Originally Posted by Child of Socrates

Clearly, the far right doesn't give a damn about children of teenagers? Can that possibly be correct?

I mean, the kid didn't choose to be born to a teenager....

Why should we be concerned with the cesspool morality of the "far right" in this kind of situation?

The "cesspool morality of the far right," as you call it, just happens to be the prevailing morality of this entire country - outside of Cambridge, Massachusetts, and San Francisco.

Originally Posted by '58 Flat

The "cesspool morality of the far right," as you call it, just happens to be the prevailing morality of this entire country - outside of Cambridge, Massachusetts, and San Francisco.

Err... young people?

Whip: Procedural Move Would Hurt Congress

I'm beginning to wonder if this 'deem and pass' approach will become another 4T catalyst. Or at least, something we'll look back at as a turning point.

Originally Posted by Ragnarök_62

Like I've always been saying, why the hell do we need "health insurance" ? The debate should focus on health care delivery, which (probably can be an economic good procured ) without the extra price add on (profits, paperwork, allocated economic resources , etc.) IOW, "health insurance" is a false choice. Of course malpractice payouts need to be capped as well. "Legal Lotto" is just as much to blame as profit penny pinching for the CF we find ourselves in. So... Who will gore the left's (malpractice lawyers) and right's (Big pharma/health insurance companies) ? So, to get real reform, it's gonna take goring quite a few sacred cows on both sides to get it done right.

As has been pointed out several times, the savings from tort reform would amount to a fraction of 1 percent of the total cost. Not saying it's not worth doing for its own sake, but don't see this as a solution to the health-care cost problem because it's not. As for the rest -- allocation of economic resources is a universal that has to be done in all industries; paperwork in the sense of record-keeping is especially important in medicine, although more of it can surely be done without actual paper and that would save money. If you eliminate profit, what you have is a public, single-payer health-care system. Is that what you're advocating here? I'm down with it if so.

Its not just the cost of lawsuits, its the fact that doctors are performing medicine based on legal precedent rather than the best practices and latest research of their specialty. The cost of that can't be measured in dollars alone..

Originally Posted by '58 Flat

The "cesspool morality of the far right," as you call it, just happens to be the prevailing morality of this entire country - outside of Cambridge, Massachusetts, and San Francisco.

Untrue. You need to get out more.

Originally Posted by independent

Its not just the cost of lawsuits, its the fact that doctors are performing medicine based on legal precedent rather than the best practices and latest research of their specialty. The cost of that can't be measured in dollars alone..

All right, fine, but in terms of dollars alone the estimates for savings include consideration of that. You can't completely eliminate a right to sue for malpractice after all. Remember, there are states that have already enacted tort reform of the sort being suggested, so we don't have to just theorize as to the savings potential, we can look at actual cost of medical care in those states compared to other states.

As I said, I don't have a problem with the idea in itself, just don't exaggerate the savings potential, which ain't all that much.

Sharon Begley in last week's Newsweek had some interesting things to say about unnecessary procedures that, among other things, is unlikely to please Orthopods.

http://www.newsweek.com/id/234514

Pax,

Dave Krein '42

Originally Posted by Brian Rush

All right, fine, but in terms of dollars alone the estimates for savings include consideration of that. You can't completely eliminate a right to sue for malpractice after all.

I guess. Its hard to argue that people don't have a right to compensation if a doctor acts with malicious intent or gross negligence, but how well are the courts equipped to know the difference between that and fate? Some level of human error is also statistically inevitable, so we can assume that every doctor is going to screw up at least once in their lives. At what point does the patient have to simply accept that fact and try to make the best choice they can as to who is going to treat them?

Remember, there are states that have already enacted tort reform of the sort being suggested, so we don't have to just theorize as to the savings potential, we can look at actual cost of medical care in those states compared to other states.

Ceteris Paribus - the economic fallacy upon which all of the others rest!

As I said, I don't have a problem with the idea in itself, just don't exaggerate the savings potential, which ain't all that much.

There's just no reason to stop short here. If we see a percent of waste here and there but its not big enough to catch our attention, how many percents are we ignoring? If a small change can not only reduce costs but also appease a traditionally contrarian conservative demographic, what reason is there to ignore it other than to benefit the special interest group of trial lawyers who primarily profit from the status quo?

