News Sicko is probably one of the most disturbing films

[jreelawg]

Why is does a country with such wealth and power rate so low in health care efficiency and quality? Because it is dominated by people who want it that way. All the incentives run that way. How is it that crooks can dominate our health care system? Because of corrupt officials who are in on it. Why would anyone support the crooks that run the show? Because no one cares to do any research. Why is Michael Moore alright in my books? Because while his conclusions may be different than mine, at least he does a huge amount of research and shows us all the sides and facts that aren't shown on the news. You bash him all you want, call him fat, call him a terrorist, whatever makes you comfortable. But to ignore cold hard facts and documentation based on a popular dislike of person who points it out isn't going to help you get any smarter.

 

[mheslep]

Why is does a country with such wealth and power rate so low in health care efficiency and quality?

Its not low in quality. In many ways its the best in the world.

 

[jreelawg]

The U.S. a nation where the Elite free load off of the hard work and services of the lower and middle class. The Elite get top notch health care, but most hard working americans get poor quality health care. War vets for example get poor quality health care. Why should those who work hard and make huge sacrifices to defend the country get the short end of the stick? The least that congress could do is pass legislating cracking down on the shady practices of Insurance companies, and drug companies. If we are going to have a capitalist health care system, let's at least pass laws to protect the consumers.

 

[Alfi]

Its not low in quality. In many ways its the best in the world.

in other ways it's 37th
http://www.photius.com/rankings/healthranks.html

There is room for improvement in Canada too. Ranked 30th.http://www.photius.com/rankings/who_world_health_ranks.html

 

[mheslep]

in other ways it's 37th
http://www.photius.com/rankings/healthranks.html

There is room for improvement in Canada too. Ranked 30th.

http://www.photius.com/rankings/who_world_health_ranks.html

For some kind of serpentine social policy discussion perhaps the WHO rankings can be entertaining, given WHO metrics like "Fairness in financial contribution". If one actually gets sick, then it is simple, the first thing you want to know is what are my chances for survival, and where do I go for the best chance? Sorry, the WHO rankings won't help you there. For actual diseases like cancer, or hip replacements, and not 'fairness measurements', very frequently the answer is the United States.
http://www.ncpa.org/images/1703.gif

The US health system has some serious problems (cost,coverage,IT), but the quality of actual medicine is not one of them. So I wish these misleading 'Cuba has great health care!' or 'France is #1!' red herrings would stop, so we don't trash what we have when fixing the real problems.

 

[Evo]

For some kind of serpentine social policy discussion perhaps the WHO rankings can be entertaining, given WHO metrics like "Fairness in financial contribution". If one actually gets sick, then it is simple, the first thing you want to know is what are my chances for survival, and where do I go for the best chance? Sorry, the WHO rankings won't help you there. For actual diseases like cancer, or hip replacements, and not 'fairness measurements', very frequently the answer is the United States.
http://www.ncpa.org/images/1703.gif

The US health system has some serious problems (cost,coverage,IT), but the quality of actual medicine is not one of them. So I wish these misleading 'Cuba has great health care!' or 'France is #1!' red herrings would stop, so we don't trash what we have when fixing the real problems.

Exactly, I just watched two healthcare documentaries where patients in the UK had to travel to the US to get life saving medical procedures. One was an infant with brain lessions, the UK would not even allow the procedure she needed, so the parents brought her to the US where they repaired the lesions and saved the baby's life. The Uk also did not cover the expense. But they don't even ALLOW cutting edge research or treatments because it's too costly. You can't even get the treatments you need in other countries. The number of people that are flown to the US each year for treatment they can't get anywhere else is staggering.

I'll gladly pay a bit more to cover research and treatments not available anywhere else in the world.

Socialized medicine in Italy killed my fiance's father. First they only diagnosed his lung cancer with an x-ray, guessed it was the wrong type of cancer and gave him the wrong treatment. They made no diagnostic tests to see which type it was. Then they almost killed him by giving him the wrong treatment at 10 times the normal dose. After I had a fit, my fiance raised hell and got his father on a SIX MONTH WAITING LIST to get an MRI, one of TWO machines in the entire country and required a plane flight across country. Here in America you'd get an MRI the same day. You'd also get tested to see which type of cancer you have. Socialised medicine is mediocre at best and only good if you have run of the mill illness.

His father died in terrible agony, they figured out what he had too late AND it required a trip to another country to even be diagnosed, by then it was too late.

If Michael Moore gets sick, where do you think he's going to go for medical care?

 

[Al68]

If Democrats really think gov't could sell insurance at a better deal than private insurers, then do that and stop trying to control private companies. If not, then they have nothing to complain about.

I'm sure they would if republicans didn't block such efforts. Maybe now they can actually get it done...one can hope anyways.

