Obama health care plan explained

[BobG]

Now I am sure a few conservatives will get on here and try to beat down what I have said...ok, have at it.

Sorry to disappoint you but I'm a liberal!

You mentioned that countries with universal health care have excellent sysems. This, I'm sure, depends on whose opinion you read or what poll you believe.

As far as I'm concerned, I really don't know. However, all judgements regarding which system is better never include the fact that more people are covered under universal care than under the system that we currently have.

The fact that more people are coverered should be factored in before making any judgement regarding which system is better.

That said, I place heavy emphasis on more widespread coverage of the population; therefore, I am for universal health insurance.

Bob Guercio

 

[BobG]

Most physicians order "unnecessary" (i.e., confirmatory) tests out of fear of missing something that they probably already knew... and the subsequent litigation, if by chance in the rare case they did miss something. Most physicians have no idea how much those tests cost or, more importantly, how much the patient is billed when they order them.

I've always believed this but it sure is good to hear it from a Physician.

Bob Guercio

 

[David Wong]

I've always believed this but it sure is good to hear it from a Physician.

Bob Guercio

But won't testing always fall on the "better safe than sorry" side? What was so disturbing to me about his post was that he was indicating that somehow fear of litigation motivated doctors to test more than concern over the patient's health.

In other words, it's weird to hear "we have to do excessive testing because if we missed something the patient would sue our pants off" when you'd think the desire to, you know, keep the patient healthy would be all the motivation they need to makes sure they didn't "miss something."

 

[BobG]

But won't testing always fall on the "better safe than sorry" side? What was so disturbing to me about his post was that he was indicating that somehow fear of litigation motivated doctors to test more than concern over the patient's health.

In other words, it's weird to hear "we have to do excessive testing because if we missed something the patient would sue our pants off" when you'd think the desire to, you know, keep the patient healthy would be all the motivation they need to makes sure they didn't "miss something."

You make an excellent; however, human nature being what it is, the Physician demonstrates very human behavior when he does this.

I don't find it at all surprising and, to be honest, I would probably practice medicine the same way if I were a Doctor!

Bob Guercio

 

[JoeTheJuggler]

Dr. I, my understanding is that frivolous lawsuits are already tossed out of court (and wouldn't therefore constitute any reason to change the way you practice medicine).

Perhaps the willingness of insurance companies to settle weak or meritless lawsuits rather than fight them might be the real source of the problem.

Maybe what needs overhauling and better regulation is malpractice insurance?

I think there's something else that goes into unnecessary, expensive testing--poorly educated patients who think they need an MRI or whatever and the expectation that their doctor isn't doing a good job unless such tests are ordered. Do you think maybe there's something to that?

 

[BobG]

Dr. I, my understanding is that frivolous lawsuits are already tossed out of court (and wouldn't therefore constitute any reason to change the way you practice medicine).

Two points:

1. I think that the Doctor was referring to the huge settlements for malpractice rather than the frivolity of the case.

2. Frivolous cases do not always get thrown out. Do you remember the case of a woman who sued McDonalds (or some other fast food restaurant) because she burned her crotch due to coffee that was too hot! The jury awarded her almost 3 million dollars which was reduced to about $500,000 on appeal.

Bob Guercio

 

[BobG]

I think there's something else that goes into unnecessary, expensive testing--poorly educated patients who think they need an MRI or whatever and the expectation that their doctor isn't doing a good job unless such tests are ordered.

I agree.

How about a patient who visits a Doctor's office and feels that he has wasted his money if the Doctor says that nothing can be done for his problem except to wait restfully for a few days.

I'm sure Doctors very quickly pull out the prescription pad for this type.

This has lead to the ineffectiveness of many antibiotics.

Bob

 

[JoeTheJuggler]

1. I think that the Doctor was referring to the huge settlements for malpractice rather than the frivolity of the case.

That was the exact point I was making.

If the cases are meritless, maybe they shouldn't be settled. And if the fact that settlements are being made regardless of the merits, then there is no logic to practicing "defensive" medicine.

I'm wondering if the malpractice insurance providers aren't the real source of the problem.

