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.
Read my posts below to discover … learn … realize … understand what you can do about
American Healthcare in Transition.
How I Would Approach Healthcare Reform
I support physician leadership, even when considering a one-party payor system. The broadest division among one-party payor system advocates is how the delivery of care is organized. The Democrats have revealed their “Medicare for All” proposal. According to the Wall Street Journal. Here are the salient features. Under the Medicare for All Act of 2019, the federal government would pay for the following[1]: Health coverage for all Americans to include items such as premiums, copays and deductibles (see the 2019 Realities for the Basics of Healthcare below) Expansion of Medicare to younger Americans essentially replacing both Medicaid (low [...]
Healthcare in 2020: What Should Be Done?
To reiterate a previous blog post, we know Health Care is an important national topic. Also, a federal judge ruling that the ACA is unconstitutional has set the stage for its continued importance. The ACA is still in place until 2019 when the mandate to have insurance goes away, thanks to the 2017 Tax Bill. Appeals have begun. The Supreme Court will become involved. Health Care will continue to be a hot topic in the 2020 Presidential Election. So what should happen to our healthcare system in 2020 and beyond? Here are my suggestions: ONE COMMON OPERATIONS MANUAL Healthcare should [...]
Cost is Key to Whether You Can Provide Adequate Health Care Coverage For You And/Or Your Family
In our previous blog, I discussed the concept of Health Care Park and Tectonic Plates. COST being a major one of those results of an angry lithosphere. I left you with a question. IS COST A VIABLE CONCEPT FOR THE INFORMED CONSUMER OF HEALTHCARE? I believe it is. But, don’t just take my word for it. Here is a discussion which will I believe will prove my point. COST becomes the chief determinant of whether you can provide adequate health care coverage for you and/or your family. There are of course other reasons for being uninsured. But COST seems [...]
Where You Live Determines Your Healthcare Cost
Last week we talked about variability. And even that variability is variable. Say what???? At the end of the day the final variable is location. Where you live determines cost -- not how sick you are. Whatever the market can bear in our FOR-PROFIT HEALTHCARE INSURANCE MODEL. And that variable variability is augmented, aided and abetted by our old friend THE THIRD PARTY. And there's a third party —the insurance company —who pays for the service, but they don't pay those listed charges. They negotiate for lower prices with each hospital and doctor on every plan. And these negotiated [...]
What Influences Access to Healthcare? Cost!
In last week's blog I talked about ROI (Return on Investment). Health outcomes (mortality, morbidity-how sick you are, life expectancy, healthcare status, functional limitations, etc.) are strongly impacted by your access to healthcare. And what influences ACCESS TO HEALTHCARE? Healthcare expenditures. COST! And WOMEN HEALTHCARE CONSUMERS are impacted more often by cost than their MALE counterparts. The primary driver of COST is VARIABILITY. There's the FIRST PARTY— the provider — who provides the service. They each have their own master list of charges for different services, and these charge lists are [...]
Healthcare 2020 and Out of Pocket Costs
In my previous blog I talked about the three obvious and prominent components of our FOR-PROFIT HEALTHCARE INSURANCE MODEL. And no, it is not a free ride for the healthcare consumer. We have OUT-OF-POCKET COST. We have the privileged of paying premiums, deductibles, co-pays, coinsurance or other fees out of pocket in order to play on one of the six teams. That process, in reality, looks something like this. In essence these six teams funnel their payment process through an INSURANCE COMPANY. They “pay” for the services, but they don't pay those listed provider charges. They “negotiate” for lower [...]
Introducing the Current Model of Healthcare
Today, I would like to introduce the current model of healthcare. It is the FOR-PROFIT HEALTHCARE INSURANCE MODEL. That model has three prominent components and one behind the scenes. Let me introduce those players under a little different name. THE FIRST PARTY The FIRST PARTY is the PROVIDER OF HEALTHCARE. Under federal regulations, a "health care provider" is defined as: a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice and performing within the scope of their practice as defined by law.[1] There is [...]
Do We Need a Border Wall From a Healthcare Perspective?
Poppy tweets about healthcare 2020 ... where are we headed? The results of the 2018 mid-term elections solidified Health Care as an important topic. The recent federal judge ruling that the ACA is unconstitutional set the stage for its continued importance. The ACA is still in place until 2019 when the mandate to have insurance goes away thanks to the 2017 Tax Bill. Appeals have begun. The Supreme Court will become involved. Health Care will continue to be of importance through the 2020 Presidential Election and beyond. Even though “Build The Wall” and the government shutdown have taken center [...]
Decision Makers
The DECISION MAKERS ... Are you listening? Previously in my POSTSCRIPTS for the Consumers and Providers, I mentioned that we have come full cycle to the place where I as a Physician Executive will ask some questions. But this time my comments will be directed to the DECISION MAKERS of our FOR-PROFIT HEALTH CARE INSURANCE MODEL. Do not consider American health care in transition in the current vacuum in which previous tectonic plates were conceived. In other words, remember the Prime Directive! NO DECISION MAKER IN THE ROOM SHOULD KNOWINGLY INTERFERE WITH THE NATURAL PROGRESSION OF AMERICAN HEALTHCARE IN TRANSITION [...]
Providers of Healthcare
There's the ‘first’ party — the PROVIDER who provides the service. Are You Listening? As I said in the first POSTSCRIPT for the Consumer of Healthcare, now we have come full cycle to the place where I as a Physician Executive will ask some questions. This set of information is only for you the “first party” of our FOR-PROFIT HEALTH CARE INSURANCE MODEL. THE PROVIDERS OF HEALTHCARE. Physicians could recapture the moral high ground and advocate for equitable access to patient-‐centric care. A career in medicine makes physicians uniquely able to see how tragically easy it would be to [...]