Originally Posted by independent

Its hard to argue that people don't have a right to compensation if a doctor acts with malicious intent or gross negligence, but how well are the courts equipped to know the difference between that and fate?

I think it's on this thread. I described above somewhere my own experience as a jury foreman on a malpractice case. I learned from this that at least under Washington state law, to establish a claim by a patient, 1) the doctor must have acted improperly under the best medical understanding of the time, OR exhibited procedural incompetence while attempting to perform medical operations, or both, AND, 2) injury to the patient must have resulted. #2 is not enough by itself. In the specific case I juried, the doctor acted improperly in one instance (breaking an arthroscope in the patient's knee and leaving it there for over a month), but acted competently according to the best medical understanding of the time in another instance (performing bilateral lateral release surgery). The release surgery, according to expert testimony, resulted in serious permanent damage to the patient, but was performed competently according to the best medical practice of the time (which, unfortunately for the patient, was wrong). The arthroscope business, on the other hand, WAS an instance of malfeasance on the part of the same surgeon, but caused no lasting damage. As such, while we found the doctor guilty of malpractice, we could only award the plaintiff $75,000 (in 1986) for pain and suffering, whereas if we had found the doctor culpable for the surgery itself the damages could have run over a million.

It's possible for courts to render informed judgments in cases like this provided they have good expert testimony available. I learned a lot about arthroscopic surgery while sitting on that case. (Enough to be very cautious about getting it, to be honest.)

Some level of human error is also statistically inevitable, so we can assume that every doctor is going to screw up at least once in their lives. At what point does the patient have to simply accept that fact and try to make the best choice they can as to who is going to treat them?

We have a different philosophy here, obviously. My own belief is that "human error" is no different in terms of statistics than any other risk of misfortune. We socialize many such risks, and I consider that a hallmark of civilized life. We are not living on the Old West frontier, and I for one consider that an improvement.

I don't know if making doctors personally liable for damage caused to patients is the ideal approach to doing so, but I am reasonably convinced that that should be at least part of a system to provide for people who suffer misfortune.

Ceteris Paribus - the economic fallacy upon which all of the others rest!

Why do you believe that all else is not equal?

There's just no reason to stop short here. If we see a percent of waste here and there but its not big enough to catch our attention, how many percents are we ignoring? If a small change can not only reduce costs but also appease a traditionally contrarian conservative demographic, what reason is there to ignore it other than to benefit the special interest group of trial lawyers who primarily profit from the status quo?

As I said, I don't reject the idea of tort reform out of hand. I'm just saying that it's a drop in the bucket as far as reducing medical costs. That doesn't mean it shouldn't be done. It just means that it can't be a significant part of our approach to health-care reform, because its impact will NOT be significant.

Originally Posted by Brian Rush

As has been pointed out several times, the savings from tort reform would amount to a fraction of 1 percent of the total cost. Not saying it's not worth doing for its own sake, but don't see this as a solution to the health-care cost problem because it's not.

1. As others here have pointed out, how $ is spent on "defensive medicine" ?
2. As like a lot of other things, this is one of my political angles to get my idea of "real reform" enacted. IOW, "shared sacrifice".

As for the rest -- allocation of economic resources is a universal that has to be done in all industries; paperwork in the sense of record-keeping is especially important in medicine, although more of it can surely be done without actual paper and that would save money.

I'm OK with my actual medical records, but when I had to do physical therapy on my left elbow last year, I got my mailbox stuffed. That is just too much. I couldn't even understand the junk.

If you eliminate profit, what you have is a public, single-payer health-care system. Is that what you're advocating here? I'm down with it if so.

See above, "penny pinching profits". Yes, single payer by setting the Medicare age to 0 is what I'd prefer. No 2000+ page CF's and mindless bickering we have now.

I prefer the "confrontation and consequences" approach.
a. Up or down vote to change the age of medicare edibility.
b. Up or down vote on removing redundant legislation (Medicaide)
c. Up or down vote on funding. My preference is replacing payroll taxes with the VAT. ( Payroll taxes discourage employment, VAT discourages consumption. )

Originally Posted by Ragnarök_62

1. As others here have pointed out, how $ is spent on "defensive medicine" ?

As I pointed out, tort reform of this sort has already been enacted on a state level in a number of states. We can see how much money it would save. No, we can't isolate how much of that results from a decline in defensive medicine, but 100% of said decline (whatever it may be) is accounted for, because 100% of the savings in actual fact are accounted for.

