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Monday, September 27, 2004

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Health care costs will equal 100% of our GNP if we allow it to happen. So some sort of rationing must take place.

Government –run health care in other countries ration health care by establishing long queues for access to doctors and hospitals. They plan on people in the queue dying or being too weak to be treated so that the government can save on their health care costs.

Our system is not perfect but it contains far less rationing than any other health system in existence. There is always a way to get the health care you need although it might not be convenient or easy to do so.

You have solved your health insurance problem by taking on more jobs to pay for your health care insurance. It is not easy but it works.

Bush has proposed legislation solve your particular problem. It would allow insurance companies to ban together to create insurance pools (these are illegal now) to reinsure high cost patients. Thus an insurance company would take on all people no matter what the person’s risk because they could reinsure high-risk patients.

Bush has also proposed tort reform that would reduce our health care costs by 30%. That is the percent of our health care dollar that is transferred to trial lawyers so they can live in luxury. That amount also includes the cost of over treatment of patients because doctors are afraid of lawsuits.

However, the Democrats have tried to block all legislation to improve our private health system. They want our private system to fail so that it will be replaced with a government –run system.

Currently I also work two jobs to maintain healthcare. I have my own business (job 1) and I work part-time for a university with health coverage.

There is a lot a free market can do to make Health Care more manageable -- for instance, it could truely be A FREE MARKET.

Every state has its own laws for health insurance. They are very complex, and make it impossible to insure across state borders. Unions, the government, and some large firms (I believe) are allowed to purchase insurance that meet FEDERAL guidelines...one set of rules makes the legal aspect of insurance far more affordable. Secretary Chao proposed allowing associations (any type; your church, your choir, the local small business association) to purchase insurance that only had to comply with federal guidelines. This was shot down.

Some have proposed making it legal to buy insurance from other states where the obligations of insurance are not as high -- i.e., they don't have to pay for $30,000 infertility treatments for instance. This would be very helpful. Is Glenn Reynolds out there -- can Article I, Section 8, Clause 3 help here?

As I understand it, to have a medical savings account you have to have catastrophic coverage someplace else. That doesn't help those who are uninsurable. Can't I just have the MSA anyway so at least I have SOMETHING?

Finally, as great as socialized medicine may sound, if we can't pay for it...it ain't great. Some things to think about--the U.S. is HUGE...a lot of people, a lot of land. I've heard Canadian friends complain about the amount of beurocracy/expense that goes into managing their health plan somewhat ineffectively. Canada has less people than the state of NY...can you imagine the beurocracy that would have to be built to support a United States health plan? To be honest, my Canadian friends have said they can't imagine the U.S. being able to do it.

Three points:

Tort reform doesn't produce anywhere near 30% savings. Here in Texas, where medical tort reform was enacted last year, malpractice rates have stopped rising or fallen only slightly, and there's no evidence that more doctors have started to practice, or that consumer health care costs have fallen.

What's been given up in exchange is any serious remedy for malpractice. If a doctor or a hospital screws up your treatment, you take what compensation they decide to give you and be happy with it. Any action in the court system has been priced out of availability. Consider what that means to a malpractice victim - heck, consider what it means to you, if you have a major organ damaged or something similar next time you undergo surgery.

Lastly, I'm not aware that the US is entirely free of long waits for specialists, especially in certain geographic areas, or that Canadians ration health care to a point where the government saves money by having people die off while waiting in line. But regardless, Kerry's actual health care plan is to use the government to pay off a big chunk of catastrophic medical bills, NOT to turn the US health care system into a government-run system. Kerry's proposal would encourage competition by making it more profitable for insurance companies to cover people who aren't in perfect health... people like the author's family, not to put too fine a point on it. As it is now, such people are either denied coverage or charged through the roof for it... and I don't see that anything Bush is proposing would aleviate the situation.

Why doesn't one of you just get a job that does offer health insurance? That seems the easiest answer.

Lulannie, that is why she said she is working the night and weekend job now, for the health insurance. I got the impression that the problem is that she is having to work nights and weekends strictly for the health benefits, which she otherwise would prefer not to do.

Chris:

It is too short a time for the benefits of tort reform to work its way through the medical system in Texas. Every drug, every procedure, every instrument, every item that a doctor or hospital uses includes a surcharge to pay for lawsuits. It will take years for the effects of tort reform to work its way through the system.

