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July 08, 2003 THE MEDICAL MALPRACTICE CRISIS....Public Citizen, a consumer
group founded by Ralph Nader, helpfully takes a look at the latest
statistics on medical malpractice for 2002 compared to 2001. The highlights:
It's kinda hard to see the crisis, isn't it? And harder still to see the case for a massive intervention in the malpractice insurance market from the current gang of free market fundamentalists running the country. Posted by Kevin Drum at July 8, 2003 03:48 PM | TrackBackComments
Apropos of nothing contextual, sometimes full justifying your text can bite you in the ass, right, Kevin? Or were you just talking really slowly so we would understand? Posted by: Kenneth G. Cavness at July 8, 2003 04:00 PM | PERMALINKNot only has he promulgated this large body of regulation but he has hired more people into federal ranks than any administration in current history. Of course, this may be a deliberate strategy. It is hard to know just what he is actually up to since his rhetoric is usually the opposite of what actually is written. It will be interesting to watch the next years unfold if he is reelected. *shudder* Posted by: Marie Foster at July 8, 2003 04:04 PM | PERMALINKHe won't last until November '04, at his 'burn rate' Posted by: squiddy at July 8, 2003 04:10 PM | PERMALINKKenneth: indeed it can! Of course it looks fine on my monitor.... Posted by: Kevin Drum at July 8, 2003 04:49 PM | PERMALINKYou can see the crisis if you squint really hard and become an industry lobbyist... yup, there it is! Posted by: Realish at July 8, 2003 04:51 PM | PERMALINKRepubs like people to EARN their money - like I don't see what you're complaining about. Businesses need to be protected from consumers. When a consumer sues a business for millions, they call it a frivolous lawsuit. When the RIAA sues it's consumers for billions each, they call it necessary for copyright enforcement. In the first case, we may appeal to idealism and call it's ban "tort reform" or whatever, but like everything else this is merely the stated policy, and it is right for the cognoscenti to present noble lies in order to attain its real agenda. Posted by: taktile at July 8, 2003 06:24 PM | PERMALINKIgnore the childish grammatical error in my previous post. Posted by: taktile at July 8, 2003 06:25 PM | PERMALINKThe real issue, as I keep trying to tell people, is not insurance premia. It's true that in certain specialties, in certain states, insurance premia are a real problem that threatens to leave whole areas bereft of [cardiac specialists, radiologists, ob-gyns, fill in the blank]. But for the most part, the insurance argument is not what doctors are really upset about. What they're upset about is the culture of malpractice litigation. Getting sued, as anyone who has been frivolously sued knows, is no fun at all. They print your name in the paper; people notice; and the newspapers don't mention it when you're eventually dropped from the lawsuit. Moreover, (most) doctors at heart don't think of themselves as businesspeople but as (noble) professionals. It is quite degrading to a doctor's morale to learn that a patient whom he did his best to help has decided to blame a bad outcome on the doctor. This is an entirely different world from, say, mass-tort or products-liability litigation. When a huge corporation makes a product, they can predict that it'll kill or injure a certain number of people. This is what actuaries do. We can thus set up a regime of liability (either strict or negligence-based) in order to control their behavior and encourage efficient precautions. Doctors, on the other hand, are usually solo practitioners or in small groups. A single large malpractice verdict can ruin someone. Juries are fine as far as they go, and probably tend to be more sympathetic to doctors than most people think, but who would want to risk one's entire career on that chance? So the ability of plaintiffs' attorneys to get settlements is very real, which encourages a sue-first-ask-questions-later approach. Finally, as I have suggested here before, we should step back even further and re-think the question whether we should even have medical malpractice liability, short of gross negligence or some similar standard. I think that if you asked low-income people ahead of time, they'd much prefer to pay less for medical services (or health insurance) and give up the right to non-economic damages. (Similarly, when the government is paying people's premia, it might be correct to prefer such a regime, allowing it to insure more people for the same amount of money.) Of course, the other main rationale for tort liability is as a deterrent. But I seriously doubt that the threat of tort liability has a significant marginal effect on the quality of health care. My instinct (which is certainly not strong evidence) is that systematic methods of error-reporting and feedback are a better way to improve the quality of healthcare. This is what the medical-malpractice debate should