The New York Times ran a story about decentralization of medical care in the UK. What if "military medical system" was substituted for NHS in the story?

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level.

Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

Comment: This story prompts a comparison between the US military medical system and the UK's National Health Service. The NHS is presumably larger but both are high centralized bureaucratic systems. In both systems, costs are out of control and inefficiencies at the top take away from direct patient care at the bottom. There are some benefits to centralization such as shared medical records and increased buying power for pharmaceuticals. At the same time, reducing decision making power of hospital commands, doctors and patients results in poor decision choices and disenfranchisement. How could the US military find a better balance between centralization and local control?