The Hegemony has built itself on turning inefficient systems of the "old countries" into efficient ones. One of these systems would be health care and the medical industry. The Hegemon decided to organize the Hegemony's national medical system along the lines of a military organization. By this I mean:

Clear command structure: the medical staff would be split into pay grades much like the U.S. military going up the chain from a resident all the way up to a Surgeon General (comparable to a 3 star general). In this context think of each hospital/medical center as a "base" and each base has a chief physician in charge. Each hospital would be connected to a region overseen by a General Surgeon. Finally each region would be overseen by the The Medical Command (Medcom for short) who would oversee the entire medical field for the Hegemony.

Would a military style hierarchy be a effective addition to the medical field or would it be more of a hindrance? If it is effective what could be some possible benefits from a strict hierarchy?


Much like the U.S. military many of the "doctors" would be trained as specialist but in general would be paid roughly the same. Ex: compare security forces to a air man of the same rank. Different job same pay.

The Hegemony is a unitary government and this post only applies to the Hegemony national health care system not the private medical industry.

The equivalent to "boot camp" would be studying and residency at a smaller hospital before "graduating" to a larger one. Ex: start at a clinic move up to a hospital in the city.

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    $\begingroup$ VTC OT:POB. This falls into what user Elemtilas calls "narrative necessity." It works if you need it to because you, the author, can always craft circumstances that permit it to work. Military structures (simplistically) increase efficiency at the cost of freedom, but you've providing no where near enough information about your culture, government, philosophies, demographics, etc., to judge whether the loss of freedom outweighs the value of efficiency. $\endgroup$ – JBH Apr 11 '19 at 18:01
  • $\begingroup$ Maybe, but experience of US' Veterans Health Administration makes me skeptical. $\endgroup$ – Alexander Apr 11 '19 at 18:06
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    $\begingroup$ Ah, the VA... I think, all too frequently, the term we're looking for there is "military inefficiency". $\endgroup$ – elemtilas Apr 11 '19 at 18:14
  • $\begingroup$ @Alexander, The VA isn't run by the military. $\endgroup$ – JBH Apr 11 '19 at 18:28
  • $\begingroup$ @JBH Yes, but the question is not asking for subjugate healhcare to unified military command, it only about "military style". $\endgroup$ – Alexander Apr 11 '19 at 18:41

It would be a hindrance.

Once upon a time (roughly 100 years ago) hospitals were organized in millitary-like structures. Slightly exaggerated, it went like this:

  • The chief physician was god-like and infalliable and knew everything there was to know.
  • Regular physicians did their job but were less respected, trying to learn everything, prove themselves and some day be as good as the chief physician.
  • The head nurse reported to and took orders from the physicians and watched over her army of nurses.
  • The regular nurses executed the simple tasks necessary when caring for a patient that didn't require medical education.

As you see, there is a single point of failure: the chief physician. He would maybe take suggestions from his physicians, but certainly no corrections and certainly not from a nurse. Observations and decisions have to be passed through several hierarchical levels and might become distorted like in Chinese Whispers.

In modern hospitals, especially in Norway, the nurses are taken much more seriously, because they are the ones who have the most contact with patients and notice problems first. That makes the medical care actually more efficient and secure by removing that single point of failure. Decisions can be made faster because people of different hierarchical positions communicate directly with each other instead of through an intermediary.

Strict supervision, on the other hand, can be a hindrance in medical care. If a doctor encounters a rare disease, they might want to prescribe rare (and expensive) medication and therapy. If the supervision is so strict that exceptional expenses must be justified, the doctor might feel oblieged to offer mediocre standard care instead of the better, but more expensive specialized care. If a doctor encounters an exceptionally high number of certain cases (maybe like silicosis in mining areas), they might seem suspicious to a centralized health general who oversees the workings of hundreds of doctors but cannot assess regional peculiarities.

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  • $\begingroup$ To some degree this is a strawman argument. Its biggest flaw is that it assumes a hierarchical military organization MUST behave as a rigidly-regimented chain of command. The US Navy, especially large ships such as carriers, has learned the hard way that this can lead to Bad Things. As a result, responsibility and power are to some degree diffused, and while the commanding officer does have final say, the system tries hard to prevent autocratic behavior. Doesn't always work, of course. The same sort of philosophical approach governs commercial flight crews - no dictators allowed. $\endgroup$ – WhatRoughBeast Apr 13 '19 at 15:14
  • $\begingroup$ @WhatRoughBeast This may also remove the single point of failure, but not the risks of strict supervision. These have proven to be a hindrance in medical care in modern democrscies like Germany. The medical care system doesn't collapse but the quality of care provided to some individuals suffers (compared to a system without supervision). $\endgroup$ – Elmy Apr 14 '19 at 7:26
  • $\begingroup$ As is so often the case, perfection doesn't happen, and striking a balance is both difficult and crucial. $\endgroup$ – WhatRoughBeast Apr 14 '19 at 17:05


It would be effective for a certain definition of effective. Essentially what you're proposing is a wholly nationalised health scheme, but instead of socialist politicians running the show, you've got military bureaucrats running the show. As an avid watcher of M * A * S * H, I have no doubt whatsoever that neither solution is actually good for people.

You state that there is also a private medial scheme available, but you don't say what it's like, so I can't really gauge how effective the MedCom would be.