Republicans can't block those efforts because those efforts don't exist. Democrats have no interest in trying to compete with private companies to sell health insurance. They're smart enough to know better.

Having a government controlled entity competing with private insurers would completely undermine their real agenda of gaining gov't control of private companies. It would be like trying to take over Fedex or UPS.

It's simple, if they don't think they can compete with private insurers, they have no business complaining about them. Put up or shut up.

Democrats just oppose private business in general. Assuming that the word private means not under gov't control.

 

[ThomasT]

No doubt such a system would cut some costs, but the evidence from other countries is that while such a system in theory attempts to provide for all, in practice it delays health care to all.

Does a single-payer system necessarily have to increase delays? This isn't a rhetorical question. I haven't studied the health care system at all, and am curious.

 

[TheStatutoryApe]

within the last year I heard several stories on the news about insurance companies attempting to dump their clients when they made expensive claims based on supposed unreported preexisting conditions that had nothing to do with the claim. last I heard I believe they were working on legislation to prevent this practice.

I've heard occasionally about medical tourism too. it apparently works out well in many cases. at the same time regulations in other countries aren't as stringent as in the US and the likelihood of something going wrong is greater, though not perhaps significantly. the worst part is that if something goes wrong an american citizen has little to no recourse in the case of fraud or malpractice while receiving medical care in another country. so people going out of country for treatment ought to be very careful about who they go to.

 

[BoomBoom]

Having a government controlled entity competing with private insurers would completely undermine their real agenda of gaining gov't control of private companies. It would be like trying to take over Fedex or UPS.

You mean like the USPS?

Maybe if private companies behaved in a more responsible manner and didn't continually try to bleed the people dry in order to maximize profits, then we wouldn't need any government control or regulations. Unfortunately, that is not the case and they must be forced to behave responsibly.

I'd be all for government competing in this market by providing affordable and quality healthcare. That would force the private companies to do the same or perish.

 

[turbo]

No doubt such a system would cut some costs, but the evidence from other countries is that while such a system in theory attempts to provide for all, in practice it delays health care to all.

The whole thrust of the private health-insurance industry is to not only delay, but deny health-treatment to as many people as possible. Insurance companies make most of their money on the "float" between premiums paid and investments they make on claims that are delayed or denied. I was the network administrator for a fairly large medical practice, and I can attest that this is how medical insurance companies operate. They are not in the business to protect individuals from financial loss - quite the opposite.

 

[Vanadium 50]

I think we need to ask ourselves "what problem are we trying to solve here?" If, as BoomBoom and to a lesser extent Turbo-1 suggest, it's that without the profit motive more treatment could be provided, let's look at the data and see how much more.

Blue Shield of California is a pretty big outfit. Their 2007 10-K says they had $318M of income on $8364M of revenue. That's 3.8%. Assuming they are representative, that's the sort of potential improvement we are talking about: 3-4%.

Of course, the same motivation that causes the insurance companies to cut operational costs also motivates them to cut administrative costs. So it's far from certain that this 3-4% actually goes to health care and not to employing somebody's brother-in-law.

 

[Al68]

You mean like the USPS?

Maybe if private companies behaved in a more responsible manner and didn't continually try to bleed the people dry in order to maximize profits, then we wouldn't need any government control or regulations. Unfortunately, that is not the case and they must be forced to behave responsibly.

Private companies only exist to make profits. Their goal is to maximize profit. That results in the best possible deal for consumers. (Despite how counter-intuitive this is to a Democrat).

I'd be all for government competing in this market by providing affordable and quality healthcare. That would force the private companies to do the same or perish.

That assumes that gov't could offer a better deal. Of course Democrats know they can't, so they don't suggest it.

And they wouldn't even need to pass a law. There is nothing stopping the Democratic Party from just starting an insurance company to compete with the others. The simple fact that they don't shows how full of baloney they are.

They want to complain about the deal consumers get from companies they are unwilling to compete against.

Democrats obviously don't think they can do better, but that's not their goal. Power is their goal. Why compete with private companies when they can just take control of them instead?

 

[turbo]

Private companies only exist to make profits. Their goal is to maximize profit. That results in the best possible deal for consumers. (Despite how counter-intuitive this is to a Democrat).

Do you really think that Democratic politicians are any different from Republican ones? That's ridiculous.

They are no different than Coca-Cola and Pepsi or Time and Newsweek. The US would be better off with a parliamentary form of government with multiple parties, but I fear that this would require a revolution more violent than our founding one.

 

[cristo]

Exactly, I just watched two healthcare documentaries where patients in the UK had to travel to the US to get life saving medical procedures. One was an infant with brain lessions, the UK would not even allow the procedure she needed, so the parents brought her to the US where they repaired the lesions and saved the baby's life. The Uk also did not cover the expense. But they don't even ALLOW cutting edge research or treatments because it's too costly.

