Health-care reform: what do we do now?

[Dymanic]

Funny, tort reform is the first thing they always bring up. Of course, tort reform will increase the cost of healthcare, but who's paying attention to insignificant details like that?

I'm familiar with the argument that since medical malpractice liability represents such a small portion of total U.S. healthcare spending, tort reform isn't likely to make much difference. I don't recall having previously heard it claimed that it would actually increase costs, but I'd be interesting in seeing the supporting arguments.

 

[Michael Redman]

I'm familiar with the argument that since medical malpractice liability represents such a small portion of total U.S. healthcare spending, tort reform isn't likely to make much difference. I don't recall having previously heard it claimed that it would actually increase costs, but I'd be interesting in seeing the supporting arguments.

The tort reform idea is based on the assumption that lower malpractice payouts will result in the insurance companies lowering premiums, and in turn doctors will lower their charges. If either the insurance company or the doctor decide to hold on to their windfall, there's no decrease in the cost of healthcare. And if they did altruistically pass on the entire amount of savings to the consumer, the difference would be so small no one would notice.

On the other hand, if we artificially reduce the cost of committing malpractice, we reduce the incentive to put in the effort to do the job right, and should reasonably expect an increase in malpractice to follow. More malpractice will require the consumption of more healthcare, and the expenditure of more healthcare dollars.

 

[Dymanic]

On the other hand, if we artificially reduce the cost of committing malpractice, we reduce the incentive to put in the effort to do the job right, and should reasonably expect an increase in malpractice to follow. More malpractice will require the consumption of more healthcare, and the expenditure of more healthcare dollars.

I imagine that one of the rebuttals to that would go something like this:

At present we are artificially inflating costs by forcing providers to practice "defensive medicine" (tests and treatments ordered not out of medical necessity but to avoid liability), and these higher costs reduce the incentive for many people to seek regular preventative care. It creates a situation where healthcare dollars are overspent on the insured and underspent on the uninsured or underinsured -- and then overspent again on those among the latter who, due to lack of affordable care, eventually end up burdening the system with catastrophic costs.

 

[WildCat]

If either the insurance company or the doctor decide to hold on to their windfall, there's no decrease in the cost of healthcare

So you're one of those people who thinks companies can just keep raising their profit margins at will?

 

[Michael Redman]

I imagine that one of the rebuttals to that would go something like this:

At present we are artificially inflating costs by forcing providers to practice "defensive medicine" (tests and treatments ordered not out of medical necessity but to avoid liability), and these higher costs reduce the incentive for many people to seek regular preventative care. It creates a situation where healthcare dollars are overspent on the insured and underspent on the uninsured or underinsured -- and then overspent again on those among the latter who, due to lack of affordable care, eventually end up burdening the system with catastrophic costs.

It would ne nice if we could actually get figures on the "cost" of defensive medicine, and see if it actually a problem, and how and where it drags on the system. I'm sure there's something to it. On the other hand, I don't agree that capping malpractice claims will somehow end defensive medicine.

A better solution to the defensive medicine issue might be to educate doctors on the real liklihood that they will be sued despite following appropriate standards of care, and the real impact on them if they are. That, and of course take away the licenses of the doctors committing all the malpractice. But doctors don't seem too interested in pursuing that.

So you're one of those people who thinks companies can just keep raising their profit margins at will?

So you're one of those people who thinks companies always lower thier prices when their costs go down?

 

[Dymanic]

It would ne nice if we could actually get figures on the "cost" of defensive medicine, and see if it actually a problem, and how and where it drags on the system.

Well, it would be nice if we could get figures that everyone could agree were based on clear-cut instances of providers exceeding necessity as defined under some univerally accepted "appropriate standard of care" -- but that being a determination that can only be made on a case by case basis, and even then only very subjectively, I don't see the question as one that can easily be solved empirically. 'Course, it never hurts to try, I suppose.

Trying to predict the cost of a theoretical increase in consumption of healthcare due to a theoretical increase in malpractice seems to involve making at least as many assumptions; I see both questions as hopelessly fuzzy.

 

[JoeTheJuggler]

Meanwhile, back at the ranch. . .

This sounds like what is likely to happen in the next week:

Multiple Democratic sources have told CNN that the emerging consensus plan is for the House of Representatives to pass the Senate bill and send it to Obama. A package of changes that mirror the president's plan would then be passed through both chambers under reconciliation rules, which require only 51 votes in the Senate.

Linky.

This way, Republicans can't use the argument that reconciliation ought not be used on a large reform package since the biggest part of the bill will just be the Senate bill that has already passed by a supermajority, and can pass in the House. Then these other bits could be passed by reconciliation making the plan closer to what Obama and the House want.

ETA: And I sure hope one of these other bits that gets passed is the repeal of the anti-trust exemption--something in the House bill that wasn't in the Senate bill.

It's certainly not the best solution. But in the "art of the possible" it's better than the status quo by far.

 

[WildCat]

It's certainly not the best solution. But in the "art of the possible" it's better than the status quo by far.

