The Health Care Bill has passed...
 

So now what?


Thoughts?

Now it's Christmas Eve.

This won't register on many people's radars until after the New Year.

Surprise.

Ha!

DS, IDK? A lot of people are like frazzled and we'll probably see what happens in 2010, possibly February. I'm not sure, but I think since it is approved, it goes through House & Senate reconciliation, and voted upon :confused: by the entire Congress the large bill. Then is sent to the POTUS for signature.

Forget about the Bill itself - Nebraska Senator Ben Nelson has set a new political low by selling his vote. The chutzpah of this act amazes me - and Arlen Specter (Mr. Magic Bullet theory!) has been one of my senators for decades!

I think that without a public option, the whole thing is useless. I will still have no choice. In my perfect world, health insurance being provided by an employer would be completely eliminated. They don't cover my car insurance, life insurance or home owners insurance. I don't want them handling my health insurance either. I would like an opportunity to opt out of my insane HMO and get some real insurance where I can have the doctors of my choosing. Right now, if we are covered by a spouse, we can opt out and we get $500. They PAY around $11K for each employee. I want to be able to opt out and get that whole amount from them to buy my own insurance. This bill is not "reform".

It's less about reform for people who already have insurance and more about people who cannot afford to buy insurance and do not get insurance from their employers. It's about time. We already pay for these people to get very poor medical care through ERs all across the US. They do not get turned away, and we pay through our taxes and higher insurance premiums. In return, we have a whole class of citizens who get horrible medical care with no follow up and only catastrophic care. They tweaked a few things with the insurance companies, but this is a first step. Congress can't make huge changes all at once....hell, look what they had to go through to do this little!

I do realize that, I just think it's a band-aid though, not a fix for what is wrong with the system. I work for a health care system in Detroit, I truly understand the need for insurance for the uninsured. Our system provides hundreds of millions of unreimbursed care annually.

The health care system is so much more broken than just the unreimbursed care though. I know he had to battle just to get this, and hopefully, in the future, people will accept that there are more changes that need to be made. Most insurance companies are in the business of making money. Most are not non-profits. None of the companies that make money off of hospitals/health care are non-profits yet most of the hospitals are (all of them are, in Michigan). A model where you have all these profit organizations having a feeding frenzy off of a non-profit entity is simply wrong. It can't work no matter what.

The only entities that insurance companies have to please are our employers. Our employers are only happy with those insurance companies who offer lower premiums. The only way that insurers can do that is to deny as much care as they can. Most people who don't work in health care do not understand that insurance companies dictate their treatment almost completely. Most do not understand that, if your primary care physician KNOWS that a certain treatment is not right for you, they cannot skip that step and move to a more expensive treatment because they will get points from the insurance company if they don't try things in a specified order. Critical pathways, managed care.. all attempts by the insurance companies to make more money, not truly ways to better manage your illness. There is no real competition among insurance companies for the users of the system. The users of the system are bound to use whatever insurance their employer chooses to provide for them. I don't see much changing until THAT changes.

I say boo! I am one of the Americans who enjoys my health insurance that I have.

Real reform should start with competition across state lines for the best deals/coverage and caps on medical malpractice lawsuit awards.


Polls show most Americans dissapprove of this bill. I think the democrats have shot themselves in the foot with this one proving it isnt about the folks they claim to represent but about power. If Congress truly cared about the folks then put healthcare aside for now and concentrate on what matters to most presently (myself included) : JOBS and the ECONOMY.

Most Americans don't understand that the health care system is on the verge of a collapse similar to the auto industry or the banking system.

I think people should be able to keep the health insurance that they have, if they enjoy it, even if they change jobs, quit work to be a stay at home mom, find themselves unemployed or forced into early retirement, etc. Being able to enjoy the health insurance that you have should be something that everybody can do. Yours may be good now, but if your employer decides to make a change, you are at their mercy. If your employer makes a change, you may end up like me... losing all of the doctors who have been treating you for 15 years, know your history and your family, know and understand how different medications work for you, etc and be stuck with whatever doctors the new insurance will cover, whether you like it or not.

