The Extremeskins health care town hall.

[PeterMP]

Tort reform was first implemented in the 1980's. As a result, medical malpractice premiums and payments to injured victims has declined severely. However, health insurance costs have continued to sky rocket.

Malpractice insurance premiums rose rapidly until the 90's and through the 90's in many cases (and in some cases still are). Health care costs growth accross the board has slowed in many cases in this country and appear as if they are going to continue to:

http://seniorjournal.com/NEWS/Medicare/6-02-22-RateOfGrowth.htm

"The 7.4 percent growth rate is 0.5 percentage points less than the 7.9 percent growth observed in 2004 and represents the third consecutive year of decelerating growth and is expected to continue in 2006."

http://findarticles.com/p/articles/mi_m3495/is_10_53/ai_n30912241/

For 2009:

"This represents the lowest increase since the study began in 2001, with cost rises remaining in double digits but slightly lower than one year ago."

(They are using different metrics so the 2009 report has it in double digits, while the 2006 one doesn't.)

I will point out, I have posted previously that we see the samething with prescription drugs. Drug prices (for individual drugs) are now increasing at a rate slower than inflation (I think like 1.8%), but total drug costs aren't (I think 8.1%) because more people are using more drugs.

[LaxBuddy21]

7. Tax the rich at a higher percentage than the rest of the tax payers to pay for it all. ;-) just seeing who is actually paying attention.

Um no! How about we just ensure that the rich pay the taxes they owe now? How about we get rid of all of these ridiculous tax credits and have a national sales tax so that there is no way for anyone to hide their money. If you buy something, you pay taxes. If we got all the taxes that were actually supposed to be collected, we wouldn't have a national debt (well until the government found more ways to blow our money )

[DCsportsfan53]

I think everything should be done to treat healthcare as a right provided to citizens and to make it less of a for profit venture. Of course, scientists and and doctors, ect should make very, very good livings as they earn it with the time they put in to get there but the amount of money the pharma corps and insurance companies make is ludicrous. This, imo, is particularly true of health insurance companies. They provide nothing of substance to health care. They do nothing but transfer money while leeching billions in the process. They should not even exist. Again, individual health professionals should make good money for what they do but the for profit core of the health industry, the pharma companies and health insurance companies should not exist as currently constructed.

Just look at the current reforms, those two entities are the primary beneficiaries. Canadian drugs are off the table, generic drugs are not allowed until a drug is ten years old, the gov't will be paying to insure the uninsured increasing insurance revenue and membership. The whole thing is designed to protect and strengthen those companies at the expense of the American people. The days of for profit health care need to end, imho.

[JMS]

I have been a small business owner most of my adult life. That means I have gone without health insurance most of my adult life. I have been hospitalized with and without insurance and I've even paid the medical bills of friends who would not see a doctor because they didn't think they could afford the fee. My father was a doctor, and my sister is a doctor now; and for a time I worked in the medical profession. My experiences have colored my impression on healthcare debate.

Here is what I would like to see.

More Consumer Options. Consumers should be free to pick from a number easily differenciated plans. I'm in favor of a national clearing house which describes and compares plans, but ideally I would like it the federal government standardized a few dozen plans and the insurance companies adheared to common definitions of their plans. Loop holes written into plans to deny benifits should end.

I'm against Pre-existing conditions. Right now they're really a way to deny folks legitamate coverage. Loose your job and loose your insurance for a day and everything you've had treated for five years is pre-existing and not covered even if you sign up with the same insurance company.

I'm against different fees based on age or sicklyness. We are all going to be old some day, and we get insurance to help us when we're sick. What good is insurance if when you need it they can raise your rates and make it unaffordable, or just drop you all together. It's insaine.

Consumer Protections, we get insurance so if bad things happen we are covered. If you have to use your insurance what you find out is when bad things happen, you aren't covered. I've seen an approved physician, in an approved hospital, for a pre-approved proceedure and come away with uncovered expenses. It's a travesty.