really be about. The insurance-premia ruckus is something of a red herring. Posted by: Chris at July 8, 2003 09:40 PM | PERMALINKHand in hand, it's the insurance companies AND government! BOTH have designed this system to fail! Doctors are forced into agreements in order to get paid. Long ago, in the 1970's, if a doctor opted out of the contract, but was entitled to payment (where he wanted the patient to pick up the differential) ... then the PATIENT GOT THE CHECK! So many of them went out with the $2,000 payment and bought personal stuff. Carpets for the home. Etc. Then where would ou get the money? We've taught people to be dishonest. And, to cheat. So doctors got cheated. And, then, instead of 'office visits' that didn't get the patient reimbursed, they put down disease factors to rule out. As if all people go to the doctor when sick. And, not healthy. Preventive medicine wasn't reimbursable. The insurance rates climbed. AND THEN THE INSURANCE COMPANIES STEPPED IN. You want to see a specialist? Take a two hour wait on line for the phone call to be answered. And, a clerk with a high school education (paid to say "NO") ... was at the other end ... while you could be bleeding to death. I remember a story where a woman, in her early pregnancy, approached an obstertricians office, hemmorhaging on the floor. The called 911. They didn't want to even take her name. They said the doctor was out. No emergency care. Because this is the stuff that threatens law suits. From people you don't know. Who show up. And, expect care. While the insurance company, itself, protected the doctor. You can't get into a specialists office without a special pass. And, where did special passes come from? Overworked general practitioners who worked large groups of people for small profits. It wasn't so long ago that doctors didn't have all that much in their kit bags. The doctor who lived in the neighborhood made house calls. You saw specialists called into your bedside once you were in terrible shape. ROUNDS. Medicine was a collective endeavor ... and the specialist came by. But your private doctor was still your private doctor. And, in lots of ways it is still like this. BUT THE FIRST CUT OF INCOME GOES TO THE INSURANCE COMPANIES. ANd, they give bonuses for keeping as much money as they can. Just like charities. Have you heard the stories of docs who drive by accident scenes? Because if they stop they get into trouble. Ditto nurses. Ditto, this is what happens when you haven't a clue whom to thank. And, if you're in an ambulance will your jewelry get stolen? Just asking. In some communities you're stripped bare. Except for ID. Because no one wants to work at the lowest end of the totem pole. No matter how advanced you make your system, you're still basing it on human nature. And, human nature is not only greedy, government is the MOST INEFFICIENT WAY TO SUPPLY YOU WITH CARE. You're lucky there are mafia payoffs in road building ... or government would stink at road building, too. Posted by: Carol Herman at July 8, 2003 10:07 PM | PERMALINKChris: doctors may be largely sole practitioners, but the whole point of medmal insurance is to spread that risk around. So I'm not sure what your point is here. Medmal insurance adds very little to the cost of healthcare, and the noneconomic portion even less, so asking people to give up the right to sue would save them very little. It would also very quickly become non voluntary: doctors would simply require you to sign away your right to sue before they would treat you. This is pretty bad public policy. (And I imagine the deterrent effect of being sued is somewhat greater than you give it credit for.) However, I'm most intrigued by your statement that it's really the culture of frivolous lawsuits that doctors are most concerned about. Since none of the reform measures I've seen does anything about this, do you have any ideas? Posted by: Kevin Drum at July 8, 2003 10:23 PM | PERMALINKAgreeed tip.. i don't see the point of Carol's post at all. She is lambasting the culture of greed for the problems of health care, which is true, but then blames government? Is she counting the HMOs as government or is it satire or what? Posted by: Glenn at July 9, 2003 03:23 AM | PERMALINKKevin, as a numbers guy, you don't get the least little bit suspicious when you see a timescale of only two years, and all the data glommed together into a great big indistinguished pile? A single year could, for any number of reasons, be a statistical blip. What's the trend? And of course, as Chris points out, the problem is not that every dermatologist, podiatrist and ENT guy is unable to get insurance. It's that in some states, cardiologists, neurosurgeons, and trauma doctors can't afford insurance, and OB-GYNs have to stop delivering babies, while a couple of states risk losing their last A- rated medmal insurer (A- is, I believe, the lowest rating most hospitals will accept from their doctors). There are documented instances of these things occurring -- cities losing trauma