Let's move forward: What parts of health care reform can Dems and Repubs agree on?

[MattusMaximus]

Okay, so let's take a different track on the Politics subforum for a change... what can Dems/Repubs, cons/libs, whatever actually agree on regarding health care reform?

What are the basic elements we can put into an HCR bill to get something useful passed through Congress with bipartisan support?

Please note: I know I'm probably pissing into the wind by saying so, but I don't want to see the thread cluttered with the usual bickering.

Proceed.

[The Painter]

bipartisan support

As long as Pelosi and Reed are in charge it will never happen.

[fishbob]

Okay, so let's take a different track on the Politics subforum for a change... what can Dems/Repubs, cons/libs, whatever actually agree on regarding health care reform?

What are the basic elements we can put into an HCR bill to get something useful passed through Congress with bipartisan support?

Please note: I know I'm probably pissing into the wind by saying so, but I don't want to see the thread cluttered with the usual bickering.

Proceed.

Removing pre-existing conditions seems like a good idea, but will affect costs in unforeseen ways. This would only work reasonably as part of a single-payer system - which was dropped by the wayside.

The pork stuffed into the Senate version is toxic.

[carlitos]

- No Pork
- More specifically, no freebies for late-arriving Senators from Nebraska or wherever
- Portability, with some creative way of giving insurers relief on pre-existing conditions, depending on patient pool

[Upchurch]

As long as Pelosi and Reed are in charge it will never happen.

Why? Because they won't work with Republican or because Republicans won't work with them?

[Random]

By not participating, the GOP makes Democrats look weak and demoralizes the Democratic base when nothing gets done. All the GOP has to do is say no, hook a conservadem or two, and the whole thing comes crashing down in flames. It’s win-win for the GOP.

The actual contents of the bill are irrelevant.

[Beerina]

Let's move forward: What parts of health care reform can Dems and Repubs agree on?

Proceed.


1. It's a massive political football.
2. Nobody shall do anything now as it's obviously what the voters want, narrative fantasies of the pro side notwithstanding.


So...that's about where it is right now, with both sides agreeing. Unless I've missed something.

[MattusMaximus]

It seems as if the new Senator from Massachusetts is interested in talking with Obama and the Dems about moving forward on this issue...

http://www.politico.com/blogs/glennthrush/0110/Brown_open_to_pareddown_Obama_health_proposals.htm l#

Are we going to descend so far down into partisan bickering that we're going to just screw ourselves? Nobody can get everything they want on this thing, but surely there are some things we can get that we all need?

[MattusMaximus]

1. It's a massive political football.
2. Nobody shall do anything now as it's obviously what the voters want, narrative fantasies of the pro side notwithstanding.

So...that's about where it is right now, with both sides agreeing. Unless I've missed something.

That's crazy. Even Republicans agree that people want health care reform. Even Scott Brown has said as much.

The question is what to do. What can we agree on?

Or are people here so damned jaded and partisan that they cannot think about anything except what to fight about?

[carlitos]

Or are people here so damned jaded and partisan that they cannot think about anything except what to fight about?
I think you have your answer there, in only a few short posts. I gave it a whirl, for what it's worth.

ETA - It could be possible that the public wants 'nothing' having seen the 'something' that this Congress put together. Maybe when there is a new set of folks, they can do better.

[MattusMaximus]

I think you have your answer there, in only a few short posts. I gave it a whirl, for what it's worth.

ETA - It could be possible that the public wants 'nothing' having seen the 'something' that this Congress put together. Maybe when there is a new set of folks, they can do better.

So are you telling me the public wouldn't even want a law passed which prevents the insurance companies from dropping your insurance for having a pre-existing condition? Or for getting really sick?

[carlitos]

So are you telling me the public wouldn't even want a law passed which prevents the insurance companies from dropping your insurance for having a pre-existing condition?

Right - that's why I suggested, in response to your post, "Portability, with some creative way of giving insurers relief on pre-existing conditions, depending on patient pool." I thought that you didn't want bickering.

I was merely suggesting the obvious. The politicians built a big crap sandwich, and it freaked everybody out. I don't find it hard to believe that >50% of John Q Public would prefer that Congress do nothing. And not just on health care. I'd like them to do a whole lot more nothing about everything. This is why we like divided governments for a lot of reasons; it stalls them from screwing things up.

[MattusMaximus]

So you suggest dealing with the problem of companies dropping those with pre-existing conditions by working in portability as opposed to a law preventing it? Just trying to get this down.

[Thunder]

i really do believe that requiring all Americans to have health insurance will offset any extra costs that the "no pre-conditions" issue might create.

the bigger the pool of customers, the more money to divide amoung more people.

however, if Republicans do insist, we could drop the health insurance requirement in exchange for a forcing Americans who refuse health insurance to sign a contract stating that if they ever do get sick, and require public assistance, there will be big monetary penalties.

[JoeTheJuggler]

Okay, so let's take a different track on the Politics subforum for a change... what can Dems/Repubs, cons/libs, whatever actually agree on regarding health care reform?

What are the basic elements we can put into an HCR bill to get something useful passed through Congress with bipartisan support?


Unfortunately, I think the major parts of it are so interdependent that there will be no piecemeal approach.

For example, you can't really end rescission, post-claim underwriting, excluding pre-existing conditions and prohibiting benefit caps (i.e. all the insurance reforms) without passing the individual mandate. And you can't have the individual mandate without some kind of subsidy in place, etc. . .

I suppose everyone agrees that the anti-trust exemption for health insurance companies should be done away with.

[MattusMaximus]

i really do believe that requiring all Americans to have health insurance will offset any extra costs that the "no pre-conditions" issue might create.

the bigger the pool of customers, the more money to divide amoung more people.

however, if Republicans do insist, we could drop the health insurance requirement in exchange for a forcing Americans who refuse health insurance to sign a contract stating that if they ever do get sick, and require public assistance, there will be big monetary penalties.

Interesting... what do my GOP/conservative colleagues here think of this idea?

[MattusMaximus]

Unfortunately, I think the major parts of it are so interdependent that there will be no piecemeal approach.

For example, you can't really end rescission, post-claim underwriting, excluding pre-existing conditions and prohibiting benefit caps (i.e. all the insurance reforms) without passing the individual mandate. And you can't have the individual mandate without some kind of subsidy in place, etc. . .

I suppose everyone agrees that the anti-trust exemption for health insurance companies should be done away with.

Good, let's start with that. Any rebuttals to this idea?

[carlitos]

So you suggest dealing with the problem of companies dropping those with pre-existing conditions by working in portability as opposed to a law preventing it? Just trying to get this down.

Health insurance companies don't usually "drop" you for having a pre-existing condition, so I'm not sure why we need a law to prevent that. What they can do is deny you coverage for that condition when you sign up. Today, most of the time, this is when you lose or change a job.

Make health insurance portable. The most logical way to do this is to de-couple insurance from employment, but I recognize that's a long-term goal. In the meantime, you could make it portable. By law. I don't know how best to accomplish this, but today, when I lose my job, I don't lose my car insurance, my life insurance, or my homeowners. I'm not sure why health insurance is so different, but people seem to think that it is.

There are valid financial reasons to deny pre-existing conditions. It messes up your costs by skewing the patient pool. So companies will need to be made whole somehow so that they will go along with it.

I'm no expert, and the above are just my humble opinions. :)


ETA - If we're looking at anti-trust, we should let health insurers work in multiple states. This will give consumers and employers more options when choosing an insurance company.

[MattusMaximus]

Health insurance companies don't usually "drop" you for having a pre-existing condition, so I'm not sure why we need a law to prevent that. What they can do is deny you coverage for that condition when you sign up. Today, most of the time, this is when you lose or change a job.

Make health insurance portable. The most logical way to do this is to de-couple insurance from employment, but I recognize that's a long-term goal. In the meantime, you could make it portable. By law. I don't know how best to accomplish this, but today, when I lose my job, I don't lose my car insurance, my life insurance, or my homeowners. I'm not sure why health insurance is so different, but people seem to think that it is.

Okay. What do my fellow Dems/libs think of this ideas? I must admit the notion of portability, in the context of other forms of insurance, does make some sense to me.

There are valid financial reasons to deny pre-existing conditions. It messes up your costs by skewing the patient pool. So companies will need to be made whole somehow so that they will go along with it.

I'm no expert, and the above are just my humble opinions. :)

So how would one go about making such a company whole?

[Francesca R]

What are the basic elements we can put into an HCR bill to get something useful passed through Congress with bipartisan support? At its most basic, I think you need mandatory enrolment and threshold coverage (no exclusions based on existing conditions) that is subsidised by Federal government in some cases according to ability to pay.

If you can't agree on those three, I think you are better off with your status quo, because universal systems are unstable without them and will probably be worse than what you have already.

You do not need "single payer"--there is no evidence that it is necessary. Plus it is kind-of practically impossible starting from where you are.

"Pork" concessions just increase the cost, unfairly, but probably don't bring runaway costs and are political "reality".

[JoeTheJuggler]

Health insurance companies don't usually "drop" you for having a pre-existing condition, so I'm not sure why we need a law to prevent that.
The practices of rescission and post-claim underwriting is a nasty problem.

The House Energy & Commerce Committee investigated it last summer (http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1671:energy-and-commerce-subcommittee-hearing-on-terminations-of-individual-health-policies-by-insurance-companies-&catid=133:subcommittee-on-oversight-and-investigations&Itemid=73).



What they can do is deny you coverage for that condition when you sign up. Today, most of the time, this is when you lose or change a job.
See above. They can also deny you coverage after you file a claim. They can also cancel your policy after you file a claim.

If you think the stories in Michael Moore's Sicko were atypical, read through the documents I cited above from the House investigation. They can even deny your claim after they approved it (and you've had the treatment done based on that approval). They can do these things under the thinnest of pretexts such as an honest error or the failure of a relative not involved in the claim to divulge something on their application.

Further, insurance industry representatives have said that the only way they can stop these practices is with comprehensive reform (including the individual mandate).