I'm sure I've said this before, but that's just one case. There are bound to be the odd case that medicine here in the UK cannot cater for: especially because we are a tiny island with far fewer hospitals than the US. The important thing (at least in my opinion) is not the availability of the specialist procedures for the odd case every decade that requires them, but the availability of basic medicine for run of the mill illnesses, that is provided free of charge on the NHS (albeit with a little wait), but that isn't available to some Americans because they simply cannot afford it.

I watched a Panorama programme on this a couple weeks ago which depicted a scene at a football stadium in Kentucky. Families were heading there at 4am, traveling from miles around, to obtain free healthcare from a third world charity simply because they couldn't afford health insurance. It was a really moving scene, one which you would not expect to see in the world's richest country. I mean, one image showed a table of reading glasses that people could take home since they obviously could not afford to visit an optician.

If you look at something like that you cannot possibly argue that the US has a healthcare system which serves its people better than a public healthcare system like, for example, the NHS.

I'll gladly pay a bit more to cover research and treatments not available anywhere else in the world.

I think this is the fundamental problem: the US has the best healthcare in the world... if you're able to pay for it. The fact is that there is a huge proportion of people living in the US who cannot afford healthcare, and a large number of those that are dying because of it. That programme gave a figure of 23,000 people dying a year because they cannot afford basic healthcare.

You can watch the programme here http://www.bbc.co.uk/iplayer/episode/b00gvflg/Panorama_What_Now_Mr_President/ , though that may be a UK link only. It should be on youtube, though...

 

[Al68]

Do you really think that Democratic politicians are any different from Republican ones? That's ridiculous.

Well, since most votes are along party lines, yes.

I don't hear Republicans advocate more gov't control over insurance companies, so on this issue, yes there is an obvious difference.

Just because they have some things in common doesn't mean there's no difference. That's ridiculous.

 

[Al68]

If you look at something like that you cannot possibly argue that the US has a healthcare system which serves its people better than a public healthcare system like, for example, the NHS.

I think this is the fundamental problem: the US has the best healthcare in the world... if you're able to pay for it.

I think different issues are getting confused here. It's like saying Long John Silvers has the best fish...if you're able to pay for it.

Just logical gibberish.

 

[Al68]

Why is does a country with such wealth and power rate so low in health care efficiency and quality? Because it is dominated by people who want it that way. All the incentives run that way. How is it that crooks can dominate our health care system? Because of corrupt officials who are in on it. Why would anyone support the crooks that run the show? Because no one cares to do any research. Why is Michael Moore alright in my books? Because while his conclusions may be different than mine, at least he does a huge amount of research and shows us all the sides and facts that aren't shown on the news. You bash him all you want, call him fat, call him a terrorist, whatever makes you comfortable. But to ignore cold hard facts and documentation based on a popular dislike of person who points it out isn't going to help you get any smarter.

What makes me comfortable is calling him a fraud. His documentaries are frauds. He was caught when his uncut tapes leaked out. He hires people to read from a script, then cuts and pastes to make his "documentary".

And it's just plain faulty logic to blame a provider of a service for their service not being good enough, if it's the same service they agreed to provide and you agreed to take.

 

[BoomBoom]

That assumes that gov't could offer a better deal. Of course Democrats know they can't, so they don't suggest it.

And they wouldn't even need to pass a law. There is nothing stopping the Democratic Party from just starting an insurance company to compete with the others. The simple fact that they don't shows how full of baloney they are.

They want to complain about the deal consumers get from companies they are unwilling to compete against.

Democrats obviously don't think they can do better, but that's not their goal. Power is their goal. Why compete with private companies when they can just take control of them instead?

Hehehe...you make me laugh!

You will find out in time because it will be done (simply because it must be done).

Out of control healthcare costs are not just hurting the unfortunate people that can't afford it, but it hurts everything. The tremendous costs to business who want to provide this service for their employees effects us all. This is probably the main reason for companies to outsource jobs overseas, or shut down factories here to open them elsewhere...not to mention these costs are passed on to the price of the products as well.

You are already paying for the healthcare of others, don't you know?

 

[mheslep]

Does a single-payer system necessarily have to increase delays? This isn't a rhetorical question. I haven't studied the health care system at all, and am curious.

The allocation or rationing of limited resources can generally be done in two ways: rationing by price or rationing the supply (queues, shortages). If a single entity fixes the price, the only alternative is to ration the supply. Experience with nationalized health systems demonstrates this. Note that the number of countries where most people actually get most of the medical care from the government, like the UK, is declining. France has 85% private coverage, Ireland 45%, the Dutch are going to 100%, and private providers are popping up all over Canada now.
http://www.euro.who.int/document/Obs/EuroObserver6_1.pdf

 

[mheslep]

Here's my take on the way to fix US health care some time back.
https://www.physicsforums.com/showpost.php?p=1616345&postcount=114

McCain's adviser Douglas Holtz-Eakin had a good health plan proposal to reduce costs during the campaign. Obama-Biden distorted it during the campaign, particularly Biden who repeatedly made outright false statements about it. Anyway, the problem seems to be that politically people don't want to give up getting health care through their employers and the employee based tax deductions, instituted after WWII. Maybe a nationalized system is the only way to break free of the status quo.