Competition. for insurance companies, and drug companies. If we can't have competition(hospitals), then we need some sort of negotiated fixed price. Today the government negotiates one price, the insurance companies negotiate another price, and folks who have no insurance get stuck paying 300% of what everybody else pays. Everybody needs to pay the same price. If I went to the grocery store it's not reasonable I pay 300% of what other folks pay. Hospitals need to list their fees and those fees should be the same for everybody who walks in their door.

I am in favor of a federal healthcare insurance option as long as it is revenue neutral as Obama has continously called for. I think this is a market based form of competition which our system has lacked for 70 years. I would not be in favor of a non revenue neutral plan after 4-8 years it must be able to pay itself or it's not competition.

I'm for a nationalized health records database. Doctors shouldn't own your healthcare records patients should and they should be freely available to your doctors to check in and out based on your authorization. These medical records should also be made available for research on the best way to treat different ailments only in these cases personal identifiable informaiton should be stripped out, and researchers should only be able to identifiy populations of patients.

Smart cards to carry patients health records both for portability and to check their validity.

All the reform we are talking about shouldn't raise our rates at all. Health insurance companies with their anti trust exceptions and their premiums raising at 2.5x the rate of inflation for 30 years make too much money today. They should take all these reforms and swallow them right out of their profits. If the reforms allow the insurance companies to pass the price of reform back to the consumer in my mind they've failed.

[DCsportsfan53]

I will point out, I have posted previously that we see the samething with prescription drugs. Drug prices (for individual drugs) are now increasing at a rate slower than inflation (I think like 1.8%), but total drug costs aren't (I think 8.1%) because more people are using more drugs.

This is a facet of for profit health care. There are far too many different drugs on the market, mostly maintainence drugs that they can sell you again and again and again, and these drugs are being made with profit in mind. Prescription drugs are over prescribed in ludicrous numbers in this country in the name of profit.

Small example, Albert Haynesworth. There was an article about him when he first signed and how he was diagnosed ADHD when he was a kid. He was doing poorly in school, bouncing off the walls and unable to focus. The shrink wanted to put him on Ritalin. His mom said "**** that" and instead decided to wake him up an hour earlier in the morning and run his ass a couple miles around the block before school. Sure enough with the extra energy burnt off his focus came back and his grades came up. I seriously wonder just how many maladies could be corrected, that drugs are normally prescribed for in this country, by simply eating healthier and excercising. I'd be willing to bet the number is astronomical.

[Thiebear]

Holy crap.. I agree with the above JMS post...

As he puts it quite well i refer the reading there and strike my original.

[Mickalino]

I will not participate in this discussion, for fear that it will turn into an Angry Mob

[SnyderShrugged]

I guess my honest question is, how does it reform health care. At all?

I know you believe in the free market, aggressively. I ask why protection from doctors based upon arbitrary numbers would do anything but hurt the free market. If doctors are not held accountable in court for their mistakes, how are they held accountable? Is it not going to simply protect doctors who have made mistakes... and let them see more patients and work longer than they show the market they are actually qualified for?

And if its not cutting the cost of health insurance, what is it really doing? How is it any kind of reform? Tort reform would not lower health insurance costs or provide better care. So, why do we want it?

I dont think it really would help the underlying issues either (as you can see, I'm not a huge advocate that tort reform is the cure for the industy's ills)

earlier in the thread, I suggested this as an approach to tort reform as a piece of the overall reform. Any thoughts?

"provide a dollar-for-dollar tax credit that permits consumers to purchase "negative outcomes" insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system."

[gbear]

1) As a BCBS insured fed worker who has two medically fragile kids covered with medicaid (foster and will still have as primary even after adoption), I have noticed I get treated far faster than my kids. If I need a specialist, I can generally get in within a week or two. My kids can wait 6 months for an appointment with the same specialist. At some point, it becomes not just about the care but the access to care. I'd like to see more equal access even if that means just telling patients you can get in today for your insurance plus $100 or because we don't think this is critical you can wait for 6 months. I'd have paid to more quickly end some of the things with which I watched my daughter have trouble.

