Jeffrey Segal, MD, JD

Obama: Insurance Carriers Reduce Profits, Legislators Put Aside Politics, But No Tort Reform

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Speaking sternly and intensely yesterday, President Obama said the “time for talk is over.” He was firm in pressing Congress to pass a bill intended to move healthcare reform forward. The President’s Health Secretary, Kathleen Sebelius, was equally firm in suggesting that health care insurance providers reduce their profits to make coverage more affordable for the nation. She went so far as to say that failing to do so will result in skyrocketing premiums; perhaps referring to the way that some California premiums were raised because people who were at less risk declined to renew policies that had become unaffordable.

President Obama addressed a crowd at a high school gathering in St. Charles, MO, putting aside fancy rhetoric to state “Folks in Washington, they like to talk. So Washington is doing right now what Washington does. They’re speculating breathlessly day or night. Every columnist. Every pundit. Every talking head. Is this proposal going to help the Republicans or is this proposal going to help the Democrats?” Even when he’s not trying to be eloquent, the President seems to get at the heart of the matter. It’s more about picking sides now than about passing health care reform legislation. Speaking as though he were outside of the political realm, he added “I don’t know about the politics, but I know that it is the right thing to do and that is why I am fighting so hard to get it done.”

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Senate OKs Extensions of Medicare SGR, Medicaid, Unemployment & COBRA — Bill Awaits House Approval

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The vote was far from unanimous – even though it’s only a temporary stop-gap measure that returned full Medicare payments to physicians. The Senate approved the $138 billion bill with a vote of 62 for, 36 against. What this means is that the 21% cut to Medicare payments is staved off until October 1, 2010. It should be noted that the SGR portion is a mere $7.3 billion of that, and that’s spread out over the next 10 years. The Medicaid, COBRA and Unemployment benefits will be extended until January 1, 2011, while additional financial aid for the states’ Medicaid programs get only a six month extension.

It seems odd that these deadlines would be staggered, though they all appear in the same bill. Perhaps this will allow the legislators to revisit each area more diligently as separate entities. But what is really needed is a comprehensive overall game plan. In light of that need, this move by the Senate is a patchy band-aid at best.

Those who voted against the extension object that the bill adds an additional $10 billion to the federal deficit each of the next 10 years, for a total of $100 billion. They’re also quick to stand up against it because it isn’t paid for. While there is a need for fiscal responsibility, one could easily argue that no budget plan is guaranteed, and that the country and the economy are more likely to prosper when certain needs are met.

This is just the Senate’s version of a solution. The House has also passed a bill. They could either

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Health Justice Instead of Tort Reforms? Best Practice Should Provide Exemption

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For the past couple years, our country has done a lot of talking about health care reform. Much of that centered on providing universal access to health care services. After that comes ways to reduce costs; pivotal to providing health care for everyone. Missing are serious discussions about Defensive Medicine and Tort Reform. It’s as though these items are off the table, presumably because reforming these elements would cut into the legislature’s fellow attorneys’ profits. Thin excuses are provided; such as statements claiming that unfettered civil suits are necessary to ensure that a patient is not violated — even when proposed reforms would not affect patients’ right to direct compensation for actual costs incurred. We at Medical Justice aren’t looking for immunity from civil recourse. We’re simply after reasonable limits, to eliminate the temptation to sue in hopes of receiving a jackpot award. When 3/4 of all medical malpractice suits are found to be baseless, it’s only right that doctors be relieved of the drains on time, energy and finances that defending against such frivolous cases require. But perhaps we’ve been using the wrong term. Rather than calling it Tort Reform, perhaps we should start asking for Health Justice.

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The SGR Band-aid & Why We All Should Care

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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

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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.

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Podcast on Defensive Medicine

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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

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

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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!

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