Even in time of plenty – and contrary to protestations otherwise this is a time of plenty – the unsexy but important are easy game for the green eye-shade and the short-term minded.

From replenishment ships, to icebreakers, command ships, and yes, hospital ships – the unsexy but important are always given very minimal support.

Hospital ships have been one of the harder ones to argue for as the metrics are challenging. They take a while to get up and running, are slow, and besides a photo-op or two, quickly slide backwards.

Starved for money, they also are sub-optimal platforms in a variety of technical ways. They are also a unique capability that are not used enough.

We have been blessed in that we have not had a brutal conflict in decades, so their utility on the high end has not been fully realized. Due to the activation and manning challenges, on the low end they have not seen as much “soft-power” use either.

However, at then end of last month – we had this datapoint;

The Military Sealift Command hospital ship USNS Mercy departed its home port of San Diego Feb. 23 in support of the 13th Pacific Partnership mission.

Pacific Partnership is the Navy’s humanitarian and civic assistance mission conducted with and through partner nations, nongovernmental organizations and other U.S. and international government agencies to execute a variety of humanitarian civic action missions in the Pacific Fleet area of responsibility.

The Mercy will visit Indonesia, Malaysia, Sri Lanka and Vietnam from February through June to provide medical, dental, veterinary, public health services, engineering and disaster response to host countries who have invited the ship to visit and provide services to the local population. More than 800 military and civilian personnel from Australia, Canada, France, Japan, Peru Singapore, South Korea and the United Kingdom will join allied and partner nations for the mission.

You would think that keeping – indeed building new hospital ships – would be an easy sell. Well, it isn’t.

Once or twice a year or so I will mention hospital ships at the homeblog or on Midrats, but the arguments on both sides always seem a bit thin. Well, there’s a great cure for that. Over at The Drive, Joseph Trevithick put together one of the better outlines of the argument, and the latest developments.

Faced with growing difficulties sustaining and modernizing its existing fleet, the need to address the underlying issues behind a spate of deadly accidents and other controversies, and a desire to increase the total number of ships in its inventory, the U.S. Navy has many different priorities to balance when it put together its latest budget request. But at least one part of its new, broad plans, includes a decision to retire one of its two unique hospital ships, possibly as early as the end of 2019, a move that has already rankled some members of Congress.
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At present, the Navy has two large hospital ships, the USNS Mercy and USNS Comfort, which it received in 1986 and 1987 respectively. Converted from oil tankers, each of the nearly 900-foot long ships displaces more than 69,500 tons and has a crew of more than 1,200 individuals when operating at full capacity. Both are part of Military Sealift Command, the service’s hybrid military-civilian logistics and support arm, which is itself under the operational control of U.S. Transportation Command, or TRANSCOM.

That is the background, here is one of the better arguments for her utility during high-end conflicts.

“I’ll tell you, for every one hospital ship we’re short, we’re going to have a requirement for 479 air-refueling tankers,” General McDew told lawmakers. That notional tanker force reflects what it would take to support the amount of medical evacuation aircraft it would take to handle the same number of casualties as Mercy or Comfort.

We won’t have those spare tankers in any peer to near-peer conflict.

It is hard to argue that from peace as people in DC are looking for every nickel … now.

…here are concerns about the relatively high costs of that treatment. The costs associated with Mercy and Comfort can translate to per patient treatment costs ranging from $10,000 to more than $30,000 during certain missions. For comparison between March 2014 and December 2015, Médecins Sans Frontières (MSF), a non-governmental humanitarian aid agency also known as Doctors Without Borders, spent approximately $12,400 per patient while helping to contain the West African Ebola epidemic.
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… the cost to keep both Mercy and Comfort on active duty is the price one pays for having that kind of unique capability. With the possible exception of China, no other navy in the world operates hospital ships with anywhere near the same capacity. The sole Chinese Type 920 hospital ship, a converted cruise ship with a similar dual military and civic-action role – taking on the names Daishan Dao and Peace Ark during war and peace respectively – can still only accommodate 600 patients in total, far less than its American counterparts.

We need to keep MERCY and COMFORT at a minimum of where they are now. If we were smart, we would be building new ones now.