WHO??????Originally Posted by mrba
Have to go, reading the works of the great German philosopher, Gerta.
WHO??????
Have to go, reading the works of the great German philosopher, Gerta.
Well, Walt, you've at least misstated the problem precisely. You're obviously listening to the BS the Bush administration is promoting. "Junk lawsuits," indeed - of course, the "junk" or, to use a more precise term, "frivolous" lawsuits aren't "the problem," because by definition, these do not result in awards. "The problem" - if it really were the problem - would be excessive awards for non-monetary damages (a/k/a "pain and suffering"), which is what the proposed $250,000 cap would, uh, cap.
And of course, this so-called "tort reform" is something that the corporate sponsors of Republican politicians - both within and without the healthcare domain - have been seeking for years; after all, these awards are costly. Now that health care costs have been rising dramatically, this becomes the perfect solution to yet another problem. Sound familiar?
Except, people who actually get paid to think about stuff, in this case, the Congressional Budget Office (that's the Republican Congressional Budget Office) - say it ain't so. While I'm sure it wasn't what they wanted to say, one must give them credit for recognizing a fact when they ran headlong into one:
"Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small."
'Course, the Bushies will not let the inconvient facts get too much in the way here any more than they do in any other sphere. These awards make a nice target - simple and straightforward. Too bad they're beside the point.
(Read the entire report at http://www.cbo.gov/showdoc.cfm?index=4968&sequence=0)
"Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small."
'Course, the Bushies will not let the inconvient facts get too much in the way here any more than they do in any other sphere. These awards make a nice target - simple and straightforward. Too bad they're beside the point.
I don't know if I qualify as a "Bushie" (would that make you a Kerrisite)... nor do I have time to read a Congressional Budget Office report just now. However, I do wonder if the "2 percent of overall health care spending" included all of the "CYA" tests that are performed each year to avoid possible litigation.
Without question, insurance- in any form- adds quite a bit to healthcare costs (for the reason I have identified earlier- health insurance companies, like every other business, seek to make profits). Another contributing factor is the types of treatments being developed. MRI technology costs more than X-ray technology.
Combined in the "cost of technology" is going to be the price of drugs (if trial lawyers are the whipping boys of the GOP, pharm companies are a favorite fixture on the Dem crucifix). Naturally, the pharms want to make money too (here comes all the "how come the Canadiens are able to purchase drugs less expensively than Americans" sillyness).
I believe we've hit on the solution some time ago- basically a cash-based medical system (wanna cut healthcare costs- try having private only payments with tort reform thrown in). The problem is, even with the lower healthcare costs that should result from such a system, there would still be those unable to procure care. At that point, we end up back in the circle we're in- people take out insurance, the insurance companies take in premiums and cut payouts to the provider, the provider raises rates to the non-insured to cover their losses on insured patients, with the higher costs more patients desire to be covered by insurance, and bam- right back where we are now!
Tort reform and major medical coverage only is my solution to this mess. You need a cavity drilled- pay for it yourself. You need chemotherapy because you have cancer- that is a major expense that can be cost-averaged throughout society via insurance.
I noticed a commercial "approved-by" Kerry (meaning, paid for with the soft money supposedly eliminated by "election reforms") last night in which candidate Kerry claimed he would cut "billions" from the cost of healthcare. Wow- if its really just as simple as electing Kerry, this alone seems worth the price of enduring his personality in the White House! Unfortunately, even with all the sniping, bickering, debating, etc. we will all do on the various and real issues facing our nation during this election season, we will be discussing the wrong election! The Presidential outcome will have very little to do with healthcare in the next term (if this weren't true, we would have had National Healthcare when Clinton was in office with a Dem majority). Same is true for public education, unemployment, etc... pretty much everything but national defense.
Whichever side of an issue you support, you're going to have to elect a strong majority in the Senate and a majority in the House- that's the way our system works. THEN, you have to get a like-minded President in office who won't veto the bill. Given the division (and polarization) in Congress right now, I don't see any real changes to an issue like healthcare in the next term- unless we have someone who can really work with both sides of the aisle (which apparently neither of these gentlemen can accomplish). Of the two, Bush is definitely more centrist than Kerry (based on his Senate voting record).
Pete Hanlin, ABOM
Vice President Professional Services
Essilor of America
http://linkedin.com/in/pete-hanlin-72a3a74
Well if this was the case, why is it that in Louisiana (I think) there are no neurologists or OBGYN because of lawsuits? The docs can't afford the insurance. I saw the story on 60 min, the state and profession may be wrong, but you get the point."Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending.