2. Frivolous cases do not always get thrown out. Do you remember the case of a woman who sued McDonalds (or some other fast food restaurant) because she burned her crotch due to coffee that was too hot! The jury awarded her almost 3 million dollars which was reduced to about $500,000 on appeal.

That was not a frivolous case. (I used to interpret for a deaf law student, and in Torts class, they covered the facts of that case, and it definitely had merit, despite what the facts sounded like in Jay Leno's monologue.)

 

[BobG]

That was the exact point I was making.

If the cases are meritless, maybe they shouldn't be settled.

This case was not settled out of court. It was a trial by jury and the jury awarded her 2.7 million dollars.

The judge should have declared it a frivolous lawsuit or else he should have directed a reasonable settlement for her rather delicate crotch.

Bob Guercio

 

[BobG]

that was not a frivolous case. (i used to interpret for a deaf law student, and in torts class, they covered the facts of that case, and it definitely had merit, despite what the facts sounded like in jay leno's monologue.)

$500,000?????

 

[JoeTheJuggler]

This case was not settled out of court. It was a trial by jury and the jury awarded her 2.7 million dollars.

The judge should have declared it a frivolous lawsuit or else he should have directed a reasonable settlement for her rather delicate crotch.

You're mixing up the coffee case with my comments about malpractice insurance companies settling medical malpractice claims.

But again, the judge should not have declared the coffee burn a frivolous case because it wasn't. And in fact, after the judgement the parties did reach a secret settlement.

My comment about malpractice cases is that if the claim is that doctors have to practice expensive defensive medicine because meritless cases are being awarded huge settlements, maybe the problem is the insurance companies giving out the settlements (and then charging doctors even MORE expensive malpractice premiums).

I don't think anyone thinks it's wrong to settle or give awards when the malpractice case has merit, right?

$500,000?????

Again--you're stuck on the coffee case which is neither a malpractice case nor an example of a frivolous lawsuit. The judge reduced punitive damages to $480,000 (which was 3 times compensatory damages). After the decision, the parties reached an undisclosed settlement.

Remember, the plaintiff originally wanted to settle for $20,000 to pay for her skin grafts! MacDonald's counter-offer was $800.

Mickey D's behavior in the case was outrageous and led to the huge punitive damages.

ETA: The compensatory damages (she suffered 3rd degree burns over some 5% of her body) were put at $200,000 and then reduced by 20% (because the plaintiff was 20% liable for the incident). The jury put punitive damages at $2.7 million which was something like 1 and a half days' worth of coffee revenues. The judge reduced that figure to 3 times the compensatory damages. But, as I mentioned, the parties reached a secret settlement and dropped their appeals.

 

[BobG]

(she suffered 3rd degree burns over some 5% of her body)

This would completely change my thinking, if true; after all, this would be an extremely serious injury.

However, a burn of this dimension (degree and percentage) seems impossible with only eight ounces of hot water!

I'm going to ask you to cite a reputable source on this. I mean reputable, not some dumb shmuck's website.

I don't want to go through the trouble of researching this myself because I don't believe it.

maybe the problem is the insurance companies giving out the settlements

It's not up to the insurance companies what they should pay out; it's up to the courts

Bob Guercio

 

[Professor Yaffle]

Lastly, I would far from consider myself in a "for profit" medical care model. I do, however, feel like I should be compensated well for working, on average, 55-60 hours a week, in my particular practice specialty, making life-and-death decisions and trying to do what's best for patients under my care all under the constant specter of being involved in an expensive and time-consuming lawsuit whether or not medical malpractice was actually committed. If you punish physicians in any way, shape, or form monetarily (by cutting reimbursements, analyzing practice patterns and publishing outcomes, etc.), there is going to be a decreased access for patients of the most highly trained members of the healthcare team for the potentially unsupervised practice of far less well-trained midlevel counterparts. I have been around long enough to ensure you that that prospect alone scares me more than anything else, both as a provider of high-quality care to patients as well as a healthcare consumer.