 

[mheslep]

If you look at something like that you cannot possibly argue that the US has a healthcare system which serves its people better than a public healthcare system like, for example, the NHS...

I can and have. However, I'm more interested in improving the US system, rather than leading with the flaws in other countries. I increasingly note that it is most often not Americans who start this kind how-terrible-YOU-are kind of discussion, above post case in point.

 

[cristo]

I increasingly note that it is most often not Americans who start this kind how-terrible-YOU-are kind of discussion, above post case in point.

Ok, sorry. Please, feel free to put those rose-tinted glasses back on. If you don't want to listen to the truth that's being put out there, then fine, but you can't take away my right to talk about something just because you don't like to hear it!

 

[mheslep]

Ok, sorry. Please, feel free to put those rose-tinted glasses back on.

Please feel free to actually show where my statements are rose-tinted.

If you don't want to listen to the truth that's being put out there, then fine, but you can't take away my right to talk about something just because you don't like to hear it!

Obviously I can't take anyone's right to talk away. What I can do is point out obnoxious and self important posts.

 

[adrenaline]

It's interesting, contrary to urban myth most doctors in this country endorse a national health insurance since we are so fed up with the private carriers.

http://www.pnhp.org/news/2004/february/most_physicians_endo.php

Nearly two-thirds (64%) of physicians favor single-payer national health insurance, far more than support managed care (10%) or fee-for-service care (26%) according to a Harvard Medical School study published today in the Archives of Internal Medicine. National health insurance (NHI) received majority support from physicians of virtually every age, gender and medical specialty – even among surgeons, a plurality supported NHI.

( for the record we look things up all the time, I have at least 14 different journal subscriptions come every other week that i wade through between being on call, teaching etc.)

 

[adrenaline]

The U.S. a nation where the Elite free load off of the hard work and services of the lower and middle class. The Elite get top notch health care, but most hard working americans get poor quality health care. War vets for example get poor quality health care. Why should those who work hard and make huge sacrifices to defend the country get the short end of the stick? The least that congress could do is pass legislating cracking down on the shady practices of Insurance companies, and drug companies. If we are going to have a capitalist health care system, let's at least pass laws to protect the consumers.

agree, but let us not forget that even in the model of universal health care,( and I will use Britain since it is cited so much, )the elite have access to better and quicker care as well. In fact, the British NHS has a very active, healthy private indepedant sector that probably accounts for more than the socialized national health service

http://www.medrants.com/index.php/archives/1675

I was reminded just how significant the independent sector is. It provides 85 percent of the UK’s residential care beds, for example, and 20% of all acute elective surgery - that’s the stuff like hip replacements that isn’t exactly life-threatening, but which you want to get done fast anyway.

Indeed, the independent sector has more beds than the NHS and local-authority care homes put together!

It employs almost as many people - roughly 750,000 of them - and it accounts for a quarter of UK health and social care spending...

I suspect if we go to a more universal health care model, like Britain, this country will also (rightfully or wrongfully )have a very healthy two tiered system ( one private and one national) as it exists in Britain. That's why I feel many Americans who dread the "socialized medical system " and want to cling tenaciously to their "private insurance system" have nothing to fear.

Unfortunately, most opponents of univeral health care cite the dysfunctional veterans medical care example that you bought up as a reason for not transitioning to a national health care model. But like everything else in this country, those veterans with the financial means ( my father who is a commodity broker) can opt out of the veteran's system and choose their own medical care through private insurance...

 

[ThomasT]

What makes me comfortable is calling him a fraud. His documentaries are frauds. He was caught when his uncut tapes leaked out. He hires people to read from a script, then cuts and pastes to make his "documentary".

And it's just plain faulty logic to blame a provider of a service for their service not being good enough, if it's the same service they agreed to provide and you agreed to take.

Yes, I think Michael Moore is a bit of a hypocrite, and I'll be forever not like him and others for abandoning Ralph Nader. (I really like Nader -- well, most of his 'message' anyway.)

And of course Moore's 'documentaries' are biased (To a fault? I don't know -- maybe the bias serves to make his essential message more clear.) But he does, I think, depict some things accurately, and he is making films about important social issues. And I agree with what seems to be the essence of his 'message' -- that our social institutions are often driven by greed of one sort or another, and rife with corruption and dishonesty. I have to wonder if a single-payer nationalized healthcare system is necessarily immune to this.

