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Medical Care Facts and Fables

Sandokan

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Medical Care Facts and Fables
RealClearPolitics - Medical Care Facts and Fables

By Thomas Sowell

There is so much political spin, and so many numbers games being played, when it comes to medical care, that we have to go back to square one and the simplest common sense, in order to get some rational idea of what government-run medical care means. In particular, we need to examine the claim that the government can "bring down the cost of medical care."

The most basic fact is that it is cheaper to remain sick than to get medical treatment. What is cheapest of all is to die instead of getting life-saving medications and treatment, which can be very expensive.

Despite these facts, most of us tend to take a somewhat more parochial view of the situation when it is we ourselves who are sick or who face a potentially fatal illness. But what if that decision is taken out of your hands under ObamaCare and is being made for you by a bureaucrat in Washington?

We won't know what that leads to until the time comes. As Nancy Pelosi said, we will find out what is in the bill after it has passed. But even now, after ObamaCare has been passed, not many people want to read its 2,400 pages. Even if you did, you would still not know what it would be like in practice, after more than 150 boards and commissions issue their specific regulations.
I can’t see anything in the Health Care bill that is going to bring the cost down. Hospitals cost control lack in efficiency because the services rendered to the sick are pay by others. There is a great probability that if reduce rate on malpractice insurance and additional tort reform were carried out in exchange for doctors and hospitals implementing cost effective measures, the cost of Health Care could be brought down.
 

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There are for sure cases of insurance company abuses, and great problems with liability issues that were not addressed by the approved H.C. bill. The majority of the people did not approve the radical changes introduced by the bill. Disregarding the opposition of the majority the Democrats in Congress went ahead and past the bill. Even now there are very few of them who voted for it, who have read the whole bill. This November they will pay the price for their arrogance.
 

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First off, I would like to bring reader's attention to this article from the NY Book Review entitled, "Health Care: The Disquieting Truth" by Arnold Relmanthat dated September 30, 2010. The article discusses the inefficiency and cost effectiveness of our nation's health care system as it stands today.

Second, whenever I hear figures (mostly) espoused by the political Right, I have to remind myself that whenever they quote the CBO estimates, they conveniently leave off that portion of the report that states that the figures are only for the first 10 years of health care reform measures. Thus, it shouldn't come as much of a surprise that such reforms will cost the government lots of money initially.

Third, it's just estimates. Even the NYBR article states that innovation, eliminating fraud waste, abuse and redundancy of test, exams and treatment will go a long way towards reducing health care cost, however, the article was also fair in stating that the government didn't (and couldn't) do enough to institute price controls in the private sector where health care is concerned. Of course, how can they? Unless government heavily subsidizes health care, there's no way any legislation alone is going to change things so radically. But the legislation is a good first start because it addresses many issues that have adversely affecting families (and businesses) for years.

People may not like it because they're only hearing the negative aspects of reform measures (taxes and the so-called "insurance mandate"), but if the Dems did a better job of explaining to the public "what's in it for them" and how this legislation can help (at least in the long-term) reduce the overall cost of health care, I think people would be able to embrace it more.
 

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People may not like it because they're only hearing the negative aspects of reform measures (taxes and the so-called "insurance mandate"), but if the Dems did a better job of explaining to the public "what's in it for them" and how this legislation can help (at least in the long-term) reduce the overall cost of health care, I think people would be able to embrace it more.
Those who believe that insurance companies are bad, wait until the Government, as a huge HMO, take over the Health care, and “bring down the cost of medical care,” at the expense of letting people die since it is cheaper. Just wait until that time comes, and as Nancy Pelosi said, we will find out.
 

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Sandokan,

You and so many others have a misconception of the health care legislation. There is no Public Option with the bill. The government will provide grants to the states to help them fund their state-sponsored health insurance exchanges (HIEs) and to off-set the cost of health care in the form of credits to those who need financial assistance, but the grants and subsidies (credits) end around 2017/2019 (atleast 5 yrs after the law is fully implemented). At that time, all states who do not opt-out from forming their HIEs OR who haven't submitted a waiver under Section 1332 of the law are required to be self-sufficient.