Really? I believe your boy John Edwards made his 100 million suing on behalf of kids with cerebral palsy and winning... All fine with me, except it is now beyond a shadow of doubt that the medicine he argued in court is bogus. the doctors he sued had nothing to do with the childrens affliction. He was able to convince a jury otherwise."Junk lawsuits," indeed - of course, the "junk" or, to use a more precise term, "frivolous" lawsuits aren't "the problem," because by definition, these do not result in awards.
A junk lawsuit, and he won. I would assume Edwards is only one example. Oh and before you attack my facts, please reference one paper anywhere that shows that a doctor can give someone cerebral palsy!
Having said all of that I agree with most of what Shanbaum says.
No, that's covered elsewhere in the same report:
"On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small."
Neurologists and obstetricians do in fact have a big problem: insurance companies can count, and they've noticed that these two specialties have suffered damage awards disproportionately - as I recall, they account for 10% of the malpractice cases, and 30% of the damages awarded. So, the insurers do the obvious - they send premiums for these two specialties through the roof; saying, in effect, that they don't want that business. Why should they?
Before I try to "attack your facts," please supply some. Please cite so much as a single case, argued by Edwards, in which the complaint was demonstrably specious, and damages were awarded.
http://www.neurologychannel.com/cerebralpalsy/
See the section labeled "Causes".
So, the insurers do the obvious - they send premiums for these two specialties through the roof; saying, in effect, that they don't want that business. Why should they?
Precisely!!! Using the same argument, why would an insurance company want the business of a person with high health risk factors? Also, why would an insurer want to insure one individual- where risk cannot be averaged out over a wider group? In other words, why would an insurance company WANT to place themselves in a position with a high probability of financial loss? This is precisely where this whole discussion originated!
The answer is, of course, no company would willingly accept business that is likely to lose them money.
Regarding the CBO's assessment of defensive medicine- well, I'd suggest that the CBO is a bit out of touch. My children and wife have undergone tests and work-ups that the physician outright admitted were CYA related. Closer to home, a concept preached incessently to Optometrists is "You don't want to be the last person to see a patient." In other words, refer that fella to an Ophthalmologist regardless of whether there is any real likelihood of a problem or not- just to put the MD on the hook instead of yourself if there turns out to be a hidden problem lurking. Of course, the patient doesn't mind being referred on because after all- "insurance is paying for it."
Pete Hanlin, ABOM
Vice President Professional Services
Essilor of America
http://linkedin.com/in/pete-hanlin-72a3a74
Some sort of Tort reform needs to be considered as part of the overall fix for the currect mess, but it's naive to think that this alone will solve the problems. The thing that worries me about some of the Tort reform proposals is that they virtually give Doctors, Insurers and Hospitals a blank check to do whatever they want to our bodies with little fear of consequence to themselves.
Perhaps some of you are happy to give them a blank check, but that's not something I'm willing to do. There needs to be real and significant consequences if someone does significant harm to another person through negligence or incompetence.
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I noticed a couple of questions I posed were never answered. I think they are worthy of some response:
For mrba:
For anyone believing that government is inherently incapable of doing anything well:
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Well, then, wouldn't it make sense to have a single insurance pool, comprising all of us? In which case, wouldn't it make sense to leave out the superfluous expense (to us) of paying a profit to the insurance companies?
At its core, insurance isn't really much of a product, is it? Couldn't we just divvy up the national health care bill on a per capita basis, and spread the risk (and the cost) as widely as possible?
As noted, we don't want to let the facts get in our way.
Regarding the CBO's assessment of defensive medicine- well, I'd suggest that the CBO is a bit out of touch.
There is, I submit, at least one other side to this coin, and that is this: as a consumer of health care, if my doctor (of whatever sort) thinks that there might be a reason to consider further care, well, by God, I want him to err on the side of too much care rather than too little. Wouldn't you?
You are, I grant, pointing to one aspect of our healthcare system that is problematic, and that's the separation that we've managed to create between consuming healthcare, and paying for it. Your solution would be simply to have everyone pay for it; there's certainly no indirection there. I'm not sure how my mother-in-law, who's taking $70,000 worth of Gleevek every year to keep her stromal-cell cancer in remission, would manage, exactly. She'd probably do her damndest to pay for it... which brings me to a point of disagreement with you: I believe that the market is particularly ill-suited to price healthcare services, simply because there is almost no elasticity in demand for health. In a market environment, unless there's an oversupply, healthcare will be overpriced.
