Sicko is probably one of the most disturbing films

[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.

 

[ThomasT]

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 makes a lot of sense. The status quo that requires you to spend ridiculous amounts of money just to avoid frivolous or unwarranted lawsuits is unacceptable.

Capping awards for alleged emotional pain and suffering makes sense to me also.

There is the argument that even doing both wouldn't lower costs by much at all. But I agree with you that the special court thing should be done. It's a step in the right direction.

 

[mheslep]

As for reducing medical errors, I think the democrats are right to pursue that. ...

I think they have it exactly backwards:

Sens. Hillary Clinton and Barack Obama also want to save on health care. But rather than capping jury awards, they hope to cut the number of medical malpractice cases by reducing medical errors,

The material I read shows the principle cause of errors in the first instance to be the exploding malpractice suits. That is, progress in exchanging medical information, patient work-ups, etc is severely hampered by fear of liability. If this is the case, then the cost of unrestrained malpractice suits include:
- direct costs in damages paid ($29B)
- indirect costs imposed by defensive medicine
- some portion of medical errors.

 

[ThomasT]

Originally Posted by ThomasT
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.

Isn't it, ostensibly, the responsibility of the government, as an instrument of the people, to ensure that the people, in their individual and collective enterprises, behave in socially responsible ways?

We have governments because people can't be trusted to be good neighbors. We have a separation of governmental powers because governments are people.

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.

You might be right about this. In any case, I don't like much of what either party is saying and doing. Imho, they're both irreparably fubar(ed).

I do like the idea of cutting out as many 'middle men' as possible. Then many of these insurance people can go do some real work. ( I'm just kidding ... really.)

 

[Vanadium 50]

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.

But isn't that an argument for nationalizing malpractice insurance, thought, not one for nationalizing healthcare? The two are, at least in theory, separate issues.

 

[adrenaline]

But isn't that an argument for nationalizing malpractice insurance, thought, not one for nationalizing healthcare? The two are, at least in theory, separate issues.

yes they are, and unfortunately obama's health plan, though I like it better than mcain's, doesn't really address this.

 

[adrenaline]

I think they have it exactly backwards:

The material I read shows the principle cause of errors in the first instance to be the exploding malpractice suits. That is, progress in exchanging medical information, patient work-ups, etc is severely hampered by fear of liability. If this is the case, then the cost of unrestrained malpractice suits include:
- direct costs in damages paid ($29B)
- indirect costs imposed by defensive medicine
- some portion of medical errors.

Obama believes investing in health informatin technology will help reduce errors. with that I agree after investing in one myself ( although it was very pricey.)

But you bring up the valid argument doctors and republicans bring up and that in this culture of fear of lawsuits, it becomes very hard for practioners and institutions to be transparent with their errors, which is the first step in tackeling and improving medical errors.
This is another benefit of tort reform.

 

[mheslep]

The Medical Malpractice Myth

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

The fact that the Slate piece doesn't address the cost of defensive medicine or how sky rocketing premiums have driven physicians out of practice, and then going to dismiss malpractice as 1% of healthcare, indicates to me it is not worth the electrons that drew it on my screen.


http://www.manhattan-institute.org/html/cjr_10.htm#02"
Figure 1 shows avg malpractice premiums up 64% in 2000-2005

 

[mheslep]

Baker's book makes a statement questioning the connection between medical error and malpractice here:

https://www.amazon.com/gp/product/0226036480/?tag=pfamazon01-20
Page 97

...We have stacks of books and reports.
In this mountain of paper there is no research testing the conventional wisdom that medical malpractice lawsuits drive medical mistakes underground. Could it be that the conventional wisdom is wrong?...

I think no its not wrong. Granted it is hard to prove the connection.

 

[Al68]

Isn't it, ostensibly, the responsibility of the government, as an instrument of the people, to ensure that the people, in their individual and collective enterprises, behave in socially responsible ways?

Of course not. As an instrument of the people, legitimate gov't power is limited to that possessed by the people. People do not have a general right to use force to control the behavior of others. People have the right to use only defensive force against others.

We have governments because people can't be trusted to be good neighbors. We have a separation of governmental powers because governments are people.

That's not why the U.S. gov't was founded.

People don't have the right to force their neighbors to be "good neighbors". People have the right to use force to defend themselves from wrongful force used against them by their neighbor.

This is what liberty fundamentally means. That each person is free to make their own decisions as long as they don't infringe on the liberty of others.

