PDA

View Full Version : Tort Reform



Curtism
02-03-2011, 06:37 AM
Tort reform is one of the ideas Republican law makers have been promoting as a means to reform health care in the US. After reading around about it, I'm still not clear on exactly how it would work and what it would accomplish towards improving our health care industry.

Would anybody care to share their thoughts on this concept?

Waddie
02-03-2011, 07:04 AM
Curtism,
Tort reform was part of the Texas health reform and has been very effective at attracting doctors to Texas. I think it should be part of any health reform.
Basically it sets limits on punitive damages and on pain and suffering in some cases. It also addresses the problem of frivilous lawsuits. In some places it sets limits on the percentages a lawyer can charge the client, which can by as high as 50% of the award.
It does not limit real estimated lifetime costs of actual care for the aggrieved party.
So while you can get the full costs of medical treatment, lost earnings, etc., you may be limited to $500,000 in punitive damages instead of $3,000,000.
Insurance rates for doctors go down and they don't feel as much pressure to run expensive but un-necessary CYA tests.
This is the short version, but I hope this helps,
Waddie

Curtism
02-03-2011, 07:25 AM
Thanks, Waddie, that does help. I hear the phrase used a lot but not many details as to what it does or why it is, or isn't, a good idea. From you're description, on it's surface, it seems like a good concept. I look forward to hearing more about the pros and cons.

Ian McColgin
02-03-2011, 10:21 AM
It’s really hard to say what portion of malpractice suits are frivolous and what are sound - not all suits that are won are really that good a thing while most patients don’t begin to recover full damages, but we can turn to such journals as Health Affairs.

The September ’10 issue notes that all costs to the health care industry, including defensive medicine, cost about $55.6 billion per year (2008 dollars). Of all that, a whopping $5.72 billion per year gets to patients. And that’s not mostly going to plaintiff attorneys.

The way to be really rich in malpractice is to partner in one of those super firms that represent the big money - insurers, hospitals, you know, the money.

OK, $55.6 billion is a lot. But it’s only 2.4% of the national health care budget.

So, why so much effort to fix a problem that does not loom large in reality? Mainly to whip up some hysteria to prevent actual reform. And it’s working. Even otherwise smart docs fall for this crud. One doc I was talking with, very public spirited and works for a three physician ‘non-profit’ was griping about his outfit’s malpractice costs and comparing it to his after tax income . . .

OK, everyone sees how the numbers are false and that he should have looked at the malpractice as part of his total overhead, which includes office, staff, other docs, and conferences in Fort Worth. Would that they could see how the whole balleyhoo of "tort reform" is a manufactured issue.

TomF
02-03-2011, 10:52 AM
I'll say two things.

First, it's probably not a bad idea. I'm sure that it will reduce malpractice insurance rates, which will either affect overall costs ... or at least physicians' bottom lines. It would be interesting to see numbers, from where it's been tried (Texas?) showing how well such savings trickle down to consumers.

Second, it's not really addressing where the big spending is.

I led a workshop the other day on a budget-preparation topic. I commented that while $100k is always $100k, it's very different finding a 1% savings of $10M, vs. a 10% savings of $1M.

The US health care spend will not be substantially affected by the savings from such Tort Reform proposals, in relation to the big spends in the system. You'd do much better looking where those enormous proportions of the budget currerently go, and finding 1% and 2% savings there. Less pain, with almost certainly better results.

boatbuddha
02-03-2011, 10:59 AM
Most tort reform plans include strict limits on non-economic damages. For example say your wife is a housewife and she dies because of a doctor's mistake you may be limited to say 300,000 in damages.

FYI: The reason there are so many malpractice lawsuits in the US is because there's so much malpractice.

TomF
02-03-2011, 11:06 AM
One item alone will not reduce costs unlike a combination of a lot of things. Hanging over the heads of every single medical facility and their workers at all levels has one common aspect to it when it comes to costs and overhead. We hear a lot of people arguing that doing nothing is not the answer for providing healthcare while reducing costs. Tort reform is just one item that would be step in the right direction no different than passing the bill that many argue is a step in the right direction. But the pushback is from the very ones that reap big rewards from donations.;) Sound familiar?:dI agree that big savings will only come from a series of actions. Tort reform could easily be one of those. I'm just saying that there are other places where the same effort will probably yield more savings.

And yes, you'll get pushback from whoever will lose money. When money's "saved," what that really means is that money doesn't go into somebody's pocket. Those people will object.

Bruce Hooke
02-03-2011, 12:18 PM
LOL, the difference here is that you are unwilling to look at both sides in these discussions.

You seem to be pretty much ignoring the detailed information that has been posted on this thread that appears to me to make it quite clear that tort reform is not worth anything like the effort that is being put into it by many here in the US. You respond to detailed data with generalized, unsubstantiated comments.

wardd
02-03-2011, 12:21 PM
isn't it about what it saves the policy holder?

John Smith
02-03-2011, 12:46 PM
Thanks, Waddie, that does help. I hear the phrase used a lot but not many details as to what it does or why it is, or isn't, a good idea. From you're description, on it's surface, it seems like a good concept. I look forward to hearing more about the pros and cons.
The last time tort reform was a big issue, Bob Novak was a huge supporter of capping medical lawsuit awards at $250,000, as that was a lot of money. I contacted him and asked if he'd accept that limit as NET to the injured party, after expenses for the suit were paid. He ignored me.

I have a different view on suits in general. If the insurance companies are afraid of juries, they might consider offering something reasonable up front. How do you put a limit on a doctor making a mistake, or operating while drunk, and screwing us your child so he loses a leg? Maybe, if a doctor tends to get sued too often, and loses, he ought not be practicing.

This country has a hobby of second guessing juries. I wish we'd stop. We keep hearing about "frivilous" lawsuits. Try to file one. I had a screwed up vasectomy. NOt that it didn't work, but I was in paid and had problems for 90 days. I consulted an attorney. He advised me it wasn't worth pursuing, as I'd have to pay out of pocket for professional testimony, which is expensive.

Elsewhere, my aunt was knocked down by a WalMart employee. Broke her wrist. Walmart was extremely non cooperative. All she wanted was her out of pocket medical covered. She had to get an attorney. I expect it will cost Walmart more than her actual bills.

We hear soundbites on tv and draw opinions. Then we are angry with the jury verdict/award.

The ability to sue is one way to make sure more doctors are more careful, no?

Curtism
02-03-2011, 01:35 PM
Anyone wonder if Norman's "actual statistics" are from a "reliable source?"

Naturally the validity of Norms stats and sources, just as those anyone else provides, can and should be up for debate.

