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Newsmaker: S. Ward Casscells
Warding Off Higher TRICARE Fees?By Tom Philpott
Winter 2007-08
Earlier this year, Congress rejected a Department of Defense plan to raise TRICARE fees, deductibles and co-payments sharply for under-65 retirees and their families.
The man now responsible for restoring DoD credibility on the issue, with Congress and with beneficiaries, is Dr. S. Ward Casscells, the new Assistant Secretary of Defense for Health Affairs. A colonel in the U.S. Army Reserve, the 55-year-old Casscells had served as a distinguished professor of cardiology at the
On taking office last spring, Casscells immediately changed the tone of the debate over TRICARE, saying he wants to work with service associations and beneficiaries to preserve the benefit. But he believes higher fees for working-age retirees are likely, through a gradual phase-in. He also favors new health care options opened to military beneficiaries, including health savings accounts.
Dr. Casscells’ interview with “Military Update” columnist Tom Philpott has been edited for space and clarity:
You have said that the Department of Defense plan to raise TRICARE fees might harm recruiting and retention. Do you still have that concern?
The Task Force on the Future of Military Healthcare, in its interim report, sounded unanimous that some adjustments would have to be made so that overall military [health] expenditures would be sustainable and [other] important defense programs would not suffer.
We also heard that the military health budget, as big as it is at roughly $40 billion [a year], is nevertheless smaller in proportion to total U.S. health care expenditures divided by gross domestic product. So we are not bumping up against [some] rule here that says TRICARE fees have to go up this year. But as a prudent matter, and a matter of fairness, it’s hard to exempt one group of people, or one type of service provided, and give lifelong immunity from free markets… For health care to be efficient, people have to have the ability to make good judgments, intelligent choices.
What does that mean for the military community?
One of our obligations is to provide people with more education, more just-in-time information and more choice to improve quality, satisfaction and sense of ownership. [This] eventually prevents waste or unnecessary costs.
As you introduce more choice into a system, more patient control, people realize they can [reduce] waste, including of their own time. Mothers at
Would a doctor prescribe Tamiflu without seeing the patient?
We do it all the time. It saves time, money and contamination of the facility. It’s a matter of the doctor and programmer sitting down together [to develop the self-diagnosis material].
Regarding co-payments, a patient has to have some skin in the game. They’ve got to get a reward for taking good care of themselves and also for not wasting resources. Taking some responsibility, some ownership, is important.
That’s the attraction of medical savings accounts. People can keep some money if they have some responsibility for spending it. Nobody washes a rental car. But if we empower and authorize beneficiaries to be better medical shoppers, they will save money… It gives you some strong alternatives to raising fees abruptly or in a big way.
Your predecessor was a strong advocate for raising fees… You haven’t embraced the increases. Why?
Just from the standpoint of doing the right thing for the patient, I think abrupt changes in fees and deductibles could be unsettling.
There are some reasons not to compare ourselves to the private sector so rigorously. For one thing, as a percent of our [defense] budget, healthcare isn’t very high, about eight percent. Yet 17 percent of our gross domestic product is health related. That is one important perspective.
And non-military healthcare spending doesn’t have a readiness mission…
No. And they have just-in-time inventory systems. They fill their hospitals the way airlines keep their planes full. There is no excess capacity for emergencies like pandemic flu or hurricanes. They are not required to be mobile and expeditionary. They are not required to practice overseas. They are not required to practice under gunfire. They don’t have to have redundancies – a [backup] in the event of the system taking a direct hit.
So you would like to broaden health options in concert with TRICARE fee increases?
We need to hear what the Task Force says in December. It sounds like they’re going to recommend a measured and thoughtful plan on co-pays, deductibles and providing a sustained but gentle incentive to encourage people to think about their medical expenses. Not something big and abrupt as though we don’t care. Not big fee increases where, because I don’t have $5 in my wallet, I’ll just have my heart attack at home, say my prayers and hope I survive. We don’t want that. And it should be done in conjunction with thoughtful programs that empower people and offer choices.
David
He’s asked me to do what I think is best to protect the soldiers and their families, to restore them to health, to change our system so they have more confidence in it, to get them to be more educated and empowered consumers whether in the military or as reservists back home. People have to have some stake in both financial outcomes and health outcomes. So I would look for some small gradual increase in fees and deductibles over the years – but not this year, because we’ve got plenty on our plate right now.
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Tom Philpott writes “Military Update,” a syndicated weekly news column for daily newspapers near military bases. It can be read online each week at www.military.com and www.fra.org.