I completely get what your saying Dee...I had this same argument with my coworker yesterday. We're on the same side. I think that the main problem in health care is that we are allowing companies to run insurance companies and hospitals as "For Profit" companies. No one should be able to make a profit on the backs of peoples' health. It's unethical and it's plain wrong. I'm glad they were able to get something started. I hope they don't think that this is going to "fix" health care, because it won't. The problem is...you can't fix a system by basing the new system on the foundation of a broken system. I agree with you that the American public has no idea what they are talking about when they say they are for or against health care reform. They are just mimicking the talking head pundits of their chosen parties. The only people who really know the ins and outs are those that have been effected by the imperfect system or work in the system.

I do think that the health care system needs to be reformed, but I'm not sure about the bill that was voted out. My view is, what do lawyers really know about health care?

Ditto

This is one of my favorite words ever. Sorry, I am a spazz for language. /hijack.

Are you old enough to actually remember ditto paper?

Don't worry. If these for-profit companies do what for-profit companies have done lately (focus on the short-term gains), then a public option won't be far off. If they do what I suspect they'll do and take us all to the cleaners, Congress is going to have to step in and do something. The only thing I can see hindering them in that regard is the 15% cap on administrative costs.

I don't think it's a question if 'if,' though, but rather 'when' the private companies wear out their welcome.

I work for a health insurance company, albeit a smaller one (not an Aetna or United), and believe me we are NOT rolling in dough. Our benefits are less then many of the groups we cover and we as employees have the same concerns about our employment as other companies. Insurance companies aren't innocent by any means, but they aren't all bad either.

What infurates me:

1. Ambulance chasing lawyers and their frivolous, ridulous law suits!
2. Collections agencies that buy accounts from doctors who have left their practice and then collect inappropriately! Seriously, I really hate collectors!
3. Doctor's and hospitals who think they should be paid astronomical amounts. I definitely think they should be paid fairly, but for Pete's sake, just because you went to medical school doesn't mean your entitled to a fortune! DISCLAIMER: This does not apply to every doctor, but there are some doozies out there who have enormous ego's and are total a$$holes!

I think this is a rarity. Doctors are generally paid an average across an area. We can bill whatever we want, but the insurance companies pay what they have set as the fee for service. Don't forget that the amount that is collected by a physician doesn't all go to the physician, also. For most physicians, this pays for their overhead, including office space, staff, insurance for their staff, medical liability insurance, etc. before it goes towards a physician's salary. For example, a surgeon can spend three hours doing a sigmoid colectomy for colon cancer. He/she will be reimbursed less than $3000 for the procedure which includes the surgery and 3 months of follow-up care including any complications. That is very little money for the time involved, not to mention the education or the 6 years of residency at 100+ hours/week of near slave labor. There are very few specialties in medicine where a doctor can make a fortune anymore....most don't involve insurance companies! Before you blame your doctor for the state of medicine, stop and ask yourself how much you'd want to be compensated for 20 years of education and a minimum of 3 years of post-graduation apprenticeship with up to 80 hours/wk (now regulated by the federal government) work hours for about $6 an hour just to work 70-90 hour work weeks when you go into private practice? Some physicians barely make $90,000 a year and have over $100,000 in student loans. I'm lucky to have picked a field with a shortage of physicians that has a growing need and good reimbursement, but who knows how long that will last. I'm compensated because no one else can do the job I do.

I'm not placing a blame game on all doctors. This healthcare mess is not a fault of theirs. They are a cog in a very large wheel. Like I said in m,y disclaimer, a FEW doctor's think they should be paid above and beyond all others. Most do not. Certainly every office manager/administrator believes their doctor is the absolute best in the state! :rolleyes:

You are correct, doctors do get paid a percentage based on their area. Medicare reimbursement is generally used as the base (which is a scary place to start considering how they pay!) and a doctor's fee's are dependant upon how they negotiate with the insurance company. Usually, the more providers in a group, the more negotiating strength they have.

Ahh and therein lies the problem!