But in the meanwhile, do you have any thoughts on the topic you'd care to add, Donn?

Curtism
02-03-2011, 01:50 PM
The last time tort reform was a big issue, Bob Novak was a huge supporter of capping medical lawsuit awards at $250,000, as that was a lot of money. I contacted him and asked if he'd accept that limit as NET to the injured party, after expenses for the suit were paid. He ignored me.

I have a different view on suits in general. If the insurance companies are afraid of juries, they might consider offering something reasonable up front. How do you put a limit on a doctor making a mistake, or operating while drunk, and screwing us your child so he loses a leg? Maybe, if a doctor tends to get sued too often, and loses, he ought not be practicing.

This country has a hobby of second guessing juries. I wish we'd stop. We keep hearing about "frivilous" lawsuits. Try to file one. I had a screwed up vasectomy. NOt that it didn't work, but I was in paid and had problems for 90 days. I consulted an attorney. He advised me it wasn't worth pursuing, as I'd have to pay out of pocket for professional testimony, which is expensive.

Elsewhere, my aunt was knocked down by a WalMart employee. Broke her wrist. Walmart was extremely non cooperative. All she wanted was her out of pocket medical covered. She had to get an attorney. I expect it will cost Walmart more than her actual bills.

We hear soundbites on tv and draw opinions. Then we are angry with the jury verdict/award.

The ability to sue is one way to make sure more doctors are more careful, no?

Interesting that Mr. Novak didn't respond. It's those sorts of silence that make me wonder what the true meat of the matter is. Who's for it, who's not. Who has the most to gain and more importantly, who has the most to lose.

I completely agree with you, and others, who've stressed the importance of being able to sue. As it stands right now though, there doesn't seem to be much equality in who can afford to seek compensation and who can not. In cases such as you pointed out, the odds seem highly stacked against the individual who has to go up against large teams of very savvy law firms who specialize in these sorts of cases.

These are the sorts of things that have been on my mind and much of my curiosity on tort reform regards how it will affect the individuals who seek compensation.

Curtism
02-03-2011, 02:05 PM
It's not nearly as big a problem as some would make it out to be... and the problem is really one of malpractice, much more so that tort abuse. There have been a number of studies on the subject, but relatively few people bother to google any of them to read the actual results, since tort reform is primarily a political issue. For example, a tiny percentage of doctors are responsible for the overwhelming majority of malpractice suits... but owing to the intransigence of the medical community (who don't like to discipline their bad actors), doctors who commit malpractice are very hard to get rid of.

I suggest you google the studies, rather than to rely on bilge evidence. *snip

Thanks for the links and additional info, Norm. I'll follow up on that as time permits. As for "bilge evidence", it's not so much something I intended to rely on necessarily. I appreciate the wide variety of opinions that are offered up here at the bilge, and respect the majority of people who generally offer them up, including you. :)

I'm truly interested in what people really think about such topics and don't know of many places where one can find the sorts of back and forth that goes on here. Yea, some of you fellows sound like old married couples but, somehow, in between some of the bickering that goes on around here, there are many gems to be found. Those are what I'm usually after.

Bobcat
02-03-2011, 02:31 PM
The other issue that no one is discussing is the amount of medical tests and procedures done to cover the health care provider's rear end from a lawsuit when there's a bad result.

Eric D
02-03-2011, 03:19 PM
what I find extremely funny about this debate is how often the "other factors" get ignored. Sure dear sweet Aunt Betty is a lovable girl. Hell, she has loved everyone in a 5 county district. Turns out she has every STD known to man, disseminated gonorrhea that is causing all sorts of manifestations in her body. But nobody thinks that is her problem. She had the RIGHT by God to do that because she is an American. Now Betty also may have eaten her way up to a nice trim svelte 455 #. Normally she can get around just fine, her severe emphysema does not normally cause too many issues despite being on 4L of oxygen at all times but lately she has been doing lines of coke again which affected her nose which causes severe epistaxis (nosebleeds). So during the latest snow storms, Betty drops a few lines of coke, lights up the joint WITH the 02 in her nose, flash goes the 02 in her face, causing 2nd degree burns on her face, but actually 3rd degree up the nasopharynx and down into her trachea. I a flash of utter stupidity, she wildly thrashes around looking for something to sooth her face. She runs outside and trips down the stairs breaking her left ankle, rt knee, and fracturing her hip. She did manage to land full on her face like superman down the stairs and now there is question about whether her neck snapped or not. Obviously, she pulled off the melted 02 hose as she plummented down. So, her our lovely Betty sits, down in a heap at the bottom of the stairs, in the snow, naked, with no 02. 3 hours later, a street bum comes by and finds dear sweet Betty. Humanely he calls 911 for her using her own phone since the house is still open. He does rob her by the way, but at least he called the cops to help her.

Enter the medical services. How shall we start. Who gets her first? what does her code status say? no clue, no family,nothing on record. Guess she is a full code. She is hypothermic, hypoxemic, in and out of ventricular rhythms. Trauma surgeons get called in, the critical care pulmonologist is involved. They have her warming up, ventilated, on a host of pressors to keep her blood pressure up. CT of the neck shows swelling, may actually be broken, not quite sure, fractures are noted. Despite over 32 hours of very intense work by a huge staff of people and many very tired workers, poor, poor Betty dies. Family is finally there 2 hours after she dies. They are grieving, they are said. Damn it, she was so young, she was only 68. She should have been able to make 100 like her mother. They start getting pissed off, they decide to sue for negligence....

Enter tort law and enter malpractice costs.

7 lawyers turn down the family, but they finally find an ambulance chaser who is down on his luck and has not had a win in quite a while. He counsels them that it will most likely NOT work, but what the hell, he is damn near out of work so let's go for it!!! yeh, now the hospital and all associated have to "lawyer up" Costs start to escalate since it turns out the ambulance guys tried to roll dear fat Betty with only 3 guys, being the obese pig that she was, they struggled. They tried to hold her neck, hell they had her in a neck roll and even on the long board, but one of them slipped on the ice, wrenching his own back since she was such a load, maybe that had something to do with her injuries. Blah blah blah...on it goes.

Wether or not they win, cost, time, efforts all get wasted. Where is the accountability of the American people? Where is the common sense? hell, why did they spend that amount of time trying to save her? I am sure there is negligence somewhere, somehow, if only you look hard enough. I mean hell, the dopamine gtt should have been there in 2 minutes instead of 15 since the pharmacist did not dispense it quick enough, (granted they were in a CODE for someone else) and the nurse who was running for blood should have seen it was ready but since she was not on the unit, I am sure it was her fault.

