Obama Ready to Talk Tort Reform

President Obama enjoyed great support from trial lawyers in his presidential campaign. Even though, as I wrote here, he voted for a very bad tort reform bill.

So no one should be suprised he's now looking at reining in medical malpractice suits as a way to cut health costs. It's another one of his "middle ground" with Republican stances.

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

He's not addressing capping lawsuit awards...at least not yet. [More...]

Restricting medical malpractice lawsuits is not the answer to our health care problems. Legislation pushing these lawsuits to the federal courts, as was attempted in 2005, is a bad idea.

The American system of civil justice provides a crucial means for ordinary middle-class citizens to hold powerful corporations and government agencies responsible for their actions. Congress should work to strengthen and preserve this system of accountability rather than seeking to limit corporate liability, restrict victims’ compensation, and obstruct access to the courthouse, as this bill and other legislation pending in 2006 seeks to do.

< On The State Secrets Doctrine: Obama = Bush | TalkLeft Turns 7 Years Old Today >
  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft

  • Display: Sort:
    We have malpractice caps in Texas (5.00 / 5) (#6)
    by ricosuave on Mon Jun 15, 2009 at 08:44:27 AM EST
    and it makes no difference to costs.  Doctors have been told by their insurance companies that this keeps their premiums down.  Healthcare costs in Texas have continued to rise in spite of these caps.  We have some of the highest cost medical markets in the country here, even with caps.  And we didn't have many (if any) suits that exceeded the caps before the law.

    The tort reform movement is primarily a way to keep the doctors from siding with the lawyers against the insurance companies.  If the doctors could figure out how much of their money goes to the insurance companies instead of the lawyers, we'd probably have them pushing for insurance reform instead of tort reform.

    Tort Reform (5.00 / 3) (#7)
    by MO Blue on Mon Jun 15, 2009 at 09:05:09 AM EST
    Just smoke and mirrors used to redirect the dialog from the real reform that is needed to give all people affordable quality healthCARE.  

    Tort Reform (5.00 / 2) (#10)
    by sj on Mon Jun 15, 2009 at 09:33:13 AM EST
    Two words that mean "limit the options of the individual"

    The history of tort "reform" (5.00 / 8) (#8)
    by BobTinKY on Mon Jun 15, 2009 at 09:30:06 AM EST
    demonstrates that "reform" to usually be a limitation on liability.  Those afforded these limitations eventually grow more and more careless,  cutting costs and corners.  Something then catastrophically bad happens & Congress or state legislatures establish a complex statutory scheme to re-impose "accountability, " a scheme typically overseen by some administrative agency.

    Better we stick with the common law of tort developed over hundreds of years of experience.  It is most efficient economically, leaves accountability in the hands of our peers, and provides predictability in the law if not always in the assessment of damages.   The ever-changing whims of government bureaucrats and politicians  make the rules associated with administrative accountability unpredictable.

    I'd trade the risk of being assessed high damages for certainty about the law being applied to my conduct. I can then endeavor to conduct myself accordingly and avoid being sued or found liable if sued.  Leaving accountability to adminstrative agencies populated by whoever is in political fashion, which is the near inevitable result of limiting common law tort liability,  makes it far more difficult to minimize risk.  Behaving "responsibly" is in the eye of whoever is currently in power.

    And I don't think attorneys charge any less, or incur less time in adjudication and appeals, for partaking in an adminstrative process instead of a trial.

    Superb comment (none / 0) (#22)
    by cal1942 on Mon Jun 15, 2009 at 11:34:11 AM EST
    wish I could give you about twenty 5s.

    Your comment neatly sums up the massive flaws of tort "reform."


    This isn't evewn 'Republican light' (5.00 / 6) (#9)
    by jeffinalabama on Mon Jun 15, 2009 at 09:32:57 AM EST
    Good grief. about 1.3- 1.5 percent of medical costs have been attributed to tort cases. Can't remember the article that made this analysis, but it was in a refereed journal.

    Can Obama look at insurance company profits? I guess he's too post-partisain for that.

    Post partisan must mean Republican.

    Soo (5.00 / 2) (#11)
    by TeresaInSnow2 on Mon Jun 15, 2009 at 09:53:42 AM EST
    Health care reform that begins with "tort reform".  Would Bush have done anything differently?

    Closed door meetings to discuss it?  Where is the transparency in that?

    I guess transparent government means that you go to 5 Guys with Brian Williams on occasion and he talks pretty about you, and you talk pretty about NBCs new shows.

    I thought I wouldn't be surprised by the Obama Administration, but I AM surprised...completely in the wrong way.  He takes my breath away with this as he did with the DOMA case.

    Where is the kicking and screaming from the left?  Here and some (for DOMA) at Aravosis, I guess.  The Cheeto doesn't talk about this at all...but they do have a front page article criticizing someone else's bias! LOL!

    There's No Comparison (none / 0) (#68)
    by maha on Mon Jun 15, 2009 at 03:35:50 PM EST
    "Health care reform that begins with 'tort reform'.  Would Bush have done anything differently?"

    Well, yes, there's a huge difference. Bush's "tort reform" measures in Texas were draconian and included massive caps on non-economic damages. Recently a guy who lost both arms and both legs to obvious hospital malpractice had his damage award cut in half because Texas law mandated it.