I think the American people should be outraged about the behavior, the track record, of our government officials wrt many issues. But is the healthcare situation in the US really as bad as some people seem to think?

 

[adrenaline]

But is the healthcare situation in the US really as bad as some people seem to think?

Yes, as one of the richest country in the world we suck but I also want to point out how infant mortality is not a good measuring stick for compating us to nationalized health care which keeps coming up with intercountry comarisons.


The United States easily has the most intensive system of emergency intervention to keep low birth weight and premature infants alive in the world.

The US is only one of a handful countries that keeps detailed statistics on early fetal mortality -- the survival rate of infants who are born as early as the 20th week of gestation.

Thus, in the United States if an infant is born weighing only 400 grams and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive -- and the mortality rate for such infants is in excess of 50 percent -- that sequence of events will be recorded as a live birth and then a death. In many countries (including many European countries) such severe medical intervention would not be attempted this would recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics!

The above paraphrased from medical site discussion board.


Take Cuba (which has a better infant mortality)... they do not register births under 1000g. In fact, this is precisely what the World Health Organization itself recommends that for official record keeping purposes, only live births of greater than 1,000g should be included. But guess what, we do register live weights below 1000g!


Cuba looks better than the United States but in fact what is probably true is that the United States takes far more serious (and expensive) interventions among extremely low birth weight and extremely premature infants than Cuba (or much of the rest of the world for that matter) does.


I would not use our infant mortality data to show what a sucky job we are doing compared to the rest of the world. Data that show how countries with national health insurance kicks our butt in terms of managing chronic, long term diseases would have more solid ground to stand on...

 

[cristo]

Please feel free to actually show where my statements are rose-tinted.

It's rather rose tinted to say that your health service serves its people better than a nationalised health service. Did you watch the programme I linked to? If not, I think you should. If so, then perhaps you could point out somewhere in the UK where people are forced to bring out their children at 4am to be helped by a charity for third world countries because they cannot afford access to doctors.

Obviously I can't take anyone's right to talk away. What I can do is point out obnoxious and self important posts.

obnoxious

1 archaic : exposed to something unpleasant or harmful —used with to
2 archaic : deserving of censure
3: odiously or disgustingly objectionable : highly offensive

What definition of obnoxious do my comments fall under? If you feel the post you quoted falls under the latter definition, then it seems you find the truth offensive. I'm at odds to believe how you get through a day without being offended!

 

[cristo]

agree, but let us not forget that even in the model of universal health care,( and I will use Britain since it is cited so much, )the elite have access to better and quicker care as well.

Precisely: one can opt to go private and skip the waiting lists for procedures (to some extent). But, the fundamental difference is that there is still healthcare available to everyone that needs it: not just the people who can afford it.

 

[DrClapeyron]

What is so universal about universal health care? Sounds Orwellian to me. The healthcare bandwagon looks to be the new gravy train for the 2010's, just like technology was the bubble of the 1990's. The US Government entitlements over the next 10 years are going to nearly triple! Can you imagine the US Government handing out $2 trillion to citizens to pay premiums for their insurance? These insurance companies are going to make a bonanza and invest the money in financial, bond and stock markets.

 

[adrenaline]

Precisely: one can opt to go private and skip the waiting lists for procedures (to some extent). But, the fundamental difference is that there is still healthcare available to everyone that needs it: not just the people who can afford it.

I agree, I also must warn people who have "great insurance" to look at their lifetime limit for their plan.

For instance, a 42 year old patient of mine had aggressive subcutaneous T cell lymphoma which over the course of 8 years gobbled up her 3 million lifetime limit. ( Chemo, infectious complications,skin radiation etc.) At that point she had to foot 100% of any health care costs, as if she were uninsured. Because she now has a pre existing, it became impossible to switch to another insurance carrier. In her best interest, I told her I would put her on disability and now she has medicare part B that will at least pay 80% of her continual mounting medical care costs. It was hard since she had worked over 25 years as a quality control lab technician and now felt guilty using tax payers funds to pay her medical bills, I told her, the free market system of providing health insurance has failed her and she has paid into the tax system all this time. Still, it was very hard for her.

This is where our existing private health insurance system truley fails us. If a family were to have one family member with a catastrophic illness ( say leukemia that required at least two bone marrow transplants to cure it or a child with a rare congenital disease, etc). You can bet that family has used up their lifetime limit of health care dollars provided by their private carrier. ( Mine happens to be 7 million but I pay through the nose in yearly premiums). At least medicare and medicaid does not have such a lifetime capitated value. ( They are essentially national health insurance for the elderly and the poor.)

 

[mheslep]

I agree, I also must warn people who have "great insurance" to look at their lifetime limit for their plan.

