Healthcare in Transition Blog 2018-08-01T17:02:31+00:00

Dr. Brian Casull’s Blog

WELCOME TO THE AMERICAN HEALTH CARE GAME OF BASEBALL

Healthcare is not a “system” in the United States. Rather it is like a game of baseball where your perceived and actual coverage is determined in large part by where you sit in the ballpark of healthcare.

basball park - where is your healthcare seat

Read my posts below to discover … learn … realize … understand what you can do about
American Healthcare in Transition.

  • medicaid enrollment chart

Addressing Current Concerns of the Healthcare Consumer

Poppy tweets “I’m worried about losing my treats!” 1. LOSING MEDICARE AND MEDICAID-DEFICIT REDUCTION MASQUERADING AS HEALTH CARE REFORM HUMANS are worried about $554 billion in cuts to Medicare as this impacts you the 55 million Americans who are over age 65 or living with disabilities. This impact may be felt through decreased access to healthcare providers. The greatest impact would appear to be on the cost of prescription drugs. The cost of Medicaid expansion has led to calls for BLOCK GRANTS to replace the Federal portion of Medicaid coverage. Opponents argue that this will decrease access to care. [...]

  • Poppy the cockatoo

The Big Picture-The Current American Healthcare in Transition Model

POPPY THE COCKATOO TWEETS HEALTHCARE: “Hi. I am Poppy and I am a Cockatoo. My human has asked me to introduce the subject.” The Big Picture Today, the for-profit health insurance model drives american healthcare in transition (non-profits make money, they just don’t share it with stockholders). This model is broken! What does the model look like? It is a three- party system. There's one party — the provider who provides the service Have their own master list of charges for different services Different from provider to provider There's a second party — the patient, who receives the service. [...]

  • aca by states chart

HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part C)

In my two previous posts, I wrote about the Affordable Care Act (ACA) and about the three components of that major driver of consumer concern. In this blog we will continue to discuss the tectonic plates which remain and discuss the potential for dying due to the lack of health care coverage. TAX PROVISIONS [1] The ACA levies hefty taxes on pharmaceutical manufacturers, medical device manufacturers, health insurers, and wealthy citizens. These taxes have been helping to pay for the law's coverage expansions and such expenses as the Center for Medicare and Medicaid Innovation (CMMI). Similarly, the ACA reduced [...]

  • medicaid expansion

HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part B)

This blog begins where the PART A left off as we continue to walk through the various provisions of the ACA and how repeal might impact you the health care consumer. OTHER INSURANCE MARKET REFORMS PROVISION INSURERS MUST PROVIDE SERVICES IN TEN ESSENTIAL BENEFIT CATEGORIES ESSENTIAL HEALTH BENEFITS WHAT: TEN CATEGORIES OF SERVICES health insurance plans must cover under the Affordable Care Act. Specific services may vary based on each State’s individual and particular requirements. [1] [2]  [3] [4] [5] LIFETIME OR ANNUAL PAYMENT LIMITS WHAT: “Insurers are prohibited from limiting the amount of health care dollars for these [...]

  • affordable care act - impact on jobs

HEALTH CARE CONSUMER’S CONCERNS ABOUT THE AFFORDABLE CARE ACT — THE LAW OF THE LAND (Part A)

(THE GOOD, THE BAD, AND THE UGLY) One area of health care related concerns where a good majority of voters are focused is the AFFORDABLE CARE ACT or ACA.  This blog is about three components of that major driver of consumer concern. In this blog we will set the stage by describing what it is and what it isn’t. Setting the Stage-The Affordable Care Act Then came the Affordable Care Act. whose purpose was to improve affordability and accessibility, oversee, coordinate and govern the many pieces in play.  It did, and it didn’t.  What it did do was stretch [...]

  • chart showing healthcare-continuum

HEALTH CARE COSTS AND PATIENT COMPLIANCE

This blog is about a major driver of health care cost which has not received the attention I believe it should: Our own involvement in our health care and how COMPLIANT we are in doing the appropriate things to improve our health and, by extension, decrease the total cost of healthcare. Compliance Along the Health Care Continuum The last variable we will take up before we close this discussion on concerns about health care costs is one that you, the reader and patient, can control: compliance.   In medicine, compliance describes the degree to which a patient correctly follows medical [...]

  • chart on biosimilar drugs

THE HIGH COST OF PRESCRIPTION DRUGS – Part B

Last week,  we discussed how much prescription drugs are costing you and what the drivers were for those high prices. (Read: “The High costs of Prescription Drugs, Part A”). In this, Part B, of my blog talking about the high cost of prescription drugs, we continue that discussion … RESEARCH AND DEVELOPMENT   To be fair, there is a cost associated with research and development. The cost of developing a prescription drug that gains market approval was $2.6 billion recently. This represents a 145 percent increase (correcting for inflation) over the estimate made in 2003, which was $1.4 billion. [...]

  • medicare drug spending chart

THE HIGH COST OF PRESCRIPTION DRUGS – Part A

Nationally, voters are “very concerned” about what is going on in the world of pharmacy and how it impacts you. Not only how much prescription drugs are costing you, but also how to lower those drug prices. The Cost of Prescription Drugs [1] The chart below gives you a visual example of the dramatic increase in the retail price of prescription drugs. [2]  Current trending has leveled off at just under 6 percent and is predicted to stay in that range through 2025. [3] Here is a summary of pharmaceutical cost drivers based on the current situation. Pharmacy (Prescription Costs) Cost Drivers [...]

  • healthcare procedures price variance chart

MEDICAL PROCEDURES AND DEVICES CONTRIBUTE TO TOTAL COST OF HEALTHCARE

If we break down the components of today’s health care concerns, one area where a good majority of voters are “very concerned” with the total cost of health care is medical procedures and devices. The cost of your healthcare procedures is dependent on where you live[1]  There were huge ranges in prices even within the same state. In the example below, a colonoscopy (a procedure that allows doctors to look inside and see how healthy your large intestine, or colon might be) could cost anywhere from $202 to $1,966 in South Dakota.[2] The Dartmouth Atlas of Health Care addresses [...]

  • how healthcare insurance flows graph

PROVIDER VARIABILITY A MAJOR DRIVER OF HEALTH CARE CONSUMER’S CONCERNS

How Providers of Healthcare charge for their services[1] Again, the constant theme in American healthcare is variability. That is why the prices in the United States are expressed as a range.  All of this means there are about as many price tags for that hypertension checkup as there are insurers and providers. There's one party — the provider who provides the service. They each have their own master list of charges for different services, and these charge lists are different from provider to provider. There's a second party — the patient or patients — who receive the service. And [...]