    Further, after Bush's "tort reform" a lot of personal injury litigation was pretty much blocked from courthouses, and people had no recourse but forced arbitration that was set up to favor the defendant.

    So far, what Obama is talking about isn't even in the same ball park as what Bush did. I may not agree with it, but to say they're the same thing is saying a shark is the same thing as a trout. The question is, can Obama hold the line where he drew it today?



    "forced arbitration" (none / 0) (#71)
    by diogenes on Mon Jun 15, 2009 at 04:04:06 PM EST
    What exactly is wrong with arbitration as opposed to a lottery-type jury system in which lawyers eat up a third of the award and most victims of malpractice don't even get compensated?

    Don't kid yourself..... (none / 0) (#77)
    by NYShooter on Mon Jun 15, 2009 at 04:51:51 PM EST
    In my experience, arbitration tends to favor defendants. And, many people believe it's informal, like small claims court, but it's not. You still need an attorney, and almost all the rules of evidence are the same as a jury trial. The only benefit I see (for the winner, anyway) is that the verdict is final; no appeal.

    Having been on both sides, both in jury trials, and arbitration, as a plaintiff, I would choose a jury over an arbitrator every time. At least with a jury you have a shot at convincing "real people," whereas, in arbitration, you really roll the dice in the choice of arbitrator. There are more incompetents than you might want to believe.

    Also, while you have to pay your attorney in either case, with an arbitrator, you also have to pay his/her fees & expenses, which can run into many thousands of dollars.

    Besides the things I've mentioned already, there are two other things why I don't like arbitration:

    1. They simply start with a prejudice of compromise; they hardly ever award either side 100%, even if that side is 100% in the right. Their motto is "cut the baby in half," just out of principal, not based on the facts, or evidence.

    2. Unless you're willing to shell out some really big bucks (besides for your attorney & the arbitrator) there isn't a stenographer, hence, no transcript. While there are certain guidelines as to how long an arbitrator may take to render a decision, they basically take as long as they want. And, if you've got an arbitrator who takes on too many cases, or is a mindless mediocrity, good luck to you. Facts and evidence you may have presented....are just simply fogotten.

    Other than that arbitration is fine.

    I assure you (none / 0) (#79)
    by Steve M on Mon Jun 15, 2009 at 05:56:12 PM EST
    that lawyers still take their full one-third in arbitration.

    Sure, but (none / 0) (#80)
    by NYShooter on Mon Jun 15, 2009 at 06:19:07 PM EST
    there are also tort cases that are billed straight-time, and not on contingency basis.
    Many people don't realize that only those cases an attorney feels are as close to a "sure thing" as there can be are taken on contingency.

    Lawyers aren't gamblers; they like to be paid.


    Light post (5.00 / 4) (#12)
    by koshembos on Mon Jun 15, 2009 at 10:11:46 AM EST
    Clearly, tort reform in its current incarnation is the drunk that looks for his/her lost keys under the light post because the keys were lost in a dark place.

    Malpractice can crudely divided into two groups: the severe cases and the nuisance. The first should stay as is, while changing the latter will make absolutely no difference.

    We also forget that the cost of malpractice insurance is outrageous the same way health care insurance is. Why not control the cost of malpractice insurance?

    We cannot reform health care insurance because it will violate the right of the insurance companies to enslave us. We cannot control the banks and credit cards because they also have the right to enslave us.

    We have more than enough of this type of oppression.

    Maybe so, but (1.00 / 1) (#4)
    by Abdul Abulbul Amir on Mon Jun 15, 2009 at 07:34:04 AM EST

    Restricting medical malpractice lawsuits is not the answer to our health care problems.

    Maybe so, but the goal is not solutions to every health care problem, but cost containment.  When the government option won't pay for granny's hip replacement because she's too old, funding the malpractice industry will be politically nearly impossible.

    Not suprising (none / 0) (#1)
    by Wile ECoyote on Mon Jun 15, 2009 at 05:39:00 AM EST
    Being retired Military, it is common to not being able to hold incompetent doctors or hospitals accountable.  This is a step toward a single payer system where the gov't will not be able to be held accountable for medical malpractice.  How else do you make it appear to be more affordable but to hold these kinds of costs down?

    What? (none / 0) (#25)
    by cal1942 on Mon Jun 15, 2009 at 11:45:32 AM EST
    Single-payer does not provide health care it only pays for health care that is provided by private individuals and institutions.

    Single-payer doesn't mean that remedy for malpractice would change in any way.


    That sounds naive (none / 0) (#28)
    by Abdul Abulbul Amir on Mon Jun 15, 2009 at 12:10:20 PM EST

    It does if the single payer decides to reduce its payments by eliminating or reducing malpractice litigation costs.

    Listen to O's rhetoric.  The problem is the uninsured and run away costs.


    Yep (none / 0) (#30)
    by sj on Mon Jun 15, 2009 at 12:39:34 PM EST
    That's definitely the problem -- if you listen to O's rhetoric.  If you listen to the actual uninsured and the underinsured that's not the problem.

    There is nothing (none / 0) (#47)
    by Steve M on Mon Jun 15, 2009 at 01:34:01 PM EST
    implicit in the concept of single-payer which requires that malpractice insurance will be provided by the same carrier.  In fact I've never even heard that proposed until now.

