Jeffrey Segal, MD, JD - Medical Justice

The SGR Band-aid & Why We All Should Care

August 15, 2024March 6, 2010 by Jeffrey Segal, MD, JD

The real problem is with the SGR itself. Medicare’s reimbursement for treatment needs to be addressed, revised so that it compensates fairly and equitably. Once the matter has been dispensed of, doctors can return their full attention to treating patients instead of worrying about how to keep the doors open for those patients…
Pardon me, Mr. President, but could you tell your stage dressers that it takes more than a garment to make a doctor, and more than those props to get the American people to believe that physicians are actually endorsing such a pathetic and woefully inept excuse for Health Care Reform?

From The Trenches (Healthcare Reform for the Real World) #4: Support Innovation

August 15, 2024March 5, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#4: Support Innovation

This is the fourth in a series examining the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Today’s medical industry is full of amazing technologies, things we never dreamt of 50 years ago; X-rays no longer need to be “processed,” oxygen levels are found with a meter, temperature with an instant temp gun. Computers keep track of inventory, monitor patients’ vitals, and we’re about on the verge of standardized, digital medical records. But much of this technology is obscenely profitable for the few, at the cost of many. Certainly that’s the way Capitalism works. It provides incentive to develop new technologies and abilities. But can be a double-edged sword. Consider this:

A diabetic’s test strips are his/her miner’s canary, the way s/he can tell if blood glucose levels are safe or if they’re causing damage to the body. With Type-2 diabetics, it’s not quite as crucial as with Type-1 patients (who administer insulin by injection) The industry developed complex and capable pumps, but those little devices cost about $6K each, and require maintenance supplies that are also very expensive. Those without pumps still have to do things the old-fashioned way, with syringes. (Granted, the needles have become much finer — so small that they’re often entirely painless.) So long as there’s money to be made, especially on a recurring basis, companies will be there, funding new developments. But what happens when a technology stands to eliminate a profitable item? Then our Capitalist system can suppress the innovation. Consider this:

Dr. Ren of the University of Florida developed a sensor chip capable of accurately detecting blood glucose levels (amongst things) from one’s breath. That may just seem clever to some, but for the millions of diabetics in this world, people who must stick themselves in their fingers every day, it’s a minor godsend. Great idea! No more sticking oneself, and no more test strips. HURRAY! But it may never see the market.

Obama & Dems To Push Half-Baked HCR Through Via Tactic Misnamed As “Reconciliation”

August 15, 2024March 4, 2010 by Jeffrey Segal, MD, JD

Surely President Obama has to realize that Reconciliation would be a huge mark against his presidency. So why continue to push for the unpopular Reconciliation tactic? A clue may come from what he said while speaking against postponing. President Obama retorted …

Podcast on Defensive Medicine

August 15, 2024March 1, 2010 by Jeffrey Segal, MD, JD

Great podcast from MDWhistleblower on defensive medicine [audio:http://www.interactmd.com/sites/default/files/Defensive%20Medicine%20and%20Gallup%20Poll.mp3] click to play :: Defensive Medicine

House Giveth, Senator Bunning Taketh Away; 21% SGR Cut Ahead!

August 15, 2024February 27, 2010 by Jeffrey Segal, MD, JD

Meanwhile, doctors would end up doing without 100% of their payments for Medicare patients unless and until the Senate acts.

President’s Plan: Backdoor Health Care Bill Thru Budget Reconciliation

August 15, 2024February 23, 2010 by Jeffrey Segal, MD, JD

What makes the maneuver itself objectionable is the method that would be used. A backdoor tactic, called a budget reconciliation bill, would allow the changes to be enacted without opening the subject to a filibuster on the floor… Passing action via budget reconciliation commits this nation’s government to addressing the matter… while allowing for amendment in times to come…. Nine hundred billion dollars divided by thirty million people is $30,000 per person. That’s a lot of health care insurance premiums!

