Jeffrey Segal, MD, JD - Medical Justice

2309 Pages in 72 Hours = 32 Pages An Hour — If They Don’t Think Or Sleep

August 15, 2024March 19, 2010 by Jeffrey Segal, MD, JD

The Reconciliation Act of 2010 sits before us now, a 2309 page .pdf file chocked full of Therefors and Wherebys and a whole slew of legalese; one piece referencing another. Even if you have a law degree, there’s no way you’ll know what it all means and how (or IF) it all works together. In short, even legislators are going to have to take each others’ word for it. But that all assumes that any of them will have or will take the time to read it.

72 hours of “transparency” means over 32 pages per hour — if they don’t sleep, eat, shower, cross-reference the spaghetti-code, or think about what any of it means or how it all supposedly fits together. The reality is that there is barely time to read it all, never mind the hope of catching mistakes or misunderstandings. There is certainly no time to analyze it, to ponder, to decide… and yet the House is expecting to vote?

From The Trenches #5 — Taking Personal Responsibility

August 15, 2024March 18, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#5: Taking Personal Responsibility

This is the fifth in a series of articles 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 ourselves enact to reduce risk and increase patient safety.

People rely upon professionals to take care of them, and it is reasonable for them to do so. Though we come from a world of generalists, medicine is a world of specializations, and we defer to these experts. Perhaps this is wise; a specialist can afford to dig into the depths of his or her field of expertise and gain greater understandings of those detailed workings. But that doesn’t mean that we have become impotent, or that we shouldn’t still have a generalist who can see the forest while standing amongst the trees. More importantly, that doesn’t mean that we delegate or relegate our responsibility for our own health and well being; We can rely upon the expertise of specialists without giving up control of our lives.

38 States Poised to Sue Federal Government Over Mandatory Health Care Insurance Requirement

September 17, 2024March 18, 2010 by Jeffrey Segal, MD, JD

But even if it passes in the next few days and the President signs it, the battle is still far from over.

Kucinich and Kildee Switch Votes on Health Care Reform bill, Deeming Arises

August 15, 2024March 17, 2010 by Jeffrey Segal, MD, JD

This morning, Dennis Kucinich, (D-OH) am outspoken opponent to the current health care reform bill, switched his vote to a Yes. Even as he announced his conversion, he made no bones about his feelings on the matter, saying “I have doubts about the bill. … This is not the bill I wanted to support. However, after careful discussions with President Obama, Speaker Pelosi, my wife Elizabeth and close friends, I’ve decided to cast a vote in favor of the legislation.” Kucinich went on to explain that he changed his position because he realized that it was better to pass a bill that can be changed than to pass nothing at all. President Obama’s reaction was anticlimactic; he simply said that it was good that Kucinich did so.

Representative Dale E. Kildee (D-MI) had also been opposed to the bill, but his objection was that he didn’t want to vote for government-funded abortions. Earlier today, he said the abortion restrictions were sufficient to win his vote, though. He expressed that he felt the sanctity of life for the 31,000,000 Americans without health insurance was a pretty strong motivation to vote in favor of it.

GOP Leadership Admits to Intentionally Obstructing Senate

August 15, 2024March 17, 2010 by Jeffrey Segal, MD, JD

Senator Mitch McConnell, the Republican Minority leader, has a singular, broad objective. He wants to oppose the Democrats at every turn, in every way, no matter what. Whether something is good for the country is entirely irrelevant (despite the seldom rhetoric to the contrary.) What matters to him is that his party “wins” by foiling the efforts of the majority of the People’s representatives. Whether we agree with him on an issue or not has become irrelevant, as his goal isn’t to do anything specific. Rather, McConnell’s goal is to weaken the Democratic majority, to block them and make them seem ineffective and foolish as often as possible. Some might say all is fair in love and war. Others might call that Treason.

McConnell Can’t Lead, Won’t Follow, and Refuses To Get Out of the Way — Though the Republicans cannot hope to lead the Congress, they are refusing to follow, even when it is clear that a piece of legislation would be good for the country. Rather, he and his fellows are dead set in standing in the way of success. On July 21, 2009, McConnell at the Senate Republicans’ weekly luncheon in the L.B.J. Room, Senator McConnell’s PowerPoint presentation bragged that the president’s approval rating was down and that Republicans were gaining ground on Democrats. “We came up with a plan, stuck to it, and now we’re starting to see results,” he claimed in his presentation (leaving us to wonder just what good those results might be for the country they were elected to represent.) Throughout, it is clear that he doesn’t care about anything except his side “winning”. Even people within the GOP agree that McConnell is more concerned with the Democrats looking bad, than with moving the country towards progress.

House Rules Committee Meeting On Friday, But Still No Real Health Care Reform

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

Louise Slaughter (D-NY), the Chair of the House Rules Committee, has announced that the Committee is expecting to convene this Friday regarding the Health Care bill. This is the next step necessary in preparing the bill for the floor of the House of Representatives. Accordingly, the earliest that the House could vote would be on Saturday. But the transparency policy requires a 72 hour period after the bill is put up on the Committee’s website before they vote on it. No matter how one counts it, the House could be voting very soon.

What does this mean? It means that it appears the Democrats are going to proceed. They are going to employ reconciliation, a legitimate tool of state, it would seem. Yet at this late hour, the American people still haven’t a clue what’s actually in the bill. We have been told that it’s not going to include Special Deals, but the claim hardly seems credible.

Special Deals Boost Support for Health Care Reform Reconciliation Bill

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

Every politician makes campaign promises that everyone knows can’t be kept. One is reminded of George W. Bush’s “Read my lips, no new taxes!” (which, of course, did not pan out to be true.) But constants like Death and Taxes aren’t quite the same thing as other platform policies. When President Obama said that he was going to require transparency in government, we believed him, and the nation elected him. Yet the back door deals march on… and they’re alive and well in the Healthcare bill. President Obama has opposed what he calls the “Cornhusker Kickback,” which requires that the Feds pay for Nebraska’s Medicaid expansion, in exchange for the supporting vote of Ben Nelson, (D, Neb). This is hardly the only special deal in the health care “reform” bill, though.

David Axelrod, senior White House adviser, recently reiterated “The president does believe that state-only carve-outs should not be in the bill.” But “the principle that we want to apply is that are these applicable to all states? Even if they do not qualify now, would they qualify under certain sets of circumstances?” Reading between the phrasing, one gets that there may be other boons for individual states, and that the White House won’t consider them to be Special Deals so long as all states COULD qualify for those benefits.

Reconciliation In Motion, Republicans Remain Opposed

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

The House Budget Committee put Reconciliation in motion today, a move to press the combined Health Care Reform bill through with a democratic majority, rather than a 60% concurrence. It remains unclear what, precisely, is in the bill, let alone what the real effects of the bill may be. What President Obama is telling us is that it will NOT affect Medicare/Medicaid and that opponents to the bill are not telling the truth. Of course, the Democrats aren’t telling the full truth either, because some of the aspects of the bill aren’t scheduled to commence for some 9 years. It’s true that the longest journey begins with the first steps, but people should know that they’ll be paying for it via taxes long before they receive any of its benefits.

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

August 15, 2024March 11, 2010 by Jeffrey Segal, MD, JD

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.”

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

August 15, 2024March 11, 2010 by Jeffrey Segal, MD, JD

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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