    With a single payer (none / 0) (#55)
    by Abdul Abulbul Amir on Mon Jun 15, 2009 at 02:05:18 PM EST
    With a single payer all of the costs of the medical delivery system will in some manner end up being paid by that single payer.  That will be true if the single payer provides the sole source of malpractice insurance, or if there are many private insurance providers, or a mix.  

    In other words the single payer is going to pay enough so that health care providers can afford malpractice insurance.  If the single payer chooses not to pay enough, you will find that health care providers have no insurance and little or no assets.  Have fun finding a lawyer.  


    You really think under a single (none / 0) (#70)
    by Wile ECoyote on Mon Jun 15, 2009 at 03:56:17 PM EST
    payer a doctor would be paid as much as they are now?  Less pay equals less for malpractice.

    In theory (none / 0) (#5)
    by Bemused on Mon Jun 15, 2009 at 08:20:42 AM EST
      the ultimate goal of reasonable compensation for injuries caused by medical negligence could be attained in a government single-payer system that eliminates civil actions for such damages.

      Yes, the "in theory" is meant as a qualifier but that same qualifier should be used in describing the current system of providing compensation for medical malpractice injuries as well. Litigation is a terribly ad hoc and inefficient method of providing compensation. Stats show that most malpractice does not even result in civil claims and that most claims fail (it's of course difficult to segregate into valid and invalid claims). In any event, it's fair to say most people injured by malpractice are not compensated and many are inadequately compensated.

      Litigation, in addition to being of limited effectiveness, is also a terribly inefficient method of providing compensation. Litigation costs and attorney fees on both sides consume most of the money.

      Under a single-payer system, a reserve fund could be set up to provide compensation through an administrative claims process. I'm not going to make wild claims that it would be fantastically effective and efficient in providing compensation but it would not necessarily be any worse than what we have.

    Amazing (5.00 / 2) (#18)
    by cal1942 on Mon Jun 15, 2009 at 11:23:16 AM EST
    The idea of an administrative claims process for compensation is like creating a giant hole through which compensation would be awarded based on the philosophy of the administration of the day.

    Count on it that if a Republican were in the White House awards for damages would be greatly reduced or dismissed out of hand.

    The Bush administration trick of restricting to federal courts should serve as a warning.

    Dating back centuries, bringing suit for damages in court is one of our most ancient and fundamental liberties and the only fair way of resolving disputes.

    It always knocks me out how modern day Conservatives work so hard to destroy traditional values and institutions.  


    As i said, it's easier (none / 0) (#83)
    by Bemused on Tue Jun 16, 2009 at 08:36:37 AM EST
     to theorize about providing proper compensation through meas other than civil litigation than to attain it.

      No system for compensating people for injuries can be ideal. My main point was to suggest how extremely imperfect litigation is in achieving just compensation for those injured by medical malpractice. We now see a relatively small proportion of people extremely well or even "over-compensated" and the majority denied any compensation. We also see a huge amount of money ending up in the pockets of the lawyers on both sides greatly diminishing the ability to provide compensation to the people who are actually injured.

      It is perfectly reasonable for people to think there might be a better way of doing this. That's not in any way to advocate or defend liability caps which are the worst sort of reform because they do nothing to address the most serious issues -- depletion of money available for compensation and equitable distribution.

       Could an administrative system perform better? I agree there are many reasons to doubt that, but it's not impossible and there is tremendous room for improvement from everyone's perspective but the lawyers.

      A compensation trust fund could be established funded by  a portion of the taxes paid to support a single-payer system and mandatory assessments from  health care providers. The elimination of profit seeking insurers and claims administrators combined with reduced diversion of money to lawyers would mean the same absolute sum of money could provide greater benefit to the injured.

       Now, the other primary  goal, of holding health care providers accountable and  "responsible" (as opposed to liable) for substandard care is also met very poorly now. That could really be much better addressed whether we have a civil litigation or administrative claims process for compensation.

      It's true that under a pure administrative system the financial risk to health care providers is eliminated but right now very very  few malpractice claims ever result in more than nominal out-of pocket payments to plaintiffs by the insured.

       The best way to create incentive for proper care is to yank the licenses of people who demonstrate inability or unwillingness to do so. The whole concept of having people insure against their potential future  harms caused is premised on permitting people to evade direct financial consequence for their wrongs, so believing the current system is even remotely effective at removing the incompetent or worse from the practice is misguided.



    Well, (none / 0) (#14)
    by bocajeff on Mon Jun 15, 2009 at 10:59:26 AM EST
    This argument reminds me of the budget mess we are in now. We want everyone to be covered, we want the same quality of coverage, and yet we want costs to be decreased. At least one if not two of these will not happen.

    no (none / 0) (#23)
    by Salo on Mon Jun 15, 2009 at 11:35:28 AM EST
    If the payment pool is universal health care would cost half as much per household. This is borne out in all statisical indices that i've seen in nations with single payer or a national system.

    no (5.00 / 1) (#27)
    by Slado on Mon Jun 15, 2009 at 11:57:48 AM EST
    Cost cutting in single payer systems is done by rationing of services.

    The reason our system is more expensive is we offer more and better advanced procdures then the single payer counterpart.   These procedures keep people alive when they would die in other nations and we have to decide whether Obama's grandmother deserves a hip replacement.  In addition we don't have waiting lists for simple procdures and exams becasue we don't care how much it costs and allow several different people to offer CT's, xrays in small areas because it will all eventually get paid for.

