September 28, 2015


It’s a word that’s tossed around a lot in medicine these days, and keeping one’s dignity is the essence of the fabric that makes us whole
and happy.

Part of keeping one’s dignity is being in control of one’s mind, body, and spirit.

Unfortunately, as we get older this becomes harder and harder to do.

We don’t move as we used to, we feel more tired than we had in the past, and sometimes, as we lose those around us, we feel more separated than ever and wonder why we keep going.

Part of this loss of dignity is also the fact that our ability to choose is being taken from us. When we’re young, it seems the whole world is open to us – later in life, not so much.

Let’s be honest, it’s scary at times.

This is happening even in medicine today. Choices are being taken from us, and with them, some of our dignity.

Here’s an example:

Several years ago, an insurance company came to the area offering a Medicare replacement product.

I don’t have the type of practice that takes every insurance that’s out there.

That’s because some Medicare replacement products restrict the care I give to patients in such a way that I feel uncomfortable being part of them.

But this was a good plan, from a company that was well known, and they seemed to be sincere in their efforts to want quality medical care.

After signing up thousands of people, the company threw many of the doctors that had participated with them off of their network. This forced many of our patients to have to choose between new Medicare plans, with new drug benefits, new deductibles, and new doctors. Many people in the medical community shared the opinion that it seemed like a bait and switch.

The choices that were once open to patients, with a wide network of physicians, had been taken away.

Other choices have also been taken from us in medicine.

Prescription medicines are a big part of the cost of medical care for many Medicare recipients. Generic medicines that have been around for decades are supposed to help with some of the rising costs of medical treatment. But even there, our choices have been taken away.

We read headlines from reputable news sources. There have been recent price hikes as high as 8,281%–the increase in the price of 500 tablets of doxycycline to $1,849 in 2014 from $20 in 2013.

Doxycycline first received approval in the US in 1967. Dermatologists often use it for the treatment of rosacea, a common skin condition as one gets older. It’s frequently effective against many different types of bacteria (even MRSA, a difficult to treat infection), and it is a first line
treatment for Lyme disease.

We use it frequently because it has few side effects, is easy to take, and until recently was not that expensive. It’s a GENERIC medicine. How did
the price go up 8000%?

There are thousands of news articles detailing this situation with many other medications.

When I have patients that have to choose between eating or paying for medication for their health, well, that’s no choice at all.

What do these two issues (poorly managed healthcare plans and rising, outrageous drug prices) have to do with each other?

When we are fearful that we can’t afford our medicines, we might choose a health plan that, while it might limit our choices, provides some prescription benefits. At first, it seems like it’s a give and take, sort of a win-win situation.

But in our opinion, this appears to be based on a false promise. Often your medicines aren’t any cheaper. Your prescription benefit may not
really be benefitting you.

There is a website called that lists the prices of various drugs available (disclaimer: I have no connection to this website). On this site, you can look up your medication, see where it’s the least expensive, and go there to buy it. It often has an option that allows you to print a coupon to get even further price reductions.

Often you can purchase medication with a coupon from GOODRX for less than the copay under your plan.


You go to the drugstore; you pay your copay and see the prescription would have cost over a hundred dollars for someone without insurance, so you feel good about your choice of health plans. For a prescription that you have to get once a month, that’s a lot of money saved over the course of a year.

But then you find out that you could have gotten the SAME medicine for even less money than your copay, if you had gotten a coupon from some website without being locked into an insurance plan that won’t even let you choose your own doctor.

While on one hand, I’m glad that some of my patients are Internet savvy and are using their computer knowledge to save money, on the other hand, I feel horrible for those who aren’t aware of these types of
opportunities to save money and escape from this trap.

Many of my patients don’t have the time, the computer, or even the resources to drive around in order to get lower prices on their medications.

Our choices are being manipulated, and knowledge is being kept from us to push us into making a false choice.

So what does this have to do with Treasure Coast Dermatology?

I can answer that with a story.

My father was a doctor, he was well known, and started the first dermatopathology lab in the country (at University of Miami) many years ago. Later on, he started his own practice and was very successful. He loved his job and was proud of the evolution of a specialty that he had helped start.

But when managed care first came, he was approached by his largest insurance provider, which insured 80% of his patients, and was told he would have to accept a 50% cut in payments or they would no longer allow specimens to be sent to his lab.

My Dad was a proud man: He felt his opinion was worth something. He said, “NO.”

And so, he was thrown out of that network. His practice almost went under, and it took years to rebuild. But he did it.

He taught me this lesson: When 80% of the patients you treat are insured by the same insurance carrier, it’s not your practice anymore. It’s theirs. It doesn’t matter the name on the wall; for all practical purposes, the insurance company controls you.

Further, managed care companies now offer to pay physicians less and less for their work. Many physicians have had to move their practices under the umbrella of hospitals or other large organizations. With the increase in costs of running a practice and the decrease in payments from insurance carriers, there was no way for these solo practitioners to stay afloat.

While I think that sometimes a large group can operate more efficiently than a small one, I also think that sometimes a human element is lost in the transition. When a doctor goes to work for a larger group, that doctor can no longer choose their staff or make many of the decisions
that he or she would otherwise make.

I AM NO SOCIALIST, and I understand that capitalism has brought many great things to this country.

But the ruthless efficiency of pure capitalism must be tempered with compassion for the members of its marketplace.

This ruthless efficiency is the same efficiency that sent millions of U.S. jobs overseas. This ruthlessness has no place in medicine. Taking away choices and dignity from our patients in exchange for false cost savings and
efficiency is a false choice.

So what did I learn from my Dad? Many things. But one thing is this: No insurance company will control my practice.

Treasure Coast Dermatology is different. We help our patients navigate health plan issues, search for the best medication prices, and even print medication coupons right in our offices.

I would write more, but this letter has gone on long enough. I hope, if you are able to take the time, you will look at our website and see some of the previous letters I have written to my patients.

A country is defined by many things.

The way we take care of our children and our elders is important to our identity as a person and a country. The first are our future and the second group has given us the foundation to live and build our lives.

We need to do better for both. I hope the information in this letter helps the senior citizens to whom it was directed. I hope they share it with their neighbors and friends, and if those neighbors don’t have a computer, that they share their time as well.

We do have some tools to help us navigate this increasingly complex world. Let’s use them together and share our knowledge of them with each other.

I started this letter with a word:


I hope this letter, even if you don’t agree with everything in it, helped open up some choices for you, and thereby helped you maintain and sustain dignity for yourself and the people that you love.

United we stand.


and the Staff of Treasure Coast Dermatology