I disagree, a better bill is possible. It's only the low expectations of US voters that allow Congress to get away with such a fecal bill under the pretense it's "the best that can be done".

 

[JoeTheJuggler]

I disagree, a better bill is possible. It's only the low expectations of US voters that allow Congress to get away with such a fecal bill under the pretense it's "the best that can be done".

So you think we can pass a real UHS reform bill? Single payer?

Those are the preferable kinds of reforms I was saying are politically not possible.

 

[JoeTheJuggler]

By the way, you'd think that by now people like Minority Whip Rep. Cantor would give up on this idea that the Democrats are trying to "ram through" healthcare reform. This process has dragged on for the better part of a year, and we've had several supermajority votes.

Characterizing this process that way is disingenuous, to put it politely. Yet, he's still doing that.

I rather agree with Obama that Congress has had ample time to discuss this. We've heard all the arguments, and it's time to get it done.

 

[WildCat]

So you think we can pass a real UHS reform bill?

Of course, assuming you mean "UHC", as I have no idea what "UHS" means.

Single payer?

Nope. As has been pointed out to you before single-payer isn't the only, nor even the prevalent, method to achieve UHC.

Those are the preferable kinds of reforms I was saying are politically not possible.

Certainly a better bill than this is possible. If not, we need new politicians.

 

[Michael Redman]

Trying to predict the cost of a theoretical increase in consumption of healthcare due to a theoretical increase in malpractice seems to involve making at least as many assumptions; I see both questions as hopelessly fuzzy.

Yes, they are. Perhaps there would be a decrease in defensive medicine great enough to make up for an increase in malpractice. Perhaps some actual competition would force the insurance companies to give up some of the increase in profits, and perhaps doctors will lower their fees in response to lowered premiums.

And after all that, the Republicans' #1 solution to healthcare costs can still have no significant impact on the problem becasue the cost of malpractice litigation is not a significant portion of healthcare expenditures.

To be fair, capping health insurance rate increases seems like a fairly worthless way to tackle the problem as well. I don't see anyone actually addressing the cost of healthcare.

 

[JoeTheJuggler]

Of course, assuming you mean "UHC", as I have no idea what "UHS" means.

Universal Healthcare System.

ETA:

Certainly a better bill than this is possible. If not, we need new politicians.

Again, what you think of as a "better bill" is not the same thing I'm talking about.

And obviously you must think that doing nothing is better than passing something like the Senate bill. That's where I think we disagree.

 

[JoeTheJuggler]

To be fair, capping health insurance rate increases seems like a fairly worthless way to tackle the problem as well. I don't see anyone actually addressing the cost of healthcare.

I note that the two goals of decreasing the overall cost of healthcare and extending healthcare access to a higher percentage of us are more or less at odds. However, I don't think it's at all fair to say that no one is addressing the costs of healthcare.

Both the Senate bill and the House bill have measures aimed at achieving that goal. You might disagree with estimates of their effectiveness, but it's factually wrong to claim that no one is addressing this issue. It's more a rhetorical device that is very similar to begging the question. (You don't have to prove that their measures aimed at reducing costs will be ineffective if you just deny that any such measures exist.)

 

[Michael Redman]

I note that the two goals of decreasing the overall cost of healthcare and extending healthcare access to a higher percentage of us are more or less at odds. However, I don't think it's at all fair to say that no one is addressing the costs of healthcare.

Both the Senate bill and the House bill have measures aimed at achieving that goal. You might disagree with estimates of their effectiveness, but it's factually wrong to claim that no one is addressing this issue. It's more a rhetorical device that is very similar to begging the question. (You don't have to prove that their measures aimed at reducing costs will be ineffective if you just deny that any such measures exist.)

I see a lot of proposals aimed at the cost of health insurance, but nothing addressing the cost of providing healthcare. I'm not claiming to have comprehensively examined all the proposals, but if someone is making proposals that address cost of providing care, they're doing a good job of burying the story.

 

[WildCat]

I see a lot of proposals aimed at the cost of health insurance, but nothing addressing the cost of providing healthcare. I'm not claiming to have comprehensively examined all the proposals, but if someone is making proposals that address cost of providing care, they're doing a good job of burying the story.

It's buried so deep it's not on the paper the bill is written on.

 

[Thunder]

It's buried so deep it's not on the paper the bill is written on.

why do Conservatives want complex and complicated issues to be dealt with in 3 page, double-spaced, size 18 font documents?

 

[AlBell]

why do Conservatives want complex and complicated issues to be dealt with in 3 page, double-spaced, size 18 font documents?

Because if it's more complicated than that, central planners have no chance of getting things right?

Maybe we need a Five Year Plan.

 

[Thunder]

Because if it's more complicated than that, central planners have no chance of getting things right?

Maybe we need a Five Year Plan.

why don't we just seize the property of millionaires, split it up and sell it, and use the funds to pay for health-care for the poor?

 

[AlBell]

Killing the goose that lays golden eggs is a Democrat speciality, so why not?