD and VA trauma registries.

Budget and personnel problems: Witnesses and senators cited long-term budget pressure and workforce shortages. Raab said the MHS has experienced a roughly 12 percent decline in hospital budgets since 2015 and called out continuing-resolution budget uncertainty as a barrier to planning and procurement. Senators and witnesses also flagged a nationwide shortage of clinicians: projections cited in testimony included a national nursing shortfall and estimates of as many as 30,000 fewer doctors by 2035. The committee heard examples of how staffing shortfalls reduce case volume and lower readiness: "They're not doing the cases," Cannon said of surgeons at underused MTFs.

Supply chain and industrial-base risks: Panelists warned of dependencies for active pharmaceutical ingredients and other medical supplies. Friedrichs said allies such as Japan, South Korea and India can help diversify supply, and urged Congress to direct DOD and HHS to catalog and reduce strategic dependencies. Senators raised specific national-security concerns about relying on single-country sources for antibiotics and other critical pharmaceuticals.

Surge planning and partnerships: Multiple senators pressed for a durable, preexisting national plan to scale medical capacity in wartime rather than ad-hoc emergency measures. Witnesses described the need to update the integrated CONUS medical operations plan and to convert voluntary NDMS participation into formal, funded commitments — comparable to how the Defense Department procures surge aviation capacity from industry — so hospitals will be available when called.

TRICARE pharmacy oversight: Senator Elizabeth Warren pressed witnesses on TRICARE's use of a pharmacy benefit manager and alleged conflicts in the prescription pipeline. Warren cited a figure that "over 13,000 pharmacies have left" the TRICARE retail network and noted TRICARE prescription drug spending of roughly $8 billion annually on specialty drugs. She called for DHA to audit the contract and data reported by the PBM. Douglas Raab agreed that auditing and adherence to contractual reporting requirements were necessary.

No committee vote or formal action was taken at the hearing. Senators and witnesses repeatedly urged statutory language in the next NDAA, more predictable funding, and stronger DOD–VA–civilian partnerships to preserve and restore medical readiness. Committee members said they would consider legislative language provided in witness materials and further oversight of DHA, TRICARE contracts and surge planning.

The hearing closed with committee leaders thanking the witnesses and noting that the testimony will be part of the congressional record and considered as the committee develops NDAA language and oversight requests.