From the House's "Supplemental Memo (http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1671:energy-and-commerce-subcommittee-hearing-on-terminations-of-individual-health-policies-by-insurance-companies-&catid=133:subcommittee-on-oversight-and-investigations&Itemid=73)" on this investigation:

IV. CONCLUSION
In written testimony for today's hearing, all three insurance companies stated that the passage of comprehensive health care reform legislation would eliminate the controversial practices of denying coverage based on preexisting conditions, investigating policyholder medical records for omissions, and the rescission of coverage for policyholders.

Richard Collins, the CEO of UnitedHealth Group's subsidiary, Golden Rule Insurance Company, stated:
[O]ur country needs comprehensive health reform.... Until comprehensive reform is achieved, we believe that the medical underwriting of individual policies will continue to be necessary. If these changes are instituted, most of the reasons for individual medical underwriting - as well as most of the reasons that individual policies are rescinded or terminated - would cease to exist.68

Similarly, Brian Sassi, the President and CEO of Consumer Business at WellPoint, Inc., stated:
[T]he elimination of medical underwriting combined with an effective and enforceable personal coverage requirement ... would render the practice of rescission unnecessary.69



There are valid financial reasons to deny pre-existing conditions. It messes up your costs by skewing the patient pool. So companies will need to be made whole somehow so that they will go along with it.
That's pretty much what I said above. Passing these insurance reforms is dependent on a more comprehensive reform.

Of course, I'd prefer a single payer system and do away with the profit-driven way of providing health insurance to most of us.


ETA - If we're looking at anti-trust, we should let health insurers work in multiple states.
I think that's what I just said above as perhaps the one thing everyone can agree on by itself. (Except the insurance companies that benefit from the anti-trust exemption.)

[JoeTheJuggler]

At its most basic, I think you need mandatory enrolment and threshold coverage (no exclusions based on existing conditions) that is subsidised by Federal government in some cases according to ability to pay.

If you can't agree on those three, I think you are better off with your status quo, because universal systems are unstable without them and will probably be worse than what you have already.

I would agree. (And of course the primary points of contention lie in those three things--and, incredibly, the abortion language that shouldn't be part of this bill at all.)

And I suspect House Democrats will realize this expedience and either pass the Senate bill as is or change the topic as quickly and thoroughly as possible.

[carlitos]

So how would one go about making such a company whole?
I don't know exactly, there would have to be some kind of formula in the patient pool. Otherwise, everyone would buy super-cheap, minimum-coverage, high-deductible insurance. Then, when they are diagnosed with something awful, they could go apply for Blue Cross HMO.


JoetheJuggler, I will admit that I thought of those stories as atypical. My wife has some serious stuff on record, and I have had great insurance, both self-purchased and company-provided while changing jobs and being self-employed, so I'm a little biased I suppose. I will read up on it more.

ETA - I just can't imagine that mandatory enrollment would be constitutional, but the SCOTUS does wacky things.

[Brainster]

How about some meaningful tort reform (http://www.27east.com/story_detail.cfm?id=151041)? Oh, wait, you want something the Dems can agree on.

[Francesca R]

ETA - I just can't imagine that mandatory enrollment would be constitutional, but the SCOTUS does wacky things.Wasn't it already passed in both bills?

(ETA--I know that doesn't make it constitutional)

[carlitos]

Yes, it was passed in both bills. Just like McCain-Feingold (campaign-finance reform) was passed by both houses, signed by President Bush, and overturned today.

I will second tort reform, but echo the pessimism expressed by Brainster.

[Francesca R]

Well as above, if individual mandates got rejected by the supreme court, I am sure you are better off forgetting about the rest of the bill :)

[carlitos]

That seems to be what the insurance guys are saying. Which makes me suspicious :)

[The Painter]

Originally Posted by parky76

i really do believe that requiring all Americans to have health insurance will offset any extra costs that the "no pre-conditions" issue might create.

the bigger the pool of customers, the more money to divide amoung more people.

however, if Republicans do insist, we could drop the health insurance requirement in exchange for a forcing Americans who refuse health insurance to sign a contract stating that if they ever do get sick, and require public assistance, there will be big monetary penalties.


Interesting... what do my GOP/conservative colleagues here think of this idea?

This is almost the same as the current plan to charge a penalty tax to people who don't buy insurance. Could you please tell me how you get "big monetary penalties" from someone on public assistance. They obviously don't have any money.

[JoeTheJuggler]

Yes, it was passed in both bills. Just like McCain-Feingold (campaign-finance reform) was passed by both houses, signed by President Bush, and overturned today.

I will second tort reform, but echo the pessimism expressed by Brainster.

There are at least a couple of threads going on the idea of a challenge to the constitutionality of the individual mandate. No one seems to be willing to offer an actual legal theory for such a constitutional challenge.

The best argument made seems to be the idea that the commerce clause (or the general welfare clause) has been over-broadly interpreted, but that approach won't succeed since it would require overturning some 50 years of precedent (and disbanding Medicare and so on).

[Magyar]

Make health insurance portable. The most logical way to do this is to de-couple insurance from employment, but I recognize that's a long-term goal. In the meantime, you could make it portable. By law. I don't know how best to accomplish this, but today, when I lose my job, I don't lose my car insurance, my life insurance, or my homeowners. I'm not sure why health insurance is so different, but people seem to think that it is..

I think this has been tried already ! Talk to ANY small business owner (me included).
Health care cost is one of the MAJOR drags on business growth and hiring. The reason is that small business are basically forced to do what you suggest above - buy insurance on our own and guess what - we can't afford it!

THE reason that the wages of US workers has not increased since 1980 IS because of health insurance costs! This includes MA where by law every one is supposed to have and 98% actually do, yet COST of Insurance in the state has NOT dropped, has not slowed but has continued to grow just like the rest of the country.

So I really don't think that passing a law requiring every one to have insurance does anything but put more money in the insurance companies pockets.

Portability doesn't solve anything either because then what you are talking about is a paperwork nightmare for small businesses!

I work for company A - I quit/get fired now I go to work for co B.
If I ported my insurance from co A will co B have to pay co A for their share of my premium or does co B just pay me and then I pay co A?

[JoeTheJuggler]

How about some meaningful tort reform (http://www.27east.com/story_detail.cfm?id=151041)? Oh, wait, you want something the Dems can agree on.

From what I've learned on these forums, high malpractice insurance premiums contribute only a teeny tiny amount to skyrocketing healthcare costs.

Further, IMO, if by "meaningful tort reform" you mean caps on awards (which are only granted in cases with merit--i.e. to plaintiffs that win in court), that would have no effect on meritless or frivolous cases which are usually blamed for these exorbitant costs.

If you mean something that would directly address and punish frivolous suits, I am in favor, but I'm not sure what that would be.

I would also be in favor of tighter regulation of the malpractice indemnifiers. It seems at least part of the problem is their willingness to settle meritless cases (since they're basically settling with their clients' money and not their own profits).

[carlitos]

I think this has been tried already ! Talk to ANY small business owner (me included).
Health care cost is one of the MAJOR drags on business growth and hiring. The reason is that small business are basically forced to do what you suggest above - buy insurance on our own and guess what - we can't afford it!
I understand this. If insurers were able to cross state lines, just think of how big the pool of insured would be for "carlito's small business health insurance company." I would target segments of small business, expand the pool, and lower the costs. Just like Obama!

THE reason that the wages of US workers has not increased since 1980 IS because of health insurance costs! This includes MA where by law every one is supposed to have and 98% actually do, yet COST of Insurance in the state has NOT dropped, has not slowed but has continued to grow just like the rest of the country.
Yes, the real-world examples are not encouraging for the national version of this plan, not at all.

So I really don't think that passing a law requiring every one to have insurance does anything but put more money in the insurance companies pockets.
Note the CEOs' statements above posted by JoeTheJuggler. Not a coincidence.

Portability doesn't solve anything either because then what you are talking about is a paperwork nightmare for small businesses!

I work for company A - I quit/get fired now I go to work for co B.
If I ported my insurance from co A will co B have to pay co A for their share of my premium or does co B just pay me and then I pay co A?
My best guess - make it a one-time arrangement with hiring. Company A, when you leave, gives you a certificate of prior coverage, with a cost associated. Company B pays upi some or all of the cost, based on your benefits package, but the employee pays the insurer directly. That way, the insurance company bears most of the paperwork burder, and as an added bonus, this gradually weans employees off employer-based plans.

[theprestige]

Why? Because they won't work with Republican or because Republicans won't work with them?

By not participating, the GOP makes Democrats look weak and demoralizes the Democratic base when nothing gets done. All the GOP has to do is say no, hook a conservadem or two, and the whole thing comes crashing down in flames. It’s win-win for the GOP.

The actual contents of the bill are irrelevant.
Yes. The GOP just blocks everything the Democrats come up with (http://forums.randi.org/showthread.php?t=165385).

[Upchurch]

Yes. The GOP just blocks everything the Democrats come up with (http://forums.randi.org/showthread.php?t=165385).
Oh, I thought we were talking about health care reform.

So, why are Pelosi and Reed an impediment to bipartisan support?

[ponderingturtle]

That's crazy. Even Republicans agree that people want health care reform. Even Scott Brown has said as much.

The question is what to do. What can we agree on?


Broadly I nothing that will actual cut health care spending. This is because any such bill would cost people their jobs. You might be able to get a more efficient system that is more effective, but those who's jobs depends on the current system will lose them.

It is going to take a lot more than we have had to get any kind of change that will control total health care costs.

You might get a certain ammount of added protections for individuals, but all this could have been at its best is the start of a reform process into one that worked well.

[ponderingturtle]

How about some meaningful tort reform (http://www.27east.com/story_detail.cfm?id=151041)? Oh, wait, you want something the Dems can agree on.

What effect will this have? Payouts have been at a stable 1% of total health care costs for a long time. It is an easy thing to gripe about, but who pays when a doctor screws up and the harmed patient has millions in medical bills because of it? If it is not the doctor then who?