The irony here is that Senate Republicans offered "state-sponsored" HIEs in their health care reform legislation and now are complaining about it! Review the linked matrix that provides a summary of all proposals that came out of the various subcommittees prior to what was eventually passed and subsequently signed into law and you'll see exactly what I'm referring to. In fact, I provided a quick summary brief of the basic similarities between what the Dems and Reps were proposing in post #3 of this thread. It's very dishonest for Reps to be calling foul now over health care reform legislation when they proposed many of the exact same ideas in their versions of the bill.
 
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phattonez

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First off, I would like to bring reader's attention to this article from the NY Book Review entitled, "Health Care: The Disquieting Truth" by Arnold Relmanthat dated September 30, 2010. The article discusses the inefficiency and cost effectiveness of our nation's health care system as it stands today.

A big portion of the argument for UHC comes from the uninsured number, but the number throw out there is a lie, a greatly, greatly exaggerated lie. See here:

http://www.debatepolitics.com/health-care/82160-lets-talk-uninsured-number.html
 

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Steve
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I can’t see anything in the Health Care bill that is going to bring the cost down. Hospitals cost control lack in efficiency because the services rendered to the sick are pay by others. There is a great probability that if reduce rate on malpractice insurance and additional tort reform were carried out in exchange for doctors and hospitals implementing cost effective measures, the cost of Health Care could be brought down.

The part I bolded in your post, although repeated ad nauseum, is misleading. Malpractice premiums and lawsuits are a tiny percentage of the costs of doing medical business:


Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.(3)

Limiting Tort Liability for Medical Malpractice


Malpractice-insurance premiums and liability awards account for less than 2 percent of overall health-care spending, according to a 2004 study by the Congressional Budget Office. Defensive medicine, the practice of ordering extra tests or procedures to protect against lawsuits, might add another few percentage points, according to some estimates.

Yet 60 percent of respondents blamed lawyers for high costs, and 69 percent specifically pointed to "frivolous lawsuits."

Health-care security, who is to blame for high costs


“Thirty years of inflation-adjusted data show that medical malpractice premiums are the lowest they have been in this entire period..."


Finally, our research makes clear that medical malpractice claims and premiums have almost no impact on the cost of health care. Medical malpractice premiums are less than one-half of one percent of overall health care costs, and medical malpractice claims are a mere one-fifth of one percent of health care costs. If Congress completely eliminated every single medical malpractice lawsuit, including all legitimate cases, as part of health care reform, overall health care costs would hardly change...


Americans for Insurance Reform
 
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phattonez

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High medical costs are because of medicare, the Flexner Report, governments legislating in favor of non-profits over profitable hospitals, etc. In the end it can all be blamed on government. People were fine with the system we had before the dawn of the 20th century.
 

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The part I bolded in your post, although repeated ad nauseum, is misleading. Malpractice premiums and lawsuits are a tiny percentage of the costs of doing medical business:


Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.(3)

Limiting Tort Liability for Medical Malpractice
Malpractice certainly is an important issue. A malpractice tort system is necessary, not only to compensate victims, but to maintain some sort of financial deterrent to the incidence of malpractice. Regardless of who wins, the average time between injury and resolution of the claim is five years. During this waiting period, the victim is without economic support.

A recent survey of doctors published in the Journal of the American Medical Association found that 93 percent of physicians admit to practicing defensive medicine. Beside the waist in cost, defensive medicine wastes patients' and doctors' time.

The 800,000 physicians in active practice in the U.S. pay, on average, premiums of $27,500 per year for malpractice coverage [1]. This amounts to $19.25 billion per year.
The cost of medically unnecessary, but legally warranted, defensive medicine takes up to 20% to 25% [2]. of the total national health care spending. Based on the 25% figure $550 billion is squandered annually in defensive medicine decisions. Because of defensive medicine, doctor’s productivity is negatively impacted. Much of the physician’s and nurse’s time is spent entering voluminous notes into the chart, which have zero or little practical relevance to the patient’s care. Administrative costs for U.S. physicians are nearly 27% of gross income. Unless trial lawyers are removed from the equation, there will never be any significant reduction in health-care costs.

