Jeffrey Segal, MD, JD - Medical Justice

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.

From The Trenches (Health Care Reform for the Real World) #1: Nature of the Problem

August 15, 2024January 25, 2010 by Jeffrey Segal, MD, JD

From The Trenches

(Healthcare Reform for the Real World)

#1: Nature of the Problem

This begins a series of examination of 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.

Some 35-40 years ago, people would see a physician PRN — as needed. They’d call up and go in to the doctor’s office, and wait to be seen. If there was an emergency, that person would go ahead of the others, so anyone who had need of urgent care would be tended to. If it was after hours or on the weekend, the answering service would patch you through to your doctor, or the doctor who was “on call,” taking care of his patients while he or she was away or unavailable. You’d explain the symptoms, the doctor would then either say it could wait for an appointment, tell you to go to the pharmacy to pick up the prescription he/she called in, or meet you at the hospital if that was necessary. My family physician didn’t have front OR back office staff. A surgeon and surgical nurse instructor, yet he had no need of staff to take care of his patients. And that was in Chicago, in the 1970’s. It stayed that way until about 20 or so years ago, and the system worked well. Then the trouble started.

Follow The Money – Medical Justice Is Still Your Best Bet

August 15, 2024January 21, 2010 by Jeffrey Segal, MD, JD

By now most of you know that Brown won Kennedy’s seat, so the Democrats can’t avoid a filibuster anymore. In the aftermath of this election, there will be a lot of speculation as to whether health care reform is dead in the water. What’s clear is that the last year has been largely wasted. Even today, Pelosi’s House won’t pass the Senate bill (and visa versa.) Perhaps they’ll come together to accept a bill that gives everyone who has a seat at the table some of what they want. But that table still consists of just two sides: Democrats and Republicans. Health Care providers aren’t seated, and most of the world isn’t even allowed to listen in on the conversations.

If Senator-elect Brown wants to walk the talk, perhaps he can push to provide us with transparency by keeping us all informed of what’s really going on. Maybe the new Massachusetts senator can make the rest of the legislature open the doors and let us in on what they’re doing for us, with our money and in our names. Brown ran as a Republican, but spoke as an Independent in his acceptance speech. That would be a pleasant change — someone who votes on the merit of the item, rather than by party line.

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