[dudalb]

It seems as if the new Senator from Massachusetts is interested in talking with Obama and the Dems about moving forward on this issue...

http://www.politico.com/blogs/glennthrush/0110/Brown_open_to_pareddown_Obama_health_proposals.htm l#

Are we going to descend so far down into partisan bickering that we're going to just screw ourselves? Nobody can get everything they want on this thing, but surely there are some things we can get that we all need?

Sadly, I have to say "Yes" to your first question . The GOP is out to win back the Congress and, in three years, The White House, and they will stoop is any tactic to do this.
I hasten to add that The Dems are no better; The Dem Congressional leadership did not make much of an effort to reach across the aisle. It might not have done them much good, but it would have made clear the Tactics that the GOP is using.
IMHO, the Health Care problem will not be solved, and it will get worse and worse as the Baby Boomers reach the age where they need more Health Care.
Look at state that California is in because of blind partisianship on both sides and the resulting total parlyisis of Government. That is way the US is going, and going fast.

[ponderingturtle]

I think this has been tried already ! Talk to ANY small business owner (me included).
Health care cost is one of the MAJOR drags on business growth and hiring. The reason is that small business are basically forced to do what you suggest above - buy insurance on our own and guess what - we can't afford it!

THE reason that the wages of US workers has not increased since 1980 IS because of health insurance costs! This includes MA where by law every one is supposed to have and 98% actually do, yet COST of Insurance in the state has NOT dropped, has not slowed but has continued to grow just like the rest of the country.

This is because covering everyone is easy politicaly, it just costs money, it does not cost people their jobs or carreers. Cutting medical costs will cost people their jobs and carreers.

So I really don't think that passing a law requiring every one to have insurance does anything but put more money in the insurance companies pockets.

Not entirely, if it permits someone to have good preventative care it will cost less than letting it go untreated until it becomes emergency care. But I don't know what percentage of health care spending this would equate to.

But the moral problems of the health care system are easier to fix than the financial.

[dudalb]

I would agree. (And of course the primary points of contention lie in those three things--and, incredibly, the abortion language that shouldn't be part of this bill at all.)

And I suspect House Democrats will realize this expedience and either pass the Senate bill as is or change the topic as quickly and thoroughly as possible.

And I suggest the second is impossible. No Health Care Bill at all would be a huge disaster, and no way they can hide that.

[ponderingturtle]

From what I've learned on these forums, high malpractice insurance premiums contribute only a teeny tiny amount to skyrocketing healthcare costs.

Further, IMO, if by "meaningful tort reform" you mean caps on awards (which are only granted in cases with merit--i.e. to plaintiffs that win in court), that would have no effect on meritless or frivolous cases which are usually blamed for these exorbitant costs.

Not sure this is entirely true, but the one that I think illustrates it best was not suing the health care industry. A class action lawsuit against makers of silicon products by people with silicosis, in that the judge turned over all the medical records in the case to the defense, it was found that a doctor was paid $75 for every X ray he diagnosed with silicosis, he even diagnosed some of the same people with aspesdosis in a previous lawsuit, though there are very very few cases of people having both.

This basicly showed that this whole case was broadly brought by frivoless people, while some of them would have had merit, But this is really an issue with class action lawsuits more than the normal citations used to encourage tort reform.

[dudalb]

Oh, I thought we were talking about health care reform.

So, why are Pelosi and Reed an impediment to bipartisan support?

Reid, not so much but if you are not aware of some of the over the top statments that Pelosi has made vis a vis the GOP,you have a world class set of Partisian Blinders.

[ponderingturtle]

I understand this. If insurers were able to cross state lines, just think of how big the pool of insured would be for "carlito's small business health insurance company." I would target segments of small business, expand the pool, and lower the costs. Just like Obama!

The thing is it is not insurers that need to do this. If small businesses banded together to buy insurance as a group this would work better than reducing regulation on insurance companies.

[carlitos]

Yeah, but small businesses within a given state only have 2 or 3 companies to petition for lower costs, even if they band together. Plus the 'banding together' could in itself be more hassle and paperwork than it's worth.

Regarding tort reform, maybe it's only a small part of costs, but the malpractice effects seem to be driving doctors away. Which, long term, is going to reduce access and quality of care, and most likely increase the cost of care.

[Dumb All Over]

OK, I'll bite on the OP. Allow health insurance companies to cross state borders and operate in any and/or all the states they choose. That I could agree on, but not much else.

[ponderingturtle]

Yeah, but small businesses within a given state only have 2 or 3 companies to petition for lower costs, even if they band together. Plus the 'banding together' could in itself be more hassle and paperwork than it's worth.

Regarding tort reform, maybe it's only a small part of costs, but the malpractice effects seem to be driving doctors away. Which, long term, is going to reduce access and quality of care, and most likely increase the cost of care.

Of course letting you buy insurance across state lines means it doesn't matter if insurance is offered in your state. So there will be some states with the lowest regulations that all the insurance companies base thier plans on. This way they only have one state legislature to petition for changes that are better for them.

[carlitos]

Of course letting you buy insurance across state lines means it doesn't matter if insurance is offered in your state. So there will be some states with the lowest regulations that all the insurance companies base thier plans on. This way they only have one state legislature to petition for changes that are better for them.

If the Feds are willing to mandate every US citizen having health insurance, surely they can abuse the commerce clause some more and just harmonize the regs nationally across state lines. I mean, it's not like rights not specifically delegated to the Feds in the Constitution are reserved for the states respectively, or the people. Right (http://en.wikipedia.org/wiki/Tenth_Amendment_to_the_United_States_Constitution) ? :)

[Random]

Of course letting you buy insurance across state lines means it doesn't matter if insurance is offered in your state. So there will be some states with the lowest regulations that all the insurance companies base thier plans on. This way they only have one state legislature to petition for changes that are better for them.

Yeah, if we are going to have interstate sales of health insurance plans, it would need to be regulated by the Fed. Otherwise, the insurance companies would just shop around for the best state to base their operations out of, and state government would be cutting back regulations in order to bring insurance company business tax revenues into their coffers in a giant race to the bottom.

Other than this limitation I have no real objection to selling insurance across state lines, other than the fact it won’t help. Health insurance companies save money by setting contracts with hospitals and doctors. If they lose market share due to competition, they lose bargaining power with those hospitals and doctors and prices go up.

[Brainster]

From what I've learned on these forums, high malpractice insurance premiums contribute only a teeny tiny amount to skyrocketing healthcare costs.

I've heard that stated as well, but it defies logic. Take the article I linked to (http://www.27east.com/story_detail.cfm?id=151041), for example and consider this part:

Dr. Alamia said his own annual premium is $189,000, which is more than his take-home salary. While his compensation from health insurance companies for treating patients remains stagnant, his liability insurance payments and other costs keep rising.

That's right, the doctor's malpractice insurance premium is more than his take-home pay (we'll assume that's after his premiums). Now let's consider the components of medical costs. It seems obvious that there are several:

1. Salaries of medical professionals and support staff
2. Drugs
3. Equipment
4. Building costs (rent or loan payments)
5. Insurance
6. Taxes
7. Profit

Anything that I've missed there? Saying in this doctor's case that insurance is only a teeny-tiny part of the cost seems the equivalent of saying that his salary is only a teeny-tiny part of the cost; let's just say I'm a little dubious.

Further, IMO, if by "meaningful tort reform" you mean caps on awards (which are only granted in cases with merit--i.e. to plaintiffs that win in court), that would have no effect on meritless or frivolous cases which are usually blamed for these exorbitant costs.

Arguably, but it's begging the question: why do lawyers and patients file meritless or frivolous cases? This would be illogical indeed if only cases with merit win.

[Random]

Arguably, but it's begging the question: why do lawyers and patients file meritless or frivolous cases? This would be illogical indeed if only cases with merit win.
The usual point of a frivolous lawsuit is to get the other guy to settle. You sue the other guy for a hundred thousand and say you will settle for ten thousand. The other guy talks to his lawyers and figures out that he will win hands down in court, but it will cost twenty thousand in lawyers fees. Settle and save ten grand. Actually winning in court is not necessary.

[JoeTheJuggler]

Arguably, but it's begging the question: why do lawyers and patients file meritless or frivolous cases? This would be illogical indeed if only cases with merit win.

You are obviously using a different definition of "meritless" and "frivolous" than I am.

This is from the Wiki article (http://en.wikipedia.org/wiki/Frivolous_lawsuit):

Frivolous litigation is the practice of starting or carrying on law suits that have no chance of winning. There are both legal and colloquial definitions of the term. In popular usage, lay persons typically call a lawsuit "frivolous" if they personally find a claim to be absurd, regardless of its legal standing. But in official usage, as by the judiciary of the United States, "frivolous litigation" is considered to consist of a legal claim or defense presented even though the party or the party's legal counsel had reason to know that the claim or defense was manifestly insufficient or futile, that is to say, had no legal merit. The remainder of this article discusses the usage of the term within the legal profession.

I'm using the legal definition. A case that is frivolous has no chance of winning. If it has no chance of winning, caps on damages have no effect on it. The problem is, why are indemnifiers settling frivolous cases?

If you're using the popular version of the term "frivolous" I suspect the problem with that is that what some people consider "frivolous" isn't what other people consider "frivolous".

But if a case truly has no legal merit, then caps don't apply--it would, by definition, never win in court.

[JoeTheJuggler]

My bolding:
Saying in this doctor's case that insurance is only a teeny-tiny part of the cost seems the equivalent of saying that his salary is only a teeny-tiny part of the cost; let's just say I'm a little dubious.

Who said that? I was talking about the contribution of the cost of malpractice insurance to the out-of-control costs of healthcare to us as a nation.

I said nothing about the costs of premiums "in this doctor's case".

[Malerin]

Tort reform, portability, and a high-deductible subsidized public option for bankruptcy protection. That last one wouldn't be cheap, but the amount of bankrupticies caused by medical bills is insane.

[theprestige]

Oh, I thought we were talking about health care reform.