centers, OB-GYNs leaving patients in the lurch as they stop delivering babies, etc. Waving around a public citizen report won't make it not be so. Posted by: Jane Galt at July 9, 2003 04:09 AM | PERMALINKJane: as you know, I've posted before about the long-term trends. Over a ten year period, medmal payouts are flat adjusted for inflation. And of course there are documented cases of doctors being unable to afford insurance. Nobody says otherwise. The question is, *why* have the premiums increased? As near as I can tell, premium increases are unrelated to payout increases, and the problem actually seems to be more related to bad management at medmal insurers during the 90s. However, it's a complex subject. If you actually have some data to share on this, I'm all ears. Posted by: Kevin Drum at July 9, 2003 08:22 AM | PERMALINK>>the problem is not that every dermatologist, podiatrist and ENT guy is unable to get insurance. It's that in some states, cardiologists, neurosurgeons, and trauma doctors can't afford insurance, and OB-GYNs have to stop delivering babies, while a couple of states risk losing their last A- rated medmal insurer (A- is, I believe, the lowest rating most hospitals will accept from their doctors). There are documented instances of these things occurring -- cities losing trauma centers, OB-GYNs leaving patients in the lurch as they stop delivering babies, etc. But is this the fault of a tort system out of control or is it something to do with the way insurance is done? So far, the right wing argument and rhetoric - and the legislative solutions offered - have been predicated on focusing on some chimera of spiraling numbers of trivial lawsuits and escalating payouts that are supposedly bankrupting the industry. Do a Nexis search and the word "crisis" DOES come up over and over again. Yet Kevin provides numbers showing that in reality, the facts don't really back up the rhetoric - payouts haven't risen at all - certainly not enough to legitimately and claim that they are the wholesale cost of this "crisis". If insurance premiums are going up so much that the medical profession can't afford them, the numbers don't indicate that that is because of payouts - yet the way the argument is usually made, and the legislative solution being offered, pretty much entirely consists of addressing payouts. Kevin provides numbers to debunk this, and suddenly everybody starts pretending that the problem is entirely something else - yet that something else never seems to address an examination of the insurance industry or ways to fix the problems by addressing the insurance side. Typical. Kevin - I think what you really need to show is the relationship of payouts to insurance premiums and see if the two are at all related. Posted by: Andy at July 9, 2003 09:27 AM | PERMALINKWhat’s missing here (I think) is the role that “medmal” insurance companies investments play in the so-called crisis. I’ve heard it reported that the real crisis is cause by the terrible returns from the bond market, which is where these financial institutions invest the proceeds from the premiums. Which bond returns down, these companies have to sock it to the Drs. to make up the cash flow. Claiming hardship due to civil suits is then just a straw dog. Posted by: Keith G at July 9, 2003 09:30 AM | PERMALINK"The question is, *why* have the premiums increased? As near as I can tell, premium increases are unrelated to payout increases, and the problem actually seems to be more related to bad management at medmal insurers during the 90s." In all the reports I've seen, 'payouts' seem to include only the settlements and judgments. The cost of defending the suit is not factored in. If a case of medium complexity goes to trial and the doctor is found not liable, the insurance company will often have paid in excess of $75,000. These statistics pretend that the $75,000 is not a 'payout'. Whatever you want to label it, it is certainly a cost to the insurance company which is therefore passed on to the doctor (which is then passed on to health consumers driving up the cost of health care). Looking at declining payouts could easily hide increasing defense costs. Insurance companies try to maximize their profits by spending the least amount of money possible in combined 'payouts' and defense costs, but typically the doctor decides if he is willing to settle, because his disciplinary record is often impacted so the decision is somewhat beyond their control. If more doctors are successfully defending malpractice suits, it is very likely that defense costs would skyrocket while 'payouts' would decline. I have been unable to find a reputable study on combined payouts and defense costs, but if someone else has one, I'd love to see it. Posted by: Sebastian Holsclaw at July 9, 2003 09:55 AM | PERMALINKI agree with Andy. If there is a crisis, it is the rates doctors have to pay to get the insurance. There needs to be two additional items of information - the price of the insurance generally and by speciality, and the return that the