My $0.02 on the matter:

Yes, being uninsured sucks & has problems; however, making insurance mandatory (thinking of the mandatory auto insurance law in Ca.) doesn't really work either. Why doesn't it work, (using results of aforementioned auto insurance) if you can't afford insurance you still won't buy it; or you'll sign up just to re-register you vehicle (or avoid the income tax penalty) then drop it. When Sacramento passed this idea the residents of the state heard the lip service from the insurance Co.s that they would offer 'low-cost' insurance for low-income residents (yeah right!) Now I've always held auto insurance (which has ALWAYS been higher than my registration/license fees have been!) But I scoff at their idea of what 'affordable' insurance is *especially* when the coverage is minimal.

How does this relate to med insurance? A for profit Co.s idea of what low cost & affordable is will be much different than the low income worker's idea who is living paycheck to paycheck (if that); perhaps the Gov't subsidies will assist, but what's the cost of that, more national debt that the taxpayers get to deal with via higher taxes *&* med insurance increases?

IMO costs need to be contained *first* before you mandate for everyone to have coverage for the out-of-control costs. How can this be achieved? a couple (less than conservative) ideas:

-nationalize health care; make health care administrators and providers government employees with set compensation, eliminating the for-profit 'must-raise-profits-each-year-for-our-stockholders' mentality

-reduce litigation; implement the (European?) system where if you LOSE you pay legal council fees for BOTH sides (this should reduce frivolous lawsuits) side tangent: redesign the juror system and adopt the (British?)system (isn't our legal system based upon theirs in the 1st place) incorporate 'professional jurors' that can be educated about matters, legalities, technology, etc. (cringing every time I think of the OJ Simpson trial; yikes!)

Sorry for going on, but it really irks me when legislation is passed that is 'supposed' to improve a situation but it is more about the elected Representatives concern about touting their own horn for re-election than taking the time to analyze policy and creating something that will actually address and improve the situation!

But hey, isn't it supposed to take effect in 2013; so plenty of time for those bureaucrats to revise, delay, extend deadlines, and ammend away for the next three years!

My other argument, generally, is... if you don't want the government to pay for the uninsured, then stop requiring hospitals to care for the uninsured. I've yet to have someone explain in a logical manner why hospitals must provide their care for free when no other industry has to do that. If health care is NOT a right, then hospitals shouldn't have to treat people who can't pay. If it IS a right, then continue to require hospitals to provide the care but figure out a way to reimburse them. Be consistent.

If hospitals are compensated, even at lower levels, for all the care they provide, the charges for the insured will go down. Currently, they have to make up the difference somehow.

Bingo! You can't send a sick person away from an ER, but they won't let us determine who is truly sick. I have a runny nose so I'm going to the ER to be treated for a cold for a $900 charge that I'll never pay and the hospital will have to eat. Nice!

One part of the argument that swanqween missed is that insurance prices should come down because with increased numbers of healthy people in the system paying in but not using resources, it decreases expenses. As dirty as insurance companies can be at times, they do actually have to justify their rates to state insurance regulators. I'm hopeful that the federal government does get a cap on their administrative fees and profit margins pushed through. If we can't make them go "non-profit", we should at least push as much of the money as we can towards paying claims.

I heard an incredible story last week. One of the urologists was talking in the Physician's Dining Room with another surgeon, arguing against reform. He was talking about paying for his health insurance policy since he is in solo practice. His wife has pancreatic cancer. He actually has Medicare which helps pay for his premiums which are $4000 a month! I was completely shocked! That's $48,000 a year!!!! How could any normal person afford that kind of bill? And he's against health insurance reform?!

As an 'ambulance chasing lawyer,' (yes I do personal injury, but not medical malpractice), I cannot actually recall even hearing about a so-called frivolous lawsuit anywhere but in the national media; and even then, I can't recall a story which was in my opinion actually frivolous other than the lawsuit filed by that former Administrative Law Judge in D.C. regarding his alleged lost pants.. (and his case was dismissed with prejudice, he was disbarred and a judgment was granted against him for attorneys fees).

Other than that, there is simply no basis for saying that if frivolous lawsuits do exist, that said lawsuits are actually a serious problem in the grand scheme of things.

And if you're really looking for the culprit in all of this, look at the doctors. Depending on the study you're looking at, medical errors account for between 98,000 and 195,000 deaths per year. And no one, not even the insurance companies which deny claims for malpractice and subsequently force and lose a lot of trials would tell you (unless they were telling lies) that the majority or even close to a significant number of lawsuits are frivolous.