So, why are Pelosi and Reed an impediment to bipartisan support?
Honestly, I don't think they are an impediment. At least, not by their essential natures.

I mean, it's clear that Republicans have been willing to support any number of issues in 2009. Bills got passed. Bipartisan support was had. Reid and Pelosi were there all year. So if we're talking about health care reform, it's not Reid and Pelosi that are the new ingredient that impedes bipartisan support for this issue. It's the issue that's the new ingredient. Reid and Pelosi got bipartisan support for other issues. Why not this one?

[JoeTheJuggler]

Tort reform, portability, and a high-deductible subsidized public option for bankruptcy protection. That last one wouldn't be cheap, but the amount of bankrupticies caused by medical bills is insane.

But even the Democrats couldn't agree on a public option. (The question wasn't about what you would agree to, I don't think.) And the Republicans were dead set against it (and voted against even the Senate version which had no public option).

[Travis]

Suppose we just throw the current efforts out and focus on true Universal Coverage. Who here is in favor of this and who here would oppose this?

[KoihimeNakamura]

To unlikely currently. So I don't have an opinion either way.

[dudalb]

Suppose we just throw the current efforts out and focus on true Universal Coverage. Who here is in favor of this and who here would oppose this?

The whole GOP would.

[MattusMaximus]

Honestly, I don't think they are an impediment. At least, not by their essential natures.

I mean, it's clear that Republicans have been willing to support any number of issues in 2009. Bills got passed. Bipartisan support was had. Reid and Pelosi were there all year. So if we're talking about health care reform, it's not Reid and Pelosi that are the new ingredient that impedes bipartisan support for this issue. It's the issue that's the new ingredient. Reid and Pelosi got bipartisan support for other issues. Why not this one?

Honestly, I think it was partly the perception via Tea Party protests that poisoned the well with rhetoric like "death panels" and "keep your government hands off my Medicare" which scared GOP politicians into opposing pretty much anything proposed for HCR. Listening to a bunch of nuts was the failure of the more moderate Republicans.

And that led to the Dems pushing back in an overly partisan manner, especially after they had 60 seats locked up in the Senate. Hubris was their failing.

Both sides screwed up on this, and bipartisanship died as a result. The question is now how the hell do we get it back in an election year? :boggled:

[theprestige]

Both sides screwed up on this, and bipartisanship died as a result. The question is now how the hell do we get it back in an election year? :boggled:
We don't. Factions get hung up on saving their seats, don't really get much done. The system works, we all sleep safe at night knowing that once again an election year has prevented the government from getting its act together and "helping" us.

[rwguinn]

Back to the OP
Nobody is better than I am. What's good enough for me (by your lights) is good enough for you.
No special favors--everybody gets treated the same. If corporations/companies/partnerships/union members get a tax break for their premium payments, so do I. If Nebraska gets an free ride, so do the other states, Districts, and territories.
We can work from there

[MattusMaximus]

Back to the OP
Nobody is better than I am. What's good enough for me (by your lights) is good enough for you.
No special favors--everybody gets treated the same. If corporations/companies/partnerships/union members get a tax break for their premium payments, so do I. If Nebraska gets an free ride, so do the other states, Districts, and territories.
We can work from there

Don't forget Congress as well.

Okay, I can go with that.

[carlitos]

Despite the hyperbole that emerges (notably from the right) on the UK and Canadian systems, there is a lot to be learned from the French system. Unfortunately, even their universal coverage seems to be augmented by private insurance, but it's the best universal plan out there.

[rwguinn]

Don't forget Congress as well.

Okay, I can go with that.
The "what's good enough for me" bit covers Congress. They're the ones dictating it...
I am tired of the BS where the lawmakers know what's best for the rest of us--and Pelosi and her ilk are GOOD at that--but they, themselves, are too good for that.
They are [church lady] Spea-shull[/church lady]

[MattusMaximus]

The "what's good enough for me" bit covers Congress. They're the ones dictating it...
I am tired of the BS where the lawmakers know what's best for the rest of us--and Pelosi and her ilk are GOOD at that--but they, themselves, are too good for that.
They are [church lady] Spea-shull[/church lady]

It's not just Pelosi. Remember that Congress has engaged in this sort of behavior for as long as we can remember, and it didn't matter which party had control.

[ponderingturtle]

If the Feds are willing to mandate every US citizen having health insurance, surely they can abuse the commerce clause some more and just harmonize the regs nationally across state lines. I mean, it's not like rights not specifically delegated to the Feds in the Constitution are reserved for the states respectively, or the people. Right (http://en.wikipedia.org/wiki/Tenth_Amendment_to_the_United_States_Constitution) ? :)

So why should the fed mandate that people can buy insurance across state lines then? Why not let states decide if they will or will not permit that, instead of forcing states to accept the regulations from other states.

[ponderingturtle]

I've heard that stated as well, but it defies logic. Take the article I linked to (http://www.27east.com/story_detail.cfm?id=151041), for example and consider this part:



That's right, the doctor's malpractice insurance premium is more than his take-home pay (we'll assume that's after his premiums). Now let's consider the components of medical costs. It seems obvious that there are several:

1. Salaries of medical professionals and support staff
2. Drugs
3. Equipment
4. Building costs (rent or loan payments)
5. Insurance
6. Taxes
7. Profit

Anything that I've missed there? Saying in this doctor's case that insurance is only a teeny-tiny part of the cost seems the equivalent of saying that his salary is only a teeny-tiny part of the cost; let's just say I'm a little dubious.


No it is like saying salaries of everyone who works in health care are a small portion of the total health care costs. Malpartice insurance costs are not what is driving health care costs up. That statement it simply wrong. Doctors complain because it is something that they pay for personaly, and in some specialties they have such large liabilities they have problems getting insurance that they can afford.

So how do you deal with something that has large liabilities fundamental to its practice?

[ponderingturtle]

The usual point of a frivolous lawsuit is to get the other guy to settle. You sue the other guy for a hundred thousand and say you will settle for ten thousand. The other guy talks to his lawyers and figures out that he will win hands down in court, but it will cost twenty thousand in lawyers fees. Settle and save ten grand. Actually winning in court is not necessary.

And how are caps and such going to effect those cases? The will only effect cases that have merit and are proven after all.

[ponderingturtle]

Suppose we just throw the current efforts out and focus on true Universal Coverage. Who here is in favor of this and who here would oppose this?

Here or in general? The thing is that to actual cut health care spending we will need to put people out of work and have some people earn less money. Many of the people who would be hurt by this have a lot of money to spend on lobying against changes that would hit them in the pocketbook.

There needs to be enough public demand for it to overcome the special interests, so I predict nothing substantial will happen until we get a serious crisis, not something small like the recent financial difficulties.

[JoeTheJuggler]

The whole GOP would.

And even a chunk of the Democratic Party.

I'd be in favor of a true universal healthcare system, and, depending on the wording, polls show a majority of Americans in favor of a single payer system, but if this extremely compromised health insurance reform bill can't pass even in the most favorable Congress we're going to have for it for the foreseeable future, anything more radical stands no chance.

[JoeTheJuggler]

And how are caps and such going to effect those cases? The will only effect cases that have merit and are proven after all.

I agree.

If people are settling frivolous cases because it's cheaper than defending them, then that's the problem we need to address. If a case is meritless, by definition it has no chance of winning, so the size of a possible award is irrelevant. What's relevant is how much it would cost to defend against a meritless case. To me, the easiest solution is that when a case is dismissed or decided for the defendant, you simply ask the fact finder whether they think the case was truly meritless (and only made as an attempt at getting a settlement). If the answer is yes, the plaintiff pays the defendant's legal fees (and if the plaintiff's lawyer's fee was contingent, the plaintiff's lawyer should be reprimanded by the bar for encouraging the pursuit of a meritless case).

ETA: As I mentioned earlier, I think the issue is that people are using "meritless" or "frivolous" on cases that actually have merit but that they think shouldn't. I believe Liebeck v. MacDonald's is their poster child for a frivolous case. It wasn't though, because the plaintiff won (and then parties reached a secret settlement to avoid any further appeals).

[Sporanox]

My bolding:


Who said that? I was talking about the contribution of the cost of malpractice insurance to the out-of-control costs of healthcare to us as a nation.

I said nothing about the costs of premiums "in this doctor's case".

But that’s not the end of the savings, either. A 0.5% reduction in health-care costs would mean $11 billion in savings per year overall, with roughly 40% of that benefiting the federal government in Medicare and other federal program costs. That amounts to a whopping $110 billion in cost savings over ten years to the entire medical industry, which would help keep premiums in check for consumers.

http://hotair.com/archives/2009/10/10/cbo-tort-reform-would-save-54-billion-to-the-deficit/

[Beerina]

No it is like saying salaries of everyone who works in health care are a small portion of the total health care costs. Malpartice insurance costs are not what is driving health care costs up. That statement it simply wrong. Doctors complain because it is something that they pay for personaly, and in some specialties they have such large liabilities they have problems getting insurance that they can afford.

It's my understanding the costs of unnecessary tests, done for liability defense, are several times the already outrageous cost of doctors' liability insurance.

[MikeMangum]

Okay, so let's take a different track on the Politics subforum for a change... what can Dems/Repubs, cons/libs, whatever actually agree on regarding health care reform?

What are the basic elements we can put into an HCR bill to get something useful passed through Congress with bipartisan support?

Please note: I know I'm probably pissing into the wind by saying so, but I don't want to see the thread cluttered with the usual bickering.

Proceed.

The problem is that conservatives and progressives have completely different approaches to the issue that conflict with each other.

The conservatives ways to address to healthcare (and yes, they were mooted about many times) are as follows:

1) remove the tax incentive to bundle health insurance with employment, either by taxing benefits or by allowing a person who purchases their own insurance to deduct the expense from their taxable income.

2) allow people to buy insurance from out of state providers

3) remove insurance mandates, which would allow people to buy an insurance policy for catastrophic coverage only instead of forcing them to purchase a (more expensive) policy that covers wigs, massage therapists, acupuncture, drug abues treatment, breast reconstruction, contraception, etc. That's like telling people that they can't buy a Kia, if they want to purchase a car, it must be a Cadillac.