insurance companies have been getting on their investments. I think you will find that premiums are going way up to offset the losses in the financial markets on investments. Tort Reform won't change that. But that also cannot be converted to a campaign issue the way Tort Reform can. Posted by: Rick B at July 9, 2003 10:26 AM | PERMALINKInsurance isn't benign, to answer your question up there. Nor is it 'low cost.' Today, people WITH insurance have to use it to get treatment. And, the partnership STARTS when you're sick and need specialists. THEN, you get the 'provider list' (from your insurance carrier). In the old days the local doc called in the specialists he knew. And, sometimes he preferred his golf partner from those famous Wednesday's off). But MOST OF THE TIME doctors who are "A" type personalities ... WANT THE BEST PEOPLE FOR THEIR PATIENTS. (Especially as the years went by and people formed relationships with their care providers.) Today, if a doctor is dropped from an insurance list, you gotta go find a new doc. Today, many docs belong to groups (to spread the risky business, and it's costs around) ... AND even under the best of circumstances, speed adds a revolving door affect to most patients lives. HOW LONG CAN YOU JUST SIT AND TALK TO YOUR DOCTOR? Isn't the practice busy? I know getting sued is ugly. Lawyers do their 'slap suits' based on ALL the names they find in the charts. So even nurses get sued. And, all these frivolous lawsuits just add to the pain and confusion. HOWEVER, THE BOTTOM LINE IS STILL THE INSURANCE! Be it Medicare (that pays for stuff the patient wouldn't want if the patient bore some of the costs). To the worst of it: WHEN YOU NEED A SPECIALIST AND YOU CALL THE INSURANCE COMPANY (as instructed), the wait is long. And, the person you're speaking to is similar to a TELEMARKETER. In today's age, GONE is the performance you once expected from CUSTOMER SERVICE. I don't know why some people just deny that this stuff is going on? Perhaps they're very healthy and have never run into this quagmire before? INSURANCE KILLED HEALTH CARE! And, ya know what? Go back to the early 1970's ... and you'll see doctors started screaming as the 'benefits' to patients took over and created this cesspool. Doctors didn't want their earnings so well monitored, that everyone laughed at them when the health care packages came along. And, for a time it was a FEASTING. Shows ya, folks, there are no free lunches. And, we're never gonna go back in time. What gets fixed ahead is very expensive. Taxpayers can get victimized, fer shur. BUT DESTROY YOUR MIDDLE CLASS AND YOU MIGHT AS WELL JUST DESTROY THE WHOLE COUNTRY. (There was a time the middle classes were not threatened by the expenses of routine visits. You could see your OB/GYN guy in the late 1970's for $15-bucks.) YOU HAVE NO IDEA HOW THINGS HAVE CHANGED. YOU ALL HAVE NO IDEA HOW CORROSIVE THIS INSURANCE PROVIDER BUSINESS HAS BECOME. They are the most invasive group around. You get no privacy. Everything that was once 'between a doctor and his patient,' has been opened up to data basing, and the selling of your stuff to outsiders, for yet another profit. OKAY. You're still confused. I'm sorry. Posted by: Carol Herman at July 9, 2003 12:53 PM | PERMALINK>>In all the reports I've seen, 'payouts' seem to include only the settlements and judgments. The cost of defending the suit is not factored in. If a case of medium complexity goes to trial and the doctor is found not liable, the insurance company will often have paid in excess of $75,000. These statistics pretend that the $75,000 is not a 'payout'. Whatever you want to label it, it is certainly a cost to the insurance company which is therefore passed on to the doctor But that's not the way the argument is framed - look at the words of Sen. Ensign (R-NEV) quoted in this afternoon's NY Times: "The problem is caused by out of control jury awards in frivilous lawsuits, which are cheaper to settle...than they are to fight,'' said Sen. John Ensign, R-Nev. ``And the reason they'll settle is because of the potential for huge awards......then pass the higher rates on to doctors." On the Senate floor they are talking about this in terms of payouts rather than the general litigation costs as you are portraying it. The over-reliance on simple inflammatory rhetoric to present the case rather than a clear and honest discussion of the complexities of the issue makes someone like me, who listened to the distortions about the destruction of non-existent "family farms" used to make the case for the repeal of the so-called "death tax", sends up lots and lots of red flags. The fact that the ususal people who defend right wing policies keep having to come up with different explanations and rationalizations which are completely different from the rhetoric being used to actually sell it really makes me wonder if there are any GOP policies that do not depend upon lies, distortions, and prejudice and appeals to emotion in order to gain public support. Posted by: Andy at July 9, 2003 