Wednesday, July 28, 2004

From The New Yorker:
There has been a great deal of speculation recently that the government might reinstate the draft at some point, in order to replenish the nation’s armed forces. Military and government officials have, for the most part, dismissed such talk. As Secretary of Defense Donald Rumsfeld said in an interview the other day, “We’re perfectly capable of increasing the incentives and the inducements to attract people into the armed services.” For years, the military has offered its recruits free tuition, specialized training, and a host of other benefits to compensate for the tremendous sacrifices they are called upon to make. Lately, many of them have been taking advantage of another perk: free cosmetic surgery.....
A Defense Department spokeswoman confirmed the existence of the plastic-surgery benefit. According to the Army, between 2000 and 2003 its doctors performed four hundred and ninety-six breast enlargements and a thousand three hundred and sixty-one liposuction surgeries on soldiers and their dependents. In the first three months of 2004, it performed sixty breast enhancements and two hundred and thirty-one liposuctions.
This got exposure from The Agitator, the Pittsburgh Tribune-Review (of Teresa Heinz-Kerry "shove it" fame) and from The Corner at NRO. Shocking, isn't it. Until you look at the numbers in context, as this reader of The Corner did:
However, there are some points of contention regarding the fact impaired New Yorker-via-Reuters story you referenced. I don't have access to the New Yorker article, but have seen it summarized on line. From these, I would like add some facts that make the story pretty dang benign and hardly the shocking waste of taxpayer dollars the spin of the article seems to be. The tenor that Sergeant Baggadonuts and/or Mrs. Major Zotz can just waltz over to the nearest military hospital and get nipped, tucked, vacuumed, or pumped up, is both bogus and irksome. I am a little weary of lies and misdirection regarding the military.

1. The Army, Navy, and Air Force have teaching hospitals.

2. These hospitals have plastic surgery programs.

3. For these programs to be accredited, the residents must perform the same procedures their civilian counterparts perform.

4. To become board certified and maintain currency, military plastic surgeons must perform the same procedures as their civilian counterparts.

4. The article mentions that between 2000 and 2003, there were 496 breast enlargements and 1361 lipos done on "soldiers" (only Army personnel are Soldiers) and their dependents. Assuming they were done at a constant rate, that is a whopping 165 breast enlargements and 457 lipos per year.

5. There are about 1,400,000 active duty military, and about an average of 3 dependents/servicemember. Completely disregarding eligible reserve component personnel and their dependents, as well as eligible retirees, that makes an eligible population of over 4, 200,000.

Do the math, and as you can see, this falls damn short of a cosmetic surgery stampede. Show me any U.S. city of 4.2 million in which the plastic surgeons only do 165 breast enlargements and 457 lipos a year, and I'll show you a town with starving plastic surgeons, or with only one moderately busy. Show me a town of 4.2 million with only one plastic surgeon, and I'll show you a town outside of the U.S. I won't bore you with the hoops and wickets one has to go through to get someone one a rare referral for these or other "elective cosmetic" procedures - trust me, it isn't the same pulling out the Yellow Pages, turning to the physicians pages, picking an ad, and calling up old Dr. Young for an appointment - there has to be some kind of justification other then "I want it".

In addition, as odd as it may seem, military and their dependents do get sick and injured - if a spouse or a soldier needed, for example, a breast reconstruction after mastectomy, I think most sentient persons (I know that whittles the pool down a fair bit) would agree that docs who have actually performed a few cases, even if those were strictly cosmetic, would be preferred over those doing OJT. Same thing goes for nose jobs or any other "elective cosmetic" procedure - the bottom line is that skills maintained by doing these procedures are helping heal servicemembers injured in combat, past and present.
I agree that this is a tempest in a teapot. Given the numbers above, the procedures don't seem to be all that out of line. There are probably even more dependents who have had cosmetic procedures done by civilian plastic surgeons. However I take issue with reasons #1-4 above, as a search of the ACGME site revealed no accredited plastic surgery programs that were affiliated with a military hospital, although there have been some in the past. A small point, I know but the official line of the Army sounds much like it:
The Army’s rationale is that, as a spokeswoman said, “the surgeons have to have someone to practice on.”
It's not just a job, it's an adventure.
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