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    This Can Kill You
    This Can Kill You
    This Can Kill You
    Ebook182 pages1 hour

    This Can Kill You

    By Brian Casull

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    About this ebook

    As a physician and Physician Executive with 40 years in service supporting the patient, I share a passion and concern about the fate of health care in this country. Per a United States Congressman: ‘Nobody dies because they don’t have access to healthcare.’ The data proves otherwise: there is a real potential for people dying. We present facts and evidence based suggestions for health care reform.
    So, at the end of the day we have a statement of belief held by a United States Congressman. ‘Nobody dies because they don’t have access to healthcare.’ How does a board certified pediatrician, Retired Colonel turned Physician Executive view Health Care in America in Transition? The Affordable Care Act (ACA) has become a house of cards as far as it’s future impact on the Health Care “System” as it is currently under the threat of repeal and replacement with the House Of Representatives recent vote. And just what happened when the House of Representatives passed the American Health Care Act (AHCA) and the potential consequence?. Essentially the real potential for loss of health care, the diminution of the benefits covered, and the price increase for insurance. Oh, yes. And the real potential for people dying because of lack of healthcare.
    Reviewing the literature documents the real connection between lack of access to healthcare and the impact on mortality.
    Medicaid-The largest drop is from changes to Medicaid; the American Health Care Plan would cut the program by 14 million people by 2026, according to the Congressional Budget Office (CBO).
    "Mortality and Access to Care among Adults after State Medicaid Expansions"-published in the New England Journal of Medicine in 2012 analyzed the effects of Medicaid expansion on adult mortality in several states and found a connection between access to Medicaid and reduced mortality. The exact figure was a 6.1% reduction in mortality.
    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, as it would 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
    UNTOWARD DOWNSTREAM IMPACT- What about the impact of Patient Compliance? What about the impact of chronically underserved Mental Health? What about the impact of the UNDERINSURED? Where is the Return On Investment?
    TOTAL AT RISK POPULATION -based on literature review to include mortality data
    271,437 deaths per year from health related causes. If six percent die from lack of healthcare insurance-16,558 Americans could die from being UNINSURED or UNDERINSUED each year.

    LanguageEnglish
    PublisherBrian Casull
    Release dateMay 24, 2017
    ISBN9781370834327
    This Can Kill You
    Author

    Brian Casull

    What the author wishes to share is the very pertinent topic of Healthcare in America in transition. As a physician Executive and retired United States Army Medical Corp Pediatrician and Hospital Commander, he has first hand experience as well as a knowledge base from almost 40 years in health care. The author feels strongly about providing affordable healthcare to many of our vulnerable fellow Americans. He was nudged “into the fray” by a comment from a Congressman who stated that no one ever died from lack of health care. Although the Congressman walked back this statement, the fact that vulnerable Americans might be at risk of the ultimate negative health care result (death) continued to trouble the author. There is much about healthcare that hasn’t been discussed that is eminently germane to any discussion of the subject. The author has tried to go beyond partisan bickering and ideology and concentrate on the confounding variables that must be wrestled with as you take up the subject of the health care. Like you and many other Americans, what motivates the author is to do what is right. Not just what is politically expedient. After spending twenty-one years in the United States Army, the author went on to a varied and successful career in Medicine. The lesson learned while commanding in the military-as a physician you can make a difference in people’s lives one person at a time. Even from his position as Chief of Pediatrics at various assignments. As a “Physician Executive” (Commander), the opportunity to help large groups of people became a reality. Following retirement from the Military, the author followed a pathway that touched many of the sections of the medical community. These included Medical Director for the Rocky Mountain Rehabilitation Center (Colorado Springs, Colorado), Chief of Staff at the Cigna Staff Model (Long Beach), Medical Director -The Traveler’s Insurance Company (Los Angeles), Los Angeles Medical Director for UnitedHealthcare, and Assistant Vice President for a Pharmacy Benefit Manager PCS in Arizona. While at PCS, the opportunity presented itself for him to again serve the military active duty and retirement community. The author became the Corporate Medical Director for TRICARE Health Care Contractor TriWest HealthCare Alliance. After multiple years in that role, the author formed his own Professional Limited Liability Healthcare Consulting Company. Along the way he has obtained an MPA in Health Care Organizations, become a "G" Gauge Model Railroader, done Musical Theatre and taken up the ukulele. Two of his proudest life experiences include becoming the grandfather of eight and the continued relationship with his wife Rebecca Ann of fifty years (and still counting).

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      Book preview

      This Can Kill You - Brian Casull

      THIS CAN KILL YOU!

      American Healthcare in Transition[1]

      THIS CAN KILL YOU

      BY

      Brian Casull, MD, MPA, COL (R) United States Army Medical Corp

      Copyright © 2017 Brian H. Casull MD, MPA

      All rights reserved.

      Distributed by Smashwords

      This e-book is licensed for your personal enjoyment only. This e-book may not be re-sold or given away to other people. If you would like to share this e-book with another person, please purchase an additional copy for each person you share it with. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then you should return to Smashwords.com and purchase your own copy. Thank you for respecting the hard work of this author.

      Ebook formatting by www.ebooklaunch.com

      PROLOGUE [2a]

      I am going to tell you about what I am going to tell you.

      "A sitting Congressman Said ‘Nobody Dies Because They Don’t Have Healthcare,’ And People Are Freaking Out[2b]

      Sometimes real life gives you the perfect example better than anything you could make up. You can’t make this stuff up. Is it me, or are we in a particular plentiful time period where guffaws run rampant and there is plenty of egg for all of the faces willing to wear it. Unfortunately, it is often the case that the person who cracks the egg doesn’t suffer from the consequences. We are at that point in American Health Care History. For example, a member of Congress not impacted by the proposed American Health Care Plan spoke volumes and prophetically as he unwittingly I believe, described the major issue at hand.

