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

Dr. Brian Casull’s Blog


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.

  • brian train conductor

The Voice of the People

The current Law of the Land is the Affordable Care Act. The question? In 2017, Republicans wanted their leaders to continue the ACA repeal and replace (66 percent). It is of interest that 28 percent of Republicans were interested in improving the way the ACA was working. Democrats told their leaders that they wanted to improve the way the ACA was working (52 percent) while 43 percent wanted them to pass a national healthcare plan.[1] How are Americans currently leaning?[2] Fifty three percent view the ACA as favorable. Forty percent view the ACA as unfavorable. Largely driven by Democrats. [...]

  • single payer healthcare chart

Which of the Four Health Care Models Would I Recommend?

In my past four posts, we have examined what our healthcare “system” choices are.  To review, they are: the Beveridge National Health Service Model, the Bismarck model, the National Health Insurance model, and the Out-of-Pocket Model.” (1)(2) What current American model would be the basis for the government sponsored healthcare portion? “’About half think they’ll be able to keep their current insurance,’” says Mollyann Brodie, PhD, Executive Director of Public Opinion and Survey Research at the Kaiser Family Foundation — which is flatly false.” (3)  That to me might be the biggest concern facing healthcare consumers moving forward. Providers [...]

What is The Return on Investment Under The Four Models for Health Care Systems?

Today we will talk about RETURN ON INVESTMENT or ROI. The first questions would be how does each model, of the four major models for health care systems: the Beveridge National Health Service Model, the Bismarck model, the National Health Insurance model, and the Out-of-Pocket Model, (1) compare when we look at population coverage? (2) Every modern nation other than the United States ensures healthcare as a basic right of human life. The current system is plagued by VARIABILITY. With VARIABILITY IN TYPES OF COVERAGE (3) comes 31 million Americans who are UNDERINSURED! And what [...]

  • Three-Party System Graph

Health Care System Choices: The Out of Pocket Model

In my previous blogs we have looked in depth at three of the four major models for health care systems:  Beveridge National Health Service Model , the Bismarck Model, and the National Health Insurance Model.  Today's blog post will discuss the final Out-of-Pocket Model (1)(2). The Out-of-Pocket Model: Market-driven Health Care Examples: rural areas in India, China, Africa, South America. Relevance to the U.S.: similar to treatment for uninsured or underinsured. We have discussed in great detail the American For-Profit Health Care Insurance Model. And the large out of pocket costs in a fee-for-service environment. A Summary of The Pros and Cons of the ACA-The [...]

  • National-Health-Insurance

Health Care System Choices: National Health Insurance Model

Among our healthcare “system” choices are four major models: the Beveridge National Health Service Model, the Bismarck Model, the National Health Insurance Model, and the Out-of-Pocket Model (1)(2). In previous blogs we looked in depth at the Beveridge National Health Service Model and the Bismarck Model. In this blog post, we are going to examine the third of the four models:  the National Health Insurance Model. The National Health Insurance Model: single-payer national health insurance Examples: Canada, Taiwan, South Korea Relevance to the U.S.: similar to Medicare This system incorporates aspects of the two systems above. Like in the Beveridge Model, the government acts [...]

  • health plan capitation chart

Health Care System Choices: The Bismarck Model

Among our healthcare “system” choices are four major models.  In my last blog we looked in depth at the Beveridge National Health Service Model. Of the remaining three: the Bismarck Model, the National Health Insurance Model, and the Out-of-Pocket Model (1)(2), this week the discussion will focus on the second of the four models:  the Bismarck Model. The Bismarck Model: social health insurance model Examples: Germany, Belgium, Japan, Switzerland Relevance to the U.S.: similar to employer-based healthcare plans and some aspects of Medicaid; Germany has a universal multi-payer healthcare system paid for by a combination of statutory health insurance officially called "sickness funds" [...]

  • common health care system finance models chart

Health Care System Choices: The Beveridge Model

And what are our healthcare “system” choices? There are four major models for health care systems: Beveridge National Health Service Model Bismarck Model National Health Insurance Model Out-of-Pocket Model. (1)(2) I will discuss them one at a time.  In this blog post, we will examine the Beveridge Model. The Beveridge Model: A single-payer national health service that was first developed by Sir William Beveridge in 1948. Examples: United Kingdom, Spain, New Zealand, Cuba. Relevance to the U.S.: similar to the Veterans Health Administration. This form of single-payer is most similar to the National Health Service of the United Kingdom [...]

  • dollars-sense

Healthcare Dollars and Sense

In this blog I begin to discuss dollars and sense. “The legislative text (“Medicare for All” proposal) won’t include a financing plan. Opponents of a single-payer system say it would require major tax increases and cost more than $30 trillion in its first decade. Supporters say it would save money by reducing the expected pace of U.S. health-care spending. Funding options include a so-called wealth tax and increasing the marginal tax rate.” (1) If the critics indicate “major tax increases” equal $30 trillion/10 years, then the average yearly cost of a one- party payor system would be $3.0 trillion/year. [...]

  • Brian Casull and his pet cockatoo, Poppy

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 [...]

  • Consider another healthcare model

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 [...]