For instance, a 42 year old patient of mine had aggressive subcutaneous T cell lymphoma which over the course of 8 years gobbled up her 3 million lifetime limit. ( Chemo, infectious complications,skin radiation etc.) At that point she had to foot 100% of any health care costs, as if she were uninsured. Because she now has a pre existing, it became impossible to switch to another insurance carrier. In her best interest, I told her I would put her on disability and now she has medicare part B that will at least pay 80% of her continual mounting medical care costs. It was hard since she had worked over 25 years as a quality control lab technician and now felt guilty using tax payers funds to pay her medical bills, I told her, the free market system of providing health insurance has failed her and she has paid into the tax system all this time. Still, it was very hard for her.

This is where our existing private health insurance system truley fails us.

I agree the existing system is seriously flawed. However, it seems to me the problem in this case is high cost - 8 years and $3 million dollars. The solution would then lie towards reducing those costs, and not just having someone else (the government) pay for them. The $3m mentioned here I assume went almost completely to hospitals, doctors, technicians, drugs; and very little to profits for insurers.

 

[adrenaline]

IHowever, it seems to me the problem in this case is high cost - 8 years and $3 million dollars. The solution would then lie towards reducing those costs, and not just having someone else (the government) pay for them. The $3m mentioned here I assume went almost completely to hospitals, doctors, technicians, drugs; and very little to profits for insurers.

Different issue, my point was to highlight the fact that if you get a rare, incurable or devastating disease , your "cadillac" insurance may not be there for you after a while.This is what most americans don't understand.

As for cost, this example can't be used to suggest how to cut costs. Subcutaneous t cell lymphoma is hard to cure, it requires a lifetime of treatments just to control the disease so it doesn't ravage her. The millions included radiation treatment,( the overhead for one radiation facility is in the millions) at least a month or so in the ICU due to sepsis yearly, ( at a cost of over 5,000 a day in the icu on vasopressors, ventilator etc.) , the exotic chemo that are not readily availabe or cheap , interminttent tube feeding through her stomach when she gets stomatitis etc I treated her for two years free until she got on disabilty ( that includes placing central lines at 2 in the morning etc.) Hard to condemn a 42 year old to death just because she was unlucky enought to get type of cancer that doesn't kill quickly nor cures easily.

The way we reduce costs in our system is not in treating these exotic diseases like hers but by providing good basic diabetes preventative care , hypertension care , good prenatal care etc., Tort reform, because you can't ask a doc to pay 6 figure malpractice premiums on a government paycheck , and it reduces the unnecessary testing to "cover your a$$" etc. These are things countries with universal health care do far better than us. ( By the way She was willing to keep working and supplement her employer's premiums by up to $1500 a month, but the insurance carrier would not let her.) So even when she was willing to pay, the system would not let her.

 

[mheslep]

Tort reform, because you can't ask a doc to pay 6 figure malpractice premiums on a government paycheck , and it reduces the unnecessary testing to "cover your a$$" etc. These are things countries with universal health care do far better than us...

What does national health care have to do with tort reform?

 

[adrenaline]

What does national health care have to do with tort reform?

If you look at my post it was regards to cutting costs in our inefficient health care system. Indirectly , on a practical level national health care will reduce payments to physicians, ( i look at what medicare and medicaid pay me) although most won't mind ( as I referranced earlier about the JAMA survey) but at the same time the overhead for such things as malpractice premiums need to come down. My profit margin is 5%, if my payments go down by 10% , I dont' have much room, can't cut my nurses salary, I've already cut my own for the last five years, I guess I could stop providing $10,000 a year medical insurance premiums for each of my 20 plus employees, but more practically, one of my biggest overheads malpractice premiums could also use a decrease. ( For the record I have never lost a suit) /Canadian physicians and Britsh physicians don't come close to what we pay.

Directly, tort reform will change the behavior of most doctors in this country which contribute to the overspending of health care dollars, which is "assurance behavior, " or over ordering of tests or speciality referall to avoid law suits:

[JAMA. 2005;293:2609-2617.

ABSTRACT

Context How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate.

Objective To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment.

Design, Setting, and Participants Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003.

Main Outcome Measures Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior).

Results A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act,43% reported using imaging technology in clinically unnecessary circumstances.The incidence of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.

Conclusion Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care

So you see, tort reform will help bring down the cost of overall health care spending, which will expedite embracing a univesral health care model of some sort and contibute to its financial solvency. Right now the specialties leading the fight against universal health care model are not surprisingly the ones with the greatest malpractice premiums ( ob/gyn, neurosurgery ets.) Generalists llike internal medicine such as I are the ones leading the advocacy.

 

[mheslep]

So you see, tort reform will help bring down the cost of overall health care spending,

Yes, I agree. I think its widely known that malpractice suits drive up the cost of health care and, as your JAMA issue details, the threat of malpractice drives up the costs even more through defensive medicine. Thus I would hope to see tort reform tried first, before nationalizing the entire system. However, tort reform has been on the agenda for decades and it hasn't happened. It may be that it is politically impossible unless and until the health system is nationalized.