2) I'd like medical record portability. Electronic records could do wonders, especially if available in aggregate as well as individual ways. Want to know how your 3 year old will do on this drug? Well let's look at the outcomes of the 2,000 patients with your demographics have done on this drug. Are there trends if they are also taking drug Y? Let's see. Is this $100 drug really 10 times better than the $10 drug? I just look at the research I do on patientslikeme.com for my own MS. That type of information should be available for any illness/condition.

3) I'd like to see a public option insurance company that can be revenue neutral after 5 or 10 years. I hear all the time about how the government is inefficeint. Well, put up or shut up. I see fuzzy math on the overhead of medicare and medicaid. At some point I want to see if it really could get better results more cheeply. The impirasist in me says let's test these hypothysies. If it really isn't as good, nobody will chose it and the free market will decide. I do think one has to allow for start up costs, hence my 5 or 10 year time line.

4) Redo social security to pay for it all. Make social security back into the social insurance it was started as. Reduce benefits to people making x above the poverty line by 50% until SS isn't paying that beneficiary. in general I would say two times the poverty line as my starting point. For example if the poverty line is $20k and I made $50k from outside work/investments plus my 10K from social security. I would then have my social security benefits cut by $5k. Make it back into poverty insurance, and I wonder whether we would be able to finance the medical insurance 5-10 option. Everybody keeps talking about defecit spending without looking at the elephant in the room. Entitlements are what is killing our economy. Want the dollar stronger?

5) Once you have a public option, mandate that everyone must be covered. Offer tax incentives for businesses to cover their employees and penalties for failure to do so. ONce everyone has the possibility of being covered as cheaply as we can, I hope to see our businesses on a more even field of competetition with companies from countries with socialized healthcare (the only reason why single payer doesn't scare me).

That's it for me off the top of my head.

[The 12th Commandment]

Over prescription is part of it, but there are a large number of new treatments, including biologically derived ones, that are part of the picture now. These drugs (I've taken a few for MS) are very expensive to produce, can be very effective but don't have the number of patients to justify making them generically after the patent expires.

[AsburySkinsFan]

Holy crap.. I agree with the above JMS post...

As he puts it quite well i refer the reading there and strike my original.

Agreed

[AsburySkinsFan]

I will not participate in this discussion, for fear that it will turn into an Angry Mob

Therein lies the problem; refusal to participate in a substantive and open form is then characterized as that person's voice being silenced. For the record if you don't have any ideas to bring to the table then maybe silence is best.

[Special K]

1) Regulate these private insurance industries, particularly in regards to denial for "pre-existing" conditions.

2) Facilitate more competition within the pharmaceutical industry, e.g more generics.

3) Tort reform, particulary in highly specialized fields such as neuro and OB. The malpractice rates are absolutely absurd and as far as I'm concerned, practically criminal, in these types of specialties and this is prohibiting physicians from even wanting to enter these specialties in several states much less maintain a private practice in these specialties.

I say if a patient wants to sue over something ridiculous and finds a malpractice attorney sleezy enough to take on their case and the jury finds the case to be totally ridiculous, BOTH the plaintiff and their attorney get massively fined. Maybe that will cut down a bit on the ridiculously lawsuit-happy society we live in right now. Maybe it will cut down on the plethora of idiotic malpractice/personal injury commericials that interrupt my freaking shows..."have you or do you know someone who experienced blank after taking blank? You may have a case! blah blah blah blah. That's just as bad as the pharmaceutical industry advertising their products. All these peole are cut from the same cloth as far as I'm concerned.

If the doctor deserves to be sued, fine (although I think a cap should be put on those damages as well). But if the case is absurd (which I have personally seen multiple cases - brought against my dad, other relatives, their partners, and one friend - so stupid it's unbelievable).

4) Screen ER patients. If it's a freaking cold, they get turned around and sent to an urgent care clinic. That way we don't have to run a battery of expensive tests and utilize expensive trauma team personnel in dealing with mundane sicknesses people are going to the ER for but are not life-threatening illnesses.

