Why not Universal Healthcare?

[thekid]

Sir T-Some great points in your posts1
Mark W- My main point was that high health care costs are not driven by the legal system and that abusive testing is not in most cases as a result of "defensive medicine". I am not against doctors earning a living but you seem to imply that only the "best and the brightest" are attracted to the medical profession because of the lure of high salaries. that logic was/is used by Wall Street to justify those ridiculous bonuses and we all know how that worked out....

Other suggestions to lower health care besides eliminate doctors from owning medical labs (and lawyers BTW whose use medical labs to generate bills in automobile accident cases)

Review patent laws that lead to drug monopolies for a drug specific period of time.
Cap administrative costs at both the provider and the insurance level

Limit the pay of hospital executives and health insurance executives to no more than 10 times the average salary of their employees

Allow people to reduce their health care premiums if they are part of a regularly monitored wellness/excercise program

Put price controls on certain basic health care items-syringes,bandages,swabs etc

How's that for a start??
A bit socialistic?? Maybe but the current market based system is a mess.....

[GMichael]

Sir T-Some great points in your posts1
Mark W- My main point was that high health care costs are not driven by the legal system and that abusive testing is not in most cases as a result of "defensive medicine". I am not against doctors earning a living but you seem to imply that only the "best and the brightest" are attracted to the medical profession because of the lure of high salaries. that logic was/is used by Wall Street to justify those ridiculous bonuses and we all know how that worked out....

Other suggestions to lower health care besides eliminate doctors from owning medical labs (and lawyers BTW whose use medical labs to generate bills in automobile accident cases)

Review patent laws that lead to drug monopolies for a drug specific period of time.
Cap administrative costs at both the provider and the insurance level

Limit the pay of hospital executives and health insurance executives to no more than 10 times the average salary of their employees

Allow people to reduce their health care premiums if they are part of a regularly monitored wellness/excercise program

Put price controls on certain basic health care items-syringes,bandages,swabs etc

How's that for a start??
A bit socialistic?? Maybe but the current market based system is a mess.....

Oh look, details! Thanks Kid. These are some great ideas. Keep them coming. Maybe somebody in DC will pay attention.
Ok, so they won't, but at least it would be good to see a plan that could work if they did.

[markw]

Sir T-Some great points in your posts1
Mark W- My main point was that high health care costs are not driven by the legal system and that abusive testing is not in most cases as a result of "defensive medicine". I am not against doctors earning a living but you seem to imply that only the "best and the brightest" are attracted to the medical profession because of the lure of high salaries. that logic was/is used by Wall Street to justify those ridiculous bonuses and we all know how that worked out....

Sorry, I can't quite let go the fact that tort reform should be a major part of this issue. Maybe where you're from it's not an issue,but it does seem to have a profound effect, at least here.

"The cumulative effect of medical malpractice claims on the health care system is staggering. A 2007 study by the Pacific Research Institute estimated that 3.4 million Americans have been added to the rolls of the uninsured because of medical liability concerns. According to several estimates, 10 cents of every dollar spent on health care can be attributed to the costs of medical liability and defensive medicine. That is as much as is spent on prescription drugs — an expenditure that actually treats patients."

Here's the link if you're interested

Other suggestions to lower health care besides eliminate doctors from owning medical labs (and lawyers BTW whose use medical labs to generate bills in automobile accident cases)

I don't necessarily have problems with doctors owning medical labs, but don't you sort of reinforce my statement about needing some sort of tort reform here?

Review patent laws that lead to drug monopolies for a drug specific period of time.

They do. IT costs a heckuva lot of money to develop, test, and get FDA approval for new drugs and they want to make that money back. They expire after a period of time after which generics can be made. I can't find an exact number but here's how the whole scenario plays out if you're interested.

Cap administrative costs at both the provider and the insurance level

Great in theory and it would be great if it can be done. It should be tried.

Limit the pay of hospital executives and health insurance executives to no more than 10 times the average salary of their employees

I think 10 x is a bit unrealistic. Nobody will go for that. These are huge corporations that require a really, really high quality level of administration just to keep the company running. I believe the Japanese used to cap it at about 100 X the lowest salary, which might be a little more realistic.

Allow people to reduce their health care premiums if they are part of a regularly monitored wellness/excercise program

That works for me. Why not add not smoking to that list?

Unless one comes in through a workplace paid plan, I do believe they have to go through a physical where their personal traits are "rated" before the final rates are specified. Getting it through work means that they have to accept everyone.

Put price controls on certain basic health care items-syringes,bandages,swabs etc

Unless the government controls the entire supply chain, distribution, and labor costs, this isn't really do-able. The people at Walmart don't make a heckuva lot to begin with and, face it, their pharmacy is greatly used for a lot of these.

How's that for a start??