The UK solution to getting the doctors on-side was "stuffing their mouths with gold".
http://en.wikipedia.org/wiki/Aneurin_Bevan

 

[Matthew Best]

This would completely change my thinking, if true; after all, this would be an extremely serious injury.

However, a burn of this dimension (degree and percentage) seems impossible with only eight ounces of hot water!

I'm going to ask you to cite a reputable source on this. I mean reputable, not some dumb shmuck's website.

I don't want to go through the trouble of researching this myself because I don't believe it.

Would the Consumer Attorneys of California do?

http://www.caoc.com/CA/index.cfm?event=showPage&pg=facts

A vascular surgeon determined that Liebeck suffered full thickness burns (or third-degree burns) over 6 percent of her body, including her inner thighs, perineum, buttocks, and genital and groin areas.

 

[Rolfe]

Don't worry, doctors in countries with proper, universal health care are still filthy rich.

And they don't work 55-60 hours a week any more either.

Rolfe.

 

[Rolfe]

Consider WellPoint, the biggest private health insurer on Wall Street, which has about 35 million customers nationwide. Last year, it paid out 83.6% of revenues in expenses. Net, after-tax income as a percentage of total revenue came to a princely 4.1%.

I smell weasel words here. What percentage of income is spent on buying healthcare? In European systems where insurance companies deliver universal healthcare, the figure is about 95%. The figure I've heard for the USA is about 78%, which is held to be absolutely diabolical in global terms. So even if 83.6% is a real figure, it ain't so good. And when they say "expenses" rather than "buying healthcare" some warning bells go off.

Rolfe.

 

[Rolfe]

Then what is? I've read enough to know that Torts are only a tiny fraction of it. If the insurance company shareholders aren't sucking all of the money out of the system, then who is?

Try this article. What is the cause of excess costs in US healthcare?

Rolfe.

 

[Rolfe]

But yes, from what I read, this stuff should more properly be called "health insurance reform" rather than "universal health care".

I understand what you're saying, but I would put in one word of caution for general consumption. Many people seem to equate the term "universal healthcare" with a state-run system such as the NHS which is funded from taxes and to which everyone has access. It seems as if the USA is not intending to go in this direction.

However, countries such as Germany and Switzerland also have "universal healthcare" in that healthcare is available to everyone at a price they can afford, but it is done by making sure that everyone has health insurance cover that they can afford. It seems to me that this is what Obama is working towards, even if he's not quite there yet on the first move.

"Universal healthcare" simply means that everyone in the population (defined elsewhere) has access to the healthcare they need at a price they can afford. The "how" is irrelevant, and there are lots of "hows".

I know you didn't make this mistake, but many people in the USA do. Many criticisms of Obama's plans seem to be assuming he's proposing a system he simply isn't proposing.

Rolfe.

 

[BobG]

Would the Consumer Attorneys of California do?

http://www.caoc.com/CA/index.cfm?event=showPage&pg=facts

I stand corrected!

Bob

 

[JoeTheJuggler]

This would completely change my thinking, if true; after all, this would be an extremely serious injury.

However, a burn of this dimension (degree and percentage) seems impossible with only eight ounces of hot water!

I'm going to ask you to cite a reputable source on this. I mean reputable, not some dumb shmuck's website.

I got the facts from the professor in a law school torts class. The pages I cited above were from Lectric Law Library and wikipedia. But you can google it yourself--the same facts turn up everywhere. It was not a frivolous lawsuit. I'm not sure where you got the facts of the case. (ETA: The case is Liebeck vs. McDonald's Restaurants.)

I don't want to go through the trouble of researching this myself because I don't believe it.

So you're unwilling to take my word for it (or either of the sites I linked to), and unwilling to look it up yourself, but you're still going to continue to call it a frivolous lawsuit and use it as an example to show that the courts don't toss out meritless suits.

Then I refuse to continue the discussion with you. Since the case is not a medical malpractice case or a frivolous lawsuit, it has no bearing on the topic anyway.

It's not up to the insurance companies what they should pay out; it's up to the courts

A settlement is between the two parties and does not involve the courts. Yes, it's up to the insurance companies if in fact they are paying out big settlements for meritless cases.