Oh God, now we have a fight brewing between the GC lawyers and doctors. Where's the popcorn?

This should be a good one. Anyone know any good doctor cheers?

Pass the popcorn, please.

From personal experience, I can say that there are frivilous lawsuits. I think there are lawyers who do NOT cross their "T"s and dot their "I"s. Doctors aren't the only ones who make mistakes. Medical errors do occur because doctors are humans, nurses are humans, information is misinterpreted, but not all medical errors are malpractice. Unlike doctors, though, we can't sue lawyers for malpractice.

I was sued for malpractice for a case which did involve malpractice by another set of physicians. I was said to be incapable of performing cataract surgery, providing anesthesia and a whole host of medical procedures that I do NOT perform simply because my name was on a chart. It took two years and a lot of money to get my name removed from the lawsuit that should never have included my name in the first place. I can also name at least three other people at the same institution named in the same case who were also not involved in the inciting incident. Multiple other people have been named in cases inappropriately. You multiply this by every malpractice suit in the nation, and you can't convince me that this does not influence the cost of malpractice insurance which most definitely does increase the cost of health care.

Malpractice suits definitely have their place. I can think of a number of cases off the top of my head from residency that I could even testify for the patient. The case above had merit and settled for an undisclosed amount. I just wish all lawyers would practice due diligence before filing these cases.

That being said, lawsuits are NOT the problem with health care, but they do drive doctors to practice "cover your ass" medicine which has driven up the cost of health care significantly.

That would be awesomeness.

[disclaimer] Yes, I am an attorney, but I've handled only one med mal case in my life and that was defending a doctor sued by a prison inmate on what I would agree was a frivolous case (like quite a few prisoner cases)[/disclaimer]

Point 1- Attorneys are often sued for malpractice.

Point 2 - Lawyers should practice due diligence before filing the cases. For instance Pennsylvania has particular standards that must be met when filing a med mal case, which generally require that a Certificate of Merit be filed with the Complaint certifying a qualified expert has supplied a written statement that there exists a reasonable probability that the defendant's care fell outside acceptable professional standards and that such conduct was a cause of injury.

Also, sometimes lawyers simply cannot obtain the information that they need before filing a complaint against a party or parties. With some information, there is no way to get it from the defendants until the parties are engaged in litigation.

This is more directed at AXiDTrish, but I agree that there are frivolous lawsuits, however, if a judge or jury finds in favor of a Plaintiff and awards damages, then that lawsuit can hardly be said to be frivolous. And capping them is a huge issue - damages are on a case by case basis. If you ever lost a loved one or incurred a grave harm, wouldn't you be pissed that some random politician told you how much you could recover?

Also to AXiDTrish, what do debt collectors have anything to do with this discussion? Why don't doctors (or anyone else) have a right to collect money owed to them? If anything, the collection of debt HELPS the industry by increasing the percentage of fees recovered. I don't agree with illegal debt collection practices, but there are plenty of statutes in place (both on a federal and state level) that protect against that (and provide with some interesting penalties).

[QUOTE=kddani;1878843]Yeah, but I can't sue an attorney for suing me frivilously, wasting my time and money when I had nothing to do with a case. Also, you have to get a lawyer to sue the other lawyer...I have a feeling that's kinda like getting a doctor to testify against another doctor!:D

In thhe case in question, they had enough information to know that I was the resident who had read the CT Brain on the patient after she had coded, but they did NOT sue the anesthesiologists or the ophthalmologists who were present when the patient coded and basically became brain dead. The whole case was ridiculous from the start. Every person listed on the complaint actually helped the patient after the incident and got slapped with the lawsuit for our trouble.

True, errors are not malpractice unless you violate the applicable standard in your jurisdiction for malpractice. But malpractice does happen. The solution should involve targeting doctors who are repeat offenders for termination of their licenses, the prompt payment of claims which obviously involve malpractice, and a fair and just manner of scheduling compensation for victims so that the respective parties would at least have some sort of legal guidelines in settling claims.