Not bad. A little more thought might be called for some of them but you've got the spirit.

Actually, I'd like to see a tax credit, preferably refundable, for the cost of premiums but that would cost the government too much. But, it might them inspire them to acting on lowering the costs.

A bit socialistic?? Maybe but the current market based system is a mess.....

A free market society can have some portions are socialistic, particularly when it comes to keeping the infrastructure needed for commerce. Public utilities are regulated, public schools are "supposed to" be geared towards the common good (but I think they are failing and moving more towards indoctronation) and the police and fire departments reek of socialism (which is a necessary thing here). But all are needed and can work well in this country.

But, to let it get too socialistic, like this takeover of GM and Chrysler scares the hell outta me.

[dean_martin]

Sorry, I can't quite let go the fact that tort reform should be a major part of this issue. Maybe where you're from it's not an issue,but it does seem to have a profound effect, at least here.

"The cumulative effect of medical malpractice claims on the health care system is staggering. A 2007 study by the Pacific Research Institute estimated that 3.4 million Americans have been added to the rolls of the uninsured because of medical liability concerns. According to several estimates, 10 cents of every dollar spent on health care can be attributed to the costs of medical liability and defensive medicine. That is as much as is spent on prescription drugs — an expenditure that actually treats patients."

Here's the link if you're interested

The PRI ranks states for businesses based on which states businesses can go to and kill, mame, injure and defraud citizens without being held accountable. To the PRI, every lawsuit brought by an individual against a business (or professional, like a doctor) is a "frivolous" lawsuit. They don't give you any stats on how the judicial system is clogged with lawsuits among and between businesses, especially the federal courts. Those same businesses that bankroll tort reform efforts wouldn't think twice before suing another business, or taking your *ss to court. There's quite a lot of hypocracy going on.

One of the most beloved legal minds in our state (he's a professor and author of the "bible" on our state's evidence law) was a featured speaker at our state bar's annual meeting this summer. His first comment was to ask the audience, "How many of you are making a living on filing frivolous lawsuits?" Think about it. For every frivolous lawsuit a lawyer files he or she is subject to monetary sanctions. No truly frivolous lawsuit survives a motion to dismiss. Motions to dismiss must be filed within 30days of getting served with the complaint. A lawyer files a frivolous lawsuit and spends up to $500 or more on the filing fee and then after the defendant is served, the defendant's lawyer files a motion to dismiss, the suit is thrown out in less than 60 days and the lawyer who files the suit is hit with sanctions. This same lawyer keeps filing frivolous lawsuits and is sanctioned each time and then he is turned into the state bar and his license is suspended. Yeah, it sounds like you can make a lot of money filing frivolous lawsuits.

Frankly, I've been practicing law for 11 years and I've NEVER seen a frivolous lawsuit, don't know anybody who has filed a frivolous lawsuit and don't know anybody who has defended a frivolous lawsuit.

Mark, you say you want to eliminate partisanship and politics from the healthcare debate but all you site is partisan bunk. Like I said, lawyers have ignored this public relations crap for too long and have taken a huge hit. Our public reputation has suffered and much of it is "our" own doing (e.g., tasteless advertising). But these "think tanks" and "grass roots" anti-lawsuit "abuse" groups have sprung up on the national and state levels well funded by big business with an agenda. My challenge to you is find a study without an agenda behind it. We have to cite the facts from our state's administrative office of courts everytime the "grass roots" tort reform group in our state throws out made-up numbers. It's propaganda warfare. Someone has to be on it 24/7. People take the bait, hook, line and sinker. Hell, I had to call into a sports talk radio show one time because they were going through the made-up list of Stella award cases on the air as if they were true! (see http://www.snopes.com/legal/lawsuits.asp)

After landing Mercedes, Hyundia and Thyssen Krupp plants, our state was ranked in the top 5 for business by an unbiased source. Right away, our own state's anti-lawsuit "abuse" group came out with its rankings saying we were 49th just ahead of Mississippi. It was believable by the masses because Alabama is always close to last in everything that matters like education and just ahead of Mississippi. You know it's bullsh*t when the PRI ranks Mississippi tops for business because of its tort reform efforts, but its sister state's anti-lawsuit "abuse" group says it's worst.

The last real study done on medical errors found that on average 98,000 patients a year DIE because of medical errors in this country - the USA - which was the worst among "western" nations. Stop medical errors and you will stop medical malpractice lawsuits (and save lives as an incidental benefit).

[markw]

No-one disputes that errors are made and redress is not due, but at some point protecting oneself from "possibilites" becomes more of the goal of the doctor than treating the patient.

"The study is based on a survey – believed to be the first of its kind – that was completed by more than 900 physicians in Massachusetts. It asked about their use of seven tests and procedures: plain film X-rays, CT scans, magnetic resonance imaging, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions.

