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Health Care Politics: V.2



 
 
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  #1  
Old September 11th, 2009, 3:44 am
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Health Care Politics: V.2

Version one was a, well, lively affair. With the amount of passion surrounding the issue of Health Care Reform in the United States, version two is likely to also be lively. But, here at CoS forums, we think we can do better than the level of discourse out in the general public now. And, we're going to ask everyone in this version to try to keep the debate impersonal and polite. This isn't anything new, but it's something that everyone should keep in mind even as we read each other's posts and cry "that's bogus!".

Well, on to the questions. With apologies to non-US members, this version is likely to be quite US-centric, since in the US the Health Care debate is more fierce than anything that I can remember. However, talk of health care politics in any country is still welcome.

1. Do you think the US will pass a comprehensive health care reform bill? Why or why not?

2. Assuming a bill is passed, do you think you'll be happy with the final bill?

*3. In 1000 words or less, what's your own thoughts about what should and should not be in a bill?

DoIMC Rules, 3rd Edition in effect.

**Resources:
Summary of HR 3200 and PDF and timeline of events
Summary of HR 3400 (pdf) Good non-partisan (from either side...) summaries are very hard to find for this bill. Most of what I found takes unfair swipes at the bill or at the Democratic bill.
Summary of Baucus Plan

*We wont' hold you to a word count, but try not to be too long-winded

**Better links accepted. This was best I could find over coffee .


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Last edited by Chris; September 11th, 2009 at 5:15 pm.
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  #2  
Old September 11th, 2009, 10:54 pm
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Re: Health Care Politics: V.2

1. Do you think the US will pass a comprehensive health care reform bill? Why or why not?

I think some sort of reform bill will be passed. I'd like to say that it's because there are real problems in the health care system in the US that need to be addressed, but the cynic in me says it'll be passed because the Democrats in Congress need something to be able to campaign on.

2. Assuming a bill is passed, do you think you'll be happy with the final bill?

Not sure. I suspect we'll end up with something like the Baucus Bill (which is still in overview form). There are parts of the Baucus bill that I like and parts that I think are absolutely horrible.

*3. In 1000 words or less, what's your own thoughts about what should and should not be in a bill?

1000 words or less - what - are you trying to kill me?????

Rather than go into specifics I just list the problems that I think need to be addressed

(1) Coverage needs to be more accessible and affordable. At present coverage is only available through Medicare / Medicaid / SCHIP, through an employer sponsored plans, or through a private, and likely more expensive, individual plan. We need to allow people to get away from their employer sponsored plans. Allowing people to enroll in plans offered across state lines and allowing membership organizations (like the AAA) offer health insurance to their members would allow that flexibility and affordability.

(2) The pre-existing condition garbage needs to stop.

(3) You can't help it if you get sick. Most of the time illnesses just happen. Yes, there are some medical conditions which are more likely if you engage is certain activities. Having your insurance premiums spike to such an extent that you can't afford them when you get sick and need your coverage the most is horrible. We need to some sort of safety net to make sure people who are sick can still afford coverage and get the care they need.

There's more, but I don't want to go on for too long.....


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Old September 12th, 2009, 1:38 am
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Re: Health Care Politics: V.2

Quote:
Originally Posted by monster_mom View Post
(1) Coverage needs to be more accessible and affordable. At present coverage is only available through Medicare / Medicaid / SCHIP, through an employer sponsored plans, or through a private, and likely more expensive, individual plan. We need to allow people to get away from their employer sponsored plans. Allowing people to enroll in plans offered across state lines and allowing membership organizations (like the AAA) offer health insurance to their members would allow that flexibility and affordability.

(2) The pre-existing condition garbage needs to stop.

(3) You can't help it if you get sick. Most of the time illnesses just happen. Yes, there are some medical conditions which are more likely if you engage is certain activities. Having your insurance premiums spike to such an extent that you can't afford them when you get sick and need your coverage the most is horrible. We need to some sort of safety net to make sure people who are sick can still afford coverage and get the care they need.