4) Make it harder for insurance companies to engage in post facto rescission of insurance.

Notice that almost all of these suggestions invlove market appraches, which the progressives absolutely hate. For them, part of the benefit of any suggested health care reform is expanding government and "changing the relationship between people and the government".

[ponderingturtle]

It's my understanding the costs of unnecessary tests, done for liability defense, are several times the already outrageous cost of doctors' liability insurance.

And that does not seem to be supported by many who study it. The most I have heard attributed to that is around 2-3% of health care costs. So in total this is less than 5% of health care costs. As we see anual increases of more than 10% there are other things driving this.

I have heard suggestions that it is that there is say little incentive to have a $1000 dollar procedure when a $100,000 procedure is available to many people. Even if the more expensive procedure is not more effective or less risky.

Odds are there are a lot of things contributing to health care costs, but defensive medicine and liability costs seem to be a very small part of the total. They might effect certain specialties in some areas disproportunatly though. In part because of disproportunate risk in some specialties.

[JoeTheJuggler]

And that does not seem to be supported by many who study it. The most I have heard attributed to that is around 2-3% of health care costs. So in total this is less than 5% of health care costs. As we see anual increases of more than 10% there are other things driving this.

And the CBO estimate that Sporanox just cited* puts the estimated savings at just 0.5% of healthcare costs.

*Actually he cited a blogger citing the CBO director's blog: http://cboblog.cbo.gov/?p=389

According to that, the 0.5% takes into account both direct (lower premiums would account for 0.2% savings) and indirect savings (slightly reduced use of healthcare services--i.e. eliminating or reducing the stuff Beerina talked about--would account for a 0.3% savings).

So the total figure is 0.5%--not even 2 or 3%.

[JoeTheJuggler]

The problem is that conservatives and progressives have completely different approaches to the issue that conflict with each other.
I agree. Conservatives are largely happy with the status quo. That's why they never proposed healthcare reform even when they had control of the WH and Congress. Conservatives will claim that the U.S. has the best healthcare system in the world.


The conservatives ways to address to healthcare (and yes, they were mooted about many times) are as follows:

You mean when conservatives saw that the public was indeed clamoring for healthcare reform and that it was clear that runaway healthcare costs would result in a blossoming federal deficit in the future (and many other problems), they finally reluctantly climbed on the bandwagon by offering a few suggestions for form's sake (which suggestions largely would result in further limiting access to healthcare to even fewer people), while their real strategy was simply to defeat healthcare reform proposals to maintain the status quo.

[JoeTheJuggler]

But that’s not the end of the savings, either. A 0.5% reduction in health-care costs would mean $11 billion in savings per year overall, with roughly 40% of that benefiting the federal government in Medicare and other federal program costs. That amounts to a whopping $110 billion in cost savings over ten years to the entire medical industry, which would help keep premiums in check for consumers.

http://hotair.com/archives/2009/10/10/cbo-tort-reform-would-save-54-billion-to-the-deficit/


The blogger you're citing is making up figures of his own. Those figures don't agree with his CBO source:


CBO now estimates that implementing a typical package of tort reform proposals nationwide would reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of a direct reduction in spending of 0.2 percent from lower medical liability premiums and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (Those estimates take into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of the potential cost savings has already been realized.)

Enacting a typical set of proposals would reduce federal budget deficits by roughly $54 billion over the next 10 years, according to estimates by CBO and the staff of the Joint Committee of Taxation. That figure includes savings of roughly $41 billion from Medicare, Medicaid, the Children’s Health Insurance Program, and the Federal Employees Health Benefits program, as well as an increase in tax revenues of roughly $13 billion from a reduction in private health care costs that would lead to higher taxable wages.
http://cboblog.cbo.gov/?p=389

ETA: I see what he did. He took "$11 billion in 2009" and changed it to "$11 billion per year overall" which isn't legit. The CBO clearly said the estimated savings was $54 billion over 10 years, not $110 billion.
ETA: And $13 billion of that $54 billion (over 10 years) is tax revenues estimated to come from higher taxable wages.

ETA: And here's the link to the CBO letter that shows the yearly breakdown: http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf (the link on that blog page was busted).

[Random]

ETA: I see what he did. He took "$11 billion in 2009" and changed it to "$11 billion per year overall" which isn't legit. The CBO clearly said the estimated savings was $54 billion over 10 years, not $110 billion.
ETA: And $13 billion of that $54 billion (over 10 years) is tax revenues estimated to come from higher taxable wages.

ETA: And here's the link to the CBO letter that shows the yearly breakdown: http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf (the link on that blog page was busted).

Who cares if it is $110 Billion over ten years? Heck, let him double it to $220 Billion over ten years. That comes to $22 Billion a year, which sounds like a lot until you realize we spent over $2 Trillion in 2007 on healthcare. Either way its chump change.

[JoeTheJuggler]

Who cares if it is $110 Billion over ten years? Heck, let him double it to $220 Billion over ten years. That comes to $22 Billion a year, which sounds like a lot until you realize we spent over $2 Trillion in 2007 on healthcare. Either way its chump change.

True. And it would limit the ability of people with legitimate lawsuits to get the awards a court would otherwise give them (not to mention that the statute of limitations part would keep people with legitimate cases out of court altogether).

The deficit reduction of the Senate healthcare plan was *only* something like $138 billion over ten years, but it also would have extended healthcare coverage to millions who now lack it, and would have removed the phenomenon of having to go bankrupt when you face a serious medical crisis.

Still--the blogger sporanox cited was playing games with the numbers. You can't cite the CBOs figures and then report a figure twice what theirs was.

[MikeMangum]

I agree. Conservatives are largely happy with the status quo. That's why they never proposed healthcare reform even when they had control of the WH and Congress.

You have that wrong. Conservatives never proposed anything that you would consider health care reform, and they never proposed a giant, do it all at once reform, but they have been proposing smaller, one step at a time changes. Specifically, at the Federal level, that means tort reform and doing something about the tax incentives that push employer provided health insurance. For those who equate health "reform" with a single payer system, no, conservatives are never going to propose what you view as reform.

You also have to keep in mind that conservatives generally believe that health care is a state issue (due to belief in federalism), and as such,
they generally push their proposed reforms at the state level, which is where all of the insurance mandates are legislated, insurance commissioners are elected, etc.

[ponderingturtle]

You have that wrong. Conservatives never proposed anything that you would consider health care reform, and they never proposed a giant, do it all at once reform, but they have been proposing smaller, one step at a time changes. Specifically, at the Federal level, that means tort reform and doing something about the tax incentives that push employer provided health insurance. For those who equate health "reform" with a single payer system, no, conservatives are never going to propose what you view as reform.

So the big thing is to go after that .5% because that is the part that is killing us, not the 30% that is far to politicaly dangerous to go after.

What cases are you trying to limit dammages in? As has been pointed out these are all cases of legitimate dammage. Or is the goal just to make it harder to bring legitimate cases to court?

[Sporanox]

The blogger you're citing is making up figures of his own. Those figures don't agree with his CBO source:



http://cboblog.cbo.gov/?p=389

ETA: I see what he did. He took "$11 billion in 2009" and changed it to "$11 billion per year overall" which isn't legit. The CBO clearly said the estimated savings was $54 billion over 10 years, not $110 billion.
ETA: And $13 billion of that $54 billion (over 10 years) is tax revenues estimated to come from higher taxable wages.

ETA: And here's the link to the CBO letter that shows the yearly breakdown: http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf (the link on that blog page was busted).

I think he was trying to draw a distinction between reduction in the federal budget deficit over ten years and reduction of health care spending in the US overall.

Moreover, handwaving away even $54 billion over ten years strikes me as rather insincere, especially when that amount is comparable to the other "savings and cuts" Congress was mulling over at the time. Here, we have a "typical package of tort reform proposals" that would save money over time and benefit the central health care profession. What's the problem? Are there people here who would simply avoid taking action because they can't stand how rich they think doctors are?

EDIT: Okay, if you don't hold that belief, I apologize. I felt that there were a few people who wanted to stick it to the doctors.

[JoeTheJuggler]

I think he was trying to draw a distinction between reduction in the federal budget deficit over ten years and reduction of health care spending in the US overall.
No. He cited the CBO and then changed the "$11 billion in 2009" part of the letter to "$11 billion per year" then multiplied that by 10 to get $110 billion despite the fact that the CBO's 10 year estimate is $54 billion.

Moreover, handwaving away even $54 billion over ten years strikes me as rather insincere, especially when that amount is comparable to the other "savings and cuts" Congress was mulling over at the time.
I wasn't hand waving anything away. Rather this merely supports what I said earlier (and that I learned strictly from conversations like this on this forum) that the effect of tort reform on run-away healthcare costs would be very small (0.5%), and come at the cost of limiting damages and limiting access to courts for people with cases that have merit while doing little (to nothing) to deter frivolous suits.

Caps on awards and statutes of limitations only apply to cases with merit. If there's something about the system that encourages indemnifiers to settle meritless cases, we should address that.

I think one problem is that indemnifiers have no real incentive to avoid settling these cases since they'll get back the money by bumping up the premiums they charge doctors and hospitals.

However, if it's cheaper to settle than to defend even against meritless cases (which I don't quite understand, since meritless cases have no chance of winning--it shouldn't matter how much or how little you spend defending against such a case), then we should address that issue. Perhaps something like I suggested earlier that would really stick it to plaintiffs and their lawyers who bring meritless cases.

[Sporanox]

No. He cited the CBO and then changed the "$11 billion in 2009" part of the letter to "$11 billion per year" then multiplied that by 10 to get $110 billion despite the fact that the CBO's 10 year estimate is $54 billion.

CBO now estimates that implementing a typical package of tort reform proposals nationwide would reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009)
Enacting a typical set of proposals would reduce federal budget deficits by roughly $54 billion over the next 10 years

Are these the same entities? I take your point about the $11 billion; certainly, we can't say that there will be $110 billion in savings for sure ten years from now.