About 83 percent reported practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons."

I'm pretty sure these costs do add up...

And, as far as the careful vetting of malpractice cases, how can this be justified?

"A study published in the New England Journal of Medicine in 2006 analyzed more than 1,400 malpractice claims and found that in almost 40 percent of cases, no medical error was involved"

So, it looks to me there's a bit of a "hail mary" approach to a lot of these lawsuits.

Here's the teaser article. There's a link to the full study in there.

[dean_martin]

No-one disputes that errors are made and redress is not due, but at some point protecting oneself from "possibilites" becomes more of the goal of the doctor than treating the patient.

"The study is based on a survey – believed to be the first of its kind – that was completed by more than 900 physicians in Massachusetts. It asked about their use of seven tests and procedures: plain film X-rays, CT scans, magnetic resonance imaging, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions.

About 83 percent reported practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons."

I'm pretty sure these costs do add up...

And, as far as the careful vetting of malpractice cases, how can this be justified?

"A study published in the New England Journal of Medicine in 2006 analyzed more than 1,400 malpractice claims and found that in almost 40 percent of cases, no medical error was involved"

So, it looks to me there's a bit of a "hail mary" approach to a lot of these lawsuits.

Here's the teaser article. There's a link to the full study in there.

It was not the first of its kind. See the GAO report from 2003 that discredited the AMA's attempted use of similar surveys that were determined to be less than reliable.

For the GAO report of 2003, the AMA did not identify Mass. as a problem state. What happened between 03 and the release of this study? What's going on in the Mass state legislature? What are the political winds in Mass?

If it's so bad in Mass, why did less than 25% of doctors respond to the survey?

Why does the study start with reliance on PRI findings?

Go here and read this report prepared under a Republican Administration:

http://www.gao.gov/new.items/d03836.pdf

[markw]

It was not the first of its kind. See the GAO report from 2003 that discredited the AMA's attempted use of similar surveys that were determined to be less than reliable.

They don't really discountthe findings of my report.

For the GAO report of 2003, the AMA did not identify Mass. as a problem state. What happened between 03 and the release of this study? What's going on in the Mass state legislature? What are the political winds in Mass?

I'm not from Massachuttes so I can't really say. Are you saying the report was bogus?

If it's so bad in Mass, why did less than 25% of doctors respond to the survey?

Dunno. MAybe they don't have the time to respond or they don't want to admit practicing "defensive medicine"?

Why does the study start with reliance on PRI findings?

gotta start somewhere...

Go here and read this report prepared under a Republican Administration:

http://www.gao.gov/new.items/d03836.pdf

Again, from a brief skim, they really don't go against the other report.

Frankly, I'm surprised that you so vehemently argue that this one component of what must be looked at when it comes to cutting costs should be overlooked. I guess you see it as simply a cost of doing business for the medical profession, eh? Well, just as in shoplifting, that "cost of doing business" gets passed on to the consumers.

You make it seem that this is the one and only cause of the problem. IT's not, but maybe it's the only one that affects you?

Remember, I was talking issues. You played the "partisan" card. Bully for you!

I thought this wasn't a "partisian" thread but, from your recent posts, it sure looks like it is, or is it simply because you're a lawyer and take offense when it's pointed out that it's your profession caused this situation.

You do realize that it's this "keep your hands off my stash" attitude that constipates real compromise and progress, not just here, but in Washington, too. Y'all are sure doing a good job of proving that and all I can say is thank God for the blue dog democrats.

Congratulations! You have just answered, by example, the question posed in this thread "Why not Universal Health Care"..

[dean_martin]

They don't really discountthe findings of my report.

I'm not from Massachuttes so I can't really say. Are you saying the report was bogus?

Dunno. MAybe they don't have the time to respond or they don't want to admit practicing "defensive medicine"?

gotta start somewhere...

Again, from a brief skim, they really don't go against the other report.

Frankly, I'm surprised that you so vehemently argue that this one component of what must be looked at when it comes to cutting costs should be overlooked. I guess you see it as simply a cost of doing business for the medical profession, eh? Well, just as in shoplifting, that "cost of doing business" gets passed on to the consumers.

I thought this wasn't a "partisian" thread but it sure looks like it is, or is it simply because you're a lawyer and take offense when it's pointed out that it's your profession caused this situation.

You do realize that it's this "keep your hands off my stash" attitude that constipates real compromise and progress, not just here, but in Washington, too. Y'all are sure doing a good job of proving that and all I can say is thank God for the blue dog democrats..