12:54 PM | PERMALINKWhoa there Andy, I'm trying to deal with empirical issue of skyrocketing insurance premiums. There seems to be quite a bit of skepticism about there being any explanation other than insurance company greed. If you want to have a useful political discussion, you have to share some common understandings. We aren't even out of the 'is there a problem' phase yet as can be seen by the various posters above who want to frame this as some evil capitalist conspiracy. My non-peer-reviewed opinion on the matter is that ridiculous jury awards have convinced many insurance companies to spend more money vigorously defending cases. The two topics are closely related, fixing one portion could very well help both parts. As such, the idea that focusing on the payouts for a solution should cause one to 'wonder if there are any GOP policies that do not depend upon lies, distortions, and prejudice and appeals to emotion in order to gain public support', seems a bit over the top. You have to mention both sides of the equation when addressing whether or not there is a problem. That doesn't tell you anything about whether or not the solution is to be found on one side of the equation or another. Posted by: Sebastian Holsclaw at July 9, 2003 01:42 PM | PERMALINKKevin, Of course I know the purpose of medmal insurance is to spread risk around. But here's the point: if I recover a products-liability verdict from GE, they're probably not going out of business. They'll have to pay the award, of course, and maybe increased premia in the future, but that's it. A doctor found liable for malpractice is in much worse shape. Sure, the insurance will pay the award (up to the policy limit), but the insurance company may drop the doctor -- or at the least, the publicity is going to seriously harm the doctor's reputation in the community. If the system worked perfectly, that would be a good thing: incompetent doctors should be out of business. But the point is that the system is risky enough that even a competent doctor runs a real risk of being found liable, and that risk makes it possible to extract settlements in frivolous or nearly-frivolous cases. (Of course, if the risk really were perfectly spread around, then almost by definition there would be no deterrent effect on any doctor!) Do you have any information on how much malpractice premia add to the total cost of health care? I really don't know (and my point above was not to answer this question, but just to say that it's the right question to ask). I would also want to include the cost of tests and procedures that doctors order, not because they're really warranted, but because the threat of litigation encourages cover-your-ass behavior. (I tend to think -- again, based on little actual evidence -- that this is what medmal liability actually encourages: inefficient overdeterrence, rather than real improvements in cutting down human error.) I'll post later in response to your request for suggestions for diminishing the culture of frivolous lawsuits. Best, >>There seems to be quite a bit of skepticism about there being any explanation other than insurance company greed. Hmmm - nice honest way to frame "a useful political discussion". I don't know that it's "greed", and I certainly haven't argued as such - interesting that you dismiss what I amd others say with some phoney label to be dirided - but rather it seems probably that the insurance system is a broken system which is hiding behind blaming "frivilous lawsuits" to deflect the blame. And as I've just shown in my post to which you responded, that the rhetoric being used to pass the legislation is NOT in the least what you and Jane and all are arguing on here. You are saying that it is the *costs* of litigation, not just limited to payouts - the Senators on the floor are talking exclusively in terms of payouts - yet when I post this rebuttal to your point, you can't even be bothered to address it - so you can come down off your high horse as regarding "useful political discussion". >>You have to mention both sides of the equation when addressing whether or not there is a problem. Why not tell Sen Ensign that, Sebastian? You guys are the ones coming up with all this other stuff - yet on the Senate floor and in the media the rhetoric is fixed upon "out of control jury awards in frivilous lawsuits". If you want a "useful political discussion", then don't hold anyone else to standards that you aren't holding your leaders to - and I certainly haven't seen or heard *anyone* in the GOP leadership or the right wing media discussing "both sides of the equation" as you put it - has anyone else? Oh, by the way, speaking of "over the top" - how about all those foreclosed-upon family farms because of the dreaded "death tax"? I'm sure you have a non-peer reviewed opinion of that chestnut too. So I'll repeat my point - why ARE GOP policies sold on the strength of lies and distortions? Why won't GOP politicians and media dicuss the issue as a systematic INSURANCE problem rather than exclusively