I wasn't hand waving anything away. Rather this merely supports what I said earlier (and that I learned strictly from conversations like this on this forum) that the effect of tort reform on run-away healthcare costs would be very small (0.5%), and come at the cost of limiting damages and limiting access to courts for people with cases that have merit while doing little (to nothing) to deter frivolous suits.

Well, tort reform proponents don't summarize their goals as deterring frivolous suits. The general proposals of CBO include:

 A cap of $250,000 on awards for noneconomic damages;
 A cap on awards for punitive damages of $500,000 or two times the award for
economic damages, whichever is greater;
 Modification of the “collateral source” rule to allow evidence of income from
such sources as health and life insurance, workers’ compensation, and automobile
insurance to be introduced at trials or to require that such income be subtracted
from awards decided by juries;
 A statute of limitations—one year for adults and three years for children—from
the date of discovery of an injury; and
 Replacement of joint-and-several liability with a fair-share rule, under which a
defendant in a lawsuit would be liable only for the percentage of the final award
that was equal to his or her share of responsibility for the injury.

A big emphasis is limiting runaway awards. This in turn ideally affects malpractice premiums, etc...

However, if it's cheaper to settle than to defend even against meritless cases (which I don't quite understand, since meritless cases have no chance of winning--it shouldn't matter how much or how little you spend defending against such a case)

Well, you admitted it yourself - it's cheaper.

[ponderingturtle]

However, if it's cheaper to settle than to defend even against meritless cases (which I don't quite understand, since meritless cases have no chance of winning--it shouldn't matter how much or how little you spend defending against such a case), then we should address that issue. Perhaps something like I suggested earlier that would really stick it to plaintiffs and their lawyers who bring meritless cases.

The trick would be how to distinguish between meritless cases, and simply cases that lost.

As for how a meritless case can bring bills, how much did the JREF spend on that corndog lawsuit?

[Peephole]

Tort reform doesn't necessarily seem like a bad idea, but it's on par with some of the other cost-cutting measures proposed by Democrats (it won't solve the problem).
You have that wrong. Conservatives never proposed anything that you would consider health care reform, and they never proposed a giant, do it all at once reform, but they have been proposing smaller, one step at a time changes.
They proposed something that won't increase coverage and would reduce the deficit by less than the Democrats' plan.

http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html

[MikeMangum]

From what I've learned on these forums, high malpractice insurance premiums contribute only a teeny tiny amount to skyrocketing healthcare costs.


Kessler and McClellan 1996 (http://ideas.repec.org/p/nbr/nberwo/5466.html) found that caps on non-economic damages reduced overall healthcare costs by between 5% and 9%. This study was, however, narrowly focused on heart disease patients.

A study (http://advance.uconn.edu/2009/090223/09022302.htm) conducted by the University of Connecticut and the Massachusetts Medical Society:
Overall, 22% of x-rays ordered by physicians in these eight specialty areas were for defensive purposes.
...
28% of all CT scans were ordered for defensive reasons.
...
The overall rate of MRIs ordered for defensive purposes was 27%, and this rate varied significantly by specialty[.]
...
Overall, 24% of ultrasound studies were ordered for defensive reasons.
...
Physicians in the sample reported that 28% of specialty referrals or consultations were motivated by liability concerns.
...
Eighteen percent of laboratory tests ordered by physicians in these specialty areas were motivated by liability concerns.
...
Physicians in these specialty areas reported on average that 13% of hospital admissions were motivated by liability concerns.
...

Overall, 38% of physicians in the sample reported that they reduced the number of high risk services or procedures they performed (Figure 11), with this most pronounced among orthopedic surgeons (55%), obstetrician/gynecologists (54%), and general surgeons (48%). Lesser restrictions in the scope of practice were reported by emergency physicians (15%), internists (19%), and anesthesiologists (23%). Differences by specialty were statistically significant (chi square = 78.6, p = .000).

A similar pattern was observed with respect to reductions in the number of high-risk patients over the past 5 years (Figure 12). Overall, 28% of physicians in the sample reported reducing the number of high-risk patients they saw. Statistically significant differences by specialty were observed (chi-square = 77.9, p = .000), with obstetrician/gynecologists (44%) and the surgical specialties (37–42%) much more likely to reduce their number of high-risk patients than emergency physicians (7%), anesthesiologists (14%), internists (18%), and family practitioners (19%).

...

The estimated annual cost to the health care system in Massachusetts of defensive medical practices is substantial. Among the eight subspecialties in this study, the estimated cost of defensively-motivated radiological imaging, laboratory testing, and consultations or referrals was $281 million in 2006 dollars. In addition, the cost of hospital admissions was estimated to be $1.1 billion, for a combined estimate of nearly $1.4 billion.

That's just for Massachusetts.

Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation (http://content.nejm.org/cgi/content/short/354/19/2024), the New England Journal of Medicine:
[ib]Methods[/b] Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error.

Results For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy — nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors ($313,205 vs. $521,560, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs.

This study found that completely meritless claims (which are successful one in four times) accounts for 22% of total medical liability costs.

Malpractice insurance premiums are 17% lower (http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.20) in states that cap awards.

When Alabama implemented damage caps, malpractice awards decreased by $20,000 on average. After the Alabama Supreme Court ruled the caps unconstitutional, awards (http://aler.oxfordjournals.org/cgi/content/abstract/3/2/199) increased by double that amount.

The result of Texas implementing a cap on non-economic damages (https://texmed.org/Template.aspx?id=4586) in 2003:
Physicians’ liability insurance premiums have continued to drop since the passage of Proposition 12 and the state’s landmark 2003 health care liability reforms. In the first nine months of 2005 alone, all five of Texas’ largest physician insurers announced rate cuts; together, they will produce roughly $48.6 million in annualized savings for Texas physicians and greater access to care for Texas patients. Since the passage of Proposition 12, five carriers have announced double-digit rate reductions. For the first time in years, Texas physicians can competitively shop their policies. Meanwhile, lawsuit filings in most Texas counties have been cut in half since the passage of the 2003 reforms.

As a result of these improvements, patients’ access to physician services is growing.

Texas physicians have definitely slowed the reduction in services that had been spurred by the lawsuit abuse crisis. Some have begun to reinstate critical services.

Before the reforms passed, the ranks of Texas internists, emergency care physicians, and orthopedic and neurosurgeons were flat or on the decline. From May 2003 through July 2005, however, more than 3,000 new doctors established practice in Texas, many of them serving in those high-risk specialties and in medically underserved regions of the state.

Some cities are experiencing unprecedented success in physician recruitment. In the year after reforms were passed, Corpus Christi added 47 new physicians. That is a stark contrast to the 40 physicians the city lost in the five previous years. Similarly, Beaumont saw a net loss of 12 doctors in the 18 months prior to the passage of lawsuit reform. In the following 18 months, the community gained 21 physicians, including five anesthesiologists and 15 emergency medicine specialists.[60]

A study (http://liberty.pacificresearch.org/publications/tort-law-tally) by Mark Crane and Nicole Crain of Lafayette College that looked at the results of various medical tort reforms across the country found a 16% reduction in insurance premiums due to tort reforms, and ranked the various tort reforms on their effectiveness in lowering costs:
1.attorney-retention sunshine (12-percent reduction)
2.Daubert rule (10 percent)
3.frivolous lawsuits (7 percent)
4.jury service (6 percent)
5.appeal-bond caps (4 percent)
6.negligence standard (3 percent)
7.non-economic-damage caps (2 percent)
8.medical-malpractice damage caps (1 percent)

[MikeMangum]

Caps on awards and statutes of limitations only apply to cases with merit. If there's something about the system that encourages indemnifiers to settle meritless cases, we should address that.

I think one problem is that indemnifiers have no real incentive to avoid settling these cases since they'll get back the money by bumping up the premiums they charge doctors and hospitals.

However, if it's cheaper to settle than to defend even against meritless cases (which I don't quite understand, since meritless cases have no chance of winning--it shouldn't matter how much or how little you spend defending against such a case), then we should address that issue.

According to one of the studies I linked, claims with no medical error have about a 1 in 4 chance of succeeding, and claims where there was no actual medical injury have about a 16% chance of succeeding.

Putting a case in front of a jury is a crapshoot, whether it is a criminal case or a civil case. Even a successful defense is expensive. Add in the non-trivial risk that a jury will rule for the plaintiff even when there is no medical error or even any medical injury, and there is a very strong incentive to settle cases before they go to trial - which increases the incentives to litigate a marginal case in the hopes of obtaining a pre-trial settlement.

[MikeMangum]

They proposed something that won't increase coverage and would reduce the deficit by less than the Democrats' plan.

http://voices.washingtonpost.com/ezra-klein/2009/11/congressional_budget_office_th.html

Klein makes a slimy, unfair attack in this article. No, the plan put forward by Boehner wouldn't increase coverage that much, because that's not what it attempted to do. It wasn't a coverage plan. The plan put forward by Boehner would have used market approaches to lowering the cost of health care and health insurance. Many of those who are 1) citizens, and 2) not covered are able to afford coverage but choose not to purchase coverage. For those people who are young, healthy, and simply see spending money on insurance as a waste, lowering the costs (or more likely reducing the rate of growth of the costs) associated with health care would not make them decide to purchase insurance. How many 22 year old males need medical insurance?

The reason it didn't have as much "deficit reduction" is that the plan put forward by Boehner didn't have all the accounting gimmicks (start the taxes immediately but don't start actual services for 5 years, pretend that Congress would prevent the regular increase in payments to doctors, etc.) that the Democratic plan did and it fully funded medicare/medicaid.

[Peephole]

So to recap: no increased coverage, no reduction of the deficit.

[JoeTheJuggler]

According to one of the studies I linked, claims with no medical error have about a 1 in 4 chance of succeeding, and claims where there was no actual medical injury have about a 16% chance of succeeding.
A claim with a 1 in 4 chance of winning is not meritless. A claim with a 16% chance of success is not meritless. ETA: See again the definition of meritless.