But I agree, there has to be some kind of linkage between consumption and cost, or consumption (instead of price) will tend to increase infinitely...
This is getting very ponderous indeed. Thought I would throw in a totally irrelevant snippet: Ken Lay today speaking to the press: "Most people consider me a victim".
Scott Fitzgerald was right, they are different.
Back to the subject at hand: without any real consequences to shoddy medical practices, the public needs the ability to redress harms in the court. (Keep in mind, as my husband always says, somebody graduated in the bottom 10% of the class!!)
I certainly don't think that the government manages defense anything remotely like well.
I remember thinking on September 11, 2001, that having spent more than three trillion dollars on "defense" since the fall of the Soviet Union, there we were, defenseless.
I'm curious why people think that Government cannot be trusted to manage large public programs efficiently and cost-effectively, yet they have no similar qualms about Defense expenditures. Why does anyone think the Govermnment is inherently unable to manage manage national healthcare, yet they have no problem with the way it handles national defense?
I attempted to address that question- obviously not very well...
First, I would point out that the government doesn't handle defense particularly efficiently (of course, since we've managed to remain a sovereign nation one could argue they have done the job adequately, but given the expenditures associated with defense I would suggest it could be done more efficiently).
However, defense is something that could not be privatized- at least not if the Commander in Chief is going to be the President of the United States (if defense were privatized, somewhere in the system the command chain would end up in the private sector somewhere, and this is both impractical and unacceptable).
So, I trust the government with defense because I really have no choice (and, as I pointed out the first time I attempted to address this question- this is probably why defense is one of the FEW things given to government to administer in the original set-up of our system).
As to why the government cannot be trusted with Healthcare- or practially any other enterprise within our society- its quite simple... A democratic government is simply not well-equipped to run a business in a capitalistic society. Now a monarchy may be able to run a business, because one person (or a small group which is accountable only to one person) can make the decisions necessary to run a profitable business. However a democracy- or any government where all are given more or less equal representation- is inherently incapable of running a business. The reason is simple- fiscal accountability. No one truly feels the immediate effects of profit and loss, so the business will ultimately cater to the whims and wills of its "owners"- owners who don't care what the bank statement is at the end of the day.
This is exactly why we have the deficits/debt we do. We are in the "businesses" of education, health insurance (through medicare), etc. Every one of these businesses is poorly managed and cost inefficient because a.) they do not compete in a fair market- so there is no incentive to produce a good product, and b.) there is no accountability regarding profit and loss- the finances are seemingly without limit.
Of course, privitization has consequences as well. Regarding health care, the consequence is a profit-motivated business is not going to willingly expose itself to any undue risk- even when such risk is necessary for the "common welfare" of all citizens. Within this situation, I believe it is the government's responsibility to impart the most basic parameters to regulate the activities of private business (through permitting businesses to conduct business and make any profit they may only if certain business conditions are met).
This is where we are lacking, in my opinion- but this is where that devil called details comes into play. What regulation is appropriate, should limits on a business' profitability be implemented, should businesses be required to expose themselves to financial harm and if so how much? These are all tangly questions that have been thus far poorly addressed.
The ultimate answer- for the reasons I've outlined above- however, is NOT having government attempt to run yet another business.
Pete Hanlin, ABOM
Vice President Professional Services
Essilor of America
http://linkedin.com/in/pete-hanlin-72a3a74
Well, shanbaum, as usual, you've undermined your own cause with thorough efficiency. I mentioned nothing about "Junk lawsuits". You're obviously listening to the BS the Kerry Johns are promoting.
(Read the entire PDF at http://content.healthaffairs.org/cgi.../hlthaff.w4.20 )
I also think it might be more constructive to focus on discussing the high insurance cost problem without once again using it as a vehicle for Bush bashing or resorting to partisan politics.
Last edited by walt; 07-08-2004 at 02:22 PM.
...if my doctor (of whatever sort) thinks that there might be a reason to consider further care, well, by God, I want him to err on the side of too much care rather than too little. Wouldn't you?
Well now, let's just see... If I am personally paying for each and every little test the doctor MIGHT want to run "just in case" I will probably be open to some small amount of risk at one point or another- perhaps you wouldn't be, but then perhaps you have unlimited funds to expend on your health.