There's more, but I don't want to go on for too long.....
I'm actually keen to hear more of what you think, if you aren't too busy.


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Old September 12th, 2009, 1:52 am
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Re: Health Care Politics: V.2

I feel that what mom said is what pretty much everyone wants. The problem is actually finding a way to do so since everyone's views are so different.


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Old September 12th, 2009, 4:08 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by canismajoris View Post
I'm actually keen to hear more of what you think, if you aren't too busy.
Gosh, thanks!

I'll try to be brief, but I do tend to run on, a lot, so please forgive me if I get too chatty (and if I go off on a tangent just shout chicken!).

When I look at the US system right now there are three ways to get coverage - buy it yourself, participate in some sort of employer subsidized and sponsored group plan where you pay a portion of your premiums and your employer pays a portion, or if you qualify, participate in some sort of government subsidized and sponsored plan like Medicaid, Medicare, or SCHIP. If you don't do any of those then you go without coverage. That doesn't mean you can't get care when you need it, but you'll have to pay cash fro any services received, unless they're life threatening emergencies.

That creates a number of problems - people are tied to their jobs if they need coverage, individual coverage can be significantly more expensive than group coverage, moving above poverty level is made more difficult because you may lose your medical benefits if you do, and going without coverage puts you at risk of not getting the care you need.

To fix the problems properly we have to know why the cost of coverage is so expensive and why people go without it.

If we look at the general population we've got about 85% with individual, employer sponsored, or government sponsored coverage. We've got another chunk who qualify for government sponsored coverage but haven't enrolled in it (even though enrollment is automatic if they show up for care), and another chunk who appear to just not want it. The rest appears to be chronically without coverage because they don't qualify for government sponsored coverage, their employer doesn't offer coverage, and they can't afford employer sponsored or individual coverage.

Among the reasons coverage appears to be so costly are increasing medical malpractice rates, costs from people receiving care who don't pay for it, and unnecessary treatments or procedures.

So how do we fix things without messing up what is working.

A couple of real easy solutions pop up.

Tort reform to reduce medical malpractice rates. Allow non-employer groups to sponsor health plans. Allow professional, industry, and trade associations to offer health plans to their member companies. Allow insurance companies to offer plans in multiple states, provided they meet the laws and regulations in each state. Create some sort of a safety net for those who don't qualify for government assistance and can't afford coverage through these options - whether that's a state backed high risk pool, opening state employee plans to the general public, or some other program.

People who don't to be tied to an employer for coverage would have the option of enrolling on a plan offered by some independent organization. Employers who can't afford to sponsor a plan could join an association plan and provide that to their employees or could just give their employees a voucher to use to enroll in a private plan of their choosing. People who don't have coverage through an employer may find that joining a group plan brings the cost of coverage down so that they can afford it. And there'd be a safety net for those whose medical conditions or financial situation makes these options unaffordable.

Just these few easy options would help. Tort reform would bring down medical malpractice insurance and having more people covered would mean that more people would be able to pay for the care they receive.

Then the more difficult issue of over proscribed treatments and procedures could be addressed. I honestly believe that these problems are best addressed by physicians associations themselves as opposed to some sort of government regulatory body. From what I've read, in areas where there are established protocols, physicians tend to follow them and unnecessary treatment and procedures are the exception. It's in areas where there aren't generally accepted protocols that you see some doctors over proscribing treatments and procedures. Those areas tend to be in emerging medical areas - like treating rare conditions or where medical advances are coming so quickly that it's difficult to keep up. Since I think innovation is good because it does lead to solutions, I'd leave much of this to the physician groups rather than some regulatory body.


