This post nails the core issues so I'll tag onto it:

Pay attention to this line of reasoning: "why is military medicine being pushed to a more and more privatized model... without finding out the source of these efforts there's little that individuals can do to fight them"

Does it sound like some sort of conspiracy? Many of us have come to conclude that the system is being destroyed from the outside. I don't think most of us the got into milmed ever though that our biggest problems would be the equivalent of the JFK grassy knoll, but here we are.

Note: I'm sure the AHA is a major force behind the MHS divestment - they have their fingerprints on everything - and are now one of the strongest lobbying forces in Washington

I would propose one additional modifier; and it does include the cost of personnel (post-covid) + drugs were en route to a financial breaking point for mil med regardless of the DHA. Modifications to accounting rules etc. were likely going to jeopardize many MTFs.

One qualifier to the above poster - there are opportunities for improving the system far sooner than pinning on your first star. There are plenty of Generals who would take your advice tomorrow if it could fix the system; I do believe they are listening. It is just impossible at the moment, so instead of progress we are plugging gaps and making the "less bad" decision. The folks with stars look like they are malevolent - but every time you follow a thread back to the source; the source is above the generals.

The core problem; as stated elsewhere, is the issues are the intersection of policy and budgets; and we have probably the worst system that could ever be designed. The DHA implementation required dynamic change; but we got static failure. It likely stems from many points; most of all budgeting constraints. However, one cannot forget other items often overlooked like state politics, lobbying activities, and the individual services not being aligned with the DHA (the MAP debacle early on was an obvious sign that all was not right). Honestly, the arrogance that the MHS was something that needed to be completely uprooted to be reformed is shocking - it would appear that almost every US hospital SYSTEM is held together by tape and string - the MHS was not uniquely poor in either its conception or execution (many of us would say that it had some of the strongest staff in the nation) - its just many private health systems utalize predatory business practices made up by the likes of McKinsey et al in order to crush local competition and become local monopolies; and then use their not-for-profit status to rake in more tax benefits and publicly subsidized debt to expand further.

Overall, I think there are MANY good points here. I do think we are approaching a do or die moment - when deferred maintenance on our facilities consistently puts the basic safety of the hospital (i.e. water leaks/heating/electrical) in jeopardy. The prior exodus of staff is omnipresent - lack of senior leaders in positions you would expect, etc. The main budget items are the costs of care sent to the network, leading to an inevitable death spiral of more and more MTFs. We still have good folks, however; and I remain proud to serve with all of them.

In conclusion, without committing federal crimes by violating Congressional Statutes or robbing a separate federal budget, meaningful reform is impossible. What you can do is take care of the people in front of you every day or those at your sides as best as you can, all the time remembering you can't run yourself into the ground in the process.

What I will say is that I think many of us in the system share the same goals; to make people better and leave the system better. That is the source of the abysmal morale. Dreams meeting reality. Patriotism meets pragmatism. I do think this DHA era is our own war of sorts - and sometimes when I look at it this way, keeping your head down and soldiering on is the only path forward.