Jeffrey Segal, MD, JD - Medical Justice

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.

John Murtha (D,PA) Tort Reform Supporter Dead at 77

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

A combat veteran of the Vietnam “Conflict”, this old warrior passed on of complications from a gallbladder surgery on Feb. 8, 2010, at the age of 77. His voice was sincere, passionate and compassionate. A true Conservative, he believed the government should not restrict people’s activities, so long as those actions don’t restrict the rights of others.

Podcast on Tort Reform

August 15, 2024February 9, 2010 by Jeffrey Segal, MD, JD

The blog MDWhistleblower posted two very nice podcasts regarding tort reform. The second is a commentary regarding the IL Supreme Court’s recent decision to rescind med-mal caps.

The Ramifications & Implications of the IL Supreme Court Decision

August 15, 2024February 8, 2010 by Jeffrey Segal, MD, JD

The ramifications of the Illinois Supreme Court’s recent decision to overturn caps on malpractice suits are clear. Frivolous malpractice suits will increase. Physicians will be discouraged from practicing medicine within that state. And access to health care providers for the people of Illinois will be restricted because off this decision. Medical Malpractice rates will increase, and the costs of healthcare will go back up. Bad as that is, the implications of that decision may be even more devastating.

Our society’s rule is a rule of Law. The Illinois state medical malpractice judgment cap law wasn’t instituted until 2005. There will still be consequences, of course, but it’s within keeping of the separation of powers for a law to be repealed by a Supreme Court shortly after it has been enacted. It’s not a question of whether they can do it, but if they should. It’s still the less than unanimous decision of the IL SC that is overriding the will of their entire legislature, presumably representing the will of the People. One would expect the Supreme Court to tread more lightly, in absence of a matter of prejudice. Yet their decision seems to support prejudice. Jackpot trial lawyers aren’t filing frivolous suits against indigent people. They’re going after doctors, based on the prejudicial (and erroneous) notion that they can afford to be taken to the cleaners. They may claim that it’s protecting the citizen’s right to redress in civil court, but the law didn’t cap the actual total of the suit, only awards for noneconomic damages. $500,000 in cases against doctors and $1 million against hospitals seems more than ample for the patient’s trouble, pain, suffering, etc.

Humana and the Exclusions — Why Healthcare Reform is of Vital Importance

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

Humana sent out a sales pitch from John Terry, Vice President, Sales. “You may be able to switch to a HumanaOne plan that could lower your monthly premiums.” Count the caveats in that? “May” and “Could” and “switch”… all presuming, of course, that you’re not only insured, but insurable. This pitch was aimed towards the self-employed amongst us, and calls those people “self-insured.” They even congratulate the self-insured on the ability to switch health insurance plans. (“Applications are subject to underwriting approval. Waiting periods, limitation, and exclusions may apply.”) Append extensive sales pitch and claims that you “may” be pleasantly surprised by their rates. (I may be the secret son of JFK too, but I’m not holding my breath on that either. — Ed.) Then, at the bottom, there is a list of conditions for which you “may be denied coverage, if you have been diagnosed with, or in the last five years* (varies by state) been treated for, any of the following conditions:

“AIDS/HIV, Anorexia or Bulimia, Cancer, Chronic Obstructive Pulmonary Disease (COPD), Crohn’s Disease, Depression, if hospitalization required, Diabetes, Emphysema, Fibromyalgia, Heart Attack Stroke or Angioplasty, Hepatitis or Liver Disease, Organ or Tissue Transplant…” It goes on to say that individuals who are severely obese, underweight or undergoing or awaiting the results of diagnostic tests, treatments, surgery, biopsies, or lab work may also be denied coverage. Ditto expectant mothers OR fathers, or children under 2 weeks of age.”

Breaking News

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

The Illinois Supreme Court just overturned damage caps and other medical malpractice reforms adopted in a 2005 reform law.

From The Trenches (Health Care Reform for the Real World) #2: Access Solutions

August 15, 2024February 3, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#2: Access Solutions

This is the second 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.

Last time, we visited the Nature of the Problem and showed how the advent of the bureaucracy of modern medicine and defensive medicine were causing an access problem. This time, we’ll take a better look at that problem, and present a few variations on practical solutions. We encourage discussion, and hope you’ll weigh in with your thoughts.

In the case study previously mentioned, the patient had Type 2 Diabetes, had acquired a stomach virus and was unable to keep down the oral medication that treated his condition. While it was a legitimate concern that the patient maintain a level of Metformin to control blood glucose levels, the symptoms were not particularly suggestive of H1N1. Since the patient complained only of the vomiting and nausea and concerns about not being able to take his medication, it’s likely that a conservative approach would have been to prescribe Ondansetron to control the vomiting. Instead, because it was a weekend and the patient had no access to his regular physician, the RN line recommended the E.R. That was defensive medicine. Then the E.R. visit itself, which included a simple test to see if he had a flu virus, basic bloodwork, and an EKG (just in case, the otherwise healthy patient is Diabetic, after all,) and a bag hung to rehydrate. An hour or two in the E.R. on a slow evening, and $2600 later, the patient walks out with a script for Ondansetron and instructions to return if symptoms don’t improve within a couple days.

Female Asian doctor looking off to the side

State of the Nation – President Asks Us How To Improve

September 17, 2024January 29, 2010 by Jeffrey Segal, MD, JD

Wednesday evening, President Obama gave his State of the Union address. He was poised, well-spoken, and charming (as usual) as he expressed his expectations that Congress focus on leading, rather than politics as usual. He chastised the U.S. Supreme Court for their decision to allow corporations, especially foreign ones, the 1st Amendment rights usually provided only to citizens and individuals. When it came to the issue of healthcare, though we agree wholeheartedly with what he said about gathering ideas from anyone, we must take exception to his statement overall.

Regarding Healthcare reform, the President said “I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop Medicare abuses, let me know. Let me know. Let me know. I’m eager to see it.”

Mr. President, while many might agree with you that what is proposed could be better than the status quo, MOST doctors, nurses and healthcare experts would say that crucial aspects are decidedly lacking. We must concur with Senator-Elect Scott Brown that we can do better. The unfortunate fact, the reality, is that we have been trying desperately to convince you and the Congress that Tort Reforms are essential and foundational to any real change. We have been trying to tell you that the 60-year old Anti-Trust exemption that medical insurance carriers have been enjoying must be repealed. We have been trying to tell you that granting physicians immunity from medical malpractice suits so long as their actions are within standard procedure guidelines established by the medical community would improve the quality of care while lowering costs. But in each of these crucial aspects, you and Congress have both turned a deaf ear.

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