From The Trenches (Healthcare Reform for the Real World) #3: Pre-Existing Conditions

August 15, 2024February 22, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#3: Pre-Existing Conditions

This is the third in a series examining the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact to reduce risk and increase patient safety.

Pre-existing conditions are a nightmare of the health care insurance. The specter of pre-existing conditions affects not only the cost of healthcare, but also the very health of patients. Patients who are concerned that they will be diagnosed with something (pre-existing) that prevents them from getting health care insurance in the future may give inaccurate information to their doctors in attempts to avoid that diagnosis. Some avoid treatment altogether, allowing the disease / condition to progress further than necessary, before they’re finally forced to seek help.

In a significant way, we all have pre-existing conditions, in that we are born with genetic propensities to develop certain diseases.

Drug Makers Playing the Numbers Game

August 15, 2024February 16, 2010 by Jeffrey Segal, MD, JD

With healthcare reform legislation pending, and the government indicating that they’ll be shaving money off the prices they’ll pay for all things Healthcare, it shouldn’t really have been much of a surprise to see drug manufacturers raising the prices. After all, if they raise them now, they won’t be amongst those to suffer or have to tighten their belts to help make healthcare affordable. The tactic makes one mindful of “Value Added” pricing on cars. They add a few thousand to the sticker price (based on some dubious excuse) and then give you a couple thousand dollars off — so you “save” and they still got more than sticker price for the car. Nothing new there.

But we’re not talking about a new car. We’re talking about the drugs that alleviate suffering and save lives. While everyone else is looking for ways to cut the fat and lower costs, they’re making certain that lower profits don’t happen in their back yards. How close is the analogy? Washington hopes new regulations will reduce the cost of drugs by about $8 billion. They’re adding $10 billion. So look! Net increase of $2 billion for the drug manufacturers. So much for the savings our legislators have spent all that time and effort wrangling into place.

Taking Health Care Reform In Hand

August 15, 2024February 13, 2010 by Jeffrey Segal, MD, JD

As the solidarity of Congress continues to deteriorate, it becomes increasingly apparent that there will be no meaningful Health Care Reform coming forth in the near future. That being the case, what are We The People going to do about it? Bemoan our fates, email our representatives, tighten the belt? Probably all of the above. And when we’ve vented frustration that way, the task will still be there before us, to take Health Care Reform into our own hands.

Though this post is most likely going to be read by physicians, it’s important to realize that we are all responsible for taking hold of the situation. Physician, patient, R.N., P.A., LPN, DC, dentist, midwife, professional and layman alike, we must all take steps to reduce the costs. This includes doctors fighting back, of course. It also includes patients being painfully honest about who is actually responsible for less than desirable outcomes.

WellPoint Blames 39% Rate Hike On Healthy People

August 15, 2024February 12, 2010 by Jeffrey Segal, MD, JD

Though it may seem like the intro to a joke, it’s no laughing matter. WellPoint, which supplies medical insurance, including their Anthem Blue Cross plan, has imposed a rate increase of up to 39% for their customers in California. To say that thirty-nine percent is hefty is an obvious understatement. How do they defend this?

WellPoint Inc. attempts to justify the increases to Kathleen Sebelius, Secretary of Health and Human Services, by stating that the weak economy has healthy people dropping coverage or buying cheaper plans. They claim that the decline in premium revenue equates to a lack of funds to pay claims from the remaining customers. WellPoint says this trend resulted in a loss for them in 2009. This is why, they say, they want to raise rates to cover the losses expected in 2010 from the same cause.

If the economy picks up and people return to coverages temporarily canceled, you can bet that they won’t return that 39% increase. They also try to defend that “most” of their customers will see an average of “only” 24% when the increases are imposed on March 1, 2010. Only 24%?!?

WellPoint claims to have offered an alternative solution if people can’t afford the rate increase: lower increases, in exchange for higher out-of-pocket expenses. Uhm no. If the patient has to pay more out of pocket, the patient is still absorbing the increases. That, too, is just semantics. It’s no real alternative for their customers. It’s still forcing the patient to pay a huge increase so that they can continue to rake in the bucks.

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