View Full Version : New health chief foresees 'gradual' Tricare fee hikes

06-14-07, 06:09 AM
New health chief foresees 'gradual' Tricare fee hikes
Published Thursday June 14 2007
By Tom Philpott

Dr. S. Ward Casscells is a cardiologist. But now he has more than medical skills to ease the stress on military retirees from recent proposals to raise sharply their Tricare fees, co-pays and deductibles.

Five weeks ago Casscells became the new assistant secretary of defense for health affairs, arriving from the University of Texas Health Science Center in Houston where he was a distinguished professor and its vice president of biotechnology.

His appointment could be good news for under-age-65 retirees and their families because Casscells isn't a fan himself of the steep increases in Tricare fees that Defense officials proposed early last year.

"Just from the standpoint of doing the right thing for the patient, I think abrupt changes in fees and deductibles could be unsettling," he said.

As the Pentagon's top policymaker on health issues, Casscells will be working with lawmakers next year on a more palatable set of fee increases.

"I would look for some small, gradual increases in fees and deductibles over the years. Not this year, because we've got plenty on our plate right now -- more than we can say grace over," said Casscells in a 45-minute telephone interview, his first since becoming assistant secretary.

Casscells, 56, exudes the good will of a country doctor rather than the caution of a new political appointee who fears moving off message. "I'm trying to be a policy guy," he said. "I haven't graduated to politics yet."

He peppers his remarks with homespun humor and self-deprecation. He compared his first weeks on the job to riding the mechanical bull at the Houston Livestock Show and Rodeo. He acknowledged that the military is upset about "efficiency wedges" imposed on its budgets. They probably liken that term, he said, to the bedside manner of Procrustes from Greek mythology who invited travelers to stay for the night and then either stretched their bodies or amputated their feet to fit the bed.

Casscells wants beneficiaries to feel they are partners in actions that will make military healthcare more efficient and effective. He praised the work of his predecessor, William Winkenwerder, saying that "in a lot of areas he had the ball on the 10-yard line," which makes a new quarterback's job easy.

But Casscells doesn't sound the same alarms over the doubling of military health costs since 2001. He noted that 17 percent of the nation's gross domestic product last year went for healthcare, yet health spending by the military is only 8 percent of the defense budget.

"By that metric we're doing OK. There are other metrics which make us look less efficient in the civilian health world. And there is no doubt we can be more efficient because we're not at full capacity" in base hospitals.

But the private sector is different, Casscells said. They "fill their hospitals the way airlines keep their planes full. There is no excess capacity for emergencies like pandemic flu or hurricane.

They are not required to be mobile and expeditionary. ... They are not required to practice under gunfire. They don't have to have redundancies -- a (back-up) system in the event a system takes a direct hit."

Casscells describes a kind of a mid-life romance with military medicine. Awarded Army research grants over the years, he got to work closely with the U.S. Army Medical Research and Materiel Command at Fort Detrick, Md.

"I was really struck by their work ethic and their integrity and team spirit. Frankly, the tone of discussion was invariably at a high level, wanting to do that right thing for soldiers and for discovery and invention."

In his university life, he said, "I frankly hadn't seen that all-for-one-and-one-for-all" attitude.

But his father had. S. Ward Casscells Sr., was an orthopedic surgeon under Gen. George Patton in World War II. In 2003, on the birthdate of his father, who is buried at Arlington National Cemetery, Casscells recalled his dad's war experiences to his own youngest son, Henry, and even showed the 8-year-old his grandfather's uniform.

"He looked at (it) with reverence, so much so that he didn't even finger the medals. Then he looked at me and looked back at the uniform, and then he looked at me -- and said nothing!"

At that moment Casscells decided to join the Army Reserve, which he knew needed doctors. The Army granted waivers for his age, then 53, and for his illness, cancer. Two years earlier Casscells had been diagnosed with metastatic prostate cancer. He still receives continuous chemotherapy.

His reserve deployments included three months in Iraq late last year where he worked as a liaison for Gen. George Casey on initiatives to improve healthcare delivery systems for Iraqis.

A priority now, as the Department of Defense's health chief, is to improve system efficiency and quality of care by building more "choice" into healthcare options. This could include the testing of military health savings accounts.

Casscells also wants to see more patients in base hospitals, more medical advice provided online and co-payments that discourage misuse of healthcare.

"A patient has to have some skin in the game," he said. "They've got to get a reward for taking good care of themselves. They've got to get rewarded for not wasting resources."

Casscells said he will await the final report of the Task Force on the Future of Military Healthcare before endorsing any fee hike plan.

"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 the free markets," he said.

Markets, he added, "do drive efficiencies."