      "An Idaho congressman became the target of intense criticism Saturday after telling his constituents that no one dies due to a lack of access to healthcare. Rep. Raúl Labrador — a Republican who voted for the GOP’s repeal and replacement of the ACA — made the comments at a town hall in Lewiston, Idaho. During a question and answer session, a woman told Labrador that by voting for the bill, ‘you are mandating [that] people on Medicaid accept dying.’

      "‘No one wants anybody to die,’ Labrador responded, adding a moment later: ‘Nobody dies because they don’t have access to healthcare.’

      "The crowd briefly erupted into jeering and booing after the comment.

      "In a statement to BuzzFeed News Saturday night, Labrador conceded that ‘one of my answers about health care wasn’t very elegant.’

      "‘I was responding to a false notion that the Republican health care plan will cause people to die in the streets, which I completely reject,’ he said.

      "Labrador added that he was ‘trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay and that the Republican plan does not change that.’ He also repeatedly criticized the media for focusing on a ‘five-second clip’ of the exchange.

      Labrador’s comments drew an immediate backlash online.

      Based on the Congressional Budget Office analysis, here is the potential impact. [3]

      The first clue that the Congressman’s comment might not be supported by fact comes from the VETERAN’S ADMINISTRATION.

      307,000 veterans may have died awaiting Veterans Affairs health care, report says. "Hundreds of thousands of veterans listed in the Department of Veterans Affairs enrollment system died before their applications for care were processed, according to a report issued (by the VA Inspector General in 2015).

      "The VA’s inspector general found that out of about 800,000 records stalled in the agency’s system for managing health care enrollment, there were more than 307,000 records that belonged to veterans who had died months or years in the past. The inspector general said due to limitations in the system’s data, the number of records did not necessarily represent veterans actively seeking enrollment in VA health care

      When adjusted for the number of Veterans who have access to the VA Health Care System, three percent of Veterans may have died due to impeded access to care.

      MEDICAID-In all of the renditions passed by the House and proposed by the Senate (although ultimately defeated-but not dead by any means), the largest drop in access to health care insurance is from changes to Medicaid; the American health Care Act (AHCA-passed in the House) as well as the Better Care Reconciliation Act debated in the Senate would cut the program by up to 14 million people by 2026, according to the CBO (see above).

      Mortality and Access to Care among Adults after State Medicaid Expansions-published in the New England Journal of Medicine in 2012 analyzed the effects of Medicaid expansion on adult mortality in several states and found a connection between access to Medicaid and reduced mortality. The exact figure was a 6.1% reduction in mortality.

      EMPLOYER PROVIDED HEALTH CARE

      Up to another 7 million people (4 million BCRA/7 million AHCA) 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, as it would under the AHCA/BCRA approach (and others of their ilk).

      INDIVIDUAL MARKETPLACE

      Still more people would lose insurance from the changes to subsidies, which help people pay monthly premiums in the individual market. The CBO made no prediction which directly applied to this group.

      TOTAL AT RISK POPULATION

      From the National Vital Statistics Reports Volume 65, Number 4 June 30, 2016 Deaths: Final Data for 2014: 271,437 deaths per year from health-related causes. If six percent die from lack of healthcare insurance-16,558 Americans could die from being UNINSURED or UNDERINSUED each year.

      TABLE OF CONTENTS

      PROLOGUE

      CHAPTER ONE

      WALK IT BACK OR DOUBLE DOWN

      What Politicians and others do when confronted with push back

      CHAPTER TWO

      THE AFFORDABLE CARE ACT (ACA)

      The basis for all the discussion and controversy

      CHAPTER THREE

      WHAT JUST HAPPENED?

      The House passed American Health Care Act BUT the Senate could not make the Better Care Reconciliation Act a reality

      CHAPTER FOUR

      DOWN STREAM IMPACT

      The impact of that act both seen and unseen

      CHAPTER FIVE

      TRUST ME I’M A DOCTOR

      About the author

      CHAPTER SIX

      WHERE’S THE BEEF?

      Data to be applied to the discussion

      CHAPTER SEVEN

      AT THE END OF THE DAY

      What the data actually support in regards to the relationship between mortality and the lack of health care Case Studies

      EPILOGUE

      The summary

      RECOMMENDATIONS

      One Physician Executive’s thoughts on how Health Care in America might be best transitioned

      ENDNOTES

      CHAPTER ONE

      WALK IT BACK OR DOUBLE DOWN

      "The worst-tempered people I’ve ever met were people who knew they were wrong.[4]

      Another trend that appears to have become popular since the Presidential Inauguration in January of 2017 is the famous side -step. The Congressman from Idaho applied some of that technique to walk back his pronouncement that nobody dies from lack of health care. I am reminded of the show BEST LITTLE WHOREHOUSE IN TEXAS. In one of my alternative lives I had the honor of playing Melvin P. Thorpe, the crusading busy-body who reminded you sanctimoniously to Always count your nuts. No pun intended. The best part of the show in my opinion and the one which illustrates my point about walking back or doubling down on a previous statement is the song sung by the Governor of Texas.[5]

      Specifically, the movie version starring Dolly Parton and Burt Reynolds, but the example I think which illustrates the point we are discussing came from another actor in that movie.

      Case in point is when movie actor Charles Durning[6] playing the Governor of Texasa answered a reporter’s question about what he thought of the Middle East saying I was sayin’ just this morning at the weekly prayer breakfast, in this historic capital, that it behooves both the Jews and the Arabs to settle their differences in a Christian manner!

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