    The only way to contain costs is through a market based system where you pay actual money for advanced procedures or by letting someone decide who gets what.

    A government run system will let a civil servant decide who gets what procedure and what doctor is allowed to offer that procedure versus an insurance (private or state run) company deciding if you're policy covers it.

    Both are rationing and both are the only way to conatin costs.

    It is impossible to garunttee all procedures and contain costs.  

    Single payer healthcare is rationed healthcare.  The only question is how much rationing can the public take.


    no waiting lists? (5.00 / 2) (#31)
    by sj on Mon Jun 15, 2009 at 12:44:22 PM EST
    In addition we don't have waiting lists for simple procdures and exams becasue we don't care how much it costs and allow several different people to offer CT's, xrays in small areas because it will all eventually get paid for.

    I waited 9 weeks for a physical exam.  And I have "good" insurance.


    I was diagnosed with breast cancer and had to (none / 0) (#87)
    by suzieg on Sun Jun 21, 2009 at 08:42:18 PM EST
    wait 6 weeks to get an appointment with the thoracic surgeon only to have it cancelled the day before because she decided she didn't want to practice anymore because she couldn't take seeing young mothers die from it, which added another 2 weeks.

    Services are being rationed (5.00 / 6) (#34)
    by Anne on Mon Jun 15, 2009 at 12:51:36 PM EST
    by private insurers now - have been for a long time - so where are the savings?  Oh, right - in the pockets of the shareholders and industry executives.  For sure they are not being passed on in the form of lower premiums - if anything, those premiums have gone up, so people are paying more and more and more - and getting less and less.

    Our system is more expensive not because we offer better and more expensive procedures than countries with single-payer; honestly, you give a truly distorted impression that single-payer countries just let people die rather than treat them.  Which should mean that the US should have really low mortality rates - but we don't.  We aren't even in the top 10 lowest rates.  How would you explain that?

    We HAVE a market-based system that already rations care and hasn't been able to bring down costs, so you are essentially arguing to continue the current system, but make it ration more care than it is already doing.  Yeah, that makes sense - if you own stock in Big Pharma, or have an office on K Street.

    Right now, in private insurance company offices all over this country, clerical workers are stamping "DENIED" on claim after claim after claim, making people jump through medical hoop after medical hoop before procedures and medications and tests will be authorized.  And they count on patients just giving up because they can't keep taking the time from work to make the phone calls and having the tests-bfore-they-will-approve-another-test, or paying the deductibles and co-pays.

    Providers are devoting more time to haggling with insurance companies when they could be providing care.  They have two and three times the administrative staff to deal with the hundreds of different claim forms, costs which they pass on to the patients.

    The system is sick - possibly termially ill - and the best some people can do is offer computerized medical records, cutting Medicare and Medicaid, medical co-ops and tort reform.  And taxing employer-provided health benefits.

    Whose health matters here?  The health of giant insurance companies, or the people they insure?  Because from where I sit, this whole "reform" thing seems more about making sure the insurance industry lives to gouge another day, than it seems to be about improving access to and delivery of health CARE to, you know - the PEOPLE.


    You're exactly on target (5.00 / 1) (#37)
    by Lacey on Mon Jun 15, 2009 at 01:02:37 PM EST
    Health care should never be about profit. We are talking about people's lives here. Until you remove profit from the equation, you will never have a system that truly works.

    Except that doctors do need to be (none / 0) (#42)
    by samtaylor2 on Mon Jun 15, 2009 at 01:10:53 PM EST
    Paid well.  

    Of course. (none / 0) (#51)
    by Lacey on Mon Jun 15, 2009 at 01:48:04 PM EST
    No one has ever said doctors don't get paid. They get paid for the service they provide. But you remove the profit that insurance companies haul in from the system.

    exactly! (none / 0) (#57)
    by otherlisa on Mon Jun 15, 2009 at 02:09:43 PM EST
    The last time I thoroughly researched this was for the 1992 Presidential campaign - over 15 years ago, the administrative costs for health care in Canada were something like 12% of total expenditures while in the US, they were over 40%.

    Not only does our current system ration care, it does not provide the care it does deliver efficiently.


    Wrong (5.00 / 6) (#35)
    by Lacey on Mon Jun 15, 2009 at 01:00:33 PM EST
    I live under a government-run service, Canada's, and myself and my doctor make all decisions about my care. The government simply acts as a benign insurance company with one big advantage - it does not try to make a profit. That's why single payer is cheaper and more effective. Profit is removed from the equation. Administrative costs are also far less expensive under a single-payer system. But don't try and act like government is telling people what treatments they can and cannot receive. It doesn't happen.

    You (5.00 / 1) (#39)
    by TeresaInSnow2 on Mon Jun 15, 2009 at 01:03:59 PM EST
    haven't actually needed coverage for a major health procedure yet, have you...

    What you are describing with Grandma's hip replacement is exactly what the insurance companies do all the time.

    And you're wrong about the other procedures.  Insurance companies deny access to procedures such as CT scans all the time.

    You are actually arguing for single payer.  You just don't realize it.

    If single payer is as bad as you describe, then it's no different than private coverage.  And if single payer costs us less for the same lousy coverage as private insurance, well then it's an improvement.