70% of the malpractice dollar goes to the lawyers to defend the cases and to pay off the vultures that are chasing ambulances. Under tort reform, all costs to repair the mistake are paid for-only pain and suffering awards are reduced.

This eliminates awards such as the 94 year-old-woman who received $75 million dollars for a bedsore she received while being bed ridden in a nursing home. $30 million of that award went to the lawyer.

Lorie and Chris are working at second jobs so that lawyers can have 14,000 sq ft homes in Vail. What is fair about that. Trial lawyers have given $115 million dollars to Democrats this year. That is 50% of what Kerry will spend on running for president. No wonder the Democrats fight tort reform tooth and nail.

I, too, lack health insurance, but as a youngish healthy man am looking to find an affordable option. Along with the MSN article on health savings accounts, the author wrote an article on high-deductible insurance that is required for the MSA to be allowed. The article mentioned that the high-deductible ($2500 before it kicked in for a single woman in San Fran) would only be $50 per month.

Intrigued, I looked into this. I learned, thanks to my lovely lawmakers, New Yorkers are unable to get high-deductible policies because the state allows anybody to get insurance (I can't recall the term they used).

I am now looking at getting just hospital insurance, though that is a little scary (but much better than where I stand now), and will cost about $120/month.

Just my $.02.

Health Savings Accounts do indeed cover catastrophic claims. I have an HSA combined with a health insurance plan that has a $2500 deductible. After the deductible, they cover 80/20, up to a total annual out of pocket of $5000. The lifetime coverage limit on my insurance is $2,000,000.

I pay $136 every three months for my premium.

Jake:

Can you substantiate some of what you're saying with references? Every doctor I talk to cites malpractice insurance, and ONLY malpractice insurance, as the reason for medical tort reform. Admittedly, malpractice insurance premiums may fall more substantially as malpractice suits filed before the tort reform are settled, and doctors may in turn lower their rates to patients. However, the idea that every single piece of the medical-industrial complex is surcharged to pay for malpractice seems... a stretch, at best. The relationship between medical costs and malpractice isn't all that complex.

What's more, I know from personal experience that most trial lawyers who work on contingency take about a third of any settlements. I've never heard of it going higher than 50%, and that's extremely rare. Unless you can cite something concrete, saying trial lawyers take 70% is simply not credible.

"...all costs to repair the mistake are paid for-only pain and suffering awards are reduced." Well, all costs are paid for... once the doctors, HMOs and/or hospitals who made the mistake ADMIT they made a mistake, which they're generally reluctant to do without at least the threat of lawsuits. And lawsuits don't happen without a lot of money - specifically, money from pain and suffering settlements. Without the potential for large cash settlements, most lawyers won't take malpractice cases, and those that do will be heavily outgunned by the medical industry. You can rail about rich, greedy, parasitic lawyers all you want, but tort reform, as practiced in Texas, leaves little to no recourse for a malpractice victim if the doctor in question is unwilling to admit a mistake.

And anecdotal multi-million dollar bedsore awards seem less of a problem to me than nearly 200,000 a year dead from malpractice:

http://www.washingtonmonthly.com/archives/individual/2004_08/004445.php

I'd argue that Lorie and Chris are working second jobs because the US health care system only wants to cover people who are already healthy and rich. If you're not healthy and rich, you're pretty much SOL. Trial lawyers seem a distant threat, if that.

I married a Doctor (internal medicine) two years ago and was amazed that her business costs were 70% of gross. I lived in England for four years, there were six months waiting periods for cancer radiation treatment, an older lady that I personaly knew, had waited for cateract surgery for over four years, then she had one eye corrected and was put at the bottom of the list for the other eye. Government has to ration health care.
Medical Savings account, with catastrophic insurance would be a big help. Tort reform would be a big help. Hospital reform would be a big help. A nation wide drive for helping the citizens become healther would be a big help. If all children in school were exposed to physical fitness classes, this would be a big help.
We cannot solve the health problems by submitting to National Health Insurance. We are wasting time and need to get started. Kerry nor anyother lefty will be able to solve this.

Jeff,

As a physician, I can tell you most of your statements are wrong.

"once the doctors, HMOs and/or hospitals who made the mistake ADMIT they made a mistake, which they're generally reluctant to do without at least the threat of lawsuits." Most doctors are afraid to admit mistakes because of fear of lawsuits. Say "I'm sorry" even if you did nothing wrong, and it will be used against you in a court of law.