There are other grounds to file suit other than medical error. (I don't think, for example, cutting off the wrong leg is a medical error. Ditto being given a faulty medical device.)

If there is no medical injury then the claim and damages must have been on some other legal basis. (Either that, or the studies are just stating that they disagree with the decisions of the court.)

[ponderingturtle]

This study found that completely meritless claims (which are successful one in four times) accounts for 22% of total medical liability costs.

Malpractice insurance premiums are 17% lower (http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.20) in states that cap awards.

Wow given that those all of one percent of total health care spending we get a hundred or so savings like that and we might be on to something.

[JoeTheJuggler]

You have that wrong. Conservatives never proposed anything that you would consider health care reform, and they never proposed a giant, do it all at once reform, but they have been proposing smaller, one step at a time changes.

Since when? I don't think they have proposed anything since the Medicare Reform Act of 2003--that is up until they got on the bandwagon after the 2008 election.

You also have to keep in mind that conservatives generally believe that health care is a state issue (due to belief in federalism), and as such, they generally push their proposed reforms at the state level, which is where all of the insurance mandates are legislated, insurance commissioners are elected, etc.
Yes. As I said, they've mostly been in favor of the status quo.

[JoeTheJuggler]

This study found that completely meritless claims (which are successful one in four times) accounts for 22% of total medical liability costs.


Again, you're using a different definition of "meritless". The legal one is for a case that has no chance of winning. If these things have a 25% chance of winning, they're not meritless. (Or the other way of looking at it, if they win in court, they weren't meritless.)

Again, this is what the Wiki article says about these terms (frivolous and meritless):

Frivolous litigation is the practice of starting or carrying on law suits that have no chance of winning. There are both legal and colloquial definitions of the term. In popular usage, lay persons typically call a lawsuit "frivolous" if they personally find a claim to be absurd, regardless of its legal standing. But in official usage, as by the judiciary of the United States, "frivolous litigation" is considered to consist of a legal claim or defense presented even though the party or the party's legal counsel had reason to know that the claim or defense was manifestly insufficient or futile, that is to say, had no legal merit. The remainder of this article discusses the usage of the term within the legal profession.

If you're using the colloquial definition, then it's just a matter of opinion as to whether something is meritless. That is, what you claim to be meritless is something a court might find has merit.

[Sporanox]

Wow given that those all of one percent of total health care spending we get a hundred or so savings like that and we might be on to something.

Why not pass it? You wouldn't have to fight a year for nothing, and the savings are tangible.

The Left tried going after a bigger chunk to shave off. Even if I choose to believe their claims that they could actually succeed in saving money (snort), since that has failed, I'd think we should try to do something rather than nothing. Or should we just whine about how small 0.5% savings are?

Good luck with that and the decline of doctors in the US.

[ponderingturtle]

Why not pass it? You wouldn't have to fight a year for nothing, and the savings are tangible.

The Left tried going after a bigger chunk to shave off. Even if I choose to believe their claims that they could actually succeed in saving money (snort), since that has failed, I'd think we should try to do something rather than nothing. Or should we just whine about how small 0.5% savings are?

Good luck with that and the decline of doctors in the US.

The thing is that it addresses none of the major problems with health care in this country. The only substantive benefit to it would be that the right wing wackos would have to find some other reason to erroneously blame health care costs on.

[JoeTheJuggler]

Are these the same entities? I take your point about the $11 billion; certainly, we can't say that there will be $110 billion in savings for sure ten years from now.
If it's not the same thing, then why is he citing the CBO estimates? (Re-read that blog you linked to. The guy just has it wrong.)

ETA: At any rate, the overall point remains that at best tort reform isn't going to have much affect on runaway healthcare costs. This is according to the CBO's estimates of direct and indirect effects of tort reform.



Well, tort reform proponents don't summarize their goals as deterring frivolous suits.
I agree. And pretty much any time it's brought up, I clarify my position by saying I'm only opposed to caps on awards as an attempt to crack down on huge settlements paid out to frivolous claims.

I think for a great many people, "tort reform" does indeed equate with nothing more than "lower caps on awards".


Well, you admitted it yourself - it's cheaper.
Yes, and I'm in favor of directly addressing this problem. I have no problem with coming down hard on plaintiffs and their attorneys who attempt to file meritless cases.

But if a case is meritless (in the legal sense) then it has no chance of winning, so there is no question of needing to spend a lot of money to defend against such a case. Again, I think a lot of this hinges on cases that some people think should be considered meritless even though they're not.

[Sporanox]

The thing is that it addresses none of the major problems with health care in this country. The only substantive benefit to it would be that the right wing wackos would have to find some other reason to erroneously blame health care costs on.

1:Would you agree doctors provide most of the actual health care in this country? (of course)
2: Would you agree malpractice premiums for doctors are too high?
3: Would you agree this proposal would save money over time?
4: Would you agree this proposal would be easier to pass than the 302847028374 page long health care bill that seems about to die?

As far as I can see, you would prefer not to support such a bill because it would mean that one right-wing pet project would actually HELP. There is NO WAY I can see that passing this bill would subtract from the chances of passing the Dem's pet bill.

If it's not the same thing, then why is he citing the CBO estimates?

CBO states two main savings stats in the post: $54 billion subtracted from the deficit over 10 years and 0.5% savings to total US healthcare spending in the form of 0.2% lower premiums and 0.3% less health care utilization (overall about $11 billion). To me, those look like two distinct savings - one for the federal government and one for consumers/doctors nationwide. Do you think they are the same?

But if a case is meritless (in the legal sense) then it has no chance of winning, so there is no question of needing to spend a lot of money to defend against such a case. Again, I think a lot of this hinges on cases that some people think should be considered meritless even though they're not.

Ok, let me propose this example to see if I got you right:

In HS, one of my teachers was a former defense attorney. He once recounted to me that in a certain worker's compensation case in which he represented the company, the plaintiff (who claimed a back injury) was filmed backflipping off a jet ski by a PI before a trial took place. Of course, this was now an open-and-shut case. At this point, would you consider the case to be meritless in the legal definition?

The ending to the story is that the company ended up settling with the guy because that was cheaper than paying their attorney to win the case in court. Do you agree with this course of action? Again, sorry, I just don't know if I got what you were saying.

[MikeMangum]

A claim with a 1 in 4 chance of winning is not meritless. A claim with a 16% chance of success is not meritless. ETA: See again the definition of meritless.

The legal argument behind the suit is almost certainly not meritless, but that does not mean that the case is not factually meritless. Notice I never talked about frivolous lawsuits.

There are other grounds to file suit other than medical error. (I don't think, for example, cutting off the wrong leg is a medical error. Ditto being given a faulty medical device.)

Cutting off the wrong leg is indeed medical error. A faulty medical device is not medical error, but neither is it litigated as medical malpractice. Those cases are litigated as product liability cases and the defendent is the manufacturer of the device, not the doctor.

If there is no medical injury then the claim and damages must have been on some other legal basis. (Either that, or the studies are just stating that they disagree with the decisions of the court.)

The study was a group of doctors reviewing the evidence of over a thousand cases and finding that roughly 1 our of 3 of those cases did not involve any actual medical error and a smaller fraction did not involve any actual medical injury. The whole point of a medical malpractice suit is to determine whether there was indeed medical error, the problem being that the body that attempts to determine this (a jury) is composed of people who have no independent ability to judge whether there was medical error not. That's the entire rationale behind the concept of an "expert witness": a person who is believed to have specialized knowledge beyond that of the average person. That's why there is such a heavy reliance on expert witnesses in these case. Because each side gets to shop around for medical experts to employ as witnesses in support of their case, these cases usually come down to a battle of expert witnesses.

From the Journal of Forensic Science (http://www.ncbi.nlm.nih.gov/pubmed/3944576):
The expert on either side is either right, partially right, wrong, or wrong and dishonest. Even strongly opposed testimony is not evidence of dishonesty, although it is clear at least one expert is wrong. Some differences are the result of legitimate differences of opinion. However, the author has identified several categories of testimony that show dishonest intent. It is clear that the growth of financial incentives has increased the number of cases in which there are opposing experts. If some kind of corrective action is not taken, expert witnesses will no longer be an effective force in the legal system. A multidisciplinary testimony review board separate from the ethics function is clearly one answer to the problem.

Who better to determine whether or not a doctor committed a medical error (a judgement requiring specialised knowledge) than a panel of people with that specialised knowledge?

A central part of all tort law is that damage must be proven. For a medical malpractice suit, that means that medical injury must be proven. This panel of doctors (the specialists who actually are capable of making this judgement) came to the conclusion that 16% of those suits involved no actual damage.

My point was not to call these frivolous lawsuits; my point was that doctors who make no medical error are routinely subject to malpractice suits and have a non trivial chance of losing those suits, resulting in enormous payouts.

Just ask John Edwards (http://www.pittsburghlive.com/x/pittsburghtrib/s_202515.html).

Despite the overwrought claims of Edwards' dazzling legal skills, winning jury verdicts in personal injury cases has nothing to do with legal talent and everything to do with getting the right cases -- unless "talent" is taken to mean "having absolutely no shame." Edwards specialized in babies with cerebral palsy whom he claimed would have been spared the affliction if only the doctors had immediately performed Caesarean sections.

As a result of such lawsuits, there are now more than four times as many Caesarean sections as there were in 1970. But curiously, there has been no change in the rate of babies born with cerebral palsy. As The New York Times reported: "Studies indicate that in most cases, the disorder is caused by fetal brain injury long before labor begins." All those Caesareans have, however, increased the mother's risk of death, hemorrhage, infection, pulmonary embolism and Mendelson's syndrome.

In addition, the "little guys" Edwards claims to represent are having a lot more trouble finding doctors to deliver their babies these days as obstetricians leave the practice rather than pay malpractice insurance in excess of $100,000 a year.