* As for the urgent care clinics, I'm all for putting more money toward monetarily encouraging more physicians to enter primary care and work at federally and state funded basic care clinics to help relieve pressure off the ER's. I would definitely be for tuition matching or paying the tuition of physicians who would work at these basic clinics for a few years, much like we do in rural-health designation clinics or on Indian reservations.

The logistics of this would be difficult, as it would be hard to ensure this is reaching the population truly without health insurance and cannot qualify for Medicaid, as opposed to the population who just don't want to pay for health insurance. Haven't really figured out how to run something like this without massive abuse, but it's something I'd like to look more into. I think if we were able to tackle the issue of private insurance and pharmaceutical competition through government regulation regarding premiums and denials, relieving the pharmaceutical industry's stranglehold over washington, etc., it would help in this process.

5) Oh yeah, and in my perfect little world, all these big-time lobbyists would be kicked the hell out of Washington. What they are doing is absolutely dirty and should be criminalized as far as I'm concerned.

[panel]

As I see it, the main problem with health care in the US is not the service, that part is fine, it is the Cost. The reason that insurance has become more expensive over the years is because of the increase in Malpractice cases. Every law students knows that if they want to make big bucks, to move into malpractice.

It is really easy for a jury to feel bad for someone or a family member of someone that has just had a medical tragedy and want someone to pay them. But there is no way that doctors deserve the type of lawsuits and legislation that they bring on, especially a lot of cases the result in huge multimillion dollar settlements.

In the old days, doctors could provide the services that they thought would best help the patient, that is not exactly what is done now. The new culture of lawsuits makes health care more expensive for three reasons. Obviously, insurance costs go up for the doctors on the risk that they may be sued for a ridiculous amount. But also, Doctors now have to run tons and tons of unnecessary test just to protect themselves from a possible lawsuit. Even though the doctor know what the test results will be from looking over at the patient, the doctor needs to order the test anyway just to protect themselves from a possible lawsuit. And the final way that it makes thing more expensive is because of all the additional administrative work that needs to be done. Test requests need to be sent to insurance companies to review and approve extra the test, the results need saved and all interactions with the patient need to be documented so there is a very detailed record in the case of a lawsuit.

I think placing restrictions on these lawsuits would result in the best outcome for the US. There are many obstacles in the way of this, and I think it is because there are a lot of people that ideologically think it is a move in the right direction when a rich person has to give money to a poor person, but that is not what is really happening, it is one poor person getting a little bit of money from a bunch of other poor people to put things in over simplistic terms. Insurance companies don't "bite" the costs of increased legal expenses, it gets passed down to the consumer.

I think health care could be very affordable if first, outrageous lawsuits were limited and controlled, and they type of insurance people would receive would be structured differently. No one is better and finding bargains that the people themselves. If with health insurance, you had to pay a higher co-pay that was a percentage of the total bill, (with a maximum co-pay to protect you if you came down with something like cancer) it would force doctors to compete a bit more to offer lower prices as people shop around to find the best values.

In cases of life and death a doctor should be thinking about saving you, and just saving you, not how to protect themselves if things go wrong. And if you are in a situation where you are in a threatening situation, you should have the mind set of "I hope the doctor can help me, but if he can't, it is the condition/illness that is killing me, not the doctor.

[Tulane Skins Fan]

3) Tort reform, particulary in highly specialized fields such as neuro and OB. The malpractice rates are absolutely absurd and as far as I'm concerned, practically criminal, in these types of specialties and this is prohibiting physicians from even wanting to enter these specialties in several states much less maintain a private practice in these specialties.

I say if a patient wants to sue over something ridiculous and finds a malpractice attorney sleezy enough to take on their case and the jury finds the case to be totally ridiculous, BOTH the plaintiff and their attorney get massively fined. Maybe that will cut down a bit on the ridiculously lawsuit-happy society we live in right now. Maybe it will cut down on the plethora of idiotic malpractice/personal injury commericials that interrupt my freaking shows..."have you or do you know someone who experienced blank after taking blank? You may have a case! blah blah blah blah. That's just as bad as the pharmaceutical industry advertising their products. All these peole are cut from the same cloth as far as I'm concerned.

