Dr. S. Ward Casscells is a cardiologist. But he has more than medical skills now 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.

His appointment could be good news for retirees younger than 65 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 phone interview, his first since becoming assistant secretary.

Casscells, 56, 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. Casscells wants beneficiaries to feel they are partners in actions ahead to make military health care 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 health care, yet military health spending 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 overseas. They are not required to practice under gunfire. They don’t have to have redundancies – a (backup) system in the event a system takes a direct hit.”

Casscells joined the Army Reserve at 53, having been granted waivers for his age and for his illness, cancer. Two years earlier, Casscells had been diagnosed with metastatic prostate cancer. He still receives 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 health care delivery systems for Iraqis.

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

To reach columnist Tom Philpott, e-mail milupdate@aol.com or write Military Update, PO Box 231111, Centreville, VA, 20120-1111.