in terms of "tort reform" and "frivilous lawsuits" and "trial lawyers" and other GOP focusgroup talking points? Posted by: Andy at July 9, 2003 03:05 PM | PERMALINKHow can so many of you be without personal experience in the health care marketplace? Politicians, for sure, went dipping into new gold when they discovered Medicare benefits. Yes, it helped people afford care that would not have been given to older people who didn't have the money to pay for it. Today, we see people on life support for years because it's income to hospitals. IF there's a problem with insurance here's the ONE that people use. You buy home, fire, life protection, you never think of the day you'll need it. But health care is an ON-GOING insurance phenomenon. It's destroyed patient confidentiality, because the insurance carriers want to know what 'they' are paying for. Hmmm. It's destroyed the real meaning of what people pay for. In other words, in no market can you charge such a high premium your product is out of the category of affordable expense. People go to work to get insurance. And, they stay in jobs they hate because they fear the loss of their insurance when they leave. (Okay, COBRA gives you 18 months ... but what if you have a life-threatening illness? AIDS? Cancer? Infertility? The stuff you can't treat without a huge bankroll. How did prices get so out of line, here? As to lawsuits, I gave up long ago when I was asked to serve on a NY jury. The complaint wasn't workman's comp (the guy had that). It wasn't even malpractice (though he had that, too.) He allowed someone to operate on his spine (after falling down at a construction site where he worked ... his legs got tripped by some extension cord he let drop to the floor.) He complained he couldn't sleep with his wife for two years. (Yeah, the law pays ya money for that.) Anyway, it never reached the jury. The lawyers settled just before they closed their arguments. I was pretty in those days. I was put on the jury to be eye candy for the judge. And, after the case was over I was impressed with the guy's lawyer (ARYE, I think his name was). But the insurance lawyer asked me out on a date. BOY, DID I DISCOVER THE WORLD OF HANDSHAKES! When I expressed surprise at what I saw go down, I got gossip that I can still remember. The 'trial lawyers' were an insiders club. They traded cases back and forth. And, settlements always were done to earn profits. Had nothing to do with the law. Or common sense. But that was in the old days. Insurance was limited to a few companies that gave policies similar to homeowner's insurance ... small fees ... or employer offered (to entice workers to stick around) ... And, no one got excited ... because the prices for this stuff wasn't going through the roof. NOW? Well, now when you want to buy something simple (like a visit to a doctor's office) you're paying for OVERHEAD. Look at it this way. There's MORE overhead now than before. AND, UNLIKE WALMARTs that brought efficiency to distribution ... the 'take' by the 'bank' ... those who collect insurance premiums ... and the doctors who get what's left ... Are just like charitable organizations. Did you know that The March of Dimes never gave Salk a dime? They didn't want a cure! It stopped their business. And, what makes me really irritated is how insurance companies need you to call them to get to treatments that require paper approvals ... AND THIS IS RUN BY IDIOTS WHO ANSWER PHONES ... AND WHO'D GET IN TROUBLE FOR STAYING ON ONE PHONE CALL TOO LONG ... or for approving care when they can just as easily push you back down the line to see your 'primary care physicians.' MY GOD! I MUST BE LIVING IN SUCH A HEALTHY COUNTRY THAT BLOGGERS HERE HAVEN'T RUN ACROSS A SINGLE PROBLEM. AND, I BET MOST OF YA HAVE NEVER EVEN GOTTEN A TRAFFIC TICKET. Healthy and happy. Well, what a pleasure to meet ya all. (I was worried that sick people were getting cheated. Go know that's not the problem.) Posted by: Carol Herman at July 9, 2003 03:30 PM | PERMALINKI don't care enough about the estate tax to get worked up over it one way or another. My point about 'both sides of the equation' is that the Senators are at a completely different point in the argument than we are. We (and I mean those on this board, I'm not sure exactly what the two of us are arguing about) are still arguing about whether or not there is a problem with skyrocketing malpractice insurance premiums that has causes other than insurance company's greed. At that phase of the argument, you have to look beyond 'payouts' and notice that the cost of litigation includes more than mere payouts. If we ever get to the point where we agree there is a problem, we could begin talking about solutions. The Senators are already beyond the 'is there a problem' point in the discussion. They believe there is, and they believe that a logical place to attack the problem can be found in liability caps. I could argue that such caps are Constitutionally beyond the province of Congress. I could argue that they were stupid. I could