From a lawyer's perspective, it is very difficult to properly evaluate a case before even getting to the first settlement demand. The client comes into your office, tells you her 'tale of woe,' and that's all you have to go on until you submit the case to an expert for evaluation. Often in the meantime, you'll have a deadline or a statute of limitations issue and have to file your case just to avoid that deadline (be it a winner or not, because contrary to your assertion, failure to do so could result in a malpractice case being brought against the attorney).

Compound that with the fact that in jurisdictions like Oklahoma, it costs the attorney (who usually foots the bill because sick/injured/dead people can't usually afford justice) a minimum of $5,000 for an expert's opinion just to file the case. Note that at least around here, we only have one malpractice insurer. That insurer will not insure any doctor who testifies or signs an affidavit against another doctor, so we either have to go out of state or go to a professional 'hired gun.' Getting a real, honest assessment of the case is damn near next to impossible.

As for something being 'frivolous,' while to you, it might appear to be frivolous, the attorney simply can't in all cases properly evaluate the case without first getting something filed and taking depositions and conducting discovery. He can't do that without shelling out some serious coin of his own to do so. So if you mean frivolous as in 'bad faith,' I'll bet that the number of those cases being filed is damn next to nil. But of course, just like with any other tort law, some losing cases will get filed. If the case does make it to trial, however, it cannot be said to be frivolous at all -- there are a lot of mechanisms preventing truly frivolous claims from making it to that stage and I'm convinced they work very well -- sometimes too well.

One of the conclusions of this 2006 study was that ". . .the number of meritorious claims that did not get paid was actually larger than the group of meritless claims that were paid." So who really should have more protections in the legal system? The folks who are killing and maiming through their negligence? Or the folks who are killed and maimed? Right now, clearly, the killers and maimers are better protected and are demanding more protection. I guess money talks.

http://www.hsph.harvard.edu/news/pre...s05102006.html

Oh, absolutely, I agree with you here. The administrative and litigation costs in settling malpractice claims are absurd. Unfortunately, both sides only favor outcomes which clearly stack the deck in their favor. For example, the insurance/physicians side wants to place hard caps on pain and suffering awards -- something which not only is morally objectionable in that it places a monetary value on human life, telling doctors and insurance companies when it's okay just to make a business decision and intentionally kill someone or maim them, it also disproportionately harms the most grievously injured patients by not affording them a proper level of compensation for their injuries.

Some things I'd possibly be in favor of (depending on the setup) would be accelerated discovery schedules, faster court dates, judges with medical expertise who are better equipped to wade through fact-intensive pretrial motions, etc. I had a friend of mine (a doctor) go through exactly the same thing. Didn't cost him a penny of course, just a lot of stress. That's why we have malpractice insurance. Turns out that the case (wasn't even that good a case) was filed by the attorney simply because the statute of limitations was about to expire and he had to get something filed to avoid malpractice on his own part. That stuff happens -- and when you have a client/victim who has twelve doctors on his charts, it's impossible, possibly even malpractice not to name every single one of them without knowing *precisely* what their involvement in the case was... and charts can be wrong.

I think in most cases, they do. In other cases, the client doesn't show up until the statute of limitations is looming and you have to get something filed to cover the bases. Still, in other cases, you really can't start to exclude innocent doctors from the case until you've had an opportunity to conduct discovery. Sometimes, due diligence doesn't happen until after the case gets filed because it simply cannot.

I'm not sure that's a bad thing though. Docs wouldn't be doing that if the risk/reward calculus for practicing that sort of medicine didn't come out in their favor. They obviously must know that doing that means that they are operating at the standard of care and that it is more likely to save lives or prevent injuries to patients.

I won't do it, but I have a go-to lawyer to refer folks to when I see a legal malpractice claim. She does a pretty good job with those things. I suspect any lawyer probably knows someone who will handle a malpractice claim.. and since it can be malpractice not to advise your client that they might be the victim of malpractice, you better believe I'm making that referral if I think it's a good case. If that happens in a city like OKC's legal community (everyone pretty much knows everyone here), it damn sure happens in larger jurisdictions.

Having the information does not mean that they had the time or expertise to properly evaluate that information, nor does it mean that they had all the information. There are just some things which can't be done until the case is at issue.