[1] “Accounting for the Cost of Health Care in the United States.” McKinsey Global Institute. January 2007. Link: McKinsey & Company - Synthesis - Accounting for the cost of health care in the United States - January 2007

[2] “The Elusive Prescription for Health Care We Can Afford.” Wall Street Journal. Feb 4, 2008. Link: http://online.wsj.com/public/article_print/SB120209669119840029.html
 

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High medical costs are because of medicare, the Flexner Report, governments legislating in favor of non-profits over profitable hospitals, etc. In the end it can all be blamed on government. People were fine with the system we had before the dawn of the 20th century.

Saying that people were fine with the system we had before the dawn of the 20th century is like saying that people were fine with the system of tribalism before we developed cities and networks of roads to build up civilization and the knowledge and learning that developed from city-states.

We do need health care reform. How it comes about, I could care less as long as it is effective. Some of things I'd want are the following:

1) No denial of coverage despite pre-existing conditions
2) Breaking health insurance away from employer coverage
3) Universal health care for children, the elderly, and the mentally ill
4) Penalties for health insurance companies to drop long-term customers, or to raise premiums foor long-term customers

There's way too much likelihood for health insurance companies to be run as a scam. That's why customers don't trust private health insurance companies. If they don't want there to be a public option, then they need to start running their business to better suit consumers.
 

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Pataki’s Bogus Health Care Claims | FactCheck.org

I do wish folks would check their "sources" for healthcare information as it is sometimes skewed, misleading, and often outright lies. Politicians and others who lie about this very improtant bill for the future of our nation should rot no matter who is lying.
 

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A big portion of the argument for UHC comes from the uninsured number, but the number throw out there is a lie, a greatly, greatly exaggerated lie. See here:

http://www.debatepolitics.com/health-care/82160-lets-talk-uninsured-number.html

The problem with using yourself as a reference is that when you are wrong it is compounded when repeated.

The count normally quoted of uninsured is from the census, but has nothing to do with the under count of Medicaid enrollments as you state.

From the pdf linked, the section on uninsured begins on page 20.
People were considered “insured” if they were covered by any type of health insurance for part or all of the previous calendar year. They were considered “uninsured” if they were not covered by any type of health insurance at any time in that year.

http://www.census.gov/prod/2006pubs/p60-231.pdf
 

phattonez

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Saying that people were fine with the system we had before the dawn of the 20th century is like saying that people were fine with the system of tribalism before we developed cities and networks of roads to build up civilization and the knowledge and learning that developed from city-states.

We do need health care reform. How it comes about, I could care less as long as it is effective. Some of things I'd want are the following:

1) No denial of coverage despite pre-existing conditions
2) Breaking health insurance away from employer coverage
3) Universal health care for children, the elderly, and the mentally ill
4) Penalties for health insurance companies to drop long-term customers, or to raise premiums foor long-term customers

There's way too much likelihood for health insurance companies to be run as a scam. That's why customers don't trust private health insurance companies. If they don't want there to be a public option, then they need to start running their business to better suit consumers.

What was wrong with the system we had at the dawn of the 20th century, then? The system is far too corrupt right now for my liking, so I'm not going to defend it. But what is wrong with the capitalist model?
 

phattonez

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The problem with using yourself as a reference is that when you are wrong it is compounded when repeated.

The count normally quoted of uninsured is from the census, but has nothing to do with the under count of Medicaid enrollments as you state.

From the pdf linked, the section on uninsured begins on page 20.

Exactly, the census overcounts the number of people uninsured, and of course UHC propoents use that number.
 

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Malpractice certainly is an important issue. A malpractice tort system is necessary, not only to compensate victims, but to maintain some sort of financial deterrent to the incidence of malpractice. Regardless of who wins, the average time between injury and resolution of the claim is five years. During this waiting period, the victim is without economic support.

A recent survey of doctors published in the Journal of the American Medical Association found that 93 percent of physicians admit to practicing defensive medicine. Beside the waist in cost, defensive medicine wastes patients' and doctors' time.