Yep, damn it, negligence...Those damn doctors. Those greedy pigs. They are the cause of the price of all of this going through the roof. Norm, stop being an idiot. There is WAY more going on than selected statistics that you gleen selectively from the net. Sure most of them support your point of view. But this issue is way deeper than just pointing fingers at doctors. Socially, we are all conditioned to think that we can and should be able to do whatever, whenever we want with NO ILL conseqences. Guess what, our bodies don't work like that. Abuse over time wears things down and when they are broken, they don't always heal well. AND FURTHERMORE, give me **** protoplasm to work with in the first place, what the hell do you think you will get on the back side??? I am soooo sick and tired of people who are barely living, just scratching to hang on, coming in and DEMANDING, absolutely DEMANDING that I fix them, make their lungs better because damn it, this 02 is getting down right ANNOYING to them, they don't WANT to wear it, they just want to be able to smoke like they always did and NOT have to pay any consequences for their actions.

yep, it is all my fault. I made you do that. Live like that. Hell, I held a gun to your head. I lit the cigs for you. I stuffed them in your pie face.

Wake up, there are many, many good people who are trying like hell to help people despite themselves and then we get slapped by the same unrealistic families who demand to have Aunt Betty back.....

Oh, bet you are wondering, no, I have never been sued in 16 years....

John Smith
02-03-2011, 03:29 PM
Interesting that Mr. Novak didn't respond. It's those sorts of silence that make me wonder what the true meat of the matter is. Who's for it, who's not. Who has the most to gain and more importantly, who has the most to lose.

I completely agree with you, and others, who've stressed the importance of being able to sue. As it stands right now though, there doesn't seem to be much equality in who can afford to seek compensation and who can not. In cases such as you pointed out, the odds seem highly stacked against the individual who has to go up against large teams of very savvy law firms who specialize in these sorts of cases.

These are the sorts of things that have been on my mind and much of my curiosity on tort reform regards how it will affect the individuals who seek compensation.

The point I made in my communication with Novak was that $250,000 seems like an awful lot of money. However, when the lawyer takes his 1/2 plus expenses, and you pay your professional witnesses, you are not left with much.

I come from the school of thought that everyone is entitled to make an honest mistake, but he's also responsible to make good on that mistake. I read some years back that California had adopted tort reform, and a doctor accidentally amputated the wrong leg. The patient was elderly, and the tort system was set up that is age meant his problem wouldn't be with him very long, so his reward would be quite limited. The net result is that no attorney saw it worth while to take on.

We assume some risks in life. If we go skiing, and we break a leg due to our taking on a steeper hill than we should, or we capsize a boat, it is frequently just that **** happens, and no one is necessarily responsible. On the other hand, if we break our leg on the slope because of an unmarked and unseen hazard known to be there, or a doctor injects us with something we have clearly informed him we are allergic to, our recourse and our award, should we get one, ought not be limited by law. Suppose, for example, you're 16 years old, and your allergic reaction costs you your eyesight?

John Smith
02-03-2011, 03:31 PM
The other issue that no one is discussing is the amount of medical tests and procedures done to cover the health care provider's rear end from a lawsuit when there's a bad result.

How does that way against not performing a test that may well have been needed? One that having done may save a life?

Eric D
02-03-2011, 03:42 PM
The diatribe you presented is known in some circles as a 'cut bag'..... a contrivance defining the exception as the norm. We don't, as a rule, make national policy based on a 'cut bag'.

Norm, if only this was an exception. Out of the 20-30 patients a day I see, about 1/4 of them in one way or another fit this bill. You do not live in the trench, but yet seem willing to express how it is for those of us who do, so by all means, be glibe all you want, the bare truth is honestly out there. Give it time, within 20 years or less, the number of MD's or NP/PA's will drop (already are dropping) since it is no longer worth it in many people's eyes. Too much government intrusion and lack of personal accountability.

Cut bag, nice neat term, no, the way I understand how we make national policy is by bribes, backroom deals, and realizing who has pictures of you buying off your vote.

I'll leave you to drivel...

Bobcat
02-03-2011, 03:51 PM
I have been in the trenches, too, defending malpractice claims. Eric D's scenario is not far fetched in my experience

Ian McColgin
02-03-2011, 04:15 PM
The defense of "tort reform" mounted in this Forum has been remarkably free of total analysis and larded with anecdote. Remember that the ENTIRE cost of malpractice - payouts, defense, plaintiff costs, defensive medicine and all that - is about 2.4% of the national health care budget. You can't save much here.

Iatrogenic homocide (ok, preventable accidental negative outcome) it the eighth cause of death in the US. There are a number of states and some institutions like Deaconess Beth Israel that have figured out that total candor with the patient as to everything that happened had two side effects:

Openness, no cover-up, enables physicians to learn from their own and other's mistakes, reducing the absolute problem; and

A candid apology straight up has the statistical effect of lowering the negotiated pay-out.

In short, the solution that deals with the problem - malpractice - rather than the false and hysterical claim that greedy lawyers drive up the costs is the cost effective way to go at this.

I know a few shysters, by the way, and they are every bit as evil scumsuckers as their medical industry counterparts. I know more attorneys who represent defendents and plaintiffs who are perfectly honorable but who, being themselves deep in the system, can't step back from their experience to see the objective picture.

Concordia 33
02-03-2011, 04:21 PM
It's not nearly as big a problem as some would make it out to be... and the problem is really one of malpractice, much more so that tort abuse. There have been a number of studies on the subject, but relatively few people bother to google any of them to read the actual results, since tort reform is primarily a political issue. For example, a tiny percentage of doctors are responsible for the overwhelming majority of malpractice suits... but owing to the intransigence of the medical community (who don't like to discipline their bad actors), doctors who commit malpractice are very hard to get rid of.

I suggest you google the studies, rather than to rely on bilge evidence.

For example:

www.centerjd.org/archives/issues-facts/2010PatientSafetyF.pdf (http://www.centerjd.org/archives/issues-facts/2010PatientSafetyF.pdf)

^ (http://en.wikipedia.org/wiki/Medical_malpractice#cite_ref-14) Faulty Data and False Conclusions: The Myth of Skyrocketing Medical Malpractice Verdicts (http://www.commonwealinstitute.org/cw/files/CI-MedMalpracticeReport-Oct2004_0.pdf),

GAO-03-702 Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates (http://www.gao.gov/new.items/d03702.pdf)

There was a huge study on the issue done at Harvard, but I can't put my finger on it, at the moment. However, from a 2006 press release, here are some of the study observations:


First of all I read the first study you listed, and it uses actual court filed law suits as its measure, and that fails to capture the larger percentage of nuisance cases that get settled out of court, because the settlement is cheaper than the cost of defending your innocence - these types of suits often go unreported and are invisible. But more importantly, if tort reform would not help that much, and if it would make the GOP feel that they get something that they want, why would you oppose it? For the one innocent party that has to defend themselves against an unjust claim, tort reform might give them a redress.