2. As like a lot of other things, this is one of my political angles to get my idea of "real reform" enacted. IOW, "shared sacrifice".

Can you clarify this?

Yes, single payer by setting the Medicare age to 0 is what I'd prefer.

Cool! You and I are definitely on the same page here.

However, I do recognize the political realities and the reason why that's not possible at this time. It's not just because the insurance companies will work to block it, but because a lot of the voters are uneasy with that radical a change. I found myself seriously frustrated with Dennis Kucinich (until his recent comearound) for that reason -- certainly not because I disagreed with him as to what was the ideal solution.

I remember the scene in the movie Nixon when RMN was confronted by a bunch of right-wing wackos who threatened to cut off his funding. "Politics is the art of compromise," he said. "I learned that a long time ago. I don't think you ever did. You want some pansy poet socialist like George McGovern in the White House? Go ahead, give your money to George Wallace. You don't like the EPA up your ass? Try the IRS."

Reverse the parties and ideologies and we have the same thing. Sure, I'd LOVE to have Medicare for all. But I know we can't get it yet. It's not politically possible, and if we hold out for the ideal, we won't accomplish anything AND the GOP will retake Congress on the people's disgust with Democrats who can't do squat even with big majorities in both houses plus the White House. This bill, as far from ideal as it is, must pass.

Originally Posted by The Rani

You do realize that caps on awards mean something to insurance companies, who have to pay them, but not the docs themselves.

Doesn't it lower malpractice insurance rates, though? (Maybe not, I'm just guessing -- lower the risk/potential payout and you should lower the premiums.)

I would think if it didn't then there would be literally NO savings from tort reform and that doesn't appear to be the case.

Here's a good example of the unseriousness of political debate in modern day America. The only reason lawsuits are brought up when the excessive cost of the American health care system is being discussion is because this concept has been thrown into the debate repeatedly.

It is well known why the American health care system is so expensive and works so poorly. The main reason is sheer complexity. With most goods and services the seller can tell you the price of what he is selling. If you think the price is reasonable you hand him your money and he gives you the good or service.

Healthcare isn't like that. A recent Business Week features an article on the charges a particular person ran up during his 7 year battle with kidney cancer. Going through the mountains of paper revealed things like identical scans done at various times by the same hospital which were charged to different insurance companies due to job changes. They found that their first insurance companies paid more than twice the price for exactly the same scan as their second insurance company. The company that paid more was United Health Care (my insurance company) which is a huge company.

This is commonplace. Widely different prices for the same product from the same seller depending on who is the customer.

Think about it. Suppose you went to buy a pair of hot new shoes at the only store that sold them. You paid the premium price they asked for. Later that day you find that your friend bought the same shoes from the same store on the same day as you did, but at a third the price you paid. You go to the store to inquire about this and they say the price they charged your friend was HIS price, whereas the price they charged you is YOUR price.

That's pretty fucked-up for shoes, but perfectly normal for medical procedures in America. Note outside America, prices for medical care aren't like this.

Originally Posted by The Rani

Here we go again. How does lowering liability insurance rates decrease the practice of defensive medicine?

Why would a physician practice defensive medicine?

Originally Posted by The Rani

Why do you think doctors don't want to get sued?

Why do you think defensive medicine has anything to do with getting sued?

Originally Posted by Brian Rush

As I pointed out, tort reform of this sort has already been enacted on a state level in a number of states. We can see how much money it would save. No, we can't isolate how much of that results from a decline in defensive medicine, but 100% of said decline (whatever it may be) is accounted for, because 100% of the savings in actual fact are accounted for.

OK, I'll try again. I'll agree it's hard to explain, but here goes. The "right wing ideology" has to give up support for "big Pharma"/ insurance companies which are of course redundant. The "left" will need to give up support for "unlimited damages". I see commercials all the time by lawyers did you take drug X? Well you're entitled to HUGE monetary damages. On this, I'd prefer to "socialize" any damages incurred while taking any drug approved by the FDA. (It's the FDA's job after all to ensure medical drugs/procedures, what have you pass some sort of criteria wrt risk/benefits. To sum up, it's not really a monetary item, but a "principle of the thing" issue. Hopefully, any Boomer on this board can relate to that idea. (I'm a cusper, so I think I'm aware that principles matter , especially for far reaching reforms. )

Can you clarify this?