I thank you for explaining why this happens. Now, why don't they fix this. Just like with medicine, saying that "It's always been that way." doesn't make it right. The malpractice insurance premiums have driven a lot of physicians out of practice in states like Mississippi and West Virginia. OB/GYN and Neurosurgery can be cost-prohibitory to practice.

I have to disagree with you here. The use of radiology services has jumped astronomically in the past 5 years with CT imaging increasing more than 60% since I started residency. This has actually decreased physicians' ability to utilize physical diagnosis (hands-on examination) skills which are FREE in exchange for high cost CTs which have a very REAL risk of CANCER! If you look at my PACS system (radiology archival system) there are patients that come to my ER that have had abdominal CTs for abdominal pain every month for 10 months that have NEVER found a single abnormality. That is $30,000 worth of medical imaging to cover an ER doctors butt that has provided to patient with over 1,000 x-rays worth of radiation. Not a good idea. More expensive is not always better!

Trouble is, the only folks really shilling methods of 'fixing things,' are just shilling means to enriching their respective constituencies, not actually fixing anything, and in many cases, making things worse.

Obviously, there must be disincentive built into the system to keep docs from performing open-heart-surgery while tripping on painkillers (it happens). And the 'driving folks out of business' argument just doesn't play well with me. They tried that argument recently in my state, but ignored the fact that while some practices did close, more practices opened in their place, meaning that there was a net-gain in the number of practices opening. It's pure speculation on my part, but I imagine that's the case in Mississippi and West Virginia as well. Unfortunately, the 'tort reform' side of the argument relies a lot on what can objectively be called misinformation or outright falsehood. They don't want an honest answer, they just want to increase their clients' (not doctors, but malpractice insurers) bottom line.

Case in point, take any of the states which have passed major medmal reform legislation, e.g., Texas. Their rates continued to climb in lock-step with the rest of the industry (but of course, the insurers ended up with a lot more cash than before).

Docs, I think, are too quick to blame the legal system for their malpractice insurance rates. They might instead look to the folks who they keep writing those big checks to (hint: not lawyers).

I think I must have heard a study confirming that on NPR recently. But I don't see any way around that short of some sort of medical tribunal actually putting out standards for that sort of care. While that, absent a statute, probably wouldn't bind a court, part of what goes into winning a medical malpractice case is proving by a preponderance of the evidence (or more depending on the state) that the physician violated the standard of care. If all physicians had some sort of guidelines as to what would and wouldn't violate that standard, maybe they could get away from defensive medicine. I'm not an expert in that field, but something like that would probably have some serious pull if physicians would actually stick to those rules more-less.

What I definitely don't think should happen is that bad doctors get insulated from practicing bad medicine.

I'll agree with you here. Unfortunately, the bad doctors aren't always the ones getting sued. I know some scary cases that would make your hair curl, and I doubt anyone would sue the physician involved. There are many factors into why people sue, and it's rarely the actual malpractice involved. The doctor must have amazing bedside manner (I can't imagine because his interpersonal skills seem non-existent) because nothing seems to stop his parade of poor care. I think what we do need is a set of standards that we are required to follow, but it will never pass until the older generation of doctors stop practicing medicine and the old paternalistic standard is completely abolished. It would also be nice to have more educated people evaluating these cases since determining what meets standard of care is not exactly at the level of the lay public. Otherwise, I am on board with a lot of what you say, Kevin, I am often sickened when blatant malpractice is ignored and physicians continue to practice the same bad medicine over and over again.

This is what is wrong with medicine in a lot of ways now days. Medicine is NOT an exact science. When patients come to the ER complaining of cough, fatigue and chills, the ER doctor SHOULD think viral infection, NOT Cancer. Yes, the patient could have lymphoma or leukemia, but these are called Zebra diagnoses. We are not supposed to be chasing after zebras when horses are so much more common. When the patient comes back with the same symptoms a month later, THEN you do the work-up for Cancer. The doctor didn't MISS the diagnosis of cancer. It isn't MALPRACTICE. If we take every single patient with vague symptoms and do multi-million dollar work-ups, we will NEVER decrease the cost of health care in this nation.