For example, one version of tort reform does not limit the circumstances of the dollar amount of the suit, but rather states that the losing side pays the court costs of the winning side. If I know I am innocent, and I can recoup my legal fees when I prevail, I am much more willing to pay my lawyer to defend me versus a settlement that will be cheaper, conversely, a lawyer that is representing the plaintiff on contingency would never file a nuisance suit, because when they lose, they get nothing, and their client will be on the hook for the defendant's legal fees. Even if you are right (and you are not) that nuisance suits are a small part of picture, it will still discourage those suits as well as to encourage a malpracticing doctor to settle their suit swiftly to avoid the legal fees over and above the settlement. Ultimately malpractice suits cost us all - Orthopedic surgeons and OB/GYN specialists have malpractice insurance in excess of $100,000 per year the cost of which gets passed along to the consumer.

Concordia 33
02-03-2011, 04:36 PM
And it's a pleasure to meet you, too, Eric! :)



The diatribe you presented is known in some circles as a 'cut bag'..... a contrivance defining the exception as the norm. We don't, as a rule, make national policy based on a 'cut bag'.

That's interesting that you would say that Norm as you gladly trashed a map on Fox News 2 days ago. Are you saying that all of Fox News' middle east maps are bad, or are you guilty of a 'cut bag' too. I agree that the example was highly contrived, but it explains the complexities that you oversimplify. I do not think that any reader assumed that that was representative of the entire medical or legal community.

Concordia 33
02-03-2011, 04:49 PM
No, I think what I was saying is that Fox News is demonstrably incompetent, on a highly frequent basis, in terms of ordinary journalistic standards. This does NOT mean that other networks don't falter from time to time.... just that Fox News does it far more often.



I'm sure nobody thought it was, either.... but you can't make a coherent case on policy on the basis of anecdotal example. There's 10,000 times more information available, on the tort reform and malpractice subject, which is competent analysis. The only thing I can conclude from a 'cut bag' is the sentiment of the person posting it.... it doesn't, and shouldn't, affect how I feel about a VERY complex issue, with lots of data to make a judgment.

What a shame that your information did not contribute to clearing it up.

I stand by the 'cut bag' remark until you contribute to criticizing the inaccuracies of the entire news industry. 'Highly frequent basis'? do you have any industry studies to support that or is this just bloviating because someone dares to disagree with you?

Ian McColgin
02-03-2011, 05:02 PM
The reason I like arguing from the fact that this is all about what's barely 2.4% of the national health budget is that it does not really matter exactly how many good claims are squashed versus how many times Bernie the Bump collects.

2.4% is not the driver. Until the people shilling for the corporate/medical corporations stop misleading people, we'll only go around and around the rat track they have laid out to keep us from bringing health costs into line.

Ian McColgin
02-03-2011, 05:56 PM
erster, like most apologists for "tort reform" regales us with anecdots of high malpractice rates - and there are some high rates out there - but slouches past the total malpractice bill - payouts, insurance premiums, industry wing tips, all of it - is but 2.4% of the total health care bill for our nation. Even if half of it's wasted, which no one claims - you'd save at best about one penny on the health insurance dollar.

Iatrogenic death remains the eight leading cause of death in the US. Note this does not include people who were unambiguously dying anyway. Just death caused by medical proceedure, not the underlying complaint.

wardd
02-03-2011, 06:06 PM
did tort reform lower premiums and improve health care quality and access in texas?

Ian McColgin
02-03-2011, 07:06 PM
I am not sure I get Donn's point. Medicaid and Medicare providers and be and are sued like anyone else. The costs of payout, premiums and all are in the total.

rbgarr
02-03-2011, 07:15 PM
Here in Maine it's difficult to find OB/GYNs. Malpractice insurance, as I understand it from one woman who closed her practice (for a number of reasons), is largely so expensive because there are two patients who may bring suit: the mother and the child.

Gerarddm
02-03-2011, 08:32 PM
It's a sop Obama is throwing to the Republicans nothing more. They hate trial lawyers because as a group they tend to give more campaign cash to the Dems ( think John Edwards ).

So-called tort reform won't move the needle of ballooning health care costs. This will: kill the law that forbids the gov't to negotiate for lower drug costs for Medicare.

Waddie
02-03-2011, 09:34 PM
Gerarddm,

Why don't we so both...have tort reform AND let the gov't negotiate for lower drug costs? Real reform would include both Democratic and Republican ideas.

regards,
Waddie

ljb5
02-03-2011, 09:50 PM
I haven't had a chance to read the whole thread yet, but I'm wondering if anyone has brought up the Seventh Amendment yet?

Anyone?

Ian McColgin
02-03-2011, 11:07 PM
Donn still leaves me confused. Doctors and hospitals paid my Medicaid or by a private insurance company getting it's money from Medicare are subject to malpractice suits. Just because you get government aid to pay a private physician does not remove from that physician any liability.

Canoeyawl
02-03-2011, 11:20 PM
CT of the neck shows swelling, may actually be broken, not quite sure, fractures are noted. Despite over 32 hours of very intense work by a huge staff of people and many very tired workers, poor, poor Betty dies.


32 hours and you don't know if she has a broken neck???

SMARTINSEN
02-03-2011, 11:43 PM
Take M&M (include their share of malpractice expenses, or not, as you wish) out of the equation.

What is the % of the adjusted health care expense contributed by malpractice expenses?

3.6% by using the estimate that Medicare and Medicare represent about 1/3 of total health care costs and not making any adjustment for malpractice expenses and accepting Ian's 2.4%. What is your point?

Source (https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp)

Medical malpractice and tort reform is part of the problem of spiraling health care costs, but it is not a big part of the problem.

Gerarddm
02-04-2011, 02:12 AM
Waddie: OK.

peb
02-04-2011, 07:11 AM
Medical malpractice and tort reform is part of the problem of spiraling health care costs, but it is not a big part of the problem

Like building a jigsaw puzzle, you always build the outside edges first. The outside edges are part of the problem, but not a big part of the problem. But they are the easiest piece of the puzzle to solve, it makes no sense not to do it.
Besides, the other day we learned that $9B a year savings from ObamaCare was important to the national deficit, so I think $56B/year should be a big factor.

Eric D
02-04-2011, 12:57 PM
norm, malpractice requires INTENT to harm, often very hard to prove.