Hopefully, the above did this for you.

Cool! You and I are definitely on the same page here.

Agreed. And of course, I do appreciate real discussions , wrt questioning, points/counterpoints here, (without stupid ad-homs etc. )

However, I do recognize the political realities and the reason why that's not possible at this time. It's not just because the insurance companies will work to block it, but because a lot of the voters are uneasy with that radical a change. I found myself seriously frustrated with Dennis Kucinich (until his recent comearound) for that reason -- certainly not because I disagreed with him as to what was the ideal solution.

As for Dennis, yup, read all about that. I still think that simple sound explanations of where we are now wrt healthcare vs. where we can go is valid. I think the word is leadership. A true leader , IMHO is willing to gamble at bit.

I remember the scene in the movie Nixon when RMN was confronted by a bunch of right-wing wackos who threatened to cut off his funding. "Politics is the art of compromise," he said. "I learned that a long time ago. I don't think you ever did. You want some pansy poet socialist like George McGovern in the White House? Go ahead, give your money to George Wallace. You don't like the EPA up your ass? Try the IRS."

I interpret the above as gauntlet tossing. Not that I care for Nixon, but the style is cool. So to update the above to a 4T... Obama should state to Democrats beholden to special interests , "Politics is means to an end. Pick your poison, special interests or the interests of your constituents."

Reverse the parties and ideologies and we have the same thing. Sure, I'd LOVE to have Medicare for all. But I know we can't get it yet. It's not politically possible, and if we hold out for the ideal, we won't accomplish anything AND the GOP will retake Congress on the people's disgust with Democrats who can't do squat even with big majorities in both houses plus the White House. This bill, as far from ideal as it is, must pass.

I think the above is the kernel of difference. The question is why the Democrats are so hamstrung at present. Perhaps they can't do squat , not because of seeking the ideal, but because of 3T style ass kissing towards special interests. IOW, post seasonal behavior.

Originally Posted by Mikebert

Here's a good example of the unseriousness of political debate in modern day America. The only reason lawsuits are brought up when the excessive cost of the American health care system is being discussion is because this concept has been thrown into the debate repeatedly.

As I alluded to Brian, regardless of the actual amount saved via caps, just treat malpractice awards as a sacred cow to sacrifice to shut the other side up.

It is well known why the American health care system is so expensive and works so poorly. The main reason is sheer complexity. With most goods and services the seller can tell you the price of what he is selling. If you think the price is reasonable you hand him your money and he gives you the good or service.

I think we agree that complexity ( mounds of mindless, indecipherable paperwork is a main cost driver.

Healthcare isn't like that. A recent Business Week features an article on the charges a particular person ran up during his 7 year battle with kidney cancer. Going through the mountains of paper revealed things like identical scans done at various times by the same hospital which were charged to different insurance companies due to job changes.

As I mentioned to Brian, a 3 month course of psychical therapy I received last summer lead to a full mailbox. 7 year? Well yeah, a mountain of rubbish is to be expected.

They found that their first insurance companies paid more than twice the price for exactly the same scan as their second insurance company. The company that paid more was United Health Care (my insurance company) which is a huge company.

Preaching to the choir there.

This is commonplace. Widely different prices for the same product from the same seller depending on who is the customer.


Think about it. Suppose you went to buy a pair of hot new shoes at the only store that sold them. You paid the premium price they asked for. Later that day you find that your friend bought the same shoes from the same store on the same day as you did, but at a third the price you paid. You go to the store to inquire about this and they say the price they charged your friend was HIS price, whereas the price they charged you is YOUR price.

That's pretty fucked-up for shoes, but perfectly normal for medical procedures in America. Note outside America, prices for medical care aren't like this.

Good analogy.

Originally Posted by The Rani

Does that mean you don't know the answer?

Just in case, here are the questions again ... open to any self-proclaimed experts who want to educate the masses:

How does lowering liability insurance rates decrease the practice of defensive medicine?
Why do you think doctors don't want to get sued?

In a competitive industry, almost anything that reduces costs reduces prices. Physicians who have practices more likely to be sued (let us say obstetrics or neurosurgery) pay higher premiums for malpractice insurance than do those less likely to be sued. But even at that, physicians have another good cause to avoid lawsuits: should they lose, physicians don't look so great to potential patients. I have noticed a book in the local library with such a title as "Bad Physicians", naming names of physicians who have had disciplinary measures taken against them not only for incompetent to substandard medical behaviors, but also sexual harassment and dishonest dealings with payers (including insurance). You wouldn't want to deal with a physician who cheats insurance companies, would you?