    Oh yeah. This just happened to my friend (none / 0) (#50)
    by masslib on Mon Jun 15, 2009 at 01:46:37 PM EST
    in VT.  Her husband was advised to get a CT scan because he's down to 141 pounds from almost 180 for no apparent reason.  But the insurers said it might be stress so not CT scan.  Unbelievable.

    well, (none / 0) (#65)
    by bocajeff on Mon Jun 15, 2009 at 02:39:34 PM EST
    when my mother was dying of cancer and was covered by medicare she was told that some treatments would be withheld because the type of cancer (ovarian) didn't respond to certain treatments. The person who made the decision wasn't a doctor. We paid for the treatment out of pocket and with assistance from the hospital while we fought the charge. It took two years for a hearing and all of about ten minutes for my mother to be awarded the treatment.

    This isn't to denigrate the system, only to illustrate that people seem to think that all of these problems will disappear once single payer is enacted.


    I'm right there with the most cynical (none / 0) (#60)
    by Inspector Gadget on Mon Jun 15, 2009 at 02:22:05 PM EST
    when it comes to the rip-off that is our insurance companies, but CT scans are over-prescribed, and many of these types of tests are actually harmful to people when done unnecessarily.

    Honestly, Medicare doesn't object to any of these tests, it seems. If you were aware of all the tests they did on my mother even after they KNEW exactly what was wrong with her, you'd wish insurances would be more diligent in stopping those unnecessary tests....maybe they wouldn't be so quick to deny the people who really need them if the doctors would stop abusing.


    My insurance pays for everything (none / 0) (#62)
    by Slado on Mon Jun 15, 2009 at 02:28:06 PM EST
    Don't equate limited insurance coverage with "insurance".

    Also don't think that a government burecrat will be any different then your limited coverage and remember once we go to single payer you won't be able to change companies.

    As someone whose spent more time in a hospital then anyone should have don't think you know what I want.


    Health care is already rationed (none / 0) (#32)
    by cenobite on Mon Jun 15, 2009 at 12:48:49 PM EST
    by ability to pay.

    Second, the for-profit insurance system already costs us $350 billion/year in excess overhead (read: keeping Gulfstream in business). Once the rent being paid to the insurance companies is removed, US health care costs come into line.

    Finally, letting people go uninsured is another unnecessary cost: the emergency room doesn't deliver primary care efficiently at all. It's much cheaper to buy medications to keep people from getting sick than it is to let them get into crisis.


    correction (none / 0) (#41)
    by bocajeff on Mon Jun 15, 2009 at 01:07:22 PM EST
    Nobody lets anyone go uninsured. People go uninsured for a variety of reasons. Illegal Immigration (undocumented workers) account for a large percentage, young adults who don't think they'll ever get sick, people who can afford insurance but are rolling the dice hoping they won't get sick.

    Now, this isn't to suggest that there is a problem. BTW, there are plenty of European countries which have Universal Health Insurance but they have insurance companies also...Germany and Switzerland come to mind.

    Question: Would you accept a lower level of health care if it meant everyone was covered?


    Well, since I'm not covered, hell yes. But (none / 0) (#43)
    by masslib on Mon Jun 15, 2009 at 01:11:07 PM EST
    I can not imagine we'd have a lower level of health care than we do now.  My father works for the World Bank and every single person he talks health care with there can not understand why we are willingly living like a third world country.

    well, (none / 0) (#44)
    by bocajeff on Mon Jun 15, 2009 at 01:23:11 PM EST
    we are not living like a third world country. Go to a third world country and report back to us if it's the same thing.

    And if you can't imagine having a lower level of health care than we do now then you're not too imaginative. I'm not saying it would happen, but I'm not saying it won't.


    I think the point is (none / 0) (#49)
    by masslib on Mon Jun 15, 2009 at 01:44:47 PM EST
    our health care is the worst of the industrialized countries.  

    Unsubstantiated silly talk (none / 0) (#59)
    by Slado on Mon Jun 15, 2009 at 02:17:32 PM EST
    Our life expectancy is worse for a variety of reasons that have nothing to do with our healthcare.

    As a three time cancer survivor I can tell you for certain I would not be alive if I lived in any other country (unless I had traveled here to receive treatment).

    Our system is devised for leading, technology advanced care and is thus very expensive.

    Every day care, checkups etc... is delivered very inneficiantly because of paperwork.

    Those who think a single payer system would work to impove this are dreaming.  It would pile on top of an already insanely bogged down system.

    As for those in Canada, you're welcome.  Your system only survives because you government can pay to have your sickest treated hear and the wealthy are able to come here for treatment.  

    The US will have no such luxuary.


    If not for that good ole USA (none / 0) (#66)
    by Lacey on Mon Jun 15, 2009 at 02:46:36 PM EST
    Us poor Canadians would have no system. You have no idea about Canada's system or single payer systems, otherwise you wouldn't have made the silly comment that it would just pile on the paperwork. In fact, the exact opposite is what would happen. Regardless, millions of Canadians are treated and cared for under our current system and don't coming begging to Uncle Same for help.

    That is absolutely the most uniformed defense of (none / 0) (#84)
    by masslib on Wed Jun 17, 2009 at 04:18:54 AM EST
    the health insurance regime in this country I have ever heard.  Where do you get this stuff?

    BTW, (none / 0) (#45)
    by bocajeff on Mon Jun 15, 2009 at 01:23:29 PM EST
    why aren't you covered?