I like that you compared me to Erster, I will take that as a compliment.

He is right, I don't have time to sit on here all day feeding the bilge full of rants, just what do you do for a living? Who is paying your salary.

Ian, iatrogenic dealths.....love statistics. They can be very misleading especially in todays morbidly obese society where there are millions of people who do not take basic care of themselves. we can haggle on this all day.

Canoe, sure, seen it happen a few times. Ever been in the ER when someone is actively trying to die? Wether or not you fractured a neck is less of a concern if your head is strapped down than having your heart stop or breathing fail. Triage rules ignore those issues while trying to save the life of the patient. Seen once case which I was using as reference, large guy, wheelchair bound, 300+, tipped the wheelchair over, subluxating he neck, and putting the head in a full extension with his own weight coming down ONTO his head with the weight of a motorized wheelchair coming DOWN onto his neck as well. Middle of winter. Newspaper guy found him the next morning, figure he was in the snow bank for 5 hours. Hypothermic, 85 degree core body temp, frostbitten, arrhythmias all over the place. Inital CT of the neck was questionable because of the soft tissue swelling associated with the strain on his neck and the C collar he was in. Standard proceedure is leave it, act like it is broken, reassess in the morning or next day when the swelling is hopefully down and the pt is stable. Side note, when the neurosurgeon took off the collar to assess his neck, his jaw relaxed, collapsing his throat. He went into immediate respiratory arrest. Code called, 4 gas guys from OR were all unable to intubate because of the massive swelling, surgeon arrived, trached him on site. Huge mess, guy was so fat and then add the swelling from his own weight and the chair being on his neck all night. In the end, family withdrew care......he was only 32.... so who's fault was it? the kid who was hammered and drove his wheelchair off the ramp into the snowbank? the neurosurgeon who was following protocol of the best practice? the gas guys who could not intubate? how about the surgeon who trached him? I mean hell, it was somebodies FAULT RIGHT???? I suppose you call that iatrogenic and add his number to the stats....

this issue is truly deep. Health care costs are out of control on so many levels. The malpractice ins is part. The tort crap is part. The need to do heroic measures on 87 y/o stage 4 cancer patients is part. You eating at Mickey D's is part. Rampent Diabietes is part. Huge influx of Medicaid patients in the last 3 years is part. You wanting your dividends on your 401 K plan are part. You want to invest in GE since they bring good things to light, but they charge the hospital 5-10 mil for the new ct scanner, why not only 1 mil? they need a profit. So the hospital needs one to pay it off and on and on it goes.

Have a good weekend all, I have patients to see.

boatbuddha
02-04-2011, 01:26 PM
Here in Maine it's difficult to find OB/GYNs. Malpractice insurance, as I understand it from one woman who closed her practice (for a number of reasons), is largely so expensive because there are two patients who may bring suit: the mother and the child.

A more likely explanation is that after incurring 100-150K in education expenses they discover they can make a lot more money in Boston than Maine.

boatbuddha
02-04-2011, 01:28 PM
norm, malpractice requires INTENT to harm, often very hard to prove.


That's simply not true. You learn your in your first year Torts class that the elements of malpractice are duty, breach, injury and proximate cause.

Bobcat
02-04-2011, 01:37 PM
Hmmm...would you trust a doctor who doesn't even know what the legal definition of malpractice is? :):)

Wow, what a cheap shot.

Concordia 33
02-04-2011, 01:42 PM
Hmmm...would you trust a doctor who doesn't even know what the legal definition of malpractice is? :):)

Hmmmm.... I wouldn't trust a lawyer that doesn't know the definition of Malpractice, but I prefer that my physician know the practice of medicine more than the practice of law.

Bobcat
02-04-2011, 01:52 PM
Not at all. Imagine a doctor who believes that he's protected against the sorts of misjudgments that might result in a malpractice case.... because he thinks he's immune from malpractice because no one can prove 'intent'. Sorry, but that isn't a doctor I'd care to become a patient of.

It's still a cheap shot, not matter how you dress it up. There's no need to personally attack those that disagree with you.

Eric D
02-04-2011, 02:26 PM
If intent IS proved, it's a criminal felony.... but malpractice does NOT require intent.




excuse me, this is what I was getting at, I was distracted with my job while trying to type. the felony issue is what I was alluding to with intent.

I can assure you, we all get classes on this as we go trying to avoid malpractice.

bobcat, thanks for the comment, Norm does not bother me one way or the other.

Notice he selectively responds to things posted to him.

good day.

Bobcat
02-04-2011, 02:32 PM
excuse me, this is what I was getting at, I was distracted with my job while trying to type. the felony issue is what I was alluding to with intent.

I can assure you, we all get classes on this as we go trying to avoid malpractice.

bobcat, thanks for the comment, Norm does not bother me one way or the other.

Notice he selectively responds to things posted to him.

good day.

No worries. I have noticed the selective responding.

I used to pay attention to what Norman posted but I found less and less worth reading. I won't read his stuff at all now. He has no credibility in my eyes anymore.

Canoeyawl
02-04-2011, 04:27 PM
http://www.newyorker.com/images/2011/01/31/cartoons/110131_cartoon_046_a15625_p465.gif

Waddie
02-04-2011, 06:13 PM
The Eric D. explanation of why health care costs are spiraling upward is spot on.....exactly correct.

P.S. I don't think most medical people give malpractice a thought when they are delivering care--at least I hope not.

regards,
Waddie

Ian McColgin
02-04-2011, 09:25 PM
Judging from his writing here, Eric D is learning medical reasoning with examples like "excuse me, this is what I was getting at, I was distracted with my job while trying to type. the felony issue is what I was alluding to with intent." [#73] Glibly sliding past a blatent error is an important part of physicians maintaining their auroa of omniscience. We hope that he approaches medical errors with more courage and candor than this.

Curtism
02-05-2011, 05:59 AM
Thanks for all the replies so far, folks. Between the discussion here, and digging around on the net, I'm starting to see just what a complex issue this is and it's pretty clear that this has been, and will continue to be yet another wedge issue for the various sides to haggle over. Part of my initial query stemmed from the fact the Republicans lawmakers mention tort reform, as it pertains to the health care industry, practically every time they get in front of a TV camera. And yet the Democrats, both in on-camera interviews and during the recent health care debates, seemingly steer clear of any mention of it.

What a bear trap of an issue this is for those who are in a position to work out some of the problems inherent in our current health care system, and now I'm wondering if it's something our lawmakers can actually reach any sort of consensus about, let alone actually come up with any real resolutions to. Or, is it simply being used as one more political line in the sand, something to keep the divisions between the various interests deep and wide. Do they really want to tackle the issue or is it yet another item to distract from the larger problems within our health care system? Is it perhaps one more issue for the two major party's to incorporate whenever thy need something to distract us from the larger problems we face as a nation?