PS Quantifying the cost of defensive medicine is difficult. I posted this Doc's anecdote that's suggestive awhile back.
https://www.physicsforums.com/showpost.php?p=1635269&postcount=186

A male in his late 30's/early fortys comes to the ER complaining of chest pain. He has a cough or some other reason to have some chest pain (nothing points to cardiac disease) but since he said the magic words "chest pain", we now feel obliged to order the full workup to protect us from the 0.001% chance that this may represent heart disease.

He gets an EKG X 2 (probably $100)
He gets cardiac enzymes drawn X 3 (probably $150)
He gets other routine labs (maybe $150 total)
He gets a chest X-ray ($100)
He gets admitted to a medical/cardiac telemetry floor 24 hour observation ($1200)
He may get a stress test if he had any risk factor at all ($750)
He gets discharged with a follow up appointment with his PCP ($75)

So, about $2500 is spent when the only thing needed was $2 worth of Motrin. Happens every day unfortunately.

 

[Al68]

Hehehe...you make me laugh!

You will find out in time because it will be done (simply because it must be done).

If by "it", you mean the gov't taking over private companies, I can't argue, they've been doing it incrementally already.

My point was that they plan to do that instead of competing with them.

 

[Al68]

And I agree with what seems to be the essence of his 'message' -- that our social institutions are often driven by greed of one sort or another

I looks to me like Moore doesn't know the difference between a "social institution" and a private company. Of course private companies are driven by the profit motive. But they are not social institutions.

Moore seems to be so confused and delusional he thinks that the fact that a private company doesn't act like a social institution is due to corruption of the institution instead of the obvious fact that it was never a social institution in the first place, except in his mind.

Sad thing is, he is not alone.

 

[ThomasT]

I looks to me like Moore doesn't know the difference between a "social institution" and a private company. Of course private companies are driven by the profit motive. But they are not social institutions.

Moore seems to be so confused and delusional he thinks that the fact that a private company doesn't act like a social institution is due to corruption of the institution instead of the obvious fact that it was never a social institution in the first place, except in his mind.

Sad thing is, he is not alone.

I agree that it doesn't make much sense to expect private enterprises, especially very large ones, to behave in socially responsible ways so long as the behavior of social institutions or government officials is often, directly or indirectly, determined by the profit motives of private enterprises.

 

[ThomasT]

Directly, tort reform will change the behavior of most doctors in this country which contribute to the overspending of health care dollars, which is "assurance behavior, " or over ordering of tests or speciality referal to avoid law suits:

What exactly does 'tort reform', wrt medical malpractice suits, entail?

Would reform of the 'legal system', that is, how suits are dealt with rather than limiting the scope of suits, be a better approach?

 

[Alfi]

Originally Posted by ThomasT View Post

And I agree with what seems to be the essence of his 'message' -- that our social institutions are often driven by greed of one sort or another
I agree. between Medical Insurance,and malpractice insurance, the layers and insurance companies are main reasons why the whole medical social system is so expensive.

 

[Vanadium 50]

So you see, tort reform will help bring down the cost of overall health care spending

Of course.

which will expedite embracing a univesral health care model of some sort and contibute to its financial solvency.

Contribute to its solvency, of course. But why does this have anything to do with universal health care? I would argue that if you reduce health care costs via tort reform, it would lessen the pressure for some sort of nationalized health care, not increase the pressure.

Right now the specialties leading the fight against universal health care model are not surprisingly the ones with the greatest malpractice premiums ( ob/gyn, neurosurgery ets.) Generalists llike internal medicine such as I are the ones leading the advocacy.

But why is that? If tort reform and universal health care go hand in hand, wouldn't obstetricians be leading the charge?

 

[ThomasT]

The Medical Malpractice Myth

The Jury's Still Out: A Critical Look at Malpractice Reform

 

[adrenaline]

The Medical Malpractice Myth

The Jury's Still Out: A Critical Look at Malpractice Reform

both very good articles thankyou giving different sides of the issue.

The first article is not giving the whole story about republicans wanting to cap injury to $250,000 dollars. A victim can still get unlimited amounts for loss of wages. So if you are an artist who makes millions selling masterpieces per year and lose use of your painting arm then you are entitled to millions and millions of malpractice settlement for lost wages but your entitlement to " emotional pain and suffering" is to be capped at $250,000. I don't agree with the republicans on this because the emotional suffering of say losing an infant is beyond any measure of money we can subsribe. However, their reasoning is that this will limit frivolous lawsuits where no real harm or death happened but people can say they were emotionally traumatised. I use a real case where a woman sued a dermatologist for leaving a scar on their shoulder blade after excising a melanoma because it caused undo cosmetic pain and suffering . ( This is an actual case that went to court even though the patient signed consent stated she realized excision of a melanoma may leave a scar).