    Because I refuse to buy private insurance (none / 0) (#48)
    by masslib on Mon Jun 15, 2009 at 01:43:38 PM EST
    for my husband and myself at $800 a month, when I never go to a doctor.  It's simply unaffordable for my family, not that that is any of your business.

    Actually, (none / 0) (#54)
    by bocajeff on Mon Jun 15, 2009 at 01:55:30 PM EST
    It is my business, and that of every other person in the country.

    You choose not to have health insurance for you and your husband, but you have no problem asking others to pay for you. That's okay since we live in a system where people are asked to subsidize others all the time. But please don't ask me to pay for you and then say it isn't my business.


    Wow (5.00 / 1) (#56)
    by Lacey on Mon Jun 15, 2009 at 02:05:34 PM EST
    A little angry man.

    actually, no (none / 0) (#63)
    by bocajeff on Mon Jun 15, 2009 at 02:28:18 PM EST
    Not angry at all. Just making the point that someone is asking for me to pay and then says it's none of my business. I haven't said anything as to what type of health insurance I want. I was simply making a point. I want Masslib to have and get the best health care available. Masslib has stated the opposite (lower level of health care in exchange for universal coverage).

    Where does masslib say that she (5.00 / 1) (#58)
    by Anne on Mon Jun 15, 2009 at 02:15:21 PM EST
    expects others to pay for her and her husband?  I'm thinking that when and if they need to see a doctor, or get a prescription, they will, um,  pay for it.  With some of the almost-$10,000 they didn't shell out to an insurance company.

    Here's another way to look at who is paying for whom: let's say that masslib and her husband fork out almost $10,000 a year in premiums, but don't have any claims.  You, on the other hand, are also paying the same amount but, due to you needing gallbladder surgery, and your wife having shoulder surgery and a boatload of rehab, the insurance company paid out almost $50,000 on your behalf...aren't masslib and her husband subsidizing your care?

    And another interesting thing to consider: those with health insurance plans that have negotiated payment amounts with providers often pay less for the same service than someone without insurance who is paying his or her own way.  You get the subsidy, but it's recouped from those who have no negotiated payment arrangements.

    Sure, there are lots of people with no insurance, no income and no way to pay for their care, whose costs get passed on up the line, but before you just assume that everyone who has no insurance is a deadbeat, you might want to consider that your assumption might be wrong.


    well, (none / 0) (#64)
    by bocajeff on Mon Jun 15, 2009 at 02:32:35 PM EST
    asking for a government system (which is funded by taxpayers) to pay for universal health insurance for someone who chooses not to have insurance due to cost is in fact asking others to pay for something for others.

    I never said anyone was a deadbeat. I have no clue to why masslib won't pay for health insurance other than it's too expensive (could be low income, doesn't think it is needed at this time, want to spend money on other things, etc...). That's what Masslib says, not me.

    And, as stated before, I agree that we all subsidize others for things. So your comment is wrong to assume things that I did not say.


    Wait a second. (5.00 / 4) (#67)
    by Anne on Mon Jun 15, 2009 at 02:52:13 PM EST
    If I don't choose to have private insurance under the existing system, why would that automatically mean the government would be paying for me to be covered under its plan?

    Let's say that we end up with a combination of private insurance and a public option.  And let's say the public option could offer me good coverage, all the choice I want, and it's half what it would cost me in the private market.  If I had not had insurance before because it was too expensive, aren't I more likely to get it if it isn't?

    Let's also say that one component of the public option, which would encourage as many people to enroll as possible, thus creating a very large pool over which the risk would be spread, would be some kind of sliding premium scale, so that those in the lowest income brackets would pay less than those in the upper brackets - do you continue to begrudge me for not making as much money as you do, and continue to feel like you are paying for me, or are you pleased that the large risk pool means you also are paying a whole lot less than you were as a privately-insured individual?

    See, this is what private insurance is afraid of.  They fear that a public plan will be able to offer better care for less money and not only will the millions who don't have insurance be plunking their dollars down with Uncle Sam, but millions of privately-insured individuals will be encouraged to take their dollars out of the private plans.

    As taxpayers we are always subsidizing something - I own property, so my property taxes subsidize things that non-property owners aren't contributing to the cost of.  So what?  That's life.  Of all the things my tax dollars might subsidize, I think I would rather they go for health care than war and weapons and faith-based initiatives - but that's me.


    so do you object (none / 0) (#74)
    by lilburro on Mon Jun 15, 2009 at 04:13:59 PM EST
    to the idea of insurance in general?

    anyway the theory behind insurance is bigger pool = lower individual cost, so if masslib were to join the pool she would hypothetically be saving you money, over time, as your costs are lowered.


    Please share your personal (none / 0) (#73)
    by lilburro on Mon Jun 15, 2009 at 04:07:54 PM EST
    insurance buying story bocajeff.

    I hate it when people make this kind of crap personal - "are you a lawyer" "do you have insurance" etc etc.  It's not your business.  And I don't think insurance is directly proportional to the cost of treatment - otherwise, why would anyone have "insurance."  Someone no doubt could end up paying for you when you're sick too, bocajeff.


    What the hell are you talking about? (none / 0) (#85)
    by masslib on Wed Jun 17, 2009 at 04:20:34 AM EST
    I can not eat and buy health insurance, get it?  I would happily pay more in taxes for government administered health care.  But I can not afford to pay profits of private insurers.