That already exists. Its called Rule 11. And if you file a frivolous lawsuit, the Court can fine you as it sees fit.

What gets lost in this is that the court house is a place where people are supposed to settle disputes. Its a dispute because its not clear. If it was clear, there wouldn't be a dispute. These are often difficult questions with both sides of the dispute able to point to some fact or theory that agrees with them.

But that's what the court does. Settles disputes. Does it better than anything else too.

Also, if you want to lower malpractice rates, why not cap malpractice rates instead of capping what an injured person who has nothing to do with the malpractice insurance a doctor buys can receive.

[Special K]

Therein lies the problem; refusal to participate in a substantive and open form is then characterized as that person's voice being silenced. For the record if you don't have any ideas to bring to the table then maybe silence is best.

Lighten up Frances, he was joking.

[Tulane Skins Fan]

I think placing restrictions on these lawsuits would result in the best outcome for the US. There are many obstacles in the way of this, and I think it is because there are a lot of people that ideologically think it is a move in the right direction when a rich person has to give money to a poor person, but that is not what is really happening, it is one poor person getting a little bit of money from a bunch of other poor people to put things in over simplistic terms. Insurance companies don't "bite" the costs of increased legal expenses, it gets passed down to the consumer.

I think health care could be very affordable if first, outrageous lawsuits were limited and controlled,

Some facts:

Lawsuits are not rising in number

The number of federal tort (personal injury) cases resolved in U.S. District Courts fell by 79 percent between 1985 and 2003. In 1985, 3,600 tort trials were decided by a judge or jury in U.S. District Courts. By 2003, that number had dropped to less than 800.

Malpractice costs are not rising health care costs

Health care costs are rising; however, medical malpractice litigation has nothing to do with it. According to the Congressional Budget Office, medical malpractice amounted to less than 2 percent of overall health care spending.3 The Government Accountability Office also found that malpractice cases have not widely affected access to health care. 4

According to the American Medical Association, the overall number of physicians is up more than 40 percent since 19905, while over the same time, the U.S. population increased by only 18 percent .6 The number of emergency physicians, neurosurgeons, and OB/GYNs has also increased significantly over the same time period.

Insurance costs are rising because of lawsuits

Your insurance premiums may be going up, but it has nothing to do with lawsuits. Look no further than the insurance industry’s annual profit reporting. In 2007, insurance companies reported a near-record profit of $61.9 billion. In comparison, the insurance industry’s 2004 profit was $38.7 billion, which broke all previous records. Their profits continue to rise, and unfortunately, your premiums are following suit.

The insurance industry has also made the argument that awards and damages should be limited; however, have later admitted that caps will not lower premiums. For example, American Insurance Association spokesman Dennis Kelly told the Chicago Tribune in 2005 that, “We have not promised price reductions with tort reform.”

All of this can be found at http://www.justice.org/cps/rde/xchg/justice/hs.xsl/2011.htm

[AsburySkinsFan]

Lighten up Frances, he was joking.

I know he was, and yet still no proposals from him. It was snark pure and simple and in a thread where we are to present ideas; i.e. raise the level of debate. :brilliant:

[Special K]

Its called Rule 11. And if you file a frivolous lawsuit, the Court can fine you as it sees fit.

And how much is Rule 11 actually implemented within our current system? I would suspect very little...

From my experience (which is what I have observed but not what I have participated in as I am obviously not an attorney), shrewd attorneys can interject something into just about any frivilous case to make a case technically not "frivilous" even though overall, the case is a total joke. I'm sorry, but I've seen that happen more than once to people I know in the medical field.

Also, if you want to lower malpractice rates, why not cap malpractice rates instead of capping what an injured person who has nothing to do with the malpractice insurance a doctor buys can receive.