argue that they are great. My point is that we aren't even there yet. Kevin's initial post clearly indicates skepticism that there is a crisis based on some numbers that weren't looking at a very large portion of the question. Andy, you express skepticism about the existance of a crisis in any but a Republican propaganda sense. You can find post after post decrying the idea that there is a problem other than insurance company greed. All I have tried to do is point out that the question is broader than 'payouts' because payouts don't include the majority of litigation costs. Republican Senators believe that they have a solution to this problem and they outline their proposed solution in debate. You want to call them liars because they don't bother to attack everything I outline in my attempts to show that there is a problem. It is not at all obvious that all symptoms of a problem need to be attacked in order to deal with a problem. Killing the 'root cause' is enough. You seem to be indicating that Republican Senators are not focusing on the right cause. Fine, but it is difficult to deal with criticism about how to deal with a problem from the same people who either deny that there is a problem, or believe that the problem is purely corporate greed. Personally I'm not convinced this is a medical insurance problem so much as a general cost of litigation problem. The fact that frivolous lawsuits can turn into multi-million dollar awards makes the court process very risky in a non-medical setting as well. But that doesn't make people who want to deal with a smaller part of the problem 'liars'. Furthermore it seems a better approach than acting as if there is no problem at all, like most Democratic Senators. Posted by: Sebastian Holsclaw at July 9, 2003 04:14 PM | PERMALINKYou can no longer cure this problem. It didn't exist in 1970. It grew like wildfire on premium's money. Unlike most insurance, (that you use it when you need it, and most people just pay and aren't taking cash out) ... it's just a spread the risk situation, so to speak. Then along comes this MONEY TREE, that feeds more people than you can believe. MORE PEOPLE GO TO WORK AND EARN DOLLARS BASED ON PAPER CHASING THIS STUFF FROM TOP TO BOTTOM. Even the post office makes money on the volumes of mail generated here. Okay. So it's like a dam. Comes along and lots of money collects on one side. And, you better hope the dam doesn't fail. BUT IT IS VERY COSTLY. AND MEDICAL CARE IS STARTING TO FEEL LIKE CRAP FOR THOSE WHO NEED IT. In one example: Gone on the days a hospital could afford to let you in the day before surgery. WHere you were sure to meet the resident assigned to your case. And, you and your family would meet the staff. You'd stay a bit longer, too. There wasn't a tendency to limit your stay to some arbitrary number of "how many days allowed." Here go the dominoes: NOW doctors don't know to get situations the way they did when they interacted with family. NOW some people are sent home too early. And, too sick, to fully recover. NOW you don't know staff from a hole in the wall. Doctors in training complain. Sure, they still do rounds ... But the rounds are going faster as patients in beds turn over faster. All this is to serve the bottom line. All this is to serve how once a river flowed, only to be dammed up so that the money can be re-distributed. I think many of you would freak out if you knew how much of this processing is done in Ireland. India. And, other countries. AMerican dollars going buh-bye. And, what it costs a doctor when he has to hire office staff just to process the mountain of paperwork it takes to get paid. You want a cure? For this disease? Fuhgetabout it. Too many hands in the pie. And, some of them belong to politicians who need an ever increasing supply of money to get elected. YOU WANT TO DISCUSS THIS IN CONGRESS? YOU'D HAVE A BETTER CHANCE DISCUSSING SEX AT THE VATICAN. BUSINESS IS BUSINESS. Of course, leadership is quite another thing. We've made attaining goals like excellence in leadership much, much harder to come by. Ask yourself, will the USA ever see another LINCOLN? Why do such mediocre, and loyal people, surround a president? And, why is it that all we get are photo-ops? THE PROBLEMS DON'T GO AWAY. Posted by: Carol Herman at July 9, 2003 05:28 PM | PERMALINKBut Kevin, my co-blogger, who works very closely with the insurance industry, has provided data. As I recall, you ignored it in favor of numbers that have been massaged by one or the other of Ralph Nader's merry band of marauders. The numbers that I saw showed losses on policies steadily increasing. Whether those are payouts, the cost of defending lawsuits, or what have you, they don't jibe with Public Citizen's line. Having worked for PIRG, and seen some of the creative ways that they generate their numbers, and having seen how my co-blogger generates his, I'm going to trust him. The problem clearly isn't just insurance company greed, because in some markets, insurers aren't raising prices -- they're exiting the