Of course, these are all rhetorical questions but my cynical nature tells me that it is just another slat in the political fence that our leaders have built.

The one thing our system of government has been extremely efficient at is finding ways to keep the citizens divided along party lines from one another. Until I find further evidence to the contrary, at this point, I feel that "tort reform", as significant or necessary as it may be, is being used as yet one more catch phrase to keep those divisions deep and wide. Our current state of affairs are the way we find them for one primary reason though. It's because we keep letting them get away with it by not demanding better from them, and from ourselves as citizens. Sad as that may be, that's my take at the moment.

Curtism
02-05-2011, 06:33 AM
Norm, thanks again for the links you posted early on. The GAO report was particularly interesting and informative. One part that jumped out at me was where they were talking about the huge variations in medical malpractice costs from state to state. Of course Florida, yet again, was one of the examples of how out of control some of the rates have become, particularly in the Miami-Dade area. What would cost around $10,000 in Minneapolis is $180,000 in Miami and the rest of our state pays approximately $89,000 per year. I wasn't too surprised to see Florida on the butt end of that joke but, what the hell is up with that?

Like any of these sorts of questions I usually find five answers, and that ordinarily leads to twenty new questions. At least, that's the way it's been with this topic.

Some additional info I happened upon was at the website for ATRA. I found the 'about' page with their mission statement interesting, particularly the sample membership list. While incomplete, the partial members list they provided were quite telling in terms of who has been supporting their efforts. Not much of a surprise there really.

Links here:
http://www.atra.org/about/

http://www.atra.org/about/members.php

Curtism
02-05-2011, 07:04 AM
. . . this issue is truly deep. Health care costs are out of control on so many levels. The malpractice ins is part. The tort crap is part. The need to do heroic measures on 87 y/o stage 4 cancer patients is part. You eating at Mickey D's is part. Rampent Diabietes is part. Huge influx of Medicaid patients in the last 3 years is part. You wanting your dividends on your 401 K plan are part. You want to invest in GE since they bring good things to light, but they charge the hospital 5-10 mil for the new ct scanner, why not only 1 mil? they need a profit. So the hospital needs one to pay it off and on and on it goes.

Have a good weekend all, I have patients to see.

Eric, thanks for adding your perspectives here. I don't imagine in your trade, particularly in that area, that you see very many fit, healthy folks in your office from day to day. Wisconsin is known for dairy and beer production and the lobbies that support those industries are obviously quite powerful there so it's easy to imagine that guys like you probably get to see the worst of the worst cases, and all too often I suppose.

I have family all scattered all over your state, some of them work in medical/insurance fields, and I'd bet if I were to ask, they would reinforce much of what you've expressed on this thread. However the vast majority of the people I know from there are hearty, healthy, outdoorsy, hard working folks who probably eat better than people in most other states. I guess what I'm getting at is, that which you see would depend largely on where you are looking.

Lazy Jack
02-05-2011, 08:26 AM
Iatrogenic death remains the eight leading cause of death in the US. Note this does not include people who were unambiguously dying anyway. Just death caused by medical proceedure, not the underlying complaint.


As an 'iatrogen' myself, I'm rather curious as to the source of that statistic??

Rich VanValkenburg
02-05-2011, 08:44 AM
It happened here in Michigan about 15 or 20 years ago and was a pet project of a governor who had both a power complex and a mission to help his rich doctor friends.

A few years ago some of you might remember a little problem I had that put me in the hospital. They thought they saw a tumor in my heart and excavated my chest to hack it out. There was nothing there when they opened me up and I lost the best job contract I'll ever have from what I surmise was a perception of lack of stamina and concentration. But because of Michigan's tort reform, I never saw a dime of compensation. It took over a year for me to feel normal again.

Attorneys were excited about my case but the restrictions that Michigan's tort reform placed on them made it impossible to press.

George Jung
02-05-2011, 09:24 AM
Like building a jigsaw puzzle, you always build the outside edges first. The outside edges are part of the problem, but not a big part of the problem. But they are the easiest piece of the puzzle to solve, it makes no sense not to do it.
Besides, the other day we learned that $9B a year savings from ObamaCare was important to the national deficit, so I think $56B/year should be a big factor.

Nice summation, and an obvious answer. What's interesting is how tort reform has been viewed (here, at least) as an untouchable. It's like some think that, unless you can come up with a single change that will have a massive effect, it's just not worthwhile. Most problems are a summation of several small problems. It only makes sense that a solution will be a summation of multiple small solutions.

George Jung
02-05-2011, 09:32 AM
Hmmmm.... I wouldn't trust a lawyer that doesn't know the definition of Malpractice, but I prefer that my physician know the practice of medicine more than the practice of law.


Yer good! I'm playing catch up in this thread but.... spot on.

Norman, docs don't study law/malpractice; they study medicine/best practices. Unfortunately, along comes real life, and Eric provided a realistic scenario. And I'd be curious - did anyone here feel malpractice occurred in that instance? I'm sure that statistic was listed as iatrogenic; do those here agree?


edit: still playing catch up. I see Eric is educated re 'malpractice'. Must be a darned kid! I don't recall much devoted to it, just asides on various issues.

Norman, for the most part, is alright. He zings occassionally (who doesn't?) but if you look at some of the other threads, he's a perfect gentleman compared to many. I've been tarred and feathered recently, pretty nasty things said. Some folk can't spin a lucid, articulate argument, and devolve into character assassination. Normans not one of them. But not to let you off the hook. What about:



How can I reaspond to anecdotes? For each and every anecdote, there's a contradicting one.


If we followed that, there'd be no bilge.

George Jung
02-05-2011, 09:40 AM
Judging from his writing here, Eric D is learning medical reasoning with examples like "excuse me, this is what I was getting at, I was distracted with my job while trying to type. the felony issue is what I was alluding to with intent." [#73] Glibly sliding past a blatent error is an important part of physicians maintaining their auroa of omniscience. We hope that he approaches medical errors with more courage and candor than this.

Now, you take that exoneration I just aimed near Norman?

Here's a counter example. Ian, you are such a pip!

George Jung
02-05-2011, 10:00 AM
I dunno, Norman. Invoking Ians' snide remark does little for your case, and most assuredly will cost you the sympathy vote....

I don't know where Eric is posting from. For all we know, he may be adding his .02 during the middle of a trauma case - and where would you want his attention more focused, were it your trauma? It's reasonable to give him the benefit of the doubt. Right?