"Without the potential for large cash settlements, most lawyers won't take malpractice cases" And that is a big part of the problem. I am obligated to see patients who can't pay, and can then sue me at no risk to them or to the lawyer. Make a loser-pays system and things would change dramatically. What does a trial lawyer have to lose by suing? Nothing but his time. And all he has to do is hit the lottery with one case to make up for that. But make the trial lawyer pay the other sides court costs, time out of work, and their "pain and suffering" (which it really is if you have ever been sued) and the economics changes. The whole system is geared to the trial lawyer now. We doctors order lots of tests and such just to help prevent lawsuits, but a doctor loses the same amount if he is sued, awards are paid by insurance. A doctor loses even if the case is ultimately won.

Lorie,
Legislating meaningful federal and state reforms of the complex markets for traditional employer-based healthcare insurance and for medical liability insurance should be critical priorities for all Americans.

It would be truly amazing if a Kerry/Edwards administration encouraged either type of market-oriented reform, rather than going in exactly the opposite direction with fewer choices for consumers and more government involvement and coercion.

I am a Rhode Island native and have been a gastroenterologist in private office-based practice here since 1967.

As you know, the new Health Savings Accounts are a key part of the important trend away from employer-based health insurance plans to a consumer-driven healthcare system.

The two best HSA information sites I have seen to date are: http://www.hsainsider.com and using the http://www.treasury.gov site and searching on "HSA".

Even with your pre-existing medical conditions, a family HSA plan may prove to be a cost-effective, long-term alternative to high-priced, high co-payment conventional health insurance options for your specific family coverage situation. I believe these sites can help you make a well-informed decision.

In regards to the growing national crisis in the medical liability segment of the $233 billion United States personal injury (tort) system, only 6 states do NOT currently have crises in both malpractice insurance premium costs and in decreasing patient access to specialist physicians, especially OB-GYNs and neurosurgeons.

This spring, my malpractice insurer's threatened to not renew any of its Rhode Island policies unless it receives an 80% premium rate increase from the Department of Business Regulation. I'm paying $16,000 in 2004 with a 20% discount for being claims-free since 1982. This is an increase of 400 percent from my $4,000 premium paid in 2000. This major practice overhead crisis led me to investigate the problem in depth and to posted my findings and conclusions on a Blogger.com Weblog :

http://www.med-malliabilityreform.blogspot.com .

These twelve essays I have posted since June 13th cover the entire subject of medical discipline/tort/medical liability insurance market reform in detail, with a focus on solving the crisis in Rhode Island by emulating the combination of legislative measures implemented in Texas in 2003. We have a population of one million and only about 4,000 doctors with only 1,045 square miles, 1/256th the size of Texas. It should be easier. However, the Democrat-controlled (84% of General assembly has other ideas.

Reforming the lottery-like aspects of the U.S. medical tort system should really be a non-partisan issue, but like almost everything else, it has been totally politicized with American trial lawyers contributing heavily to the Democratic party annually (this year, lawyers gave about $81 million to Democrats and about $31 million to Republicans according to David Brooks NY Times Op-Ed columnist in his essay of 9/11/04 entitled: "Ruling Class War").

In September 2003, the Texas legislature passed a specific combination of legislative initiatives designed to improve patient safety long-term and reform the medical liability insurance market in a way that will not adversely affect either the patients who have been truly injured by medical negligence or the non-negligent majority of the more than 41,000 physicians in Texas.

There is objective evidence that these reforms are already starting to heal the healthcare system in Texas for its population of over 21 million.
(See:http://www.governor.state.tx.us/divisions/press/tortreform/factsheet.htm)

Bob Coli, MD

Dale:

Jeff didn't write that post, I did. (Posted by refers to the post above, not below.)

"Most doctors are afraid to admit mistakes because of fear of lawsuits. Say "I'm sorry" even if you did nothing wrong, and it will be used against you in a court of law."

Yep. Doctors are often in high-scrutiny situations, and they have to behave accordingly. It'd probably be better for everybody if doctors could just concentrate on medicine and nothing else, but things are what they are. For what it's worth, you're hardly the only profession who has to handle an obscene amount of legal BS.

However, I strongly disagree with your implication that doctors would be more than happy to admit that they made a mistake if it weren't for the threats of lawsuits. Even if the only thing at stake were the costs of correcting medical errors, HMOs would still have a large financial incentive never to admit fault.