The 800,000 physicians in active practice in the U.S. pay, on average, premiums of $27,500 per year for malpractice coverage [1]. This amounts to $19.25 billion per year.
The cost of medically unnecessary, but legally warranted, defensive medicine takes up to 20% to 25% [2]. of the total national health care spending. Based on the 25% figure $550 billion is squandered annually in defensive medicine decisions. Because of defensive medicine, doctor’s productivity is negatively impacted. Much of the physician’s and nurse’s time is spent entering voluminous notes into the chart, which have zero or little practical relevance to the patient’s care. Administrative costs for U.S. physicians are nearly 27% of gross income. Unless trial lawyers are removed from the equation, there will never be any significant reduction in health-care costs.

[1] “Accounting for the Cost of Health Care in the United States.” McKinsey Global Institute. January 2007. Link: McKinsey & Company - Synthesis - Accounting for the cost of health care in the United States - January 2007

[2] “The Elusive Prescription for Health Care We Can Afford.” Wall Street Journal. Feb 4, 2008. Link: http://online.wsj.com/public/article_print/SB120209669119840029.html

Trial lawyers are very important if you have been wronged. They can't be removed from the system. It's myopic to think so. If I or someone in my family is wronged by an incompetent doctor I am going to sue him. So would you, and anybody else who is normal. There is no way we shouldn't have that right, and no arbitrary limit should be placed on damages.
 

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Trial lawyers are very important if you have been wronged. They can't be removed from the system. It's myopic to think so. If I or someone in my family is wronged by an incompetent doctor I am going to sue him. So would you, and anybody else who is normal. There is no way we shouldn't have that right, and no arbitrary limit should be placed on damages.

Just wondering if you ever made a mistake at work. My sense is that like just about everyone you did. Should people who used the incorrect information be able to sue you. In the world you mention above all non-perfect people should be sued without limit.
 

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Trial lawyers are very important if you have been wronged. They can't be removed from the system. It's myopic to think so. If I or someone in my family is wronged by an incompetent doctor I am going to sue him. So would you, and anybody else who is normal. There is no way we shouldn't have that right, and no arbitrary limit should be placed on damages.
Malpractice suits results in massive and random settlements that raise everyone's insurance premiums. A third of the proceeds go to the pockets of trial lawyers. Cap on damages will help the Medical profession to manger the risk.

The potential threat of a legal suit is considered to be a deterrent to physician malpractice. In a single-payer malpractice system, all physicians will be assessed a percent of their net income to be placed into a pool to compensate victims of malpractice. Panels of actively practicing physicians, drawn like juries, would review and adjudicate the claims. Money, instead of going to malpractice insurance companies and lawyers, would go to the malpractice victim, and the case would be resolved within weeks, not years.

A physician guilty of malpractice shall be reported to the state medical board immediately to be suspended or removal of the license dependent on the gravity of the case.
 

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phattonez said:
Exactly, the census overcounts the number of people uninsured, and of course UHC propoents use that number.
You haven't provided proof that the census overcounts the number of people uninsured.



The Heritage Foundation - and you by extension - claim that the census count of uninsured is unreliable because of the undercount of Medicaid enrollees (comparing actual Medicaid enrollees to census report of enrollees). They have nothing to do with one another as far as a census count goes.

This is nothing but an assumption, without proof, by the HF.

In fact the HF says:

"The inaccuracy of the census count of the uninsured may be due, in part, to its undercount of Medicaid enrollments.'

There is nothing to connect the two.

There could quite possibly be MORE uninsured than reported. If the census undercounted Medicaid enrollees, why would it not be plausable for the census to undercount the uninsured?
 

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Just wondering if you ever made a mistake at work. My sense is that like just about everyone you did. Should people who used the incorrect information be able to sue you. In the world you mention above all non-perfect people should be sued without limit.

I've made plenty of mistakes. None of them threatened any other person's life or health. If one of them did, sure I would be open to lawsuit. That's as it should be.

You make big assumptions. What I'm saying is I should be able to sue a doctor for malpractice if he harms me. Also, I should not be limited by an amount that some disinterested party favors.