I have always kept the spector of 'malpractice', however you want to define it, in the back of my mind. I literally have a work, and an off-work, personna, and my friends/family definitely notice the difference. I'm very focused at work, gain is turned up 'full', and I'm single-minded in what I am doing, esp. for trauma/serious illnesses. I've had the privilege of working with a lot of different docs over the years, and that characteristic is, maybe, universal. But I don't practice differently because of that spector, I just realize, esp. in the very ill, that my families livlihood is also on the line. You folk look at a malpractice suit as an inconvenience for the doc, when most of us would (or have) found it devastating/life changing. And despite the catcalls that 'malpractice docs' continue to practice, aren't reined in, that's not been my experience (with one exception). Get sued? Rates go up. Repeat offender? Can't get (or afford) insurance.
Another aside - I've never been successfully sued, despite delivering over 1000 babys in the highest risk population in the state (perfect outcomes), but I've had suits filed, and not pass muster. Those filed were, without exception, meritless. But I have had outcomes where, despite my best efforts, mistakes were made. Not one of those, which might have progressed, were ever filed. Patients (most, anyway - Ian may be the exception) know docs aren't perfect, and mine appreciate my efforts and intent.
What I know of the variance in insurance rates relates to the stance various states have taken on tort reform. Midwest states are more doc friendly, and those I'm familiar with allow suits, but have laws that limit the more egregious ones. I don't recall which east coast state that, a few years ago, had legislation that was basically open season on Ob docs. They all, essentially, left the state, with none left to perform deliveries. 60 minutes had a story on a county in some SE state that basically treated malpractice suits as their lottery, openly admitting it was an easy way to extract money from 'those rich docs and insurance companies. they can afford it!', with the same outcome - all the docs left.

So there's a middle position, most would do well to consider.

George Jung
02-05-2011, 10:17 AM
I'm not that impressed with Ob's delivering babys, truth be known. One of the reasons we have such a high c-section rate is convenience - often the Obs'. Or inductions, performed unnecessarily and outside of protocols, also for convenience. Darn kids tend to be born about the same time of day they're conceived. I'd prefer family docs doing the deliveries, but.... midwives seem to be what folks want.

And we often get what we wish for.

Ian McColgin
02-05-2011, 10:48 AM
George Jung is reading a bit much into my writing. Eric has every right to be mistaken. He is an adult and should be responsible enough to say he was wrong, rather than gloss it.

I've either had a small part in or observed at close range a number of investigations where an issue of personal error was one potential cause. These include airplane crashes, boating accidents (including one happily contained oil spill I caused), malpractice claims against physicians and attornies, and excessive force complaints against police officers.

Even as something happens, as an awareness that it's going badly comes upon one, all the reasons why it was some other fault also spring to mind. Human nature. Nor does the attitute of the person towards accepting or rejecting responsibility make much difference. One physician I did some background on was incredibly difficult to get the straight story out of - same 'blame someone or something else' bit whether he was right or wrong. I had to dig very deeply and very hard to establish that the outcome was firstly not so bad and secondly not a matter of malpractice.

(More later. My physical terrorist has just arrived.)

George Jung
02-05-2011, 10:54 AM
You'll be surprised to hear I agree, almost entirely , with you, Norman.

And it's only my perspective, but I've always thought a board for mediation would be a fair, and reasonable, option. More funds would go to the injured party; the financial incentive for frivolous lawsuits would be gone (and trial lawyers could make their nation-leading PAC donations for a new 'cause'), and I believe it could be more fair. I also suspect more malpractice - prone docs would be disciplined, though truth be known, for those docs so inclined, I don't believe their practice 'habits' can be changed. They simply shouldn't be practicing. Docs don't practice good medicine for fear of being sued. They practice good medicine, because that's just what they do.

edit: Erster - outdated drugs? I don't understand.

Ian McColgin
02-05-2011, 12:36 PM
Carrying on with my thought - I'd mentioned in my book review of "Being Wrong" the Deaconess Beth Israel example of dealing with negative outcomes. There and elsewhere it was found that total no bull candor, even when the mistake was very bad like operating on the wrong leg, beats any form of "tort reform" for a couple of reasons.

- There's nothing like a come clean apology and a stance of what it takes to fix this to calm the patient. This is especially the case if the medical provider is clear that nothing in that interchange is about signing away or reducing rights to compensation. Candor does, objectively proven, reduce the total malpractice bill but it's not a quid pro quo. The candor and the look down the road to whatever might be involved in setting things as right as possible are in a profound sense a one-way duty from the provider to the patient. At the end of all that, some patients may still call Attorney Suckitoff (You hurt. Someone should pay.) And that's the way it goes.

- An environment where professionals are candid with each other and with patients is an environment where mistakes are reduced by people looking clearly at how things work.

Some of this candor helps in advance. Prior to the neurosurgery last week, my doc was very clear about risks, including the perhaps 10% risk he'd nick the neural sheath. He gave me the number of this operation he'd done and how many times it happened. He told me the consequences. He explained the treatment. I was an eyes wide open part of the risk assessment. These are all part of a good physician/patient relationship.

That attitude extends to other professions. As a rigger, charter captain, tug mate, and delivery captain I have a certain level of professionalism to live up to and I can certainly make mistakes, like crunch a dock or something. I'm not about to force my clients to find such things on their own. Rather the whole log is available, including any damages and repairs.

Part of being human is being wrong. Part of being adult is taking the responsibility. In the case of "tort reform", the solution to this 2.4% of our national health care cost is not gimmicks to limit recovery. The solution is the integrity to deal with facts up front.

Edited to add: During the most tension-filled times of my work in health care access, when physicians were openly saying at public meetings that if forced to help the poor they would inevitably provide second level care to those who couldn't pay, I had no hesitation about getting treatment from a doc with whom I had some huge and on his part bitter policy arguments. Army docs can treat enemy wounded every bit as well as our folk, after all. I've not seen an example of a physician who would sabotage a medical procedure to make a political point.

George Jung
02-05-2011, 12:42 PM
For those with solutions re: 'Tort reform', I'd point out that your opinion, and your perspective, is

definitely informed by which side of the effect you're on.

The ox doesn't think so highly of 'being gored' as does his antagonist.

Ian McColgin
02-05-2011, 12:52 PM
I'm not so sure that one's perspective on "tort reform" is determined by whether one is in the health care industry or not. I know too many physicians, clinic and hospital administrators, and actuaries who view it as a distracting non-issue.

Bobcat
02-05-2011, 01:08 PM
The current tort system does not promote good medical decisions. Litigation in general is an expensive and poor way to settle disputes. That is especially true in the area of medical judgments, which are at the heart of almost any malpractice case. We need wholesale reform of the tort system. The solutions generally proposed such as limiting damages are band aids at best.