    BING BING BING (none / 0) (#61)
    by Slado on Mon Jun 15, 2009 at 02:24:17 PM EST
    We have a winner.

    If people had to pay for the services they use your insurance would be more affordable.

    Instead your $200 insurance turns into $800 because you are not paying for yourself.  You are paying the inflated costs so that all insured get every un criticle health service for free.

    I'm sure you'd pay $200 a month for catastrophic coverage and a huge deductable.

    That would make sense.   Instead our insurance system pays for everything causing no one to shop around, no one questions the drugs and services they are prescribed and everyting costs too much and takes too much paper work to deliver.

    The answer is insurance for health emergencies.  A trip to the dentist for a cleaning should cost you money.   If it did you'd shop around and market forces would be at work.   Instead we don't care what it costs so it always costs more then it should.  


    I don't know what kind of (5.00 / 1) (#72)
    by Anne on Mon Jun 15, 2009 at 04:05:34 PM EST
    insurance you have, but if you think everyone gets what they want and cost is no impediment, you need to think again.

    Insurance does NOT pay for everything and a lot of people cannot get the treatment their doctors think is best for them without a knock-down drag-out fight that takes time and costs money, can't even get the drugs their doctors want them to have because the drugs they need are not in the formularies the companies have approved.  

    Have you tried getting insurance on your own?  That's a lot of fun.  If you've actually had to make use of the doctor for other than annual physicals, expect to be either denied or rated high, or accepted with exclusions.  And what good is that, exactly?  Private insurance companies want healthy people on whose behalf they don't have to pay any claims.  With employer-based plans, the insurance companies still want to keep most of the money that's paid in, so they limit and ration and guard the gateway to health care like it was Fort Knox.

    I really wish you would stop posting as if you actually knew anything about health insurance, because it is quite clear that you are talking out of your nether regions.


    As someone who works at a large health insurer (none / 0) (#76)
    by vicndabx on Mon Jun 15, 2009 at 04:37:03 PM EST
    do you have any idea how many millions of claims get processed and paid daily?  Is this statement
    the insurance companies still want to keep most of the money that's paid in, so they limit and ration and guard the gateway to health care like it was Fort Knox
    based on information you've read somewhere or anecdotal stories you've heard?  Also this statment:
    can't even get the drugs their doctors want them to have because the drugs they need are not in the formularies the companies have approved
    .  Medicare and Medicaid do the exact same thing.  I find it highly unlikely that would change under a some new gov't run plan.

    Oh, come on...I get that you feel obligated (5.00 / 1) (#78)
    by Anne on Mon Jun 15, 2009 at 05:27:14 PM EST
    to defend the industry that is responsible for your paychecks, but you cannot be serious.

    Medicare operates with administrative overhead that is less than 5% - the private sector is spending 30 cents of every premium dollar on administration - it manages to insure the oldest and sickest population for less than $100 a month.

    The VA does it even better than Medicare.

    Private insurance is in the business of making money.  How do you make money?  You pay out less than you take in.

    Expand Medicare by lowering the qualifying age.  Open the VA system to non-veterans.  We already have systems that are delivering more care for less, so why not do more of what works, and less of what doesn't?

    If the private companies really want to compete, they should have some competition, don't you think?  

    Seriously, everyone has anecdotal stories about private health insurance companies, and how hard they work to limit the amounts they have to pay out - surely you must have heard a couple, working as you do for an insurance company?


    Let me debunk a number of myths (none / 0) (#81)
    by vicndabx on Tue Jun 16, 2009 at 08:06:14 AM EST
    Medicare operates with administrative overhead that is less than 5% - the private sector is spending 30 cents of every premium dollar on administration - it manages to insure the oldest and sickest population for less than $100 a month.

    This is a huge myth.  Normal operating costs such as rent, salaries, health insurance, taxes, capital to purchase equipment, etc., which private insurers must include in their administrative costs, are counted elsewhere in the federal budget.  Oh and btw, you know who does have all these costs and helps keeps Medicare running smoothly and effectively?  Private Insurance companies.  The gov't doesn't actually process any claims.  The gov't doesn't actually send out any checks.  Add those costs in and it's no longer 5%.  I posted this on another thread, but here's that same link again.  Even using your 5% number, you'll see private insurance administration is only slightly higher.

    The VA does it even better than Medicare.

    Well, that's likely because they have a direct line to CMS to know what is/what is not covered and what should/should not be billed.  Think they're using a lot of experimental drugs at the VA?  I seriously doubt it.  What are the facilities like at the VA?  Think they're as good as those in most other private hospitals?  In addition, the VA, from a technology, administrative simplification perspective, under-utilizes the tools that are available that help them cut costs.  Call your local VA and ask them if they use an 835 Electronic Remittance to process their insurance payments.  Betcha they don't, betcha they have a person sitting at a desk opening envelopes and manually posting payments.

    If the private companies really want to compete, they should have some competition.

    Sure, as long as the competition is fair.  Competing w/an endless pool of capital in the form of us taxpayers ain't fair.

    Seriously, everyone has anecdotal stories about private health insurance companies, and how hard they work to limit the amounts they have to pay out - surely you must have heard a couple, working as you do for an insurance company?