Let's say your wife or mother is undergoing an appendectomy. The surgeon, who is late for his son's graduation, is in a big hurry and nicks an artery, causing hemmorhage and profound brain damage. How much money should you be able to recover by suing this doctor?
 

phattonez

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You haven't provided proof that the census overcounts the number of people uninsured.



The Heritage Foundation - and you by extension - claim that the census count of uninsured is unreliable because of the undercount of Medicaid enrollees (comparing actual Medicaid enrollees to census report of enrollees). They have nothing to do with one another as far as a census count goes.

This is nothing but an assumption, without proof, by the HF.

In fact the HF says:

"The inaccuracy of the census count of the uninsured may be due, in part, to its undercount of Medicaid enrollments.'

There is nothing to connect the two.

There could quite possibly be MORE uninsured than reported. If the census undercounted Medicaid enrollees, why would it not be plausable for the census to undercount the uninsured?

How is it not proof? If the census reports less than the number of actual medicaid enrollees, then how is it not undercounting the number of enrollees? Just tell me any other explanation.
 

phattonez

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You make big assumptions. What I'm saying is I should be able to sue a doctor for malpractice if he harms me. Also, I should not be limited by an amount that some disinterested party favors.

Let's say your wife or mother is undergoing an appendectomy. The surgeon, who is late for his son's graduation, is in a big hurry and nicks an artery, causing hemmorhage and profound brain damage. How much money should you be able to recover by suing this doctor?

You should be, but punitive damages gives you more than justice. It also punishes the other party. I have nothing but disdain for the rewarding of punitive damages. You can sue all you want, but I want punitive damages to be done away with.
 

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I've made plenty of mistakes. None of them threatened any other person's life or health. If one of them did, sure I would be open to lawsuit. That's as it should be.

You make big assumptions. What I'm saying is I should be able to sue a doctor for malpractice if he harms me. Also, I should not be limited by an amount that some disinterested party favors.

Let's say your wife or mother is undergoing an appendectomy. The surgeon, who is late for his son's graduation, is in a big hurry and nicks an artery, causing hemmorhage and profound brain damage. How much money should you be able to recover by suing this doctor?

Now you are making the assumption that most lawsuits are based on gross negligence by a doctor. Actually many lawsuits are simply that there was an undersired outcome.

If the only cases allowed to go to trial are such as the one you outline then there should be damages. What about if the doctor did not committ malpractice but the patient dies or has a bad result. Do you really think 12 people off the street can tell the difference.
 

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Now you are making the assumption that most lawsuits are based on gross negligence by a doctor. Actually many lawsuits are simply that there was an undersired outcome.

If the only cases allowed to go to trial are such as the one you outline then there should be damages. What about if the doctor did not committ malpractice but the patient dies or has a bad result. Do you really think 12 people off the street can tell the difference.

Not an assumption, just a scenario.

As far as just an undesired outcome, or whether or not there was malpractice, that's what the courts are for. There has to be evidence presented and a decision made. I'll trust a jury for that.
 

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You should be, but punitive damages gives you more than justice. It also punishes the other party. I have nothing but disdain for the rewarding of punitive damages. You can sue all you want, but I want punitive damages to be done away with.

Done away with, for a doctor who does deliberate harm? Why?

In medical malpractice cases, punitive damages are unusual, are only permitted by some states, and are generally awarded only when there has been proof that the harm was the result of an act that was reprehensible, which usually means that there was actual intent to cause harm or that there was reckless disregard for the safety of others.

Those states that permit punitive damages in medical malpractice cases often limit the amount of damages that can be awarded, and many states set standards of proof that are higher than are needed for ordinary damages.


Medical Malpractice Insurance and Punitive Damages - Physician Entrepreneur
 

washunut

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Not an assumption, just a scenario.

As far as just an undesired outcome, or whether or not there was malpractice, that's what the courts are for. There has to be evidence presented and a decision made. I'll trust a jury for that.

Perhaps you know the facts. Most cases do not go to trial. largely because the cost of lawyers fees etc. are so high it is easier for companies to settle.

Also to think that most juries can figure out the science involved in a medical malpractice case is almost laughable.
 
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