George Jung
02-05-2011, 01:18 PM
I hadn't read the entire first page, until now.

And caught this: "Iatrogenic homocide" by Ian.

That's absolutely amazing. You do realize you've managed to cut your own legs out from under you, correct?

But that's okay.

Iatrogenic. Or maybe 'Iantrogenic'

Ian McColgin
02-05-2011, 01:55 PM
I am so sorry that people like Mr Jung are thrown by their assumptions about the term "iatrogenic homicide." It's simply a more negative outcome than iatrogenic disease or iatrogenic injury.

As Mr Jung may not know, homicide is simply one person causing another's death. It's by no means always a criminal matter. For example, absent some extra showing of intent or negligence or such, if one accidentally discharges a firearm and kills someone, that's an accidental homicide.

But, if the correct term is to be anyone's excuse for not looking at the issue, let us try simply iatrogenic death.

George Jung
02-05-2011, 03:16 PM
iatrogenic homicide. I 'looked it up' and was mildly (only mildly) surprised there was no such listing - except in the context of a homicide (murder, in the instances noted) with a suspicion of an iatrogenic etiology.

It's not 'simply a more negative outcome from iatrogenic disease or... injury', as Mr. McColgin has implied. It is at worst prejorative, at best prejudicial, and is the very intent our own Ian had in mind.

Honestly, you do yourself no favors with your linguistic contortions. That you bring a certain prejudice to this topic comes, I'm sure to most, as no surprise. The exchanges are sufficiently virulent without resorting to hyperbole.

And btw, your condescension is on full display, and in fact is blinding. Try subtlety for a nice change of pace.

Ian McColgin
02-05-2011, 04:11 PM
I am sorry that the term I thought neutral turns out not to be to at least one - likely more - reader. It's wrong to use a term understood to be inflamatory unless one wants to inflame, and I don't. Please allow me to identify the various forms of physician (and health care in general) caused death as iatrogenic death. As those who've searched the literature already know, most forms of iatrogenic death are neither deliberate nor especially negligent since the term covers everything from a reaction to anesthesia to infection as well as errors - not always foreseeable - in proceedure.

Iatrogenic death is believed to be wildly under-reported, which is easily understood since if one knew that doing whatever would cause death, one would not do it.

So please, accept my apology for an inflamatory term. It not only does not advance the discussion, but it's been such a positive reason to swing wide of the goal - discovering whether "tort reform" can have a meaningful impact on our national health costs, that the only reason for using it deliberatly to piss off anyone would be if I did not want meaningful health care cost control.

Accusations and assumptions abound down here without my adding to them. I apologize.

George Jung
02-05-2011, 04:44 PM
Me?

Ian?

Both? Maybe.

I appreciate the extension of courtesy, Ian.

Lazy Jack
02-05-2011, 04:55 PM
Naw, lets not keelhaul anyone...

In my mind, Iatrogenic death = Michael Jackson. A patient who suffers a complication while undergoing medical/surgical intervention in accordance with established guidelines and ultimately dies as a result = not 'iatrogenic homicide'. For example, if an otherwise healthy trauma victim is admitted to an intensive care unit after undergoing aortic root repair and stabilization of multiple rib fractures and suffers a rip roaring pneumonia as a complication of prolonged intubation and dies as a result...I wouldn't consider that 'iatrogenic homicide' as he couldn't have survived if doctors had NOT placed the tube. If doctors elect not to treat him at all because he is high risk of dying while under their care, and his damaged aorta ruptures and he bleeds out...would that count as iatrogenic homicide?

Still intrigued by that '8th most common cause if death' statistic you quoted...what is the source, and what constitutes an iatrogenic death?

Ian McColgin
02-05-2011, 05:48 PM
The journal articles that I read all turn out to point to these two studies, which I’ve not read. They believe that it’s all a gigantic underestimate, but the efforts to correct for the under-reporting are a bit like correcting Iraqi deaths - and we all remember the drubbing (no actual numbers rebuttal but drubbing) the the British Journal of Medicine (correct publication?) got for that.

Understated as they are, these two are controversial. They are the only solid studies since there is some concern as to what NIH would find if commissioned to look at the question anew.

Quality Interagency Coordination Task Force. Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact. Washington, DC: Agency for Healthcare Research and Quality, 2000.

Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.

MiddleAgesMan
02-05-2011, 07:06 PM
...his overhead, with all the billing people, is substantially higher.... and those folks would be largely unnecessary, in a universal single payer environment.



This statement deserves repeating: While the reps and dems argue about the merits of tort reform, the huge savings to our overall health care expense that would come with single-payer "universal health insurance" is ignored.

Thank you, Norm, for slipping that in.

George Jung
02-05-2011, 07:16 PM
I think everyone knows that, and it's been expressed multiple times, previously, perhaps even in this thread.

The point has also been made that there's no reason, nor prohibition, for not looking at the entire cost of care, and addressing any/all expenses that might lower costs. We may or may not get singlepayor. While that issue is being pursued, we can multi-task, and look at other options. This thread is considering tort reform.

Ian McColgin
02-05-2011, 07:36 PM
The reasons that I counter (rather repititiously) that instead of "tort reform" we should be pushing for open, candid communication is three-fold:

"Tort reform" is really a 'blame the lawyers' diversion from very real needs for reform in and greater attention to medical proceedures;

The openness that leads to a clear and unreserved apology and corrective action, no mealy-mouthed morphing of error into "unaticipated outcome", untied to any promice from the patient not to sue, in actual practice has been show to create an environment where patients are less likely to sue or sue for so much. Like half off!!

The public nature of error discussions leads to a greater level of consciousness on the part of medical personnel, leading to an absolute reduction of errors.

So rather than fail to attack a mere 2.4% of total budget, this method actually addresses the total amount of medicine to be done, creating savings in a whole new dimension.

So, I'm not interested at all in "tort reform" as being mooted as it only makes things worse. Rather, I favor what might be called "preventative reform" which is really little more than rewarding the practice of good medicine.

George Jung
02-05-2011, 10:12 PM
And that's where we disagree.

The 'openness policy' is already in place, and recommended by the medical societies. Note that recommendation is not a legislative one, including your take on it.

The public discussion et cetera - likewise.

As far as tort reform - that has many various incarnations other than 'blame the lawyers', Ian. Sheesh.

And if those reforms lower total costs yet provide for those injured, how can any reasonable person be against it? (You can't)

In fact, only those who felt their golden goose was about to be plucked would raise much of a fuss.