market. There are, I'm told, a couple of states that are down to one medmal provider who is thinking of exiting the market. If all they were trying to do was squeeze every last dollar out of the market, the solution wouldn't be to leave. Yet we see, in the crisis states, a continuing pattern of companies simply deciding not to offer the insurance. The 1990's were what's known as a "soft" insurance market, characterized by a lot of competition, with losses camouflaged by rising security values. Now securities aren't appreciation, interest rates are way down, and the insurance companies can't absorb losses in capital stock. Ralph Nader's minions like to characterize this as "mismanagement", but of course, they offer no opinion as to how they would make policies on which losses are greater than premiums make money in a falling asset market. (And I would pay cash money to meet anyone who will put their retirement portfolio in the hands of a Public Citizen organizer who is not a relative or a friend instead of the Pru.) One can fault them for writing policies at a loss, of course, but all that tells us is that premiums should have increased sooner -- not that the money was mismanaged. I've no doubt that there are bad managers in the insurance industry. But PIRG seems to be positing that thousands of insurance companies are all incompetent to manage their money -- and yet, strangely, only in the medmal line, not in fire insurance or life insurance, or any other kind of insurance where premiums have remained steady. Moreover, teh insurance company is heavily, heavily regulated as to what they can do with their money, so the latitude for jaw-dropping mistakes of the kind that would be required to take down the whole medmal market is slight. Posted by: Jane Galt at July 10, 2003 04:29 AM | PERMALINK1) Eliminate Medicare, Medicade, and all, state programs; 2) Create a national insurence program (based in physical structure on the Federal Reserve) 3) Cover all children; 4) Create several levels of coverage and co-payments based on what each citizen/family can contribute; 5) Collect premiums through pay-roll deduction when possible; 6) Use economic data and computer modeling to set appropriate payments (too few pediatricians - then pay them more); 7) Create a system to rembuse patients hurt by mistakes or incompetence for their economic damages 8) Stop paymnets to Drs. who show incompetence or neglegence. Not perfect, I know, but a point to start discussion. Posted by: Keith G at July 10, 2003 11:25 AM | PERMALINKWhy anybody would believe all of this malpractice crisis B.S. is a bit of a mystery to me. Remember who is spinning this web, after all, the insurance industry. Research proves that caps on damages only aids the insurance industry, because they do not pass on any savings to policyholders. Oh, what a shock, Lucy! Unless you really regulate insurance companies, like California does with Prop. 103, the insurance industry will continue to rape and pillage doctors and hospitals just like they plunder car owners and homeowners. Posted by: Terry Lavin at February 5, 2004 12:31 PM | PERMALINKPrior to performing any procedure on a patient, a physician routinely cites possible complications of the prospective procedure and obtains informed consent from the patient, to the effect that the patient understands that, even in the best of hands, certain bad things can happen if the physician performs the procedure. The patient signs the informed consent and that document becomes part of his medical record, yet the patient STILL retains the right to sue the physician if any of the cited bad things happen, on the theory that the physician must have been negligent, or the bad thing would not have occurred. What is wrong with this picture? Manufacturers have taken to labeling their products with warnings about bad things that can happen if consumers use them, for example, ladders carry the warning label with words to the effect, if you climb onto this ladder, you might fall and hurt yourself. By the expedient of warning labeling, corporations seek to avoid product-liability and I understand that it works for corporate manufacturers. The fast-food restaurant that had to pay millions to the woman who spilled hot coffee on herself and scalded herself a few years ago lost the suit presumably because the coffee bore no warning label to the effect, "If you spill the contents of this coffee-cup on yourself, you could suffer scalding." Why can't physicians escape liability by means of the extensive informed consent they routinely obtain (much more extensive and exhaustive than any manufacturer's warning label)? If courts would enforce standards of labeling that apply to corporations for product-liability purposes, the malpractice-crisis could go away. Posted by: Eric at April 20, 2004 04:30 AM | PERMALINKOral Addiction - Perfect Toes - Petite Latinas - Pregnant Babes - Red Hot Pornstars Posted by: Free porn thumbs at June 21, 2004 05:50 PM | PERMALINK
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