    Actually I haven't.  Of course, I've seen claims denied - for a reason.  I don't think this is what the debate should be about though - because this is simply not true.  Things like coverage for pre-existing conditions, OK, sure, such things can be easily remedied.  Harder issues such as coverage for new and experimental treatments with the emotional component involved, should be also discussed, but grounded in facts.  Let me ask you, when was the last time you heard about the millions of claims that get processed and paid daily?  No one talks about that, i.e. how often claims don't get denied.

    As far as defending my industry, hell yeah, it is my paycheck.  There's no reason why the health insurance industry can't remain viable and hundreds of thousands of your fellow citizens can keep their jobs.  Day after day I hear these negative stories about an industry whose employees work real heard to ensure folks don't have to worry about coverage when their parents get sick, or their kid breaks a leg.  We're not perfect, but don't believe the hype.  Please get all the facts and accept them w/an open mind.


    Geez, don't ya hate when the closing line (none / 0) (#82)
    by vicndabx on Tue Jun 16, 2009 at 08:12:31 AM EST
    gets screwed up?

    Day after day I hear these negative stories about an industry whose employees work real hard to ensure folks don't have to worry about coverage when their parents get sick, or their kid breaks a leg.  We're not perfect, but don't believe the hype.  Please get all the facts and accept them w/an open mind.


    The answer is insurance for health emergencies. (none / 0) (#86)
    by masslib on Wed Jun 17, 2009 at 04:21:25 AM EST
    You have got to be effing kidding me?

    tort reform (none / 0) (#15)
    by rocky11 on Mon Jun 15, 2009 at 11:04:35 AM EST
    Would this pass constitutional muster with this SCOTUS? Malpractice and disciplining of doctors should be a state function.

    Expect the Roberts Court (5.00 / 2) (#24)
    by cal1942 on Mon Jun 15, 2009 at 11:39:38 AM EST
    to warp the Constitution in any way to suit movement conservative objectives. "Tort reform" is one of those objectives.

    We have caps here in California (none / 0) (#16)
    by MKS on Mon Jun 15, 2009 at 11:10:48 AM EST
    There is a cap for pain and suffering at 250k iirc.

    And, the verdicts in most malpractice cases are defense verdicts here.

    Our costs in California are still very high.

    Single payer would end the need... (none / 0) (#21)
    by Salo on Mon Jun 15, 2009 at 11:33:24 AM EST
    ..for law suits.  If care is seen a basic human right and free at the point of delivery, there'd be no need to ring up a lawyer to get the cash to cover expenses from medical complications and follow up operations.

    So (5.00 / 1) (#26)
    by TeresaInSnow2 on Mon Jun 15, 2009 at 11:50:36 AM EST
    What about pain and suffering?

    What about keeping a rein on incompetent doctors?

    Single payer is a great idea, but I don't think you can argue that with it, you won't need lawsuits.


    Under our single payer system in Canada (none / 0) (#53)
    by Lacey on Mon Jun 15, 2009 at 01:51:22 PM EST
    We can still sue doctors.

    Lost income? (none / 0) (#29)
    by Abdul Abulbul Amir on Mon Jun 15, 2009 at 12:16:38 PM EST

    What about lost income from time out of work due to a botched operation?  If you think the feds will just cut you a check for whatever income you claim to have lost, good luck with that.

    Not eliminate, but greatly reduce...Yes. (none / 0) (#40)
    by masslib on Mon Jun 15, 2009 at 01:04:25 PM EST
    The parts that it wouldn't (none / 0) (#46)
    by TeresaInSnow2 on Mon Jun 15, 2009 at 01:31:05 PM EST
    eliminate are typically the most expensive parts....

    Yes, of course. (none / 0) (#52)
    by masslib on Mon Jun 15, 2009 at 01:49:04 PM EST
    Those shouldn't be eliminated.  They are the cases most in need of legal remedy.  

    Look there's no need for tort reform (none / 0) (#33)
    by Socraticsilence on Mon Jun 15, 2009 at 12:50:16 PM EST
    in corporate issues, but medical nuisance lawsuits are ridiculous, I mean it really is an actual factor for Doctors choosing not to practice in certain fields- OB/GYN most prominently- if there was a government cap on damages and a government run malpractice insurance with low premiums then this might no longer be the case.

    See, the cap isn't necessary. (none / 0) (#38)
    by masslib on Mon Jun 15, 2009 at 01:03:46 PM EST
    The cap is for lawsuits that are not just nuisance cases.  The other part I agree with.

    The "frivolous" lawsuits are (none / 0) (#36)
    by masslib on Mon Jun 15, 2009 at 01:02:36 PM EST
    actually the ones with the small awards, typically paid out before ever going to court.  Hillary had this as part of her health platform, which was basically to have a pool that would pay out when a doctor admitted error.  It would save doctors about 40 percent in malpractice insurance, and is a way for the medical profession to actually learn from their mistakes.  I thought that's where Obama was going.  Maybe  it is, hard to read into this too much.

    LOL (none / 0) (#69)
    by Wile ECoyote on Mon Jun 15, 2009 at 03:54:52 PM EST
    No need for suits?  So if the doc screws up under single payer, you would not sue?

    Happy B'Day TL (none / 0) (#75)
    by squeaky on Mon Jun 15, 2009 at 04:15:49 PM EST
    Keep it coming.... This site is the best. Thanks for all the hard work, opinions, reporting, analysis, insight and fun.