I would hazard the guess that such a system would tend towards the cooky-cutter end of the spectrum when it comes to diagnosis and treatment. It's the military after all, and they're all into step-by-step manuals. It might take several tries to go from "nose bleed" to proper diagnosis and treatment. I'd think such a system would go for a kind of check-list triage system where a nose-bleed patient in an intake clinic will probably end up with a silver nitrate swab shove up his nose to stop the bleeding. Maybe after several tries, the case will be bumped up to an intern who might actually look in the nose. And then stick several more silver nitrate swabs up there to stop the bleeding. It might be quite a while before someone shunts the patient over to a specialist clinic where an ENT will actually look in the nose and determine that something ain't quite right here! They'll promptly shove some more silver nitrate swabs up there and send the patient on to a specialised clinic where actual diagnosis and treatment can happen.

How effective is a highly regimented, hierarchical, bureaucratic system? Well, our patient got his nose bleed treated!

In any arena, like healthcare, you tend to get what you pay for. I would imagine that in the posh private system, our savvy nose bleed patient would simply make an appointment with an ENT specialist right away who would inspect & examine the whole system, order various diagnostic exams, treat any immediate issues and schedule for a more comprehensive treatment of nasopharyngeal angiofibroma, a skull base tumor one symptom of which is nose bleeds, but won't be caught without visual examination, imaging and good medical history taking.

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  • $\begingroup$ I'm a fan of the nose bleed illustration. The doctors aren't butchers or cruel they're just quick and go for the easiest solution. Of course more serious cases would require a lot more care. $\endgroup$ – Celestial Dragon Emperor Apr 11 '19 at 18:51
  • $\begingroup$ @CelestialDragonEmperor -- Right. I hope I didn't make it sound like militarised system was full of incompetent practitioners! It's just that regimented, corporatised health care systems always lead to poorer overall experience for both patient and care giver. $\endgroup$ – elemtilas Apr 11 '19 at 23:29

This might work if:

1) It's the distant future, and there are clear algorithms for treating almost every known disease. There's very little room left for the doctor's own intuition, initiative and resourcefulness. All you have to do is memorize many manuals and execute them as precisely as possible - which the military teaches you to do very well.

2) It's the distant future, and most medics are being replaced by machines. The only doctors which mostly remain employed are the paramedics. This is because machines are hard to train to work in unpredictable situations and environments - outside of a hospital, with few diagnostic tools at hand, and each emergency being different from another. The paramedics don't have to work out the optimal treatment and recovery plan - they need to act rapidly and decisively so that the patient reaches the hospital alive with a reasonable probability. That's another thing the military people really excel at - when in dire situations, find and execute a solution that might not be the optimal one in the long run, but guaranteed to keep everyone alive right now.

3) It's the distant future, and almost all of Earth has become a frontline in a war to end all wars. Either fighting an external threat or, for some reason, each other, but nearly all the planet's population not busy operating the factories has been mobilized, with all civilian doctors assigned to military units. In this case, the military doctors simply become officers with ranks. This is, once again, only feasible if there's virtually no rear, and even the civilian clinics are being converted to field hospitals.

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If the old system was particularly inefficient, you may be able to do better with a military style structure. However, you can be confident that you can always do better with a non-military structure.

The reason for this is purely a game of optimization. The military structure, with its strict hierarchies, has a fundamental goal in mind. It needs to make sure an entire army responds as one cohesive unit to the orders of a general. The time delay between a general making decisions and "boots on the ground" is frighteningly short if you're not used to the way a military operates.

The military structure supports this. It is incredibly effective at supporting cases where a subordinate needs to act quickly, possibly faster than they can fully comprehend the situation, and may need to act on partial information that their superior has (for security reasons, not all information flows down to the troops). This is a reality militaries face, and their structure responds to that reality.

Where it falters is creativity. If you follow the opinions of the upper echelon of the US generals (the 3 and 4 star generals), you find they all continuously harp on the same topic: we need to figure out how to make a military which permits more individual creativity and spontaneity in order to keep up with the current threat climate. Military structure just isn't designed for that, and the militaries of today are currently in the process of reinvisioning how to make that structure work. In twenty years, we may understand how this can work. At this present day, this is considered to be a major impediment to militaries around the world.

Without the strong need for such cohesive action, the military structure is wasteful. Don't get me wrong, this structure could probably have all of New York vaccinated for the measles in 72 hours, should some General Surgeon deem it necessary. But most advancement of medical technology and practice occurs on a much slower time scale. In medicine, it's more important that each doctor review the latest state of affairs and come to their own decision.

So as such, if you could make a military structure work, you can immediately start doing better by not using a military structure. The obvious proof of this: not all of society is implemented in a military structure!

If I widen the scope a bit to include all hierarchies, not just those with a military style to them, there's much more possibility of this working. If you look at the social structures in the Japanese businesses of the 20th century, they had extremely strict hierarchies. However, their hierarchy did not necessarily have a military style. Their style was somewhat different. This style permitted the Japanese businesses to innovate rapidly. Anyone in a manufacturing business knows of the extraordinary effects that lean manufacturing processes from Toyota have had on the field. It's clear they made the innovation thing work.

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  • $\begingroup$ I'll look into the Japanese corporations. Maybe they'll have a hierarchy that I can jerrymander $\endgroup$ – Celestial Dragon Emperor Apr 12 '19 at 11:18

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