If that's the mentality docs are approaching their craft with, then they really need to get educated on what constitutes malpractice. Missing an obscure diagnosis when more obvious symptoms were presented in an ER setting is almost never going to be malpractice. Doing a CT in that case, or treating anything beyond an acceptable minimum just opens the door to other sorts of medical errors.

Do you think part of this 'defensive medicine' aspect is really that hospitals and certain practices want to conduct as many expensive procedures as possible in order to bill health insurance companies/medicare for more services delivered?

I know that the practice of law is often handled that way -- especially by insurance defense firms. They do an excellent job at billing that file. Most of them bill by the hour, and there's a saying about those guys that you'll never be deposed by an insurance defense attorney. . . because there's never just an insurance defense attorney there. They invariably send 2-3 lawyers (or more) to sit and bill their full hourly rates for listening to another lawyer conduct a deposition... but I digress.

MedMal lawyers will tell you: about one case in a thousand has enough merit to go to trial, in any shape - physicians still win the "public opinion" battle here. So yeah, while there are some "chop shop" firms, the overwhelming majority of cases are not fueled by attorneys at all. In fact, medical malpractice is likely grossly underreported, because "minor" malpractice has no recourse (trials are brutal, on the doctors, on the families, on hospitals, even on the insurance companies who need to keep a careful balance sheet to pay out all premiums paid in).

Studies of potential tort reform methods indicate that capping non-economic damages at $250,000 in every state that does not have such restrictions already would reduce medical malpractice premiums by a whopping . . . 8%. The problem obviously isn't verdicts.

The problems with malpractice insurance, as it relates to medical costs, are difficult to pin down - insurance companies claim the problems are "huge awards" that happen rarely in reality (and usually only for deaths/permanent disfigurement/botched births), doctors and insurers blame fear of litigation for "defensive medicine" that drives costs up across the board, attorneys blame doctors, and the consumer really doesn't care because they foot the bill either way.

There are a couple of problems with this (not "logical" problems, but endemic issues as medicine and litigation interrelate):

1 - If "defensive medicine" actually does its job and reduces lawsuits (because verdicts and/or sheer number of lawsuits are the problem), then it should pay for itself, and insurers should be all for it, right?

2 - And if defensive medicine doesn't "work" (under our operating definition), then the problem is on the supply side, and not the demand side, right?

3 - Isn't one of the problems with the "system" (as it were) that you're generally discouraged from testifying in these cases you say you could have testified in? Wouldn't that drive the case to settlement/fair-value judgment much faster? Remember, the long, drawn-out process you describe earlier is only partly a product of the plaintiffs' bar (which will generally carpet-bomb with claims, then clean up the mess later once discovery begins) - the insurers, who generally take over the case from the doctor/hospital immediately, have much more to gain from a long, drawn-out process than the plaintiffs do.

I can't say this last part strongly enough: insurance companies who have taken over defense for the doctors have made an amazing mess of costs as well. Whether it is dragging discovery out for six years in a cerebral palsy birth case to get the family to "quit" or accept a favorable settlement (because of pain, needing money, private insurance reaching its cap, etc.); or calling 30 experts to testify about causation, life care exceptions, state aid or just to read an MRI (at an average of $1,000 an hour); or using the same "trial in a box" that has been used for 35 years in court - all of which actually happen in just about every botched-birth case, etc. - the attorneys from the defense side are just as much the problem.

I don't think that physicians are ordering more tests to bill more because THEY don't get to bill more for those tests. It sounds good to lawyers because it works that way for y'all, but it doesn't work that way in medicine. The primary care doctors never see a dime for all of these extra tests. They really do just think they're protecting themselves from being sued. It's more common than you think, too. I've seen it happening at more than one hospital in more than one state, and have friends in other states that have the same experience. Physicians really think that lawyers are out to sue them if they miss anything. It may not be true, but that's the perception.

See my responses in Bold

Oh, I wasn't implying that you were in favor of tort reform - I'm pointing out that "large verdicts" really cannot be a part of the malpractice insurance problem, because capping awards affects less than 10% of the cost of the insurance.

The problem is deeper than "too many lawsuits" or "juries giving out truckloads of money" - I was agreeing with you, and providing some evidence to support your points.

