Chapter Overview of “This Can Kill You” 2018-07-02T23:59:31+00:00
Book Cover - this can kill you


American Healthcare in Transition

with the House of Representatives passing the 
American Health Care Act (AHCA)




How to make health care work for all Americans is the unanswered question

Brian CasullAs a physician and Physician Executive with 40 years in service supporting the patient, I share the passion and concern about the current health care law of the land the Affordable Health Care Act (ACA). Having supported our men and women in uniform, people with private sector healthcare, and folks with pharmacy benefits; I feel compelled to speak out about the very pertinent subject of the ACA and American Health Care Act (AHCA).

In fact, I feel so strongly about the issue of providing affordable healthcare to many of our vulnerable fellow Americans that I am self-publishing a discussion of Healthcare in America.

I was nudged “into the fray” so to speak by a comment from a sitting Congressman who stated that no one ever died from lack of health care, before he walked back this statement. The fact that vulnerable Americans might be at risk of the ultimate negative health care result (death) continued to trouble me. There is much about healthcare that hasn’t been discussed that is eminently germane to any Senate discussion of the subject. What I have tried to do is concentrate on the confounding variables that our representatives must wrestle with as they take up the subject of the ACA/AHCA.

I have even become so bold as to offer some advice. Like you and many other Americans, what motivates me is to do what is right. Not just what is politically expedient. A U.S. Congressman said ‘Nobody dies because they don’t have access to healthcare.’


Read this chapter by chapter overview:

In the Prologue we will introduce the issues under discussion.

The Congressmen walked it back. In Chapter One I address the Washington Norm of walking back or doubling down on a previous statement. “Ooh I love to dance a little sidestep, now they see me now they don’t — I’ve come and gone and, ooh I love to sweep around the wide step, cut a little swathe and lead the people on.”

In Chapter Two we discuss the Pros and Cons of the ACA. The Affordable Care Act was signed on March 23, 2010 by President Barack Obama and included about 400 sections of reforms to the health insurance and healthcare industry. Included in this chapter is the lengthy U.S. Preventative Services Task Force recommendation in total.

Going on to Chapter Three we look at WHAT JUST HAPPENED with the House of Representatives passing the AHCA. “Get ready for a bumpy ride.”

  • UNINSURED-MEDICAID: American Health Care Act (AHCA) cuts program by 13-14 million people by 2026, -Congressional Budget Office (CBO).
  • EMPLOYER PROVIDED HEALTH CARE: Another 7 million people who currently have insurance through their employer would drop that coverage if the individual mandate- which currently requires that most people have coverage or pay a penalty at tax time – goes away under the AHCA.
  • INDIVIDUAL MARKETPLACE: Still more people would lose insurance from the changes to subsidies, which help people pay monthly premiums in the individual market. Nearly 83% (10.5 million of 12.7 million) received premium subsidies according to HHS.

BUT NOW FOR THE REST OF THE STORY … the down stream impact. Chapter Four deals with the UNDERINSURED & UNINSURED. Then we discuss areas not even being considered in the political debate – the NONCOMPLIANT, RETURN ON INVESTMENT (results versus cost of healthcare), and the MENTALLY ILL.

We begin to unearth the data showing that NOT having healthcare can lead to death:

  • VA — 307,000 veterans may have died awaiting care. (the VA Inspector General (2015) — 3% of Veterans may have died due to impeded access to care.
  • NEW ENGLAND JOURNAL OF MEDICINE (2012) found a connection between access to Medicaid and reduced mortality. There was a 6.1% reduction in mortality.

Who is this brash character asking you to essentially “Trust me, I’m a doctor?” Well, in Chapter Five we will go into my CV.

Clara Peller was the diminutive octogenarian who uttered the famous hamburger challenge, ‘‘Where’s the beef?’’  In Chapter Six we present the “beef” (data).  Published reports, graphs and charts paint the picture.

Chapter Seven is home to our conclusion — 16,558 preventable deaths per year if six percent die from lack of health care. Six individual case studies follow to bring the issue home to the patient level. The Epilogue which follows is a summary in case you want to cut to the chase.

So at the end of the day, what have we discussed?  In the Epilogue we provide a summary of the case under discussion.

I would not be a Physician Executive worthy of his computer and data research if I didn’t offer up what in essence is one man’s opinion as to what the Senate should do about the American Health Care Act. I see chaos as an opportunity for growth.  Here is what I suggest.


About The American Healthcare System in Transition

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