That is more economics than medicine. Of course, I don't know what share of the cost of medicine is. You tell me.

There are also lists of people with a proclivity to sue physicians for malpractice. Some people are looking for easy money, as in getting a settlement for a bad diagnosis. Such a bad diagnosis could be a patient's fault -- such as for failing to disclose an existing condition while tempting a physician to commit malpractice. If you are a physician you want no such person as a patient. It is up to patients to disclose all pre-existing conditions to a physician. Good physicians of course insist on the transfer of records from previous physicians.

But before you go on a spiel about the necessity to constrain the costs of frivolous lawsuits for malpractice (and they happen, and they cost physicians dearly), then that would be a valid reason for a single-payer system that would maintain lower costs in part by taking malpractice lawsuits as a potential gravy train for some "winner" of the medical lottery.

Originally Posted by Child of Socrates

Untrue. You need to get out more.

You - and Matt1989 - don't seem to quite understand where I've been coming from here.

So let me go through it, once again, real slow:

The Democrats are trying to sell the American public a product; and I'm calling them out for the comically bad moves, from strictly a strategical standpoint - not a "moral" one - they're making while doing so.

Say you were the head of marketing at Pfizer. Would you have Tiger Woods star in the next Viagra commercial?

Of course not, since it would be a total disaster.

Yet all we're hearing as to why the health-care system needs fixing is "lose your job, lose your health care" - which can be easily, and in fact is, being contorted into, "it's a bunch of lazy people who aren't working who aren't insured."

Then compound the public-relations calamity by using as your "poster child" the son of a woman who got pregnant when she was 15 - and not for nothing, but where's the father in this drama?

You're not going to drum up a whole lot of empathy for the cause of health-care reform in "Middle America" by presenting a scenario like this; and if the uninsured aren't "lazy," they're "illegal aliens" - and the left has fallen headlong into this trap too: Witness the signs in Spanish on view at these free health-clinic fairs that have been put on in recent months in an effort to highlight the plight of the uninsured; and it has been MSNBC cameras - not Fox News cameras - taking the pictures at these events (also note how the number of uninsured has suddenly - and conveniently - dropped by about 15 million).

All of this is so dumb that it almost makes me think the Democrats want to fail; maybe they think if they let things deteriorate further for another 15 years or so, then they can get "the whole enchilada" - that is to say, single payer?

Even if that's what they're doing, and that strategy turns out to be successful, think of the millions of lives that will be impacted in the meantime, as the status quo is allowed to fester.

Originally Posted by The Rani

Does that mean you don't know the answer?

Just in case, here are the questions again ... open to any self-proclaimed experts who want to educate the masses:

How does lowering liability insurance rates decrease the practice of defensive medicine?
Why do you think doctors don't want to get sued?

OK you want to play games. Just one more example of unseriousness.

I thought he was just trying to be an example of this "unseriousness" he keeps talking about.

Originally Posted by The Rani

Here we go again. How does lowering liability insurance rates decrease the practice of defensive medicine?

You tell me. But if it wouldn't, then award caps would do absolutely NOTHING to reduce this practice, so why are we discussing them exactly?

Unless, of course, the huge awards run over the limits of the policies? (I've hardly ever dealt in professional liability and don't deal in it at all now, so I'm not sure how it works.)

In any case, any savings from tort reform regardless of where they come from -- defensive medicine or anything else -- will have shown up in the places where it's actually been put in place.

Originally Posted by The Rani

Because our policies are made by politicians who are knowledgeable about what their constituents (such as yourself) can be duped into believing, but completely ignorant about what happens in the industry that they are trying to regulate.

OK, so you're a practitioner. What would you do? People are hurt by doctors, hospitals, nurses, and most other medical providers. Some are damaged for life. How would you make them whole?

If caveat emptor is the right standard, then why would anyone come to any health provider until they are seriously ill or dying? Is last-ditch-stand your model for modern medicine?

Originally Posted by The Rani

Because our policies are made by politicians who are knowledgeable about what their constituents (such as yourself) can be duped into believing, but completely ignorant about what happens in the industry that they are trying to regulate.

That's why I asked you some questions. Would you care to answer them?