I'm not arguing that it shouldn't be looked at or factored into the overall resulting plan. My position is that medical malpractice liability is not as big a problem as some interests make it out to be. But limits on medical malpractice liability is the only thing some interests hope to achieve in this process. Medmal fears do not account for the uninsured being charged $98,000 for the same procedure that costs the insured $20,000, most of which is paid by their insurance company. It doesn't fully explain why medmal premiums are so high. Please don't think I'm anti-doctor. I like my doctor a lot. I like many of the doctors who've treated my clients. Interestingly, the only time I feel resentment from doctors (and I get frustrated with them) is when I'm deposing a doctor who's treated a worker's comp client. It amazes me because workers' comp insurers micro-manage the care and don't pay the doctors much at all. I'd much rather have doctors on my side than against me. I always treat them with respect and I know their opinions carry great weight. But that doesn't mean I think they should be above the law or have special protections, privileges and immunities from lawsuits.

If there is a medical liability act included in the healthcare plan, it will have to include a provision that, although this new federal law will apply to the case, the case can be filed in state court. The federal court system is overloaded with civil and criminal cases that used to be state cases but have become "federalized" because Congress stepped in. My state's medmal act that was last amended in the early 90s is pretty tough on plaintiffs (but not as tough as some like Texas's). If a Federal medical malpractice act is passed as part of a national health care plan, my specific recommendation is that plaintiffs be allowed to file in state court. And if the act is as tough on plaintiffs as my state's law but not as draconian as some of the toughest in the country, then I can live with it.

One of the reforms pushed hardest is caps on noneconomic damages which include pain and suffering, mental anguish and emotional distress, and disfigurement. But compare the case of a 40 year old professional entitled to damages for lost wages in addition to noneconomic damages to the case of the child or retired elderly who has no claim for lost wages. If noneconomic damgages are capped at $250,000 and it costs $125,000 to try a medmal case, my recommendation to the parents of the child and the elderly person would be to apply for social security, medicare and medicaid. We'll all pay for it rather than the doctor's medmal insurance carrier.

[dean_martin]

They don't really discountthe findings of my report.

I'm not from Massachuttes so I can't really say. Are you saying the report was bogus?

Dunno. MAybe they don't have the time to respond or they don't want to admit practicing "defensive medicine"?

gotta start somewhere...

Again, from a brief skim, they really don't go against the other report.

Frankly, I'm surprised that you so vehemently argue that this one component of what must be looked at when it comes to cutting costs should be overlooked. I guess you see it as simply a cost of doing business for the medical profession, eh? Well, just as in shoplifting, that "cost of doing business" gets passed on to the consumers.

You make it seem that this is the one and only cause of the problem. IT's not, but maybe it's the only one that affects you?

Remember, I was talking issues. You played the "partisan" card. Bully for you!

I thought this wasn't a "partisian" thread but, from your recent posts, it sure looks like it is, or is it simply because you're a lawyer and take offense when it's pointed out that it's your profession caused this situation.

You do realize that it's this "keep your hands off my stash" attitude that constipates real compromise and progress, not just here, but in Washington, too. Y'all are sure doing a good job of proving that and all I can say is thank God for the blue dog democrats.

Congratulations! You have just answered, by example, the question posed in this thread "Why not Universal Health Care"..

Geez, Mark. I didn't realize what a personal attack your post was until I re-read it. I pointed out that some of the stuff you linked to promotes partisan agendas. That New Jersey tort reform website and the PRI I know from experience have to be watched like hawks. Maybe you didn't realize that and I apologize for accusing you of going partisan if you didn't know that these groups establish pre-determined outcomes for their "studies." I'm waiting for a real "fact check" website to tackle all the claims that come out of the healthcare debate. Again, Mark, my counter point is that defensive medicine/medmal reform is not a "MAJOR" problem. Your point is that it is. I disagree with the degree which you claim.

I'm not saying that it should be overlooked, but I certainly don't agree that my profession caused the problem as you say. Thanks a lot by the way. And thanks for equating my profession with shoplifting. I'm sorry you hate lawyers.

The GAO report doesn't come to many conclusions, but what should be taken away from it is that it's not easy to establish an accurate reliable number spent on defensive medicine. A later report that came to a more specific conclusion estimated that the number is $60 billion a year which is a lot but makes up only 3% of the total yearly health care cost. If we can cut some of that then I'm all for it, but cutting part of 3% is not going to save much. Thus my conclusion that this isn't as big a problem as some interests would have you believe. Did you look at the NY Times article I linked earlier? It came out this week. Again, I disagree with you that defensive medicine/medmal lawsuit reform should be a "major" part of the plan. Some interests want it to be the only part of the plan.

Personally, I'd rather have the extra lab test anyhow. My doctor wrote me an order to have my cholesterol checked because I'm 41 and have not had it checked before. He warned me that my insurance company might not pay for it. My thought was why would my insurance company not pay for something my doctor ordered? Do they know more than my doctor? Maybe I should see them instead of my doctor.