What exactly does 'tort reform', wrt medical malpractice suits, entail?

Many physicians feel there should be a health court set system set up with judges and lawyers who are experts on medical field, much like you have traffic court, immigration court etc.

This court would review cases and decide what was frivolous and what were true negligance. They could decide what goes to court. Our current system right now bogs down the court system with too many frivolous malpractice suits and allows true negligence to sometimes go unpunished. which the article correctly surmises.

For instance, I got dragged into a lawsuit where 8 weeks before a woman died I treated her for an allergic reaction to sulfa. ( had hives and wheezing). She died 8 weeks later due to complications of back surgery. The lawyers threw out a net to grab every doctor involved in her care ( wether we contributed to her death or not .) I spent $70,000 in legal fees extracting myself from the case. $70,000 to prove to the lawyers I was completely innocent of any complications suffered by her back surgery she had done 2 weeks after seeing me! Now a health court would have thrown my involvement right out from the get go.

As for reducing medical errors, I think the democrats are right to pursue that. I invested in a $150,000 electronic medical records system that warns me of drug interactions, when the person is due for a pap, prescriptions electronically etc. I also pay 15,000 a year for IT support, updates etc. However, a pediatrician in South Georgia who sees 90 percent medicaid and a take home salary of $58,000 or less can't afford such a high overhead investment. The democrats have not devised a solution to help that pediatrician obtain electronic medical records and embark on an important step in reducing medical errors.

 

[Al68]

I agree that it doesn't make much sense to expect private enterprises, especially very large ones, to behave in socially responsible ways so long as the behavior of social institutions or government officials is often, directly or indirectly, determined by the profit motives of private enterprises.

Or as long as the behavior of government officials is limited by the constitution or libertarian beliefs.

Private companies are NOT a part of the gov't or any gov't agency. Holding gov't responsible for their actions is illogical to say the least.

If Democrats think they can offer a better service and/or price than the private companies they should compete with them, not try to control them. If not, then they should shut up.

The truth is Democrats don't want to compete with them to offer a better service or price, they want a monopoly. They can achieve this by just controlling all the private companies.

Of course the people that desire a monopoly on the control of insurance companies will claim that the centrally controlled entity in charge will provide a better service/price than competing private companies, and they know with enough propaganda, people will actually believe such nonsense.

 

[adrenaline]

But why is that? If tort reform and universal health care go hand in hand, wouldn't obstetricians be leading the charge?

They feel that tort reform has to happen first. Medicare and medicaid pay doctors a dismal amount compared to private insurers ( which is why many doctors no longer see either) and going to universal health care will mean lower reimbursements for doctors as a whole ( which is probably why most people are surprised a majority of us still advocate a national health insurance policy. ) The anesthesiologist that pays $500,000 in malpractice premiums is not going to be able to pay their premiums when reimbursments are cut in half.


There is a ob/gyn who takes medicaid patients in Savanah,georga. She is the only ob/gyn left who takes medicaid in that area ( national health insurance for the poor), as a result, she cannot afford malpractice and practices without a malpractice policy. I myself have to limit medicaid to 15% of our patient volume because we don't even break even seeing them, we actually lose money with each one. I could not pay my $300,000 a year rent, malpractice premiums, workman's comp, health insurance, disbability, 401 etc. if I saw more than 15% imedicaid n my outpatient practice ( I can't control what I see in the hospital since I am also an intensivist).

 

[adrenaline]

By the way here is a link describing health courts and how it can benefit patients as well as doctors and actually provide a more consistent means of punishing the repeat offenders ( on both sides, victims and doctors.) and how it can help curb costs of medicine in general and malpractice costs.

http://www.medrants.com/index.php/archives/2956

This is my answer for tort reform, special health courts ( not the $250,000 dollar cap for emotional pain and suffering advocated by the republicans, something we cannot quantitate anyway.)

 

[Vanadium 50]

The anesthesiologist that pays $500,000 in malpractice premiums is not going to be able to pay their premiums when reimbursments are cut in half.

You look far too young to have been practicing in the 80's, but back then Massachusetts really got themselves into a bind. The state regulated what doctors could charge (via banning balance billing), and it also imposed minimum malpractice insurance (and even allowed retroactive premium increases!). When the premiums exceeded the income, a number of doctors -particularly obstetricians, who had relatively high insurance premiums and relatively low permitted income - simply closed up shop.

Women ended up driving to Rhode Island and New Hampshire to have babies.

 

[Art]

In a universal health care system such as in the UK the state takes on the fiscal responsibility of doctor's malpractice suits. The doctors are of course still held personally liable in terms of disciplinary procedures.