In one of Edwards' silver-tongued arguments to the jury on behalf of a girl born with cerebral palsy, he claimed he was channeling the unborn baby girl, Jennifer Campbell, who was speaking to the jurors through him:

"She said at 3, 'I'm fine.' She said at 4, 'I'm having a little trouble, but I'm doing OK.' Five, she said, 'I'm having problems.' At 5:30, she said, 'I need out."'

She's saying, "My lawyer needs a new Jaguar ... "

"She speaks to you through me and I have to tell you right now -- I didn't plan to talk about this -- right now I feel her. I feel her presence. She's inside me, and she's talking to you."

Well, tell her to pipe down, would you? I'm trying to hear the evidence in a malpractice lawsuit.

Keep in mind the bolded paragraph if you want to argue that defensive medicine does not have costs. The cost of malpractice litigation is not simply the payouts; the costs are the payouts, the payments to lawyers, the out of court settlements, the insurance load on doctors, and the costs of all the unnecessary treatments that are done solely to protect from liability but may actually worsen outcomes for patients. Some of that cost is necessary, but much of it is not.

I guess the fact that essentially all hospitals in the Puget Sound area require cesarean sections (expensive, major surgery) for any mother who has ever had a cesarean and explicitly explain their policy is due to liability concerns, isn't a cost...

http://www.ican-online.org/vbac/your-right-refuse-what-do-if-your-hospital-has-banned-vbac-q
The International Cesarean Awareness Network has tracked over 800 hospitals across the U.S. that have instituted policies seeking to ban vaginal birth after cesarean (VBAC), misleading women to believe they must undergo cesarean surgery whether there is a medical need for it or not. Clinical research shows the risks of VBAC are small and that repeat cesarean surgery carries its own risks. In spite of this, many hospitals have attempted to ban VBAC in order to limit their exposure to liability.

Here's a resolution (http://www.now.org/issues/reproductive/vbac.html) from none other than NOW on the subject:
WHEREAS, the National Organization for Women (NOW) has a long history of supporting a woman's right to make reproductive choices; and

WHEREAS, Vaginal Birth After Cesarean (VBAC) has repeatedly been shown to be a safe and reasonable choice for women; and

WHEREAS, VBAC labors that are not induced or augmented with drugs proceed without the need for emergency surgical intervention 99.6% of the time; and

WHEREAS, unnecessary cesareans pose serious risks to mothers, including two to four times a greater chance of maternal death; increased risk of emergency hysterectomy; injury to blood vessels and other organs; chronic pain due to internal scar tissue; increased chance of re-hospitalization; complications involving the placenta in subsequent pregnancies; and

WHEREAS, unnecessary cesareans pose risks to the infant, including an increased risk of respiratory distress syndrome; prematurity; the development of childhood asthma; and a 1-9% chance the baby will be cut during surgery; and

WHEREAS, over 300 hospitals within the United States have banned VBAC, including at least one hospital in every state; and

WHEREAS, it has been reported that some women seeking care in hospitals that ban VBAC have been forcibly anesthetized and C-sectioned when they try to withhold consent to surgery; and

WHEREAS, the right to refuse unwanted and unnecessary medical treatment is a fundamental right; and

WHEREAS, the right to bodily integrity is a fundamental right,

THEREFORE BE IT RESOLVED, that NOW oppose institutional and healthcare policies that deny women's access to VBAC; and

BE IT FURTHER RESOLVED, that NOW's policy statements, brochures, and fact sheets concerning reproductive freedom include information on VBAC; and

BE IT FINALLY RESOLVED, that NOW and its chapters work with national and state health care organizations and providers to oppose legislation and public policy that would restrict women's access to VBAC and to medically accurate and comprehensive information on childbirth and the right to choose VBAC.


But nope, no costs associated with defensive medicine.

[MikeMangum]

(Or the other way of looking at it, if they win in court, they weren't meritless.)

BTW, I don't think I've ever seen a better example of begging the question. I guess according to that logic, these (http://www.msnbc.msn.com/id/10995872/) men (http://www.usatoday.com/news/nation/2008-01-03-dna-exoneration_N.htm) were (http://www.washingtonexaminer.com/local/Source-DNA-clears-man-jailed-25-years-for-rape-murder-79283937.html) actually guilty of rape.

[ponderingturtle]

1:Would you agree doctors provide most of the actual health care in this country? (of course)
2: Would you agree malpractice premiums for doctors are too high?
3: Would you agree this proposal would save money over time?
4: Would you agree this proposal would be easier to pass than the 302847028374 page long health care bill that seems about to die?

Yea it will be like having a 11.82% increase in healthcare spending next year instead of a 12%. That will fix the system clearly.

[Faithkills]

So to recap: no increased coverage, no reduction of the deficit.

No, it wasn't perfect, but it did reduce the deficit. And as it is designed to lower costs it will in fact increase coverage since more people would be able to afford it.

As opposed to the Dem plan which merely expands the policies which caused the costs to decouple from overall inflation in the first place.

[JoeTheJuggler]

CBO states two main savings stats in the post: $54 billion subtracted from the deficit over 10 years and 0.5% savings to total US healthcare spending in the form of 0.2% lower premiums and 0.3% less health care utilization (overall about $11 billion). To me, those look like two distinct savings - one for the federal government and one for consumers/doctors nationwide. Do you think they are the same?

You're right about that.

The CBO report spells it out.


The Effects of Tort Reform on Total Health Care Spending and the Federal Budget
CBO now estimates, on the basis of an analysis incorporating the results of recent research, that if a package of proposals such as those described above was enacted, it would reduce total national health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of the direct reduction in spending of 0.2 percent from lower medical liability premiums, as discussed earlier, and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services.

But the blogger you cited took that "about $11 billion in 2009" and multiplied it by 10 years to arrive at the $110 billion figure, which is not legitimate. I see nothing in the CBO report to support the assumption that the estimated annual savings on overall healthcare spending would be the same for 10 years. At any rate, even if it is, that would make the overall savings less than 0.5% over the ten year period.

So it still supports what I said earlier--that any savings we can get from caps on benefits is miniscule.


In HS, one of my teachers was a former defense attorney. He once recounted to me that in a certain worker's compensation case in which he represented the company, the plaintiff (who claimed a back injury) was filmed backflipping off a jet ski by a PI before a trial took place. Of course, this was now an open-and-shut case. At this point, would you consider the case to be meritless in the legal definition?
I have no idea. If the claim is that he sustained a back injury that has him currently disabled and backflipping off a jet ski is evidence that he doesn't have that injury, then I would say it's probably meritless. But since I don't know any of the details, I don't really know.

The ending to the story is that the company ended up settling with the guy because that was cheaper than paying their attorney to win the case in court. Do you agree with this course of action? Again, sorry, I just don't know if I got what you were saying.
If the case was meritless, it wouldn't be cheaper to settle than to go to court. There would be no need to pay a lawyer if the suit has no chance of winning.

If the system is set up that you have to pay a lawyer even to get a meritless case dismissed, then I say we should reform those aspects of the system (which have nothing to do with caps on awards since awards are only given to cases that win).

I understand that you might be referring to "tort reform" as something other than caps on awards. Inasmuch as that's what you're referring to, I agree with you. For many, however, "tort reform" means only caps on awards--especially punitive damages.

[JoeTheJuggler]

The trick would be how to distinguish between meritless cases, and simply cases that lost.

I still haven't seen any major flaw in my idea. Any time a plaintiff loses a suit, you explain what a meritless case is (legal definition--that it had no chance of winning in court and was filed only for the purpose of trying to get a settlement or otherwise to annoy the defendant) to the finder of fact (jury or judge or panel), and then ask them if this case was meritless. If yes, have them decide how much (up to all) of the defendant's expenses the plaintiff has to pay. It'd basically be a built-in counter suit.

And I think the bar should go after plaintiff's lawyers (reprimand or suspension) who file such suits.

There could also be systematic changes in place to resolve the problem that a case costs less to settle than to defend. (Again, a truly meritless case shouldn't take great expense to defend against. You move to dismiss, the judge looks at it, and the case is dismissed. I don't think you even need a lawyer to do this, and probably no in-person appearance.)

Another idea is when such cases require a defense lawyer, the defendant can opt for a court-appointed lawyer. If the case is dismissed, make the plaintiff pay for this lawyer. If it's not (if it turns out the case isn't without merit), then the defendant pays the legal fees. I'm sure there are other ways of addressing this issue directly. Caps on awards, at best, hopes to be an indirect solution. At worst, it can adversely affect the ability of someone with a truly legitimate case from collecting damages they deserve or from a jury imposing punitive damages that might get the attention of a large corporation and give them an incentive to clean up their act.

[eeyore1954]

That's crazy. Even Republicans agree that people want health care reform. Even Scott Brown has said as much.

The question is what to do. What can we agree on?

Or are people here so damned jaded and partisan that they cannot think about anything except what to fight about?
People who cannot afford health care should be able to get it. For the most part I believe that is already true. Every person who i know who has very little money gets some sort of government plan with little or no out of pocket. A sliding scale of aid for those who are in the middle class would help.
People should not be forced to have health care ( although I could go along with a plan with a very high deductible being compulsary)
Insurance companies should not be able to drop someone when they encounter serious helath problems.
Maybe self and un employed people should have access to plans priced similar to the prices companies can buy insurance for.
I don't know about pre existing conditions but I wish auto insurance had it. Then I could wait until i am in an accident to buy it. I believe people who choose to not have health insurance should lose some of their assets and income before the tab is picked up. When I was a healthy 20-40 year old there were plenty of times I choose to not have insurance and I realized if I got a serious illness I could lose my home or other assets.

[Allen773]

How about some meaningful tort reform (http://www.27east.com/story_detail.cfm?id=151041)? Oh, wait, you want something the Dems can agree on.


You know why the GOP wants that. And it is for a purely political reason.

[Faithkills]

You know why the GOP wants that. And it is for a purely political reason.

You have that backwards. You know why the Dems don't want to do that, and it's for purely political reasons.

There's no reason not to except politics. Loser-pays is common in most nations. The U.S. is the exception.

It would save money. You may debate how much but there's no reason not to do it except politics.