Live and let live, not live and tell others how to live to please their neighbor. That's what the word oppression fundamentally means.

 

[ThomasT]

Originally Posted by ThomasT
Isn't it, ostensibly, the responsibility of the government, as an instrument of the people, to ensure that the people, in their individual and collective enterprises, behave in socially responsible ways?

Of course not. As an instrument of the people, legitimate gov't power is limited to that possessed by the people.

The people, via their elected representatives, have the power to regulate industries that act contrary to the public good. Unfortunately, in many cases, the elected representatives are tools of the industries (whose primary motivation is profit) that need to be regulated.

Moore's contention (at least one of them), I think, is that adequate health care should be a public service, and not primarily motivated by financial gain. And I agree with that.

This is what liberty fundamentally means. That each person is free to make their own decisions as long as they don't infringe on the liberty of others.

The contention is that profit motivated enterprises are screwing up the healthcare industry (the insurance industry, the drug industry, the legal system vis lawyers, unwarranted lawsuits, inordinately high awards, etc.) -- so their freedoms need to be further limited.

History has taught us that if people are free to make their own decisions, then they will inevitably infringe on the liberty of others. This is especially true if the primary motivation of the people concerned is financial gain.

Left unregulated (or if regulations are poorly enforced), private enterprise has given us economic meltdowns,
inordinately high prices wrt certain essential commodities and services, inordinately low wages, sweatshops, child labor, slavery, etc.

But society is evolving. Increased socialization is inevitable. I think that a single-payer healthcare system (along with necessary reforms) that administers to everyone on an equal basis should be given a shot. But it doesn't seem like we're ready for that yet.

 

[ThomasT]

The fact that the Slate piece doesn't address the cost of defensive medicine or how sky rocketing premiums have driven physicians out of practice, and then going to dismiss malpractice as 1% of healthcare, indicates to me it is not worth the electrons that drew it on my screen.

With all the defensive medicine it would seem reasonable to expect malpractice, and malpractice lawsuits and awards and insurance premiums, to decline. But the trend is generally upward. Maybe the standard defensive medicine practices are superfluous to, not addressing, the actual causes of malpractice.

I thought this passage from that article was interesting:

Anesthesiologists used to get hit with the most malpractice lawsuits and some of the highest insurance premiums. Then in the late 1980s, the American Society of Anesthesiologists launched a project to analyze every claim ever brought against its members and develop new ways to reduce medical error. By 2002, the specialty had one of the highest safety ratings in the profession, and its average insurance premium plummeted to its 1985 level, bucking nationwide trends. Similarly, feeling embattled by a high rate of malpractice claims, the University of Michigan Medical System in 2002 analyzed all adverse claims and used the data to restructure procedures to guard against error. Since instituting the program, the number of suits has dropped by half, and the university's annual spending on malpractice litigation is down two-thirds. And at the Lexington, Ky., Veterans Affairs Medical Center, a program of early disclosure and settlement of malpractice claims lowered average settlement costs to $15,000, compared with $83,000 for other VA hospitals.

I don't know how to take the 1% thing:

After all, including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending. If anything, there are fewer lawsuits than would be expected, and far more injuries than we usually imagine.

http://www.manhattan-institute.org/html/cjr_10.htm#02"
Figure 1 shows avg malpractice premiums up 64% in 2000-2005

This link was informative, I think. Thanks.

 

[mheslep]

With all the defensive medicine it would seem reasonable to expect malpractice, and malpractice lawsuits and awards and insurance premiums, to decline. But the trend is generally upward. Maybe the standard defensive medicine practices are superfluous to, not addressing, the actual causes of malpractice.

I'm sure that's what the tort attorney's argue. The other argument is that many malpractice lawsuits are frivolous, or cast a wide net over anybody remotely connected to the case in search of deep pockets as adrenaline suggested above, because the laws in some states enable big awards for these attorneys, i.e. malpractice is big business for them. Ever hear of the phrase 'ambulance chaser'? I don't suggest most lawsuits are such, but it baffles me that just because there is a lawsuit people many people (apparently) consider the fault is with the medical profession.

 

[Al68]

History has taught us that if people are free to make their own decisions, then they will inevitably infringe on the liberty of others. This is especially true if the primary motivation of the people concerned is financial gain.

So, offering to sell me something (voluntarily) is an infringement of my liberties? But forcing me to pay for something against my will is not?