However, if somebody ELSE is paying for the tests, then doc- please have at me with every and any medical device, procedure, medication, etc. you would like!!!
This pretty much explains why the "one big group that all pay into the system" doesn't work as well. Let's say we had national car insurance (heck, why not- some people can't afford car insurance and we all have a right to drive, correct?). Let's further suppose your rates were simply averaged out by including everyone in the country. Now, if you got a tiny scratch on your car, are you going to report it? Well, if you pay private insurance where the rates are affected by the number of claims you make, you might take pause. However, if the whole nation is going to absorb the cost of your scratch, then why not err on the pleasant side and have the thing fixed (in fact, have the whole car painted, after all- someone ELSE is paying for it).
;)
PS- So, if I understand you correctly, anything the CBO says can be taken as "fact" (do you really want to give me that to play with)? If not, then support the "let's not let the facts get in our way" statement regarding defensive medicine using something other than a CBO report. Not saying it can't be done or that defensive medicine isn't indeed a small problem- just that glibly quoting the CBO (Rep or Dem controlled) carries little weight with me.
Pete Hanlin, ABOM
Vice President Professional Services
Essilor of America
http://linkedin.com/in/pete-hanlin-72a3a74
We appear to be on the road to privatizing some defense (support) functions. The wisdom of this is plain: why shouldn't the army pay Halliburton $45 for a case of Coke?? I think we should stop these half measures: privatize the government stem to stern.
Let's see: the justice department could be taken over by Motts (experienced in tossing bad apples); treasury by Parker Brothers (with their years of experience with Monopoly and Risk; defense by Hallmark (when you care enough to send the very best!!!).
And let's not forget the faith based initiatives taking over some government functions. (My favorite, faith based air traffic control....kinda makes you think doesn't it!):D
OK, let me see if I can help you put this all together: the CBO report points out that malpractice insurance premiums constitute about 2% of healthcare expenditures. The Thorpe report asserts that in states with caps on damage awards, malpractice insurance costs 17% less than in states that don't.
THEREFORE, if all states had caps, healthcare costs overall would be reduced by: 0.34%.
Yes. That must be the solution.
And no, you didn't mention "junk lawsuits," that's a Bush phrase. The one he uses to convince people that this is the problem.
Oops, I did it again.
CHM,We appear to be on the road to privatizing some defense (support) functions. The wisdom of this is plain: why shouldn't the army pay Halliburton $45 for a case of Coke?? I think we should stop these half measures: privatize the government stem to stern.
If you can ship a case of coke to Iraq and deliver it to the troops all over the country for less than 45$, I will personally fly over there to drink some.
What is it you like to say so often, "use your head"?
I think this discussion would be greatly helped by a little focus of costs to healtcare:
Where does the money go?
1.Doctors
2.Expensive tech
3.Drugs
4.Lawyers
5.Ins. Companies
6.Fraud
7.Illegal aliens
8.Medical Staff
9.Buildings, machines etc
What am I missing?
These categories could be broken down into major sub-categories... But my point is what % could be cut out of each section to get costs down? Perhaps making Drug companies charge the same to us as canadians for instance etc...
Well actually, using my head, I would ship it from a local or regional bottler. I would guess you would find one in Saudi Arabia? Certainly Turkey. Wholesale cost of a case of Coke is what, $4-$5?
Have a good trip.
Actually I thought of that myself.
1. It could not come from a non islamic country, the writing on the bottles could offend Iraqis.
on a more serious note:
2. I would assume Halliburton being under govt contract would have to ship product manufactured in the US. This is not Halliburtons fault. So I guess we could see a 45$ case of coke as a domestic subsidy.
Nice try.
And lets say you did get it from Saudi Arabia. I'm not sure there are any regional factories anywhere in the middle east, but if there were, you would have to truck it all over the country under armed guard... Wholsale to the end user, 45$
This is fun:http://www.cocacola.co.il/plugin.htm
I wish I could trade some of customers for someone like you!! Mine usually won't accept crazy s*** as a rationale for price gouging. Silly customers.
Buy american and delivery under armed guard in Iraq is crazy sh-word?
Really? Well ok then you win.
In fact, Halliburton contracted with a Kuwaiti company to supply the beverages in question.
There was some issue about their having delivered 85,000 cans instead of 85,000 cases.
Probably an error in translation.
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