"What does a trial lawyer have to lose by suing? Nothing but his time. And all he has to do is hit the lottery with one case to make up for that."

The "trial lawyer lottery" idea tends to assume that the merits of the case are essentially meaningless - that there are lots of trial lawyers who are working with lots of whiners who have no real grounds for complaint, and that every once in a while one of them will get lucky. From the evidence I've seen, the majority of the malpractice cases that get brought to court actually have pretty good grounds for complaint... and only a tiny percentage of the people could bring legal suits actually do.

Meanwhile, I'd love to hear you, as a doctor, talk about how multiple studies suggest that a small percentage of doctors are repeatedly involved with a large percentage of malpractice claims.

As bad as what your health insurance situation is I think my personal experience of the last year might top it.

First, Im 52 years old and underwent lifesaving esophageal surgery last year. I was still on work restrictions from the surgery, and will need 6 month EGDs and biopsy surveillance for the rest of my life, when on January 28th 2004 myself and every employee that works for company that I'm employed by received faxes informing us, that our President and CEO, had cancelled our group health ins. policy EFFECTIVE JANUARY 31st. 2004....We were given a 3 day notice that all our ins. would be gone.

To make it even worse, because he had cancelled the entire policy none of us were eligible for COBRA! My pre-existings got me denied at every ins. company that I sought to find coverage. HOWEVER, because of the HIPAA laws and because I had lost my ins. through no cause of my own, someone had to offer me a policy...It came by way of AFLAC and was laughable! I had been paying 15.00 per work through my employer for my single plan coverage. What I was now offered would cost me 1,158.00 per month for a single plan, with 5,000.00 deduct.,2,500.00 maximun per calendar year for prescriptions. I couldn't do it..There was no way I could afford it...

My only option at 52 years old was to QUIT my job after many years of employment and start from scratch. The reason that was an option is because of the laws that state; If you lose insurance coverage through no fault of your own, you have exactly 63 days from the last day you had coverage to get into a new group plan, for pre-existing coverage to begin immediately. In other words, I needed to start a new job within 63 days for my medical conditions to be covered. On the 64th. day I would be out of luck. AND I WAS!

I did find a new job but it took longer than 63 days..As a matter of fact I just received my new ID insurance cards and policy last week from my new employer...Just when I thought things could get no worse this is what is in BOLD LETTER ACROSS THE FRONT OF my ID cards..."THIS PLAN HAS A 10,000.00 PER CALENDAR YEAR MAXIMUN BENEFIT!" When I accepted this position I thought I had asked all the right questions; Yes, we have a physician co-pay, yes, we have prescription coverage, yes, we have eye and dental coverage, etc etc....It never occured to me to ask if we had a yearly maximum benefit...My mistake I guess...My old plan had a 2 million dollar lifetime benefit...

Anyone who has any type medical conditions will tell you that 10,000.00 per year is nothing in the big picture of things... The surgery from last year was more than 50,000.00 and that didn't include the hospital bill...

Where am I at today? Still working, but once again actively looking for a new job.

Cathy, your story beats mine hands down. It really is sad and scary out there. Good luck and keep me updated on your situation.

I am going to read through all these comments and look into some of the suggestions. Thanks to all who have commented. There are some great ideas I did not know about and I look forward to investigating each of them.

Chris,

Regarding your 9/28th comment: "multiple studies suggest that a small percentage of doctors are repeatedly involved with a large percentage of malpractice claims."

You are exactly correct. This critical, long-ignored aspect of necessary reform is detailed with national and Rhode Island data on my Weblog at:
http://www.med-malliabilityreform.blogspot.com .

The three essays covering this important aspect of the problem were posted on June 15th ("Shifting the Focus to Patient Safety", Scope of the Problem in Rhode Island") and June 20th (Tyranny of the Minority: Rhode Island 2002 National Practitioner Databank Data").

So-called "organized medicine" (i.e. the AMA and many state medical societies) has always protected this small minority of the most dangerous and least competent and/or impaired among us by consistently ignoring this issue. Only those of us without any or only a few valid negligence claim settlements or jury verdicts and no medical disciplinary actions who are forced to pay open-ended increases in malpractice insurance premiums are interested in permanently eliminating the ongoing damage done by this dangerous minority (which probably includes less than 150 Rhode Island doctors, or about 3.8 % of the 4,000 practicing here. In Texas, 3.8% of 41,000 is 1,558).