My point is that "defensive medicine" (which everyone will agree sucks) isn't really a consumer issue in the truest sense. That's what the logical fork was intended to show - I'm not sure why "defensive medicine" is a health care cost issue since the arrow can only go one direction. I don't mean to say it's the "fault" of doctors - that's really not the issue - but I don't really see how health care reform can address this issue without taking odd steps that benefit those other than doctors/patients the most.

Longer-form issue: if such a tiny proportion of Mal insurance costs are tied to non-economic damages, how exactly do we propose curtailing those costs? It's a chicken/egg dilemma at that point, it seems. Do you simply say "this is what something is worth" and limit income? Do you force f-ed up rates on insurers? Do we increase the disparity for those using certain types of medicine (aka "screw pregnant women one more time")? It's tough.

Obviously I did not imply anywhere that some non-specific trauma "causes" cerebral palsy - and I'm sure everyone's seen the commercials for James Sokolove or Ken Suggs, it can certainly be a factory-firm game, but that doesn't mean CP cases are somehow implicitly exploitative.

The bolded is definitely true, mostly because the womb isn't see-through and knowing exactly when, say, hypoxic ischemic encephalopathy (which I'll use as an example, since it's the most common claim in my experience) takes place is impossible, and because the very term "CP" is borderline useless due to its umbrella nature (actually, that's not true - it's insanely useful to, again, defense council, because the "WE DON'T EVEN KNOW WHAT CAUSES CP!" defense is one of the strongest on the planet, although it is akin to saying "WE DON'T EVEN KNOW WHAT CAUSES BROKEN LEGS!" in many ways . . . again, not passing judgment, but it is one of many benefits the defense enjoys in MedMal cases).

Most of the time, a link is indeed very hard to prove - which is why so very few cases make it to court. This is actually the case with every non-traumatic MedMal request - obviously causation is easy for a sponge, and difficult for a non-specific brain injury. I'll agree that OB/GYNs, along with ER doctors and some other specialists, receive the brunt of the litigation maelstrom, fairly or unfairly. Of course, it's also perfectly feasible that OB/GYNs make poor decisions that carry much more tangible and lasting impact, too, but either way, the train has so much momentum that it will be next to impossible to stop.

However, in court, the issue is basically whether we can say with 50.0001% certainty that a certain poor decision led to the hypoxic event, and that the event led to the injury. About 0.3% of babies are born with CP - of course, some of those "bad decision" births were already in trouble. However, it's quite the coincidence, don't you think?

OB/GYNs get a bad name both because their cases are high-profile and high-emotion (there is no puke like seeing 45 minutes' worth of PowerPoint slides on a kid looking cute just before a seizure with no other purpose than fiddling the heart strings) and because negligence that leads to HIE is probably worth about $16 million. It's just the way it is.

And, to bring this back to the health care bill . . . Congress apparently does not address this issue, or the others we've discussed, in the slightest. Medical malpractice is barely touched at all, from what I've read. So, apparently, we're going to "reform" health care and get it to everyone, for cheaper, with better service, without addressing any of these fundamental issues. Pardon me if I'm skeptical.

I must say, I LOVE this thread. Kevin, AOII Angel, KSig....your discussion has been very interesting!!

Not that I want to bring this up and interrupt, but...

Doctor's absolutely have the right the collect money that is owed to them and should! It's when balance billing takes place or collector's balance bill on a doctor's behalf that is the problem. Ex: A doctor bills $100 for a procedure and their negotiated rate based on their contract is to receive payment of $75 whether from an insurance company or through a members/patients copay, coinsurance, deductible or a combo of all three. The doctor, by signing a contract (and they don't have to) has agreed to write off the other $25. Balance billing is when they bill the member for the additional $25 making them in breach (sp?) of their contract. Many times that ends up in a collections agency's queue. I'm working a scenario right now where the doctor closed their practice and sold all their accounts to a collector. The collector going after a member for a claim from three years ago that they paid correctly according to their benefits! The collector doesn't care that the member has paid everything they are supposed to and the provider is in breach of contract. All they care is that they get a cut of any money they collect at the expense of a member/patient. It's infuriating and unfair. Balance billing is very, very common. Sometimes it's due to a simple A/R mistake, sometimes inexperienced billers, sometimes intentional.