Fine with me. I'd support capping both malpractice rates and damage awards.

[DjTj]

It's interesting that so many people think tort reform is such a big deal. I suppose if there is one group that people hate more than the insurance companies, it's the lawyers.

Every law students knows that if they want to make big bucks, to move into malpractice.

I don't think I have ever met any law student that wanted to go into medical malpractice to make big bucks ... corporate transactions work is where the real money is (although not as much as just a few years ago).

Medical malpractice is really pennies compared to really big corporate litigation, whether it's contracts, intellectual property, fraud, or product liability.

http://www.verdictsearch.com/index.jsp?do=top100

[Special K]

Some facts:

Lawsuits are not rising in number

Malpractice costs are not rising health care costs

Insurance costs are rising because of lawsuits

Your insurance premiums may be going up, but it All of this can be found at http://www.justice.org/cps/rde/xchg/justice/hs.xsl/2011.htm

That's all well and good, except for that fact that there are statistics that say the exact opposite of what you are claiming. Statistics that show that states who have enacted tort reform and capped damages have significantly lower premiums.

http://www.ama-assn.org/amednews/2008/03/03/prsa0303.htm

[The 12th Commandment]

It seems unreasonable to me that we would subject health care reform to changes in immigration policy and tort claims. Why is the health of the millions of uninsured figuratively held hostage by demands that illegals be unable participate and lawyers not get rich? Those may be valid concerns in our domestic policy, I certainly think so, but it shouldn't preclude people that aren't responsible for it from getting help. To prioritize things that way doesn't make any sense to me.

[SnyderShrugged]

It seems unreasonable to me that we would subject health care reform to changes in immigration policy and tort claims. Why is the health of the millions of uninsured figuratively held hostage by demands that illegals be unable participate and lawyers not get rich? Those may be valid concerns in our domestic policy, I certainly think so, but it shouldn't preclude people that aren't responsible for it from getting help. To prioritize things that way doesn't make any sense to me.

maybe that "help" should be reserved for those who actually need it?

[DjTj]

It seems unreasonable to me that we would subject health care reform to changes in immigration policy and tort claims. Why is the health of the millions of uninsured figuratively held hostage by demands that illegals be unable participate and lawyers not get rich? Those may be valid concerns in our domestic policy, I certainly think so, but it shouldn't preclude people that aren't responsible for it from getting help. To prioritize things that way doesn't make any sense to me.

It is an easy deflection for those who want to stifle debate. People hate the government, but they hate insurance companies more. People hate insurance companies, but they hate lawyers more. People hate lawyers, but they hate illegal immigrants more. If there were ways to bring terrorists and drug dealers into the debate, then politicians would do that too. (See, e.g., calling the opposition "un-American.")

[Tulane Skins Fan]

And how much is Rule 11 actually implemented within our current system? I would suspect very little...

From my experience (which is what I have observed but not what I have participated in as I am obviously not an attorney), shrewd attorneys can interject something into just about any frivilous case to make a case technically not "frivilous" even though overall, the case is a total joke. I'm sorry, but I've seen that happen more than once to people I know in the medical field.

With due respect, you don't have any experience. The medical field thinks every lawsuit is frivolous. In reality, they are 99% of the time not frivolous. Your misconception seems to be on the idea that attorneys can make things up or get facts into evidence which don't really exist. Well, they can't. Unless you are actually involved in a lawsuit, you haven't seen enough to determine whether its frivolous either. You are getting one side of the story, but not the others. I wish people realized that more, but they don't.

There is absolutely no incentive to file a frivolous lawsuit. NONE. It costs the law firm about 100,000 bucks to prosecute a claim competently. And lawyers who take these cases make no money if they don't actually win and collect. That is a built in 100K fine already.

Point is, why on earth would I, or any other malpractice attorney, want to take a case that we didn't think was a good case in which someone was negligently injured? The answer is, no one would. Its bad business. Its not advantageous to file frivolous lawsuits.