Beneficial medical liability market reform that improves patient safety and doesn't further economically harm patients who have been physically injured by truly negligent providers of professional healthcare services requires three different but interrelated types of state legislation addressing structural defects in:
(1)the medical discipline system
(2)the lottery-like aspects of the tort system
(3)the medical liability insurance market

According to Governor Rick Perry, one of their sponsors,this three-pronged approach enacted into law in Texas in September, 2003 is already starting to "heal healthcare in Texas."

http://www.governor.state.tx.us/divisions/press/tortreform/factsheet.htm

In an ideal world, reforming the lottery-like aspects of the U.S. medical tort system should really be a non-partisan issue, but like almost everything else, it has been totally politicized with American trial lawyers contributing heavily to the Democratic party annually (this year, lawyers gave about $81 million to Democrats and about $31 million to Republicans according to David Brooks NY Times Op-Ed columnist in his essay of 9/11/04 entitled: "Ruling Class War").

In Rhode Island, the 100-year-old Democratic monopoly control of the General Assembly (84% Democrat incumbents with only 6 of 38 Senators and 12 of 75 Representatives currently Republicans) has ensured that the Chairmen of both Senate and House Judiciary Committees will remain Democrat lawyers who are interested only in preserving their very favorable status quo. Like Texas, we do have an incumbent Republican Governor Carcieri whose first 4-year term expires in October, 2006.

Despite the powerful political barriers to change, a group of practicing physicians is trying to reproduce the proven Texas reform triad in the 2005 Rhode Island session of the General Assembly.

Bob

Bob, a couple of things:

1.) About half your response to me is a repeat of your post from the 28th; I read that one already, thanks all the same.

2.) As a Texas resident, I'm quite aware of the state of health care tort reform, and it's a long way from "proven". Governor Perry's press release is just that: a press release, with cherry-picked facts to make him look good. There has been some good news about health care in Texas over the past year, but it's far from spectacular, and correlation to tort reform has yet to be proven.

I also find it telling that the big number Perry touts - the 17% decrease in hospital premiums - is mostly composed of _projected_ savings for a year that hasn't happened yet. Furthermore, most doctors haven't seen anywhere near the drop in rates that hospitals have, nor have health care costs dropped correspondingly. Thus far only one malpractice insurance provider has dropped its rates; meantime, one malpractice insurance provider was prevented from _raising_ its rates by the state. Details here, in this Google cache of a Houston Chronicle article on tort reform effects:

http://216.239.39.104/search?q=cache:Eik9Cw7QomsJ:www.chron.com/cs/CDA/ssistory.mpl/metropolitan/2755514+Texas+medical+tort+reform&hl=en

3.) If I undergo a medical procedure in Texas and I'm seriously harmed, I have virtually no legal recourse against the doctor or hospital that did the damage, if they refuse to admit fault. I consider this a serious problem that no amount of sound bites about "healing health care in Texas" makes up for. Please tell me why I should not be worried about a lack of legal options without resorting to canned rhetoric and biased fact sheets. Thanks much.

you write that Canadians wait weeks or months for hospital visits. As if Americans don't?

I don't know where you live, Paul, but where I do it is not necessary to wait weeks or months for cancer treatments and surgeries of the type my daughter had. As I said in my post. We did not even want to wait a month so that we could have the same doctor who had treated our daughter before and who we trusted, knowing that the cholesteatoma would continue to grow in her head and do additional damage. We chose instead to have his partner do the surgery.

There are sometimes long waits here for treatments for non-life threatening conditions and elective surgery, but I was shocked to learn that people with the condition my daughter had were in some cases having to wait for months for their surgeries.

Lorie:

I'm hesitant to say much, because you clearly know far more about your daughter's conditions and medical options than I do. However, just about every Canadian I've ever met has been absolutely ecstatic about their health care system, and I've never before heard that wait times there are so bad that they can actively harm the health of patients.

From the link you provided, it sounds like your daughter's condition, while potentially quite serious, is not always immediately life-threatening. Could it be that those Canadians who were waiting for surgeries were people for whom the condition _could_ be serious within a year or two, but for whom a few months wouldn't make a huge difference? I only suggest this because my wife went through a similar situation a few years ago - removal of a benign cyst from her neck that was annoying, but not life-threatening. We still had to wait about six weeks to schedule the surgery.

All that said, it sounds like your daughter's condition was certainly one that should have been taken care of immediately, and I'm glad you were able to work things out.

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