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  #6  
Old September 12th, 2009, 5:42 pm
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Re: Health Care Politics: V.2

I agree with tort reform, but in order for it to actually work in reducing costs, I think it needs to be tied with "best practices" research. In theory, I can see two ways in which tort reform can reduce costs. First, is malpractice insurance. Second, lowered cost of treatment via reduction in "defensive medicine". Maybe the reason that tort reform hasn't lowered costs in the areas that it's been implemented is that defensive medicine is still being practiced. The way I envision it, it's actually empowering to the patient, too. If tort reform is enacted and tied with ways of giving doctors and patients the latest research about what methods of treatment give the best outcome and what tests are nearly useless, patients and doctors can choose the method of treatment, with the doctor insulated against a lawsuit in the event that the doctor and patient together chose the less aggressive, less expensive treatment or skipped a few tests because research showed that the outcomes in the end were comparable.

I'm interested to hear details of the pilot projects Obama directed Sebelius to enact. If these pilots are tied in with greater doctor and patient education, then they might work. If it's just capping damages / etc, I doubt it'll actually lower costs.

To me, tort reform and preventive medicine are two areas that should be reformed, even though currently the theory of them reducing costs when enacted hasn't actually come true. The CBO in 2003 may have summed it up best:

Quote:
Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency--through changes in defensive medicine, the availability of medical care, or the extent of malpractice--is at best ambiguous.
So, we may see happier doctors, but for a real effort to be made to cut costs we either need to look elsewhere or we need to couple it with aggressive implementation of best practices, particularly in areas where surgery and expensive tests are not linked with better outcomes. Doctors and patients alike need to have that information available, with doctors being protected against a lawsuit in the event that more conservative treatment was chosen.

Other Sources: long Q and A


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  #7  
Old September 12th, 2009, 6:10 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by Chris View Post
I agree with tort reform, but in order for it to actually work in reducing costs, I think it needs to be tied with "best practices" research. In theory, I can see two ways in which tort reform can reduce costs. First, is malpractice insurance. Second, lowered cost of treatment via reduction in "defensive medicine". Maybe the reason that tort reform hasn't lowered costs in the areas that it's been implemented is that defensive medicine is still being practiced. The way I envision it, it's actually empowering to the patient, too. If tort reform is enacted and tied with ways of giving doctors and patients the latest research about what methods of treatment give the best outcome and what tests are nearly useless, patients and doctors can choose the method of treatment, with the doctor insulated against a lawsuit in the event that the doctor and patient together chose the less aggressive, less expensive treatment or skipped a few tests because research showed that the outcomes in the end were comparable.
Doctors already get best practices information from their peer groups. The ACOG (American College of Obstetrics and Gynecology) provides OB GYNs with the recommended best practices for their area of specialty. Same with the Pediatric, oncology, family practice, ENT, and other such practices. So I'm not sure how you would tie tort reform to communicating "best practices" as those best practices are already shared and generally accepted within the specialty.

Quote:
I'm interested to hear details of the pilot projects Obama directed Sebelius to enact. If these pilots are tied in with greater doctor and patient education, then they might work. If it's just capping damages / etc, I doubt it'll actually lower costs.
I'm skeptical that anything Sebelius develops for tort reform will accomplish anything. Why? Because she served at the head of the Kansas Trial Lawyers Association for almost 8 years. Kinda like asking the fox to guard the hen house.

Like you said, fear of lawsuits has, in may cases, driven what has developed as best practices. Obstetrics is one are where that fear is quite evident. While C-Section rates have come down, induction rates are up primarily because Doctors fear a negative outcome if they follow a wait and see approach in the later stages of pregnancy. The net effect, if there are any hiccups in the last 3 weeks of pregnancy, you're getting induced. Most pregnant Mom's agree with this approach as the negative outcome may be the death of their child.

A pilot program over a couple of years in a couple of states won't change that one bit.


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  #8  
Old September 12th, 2009, 6:15 pm
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Re: Health Care Politics: V.2

As far as tort reform goes, I'm not sure it's the panacea for cost cutting that it is presented...at least in it's current form where it has been enacted.

Now, I read some of the posts on this forum (and other forums) and at first though, "Wow, this could be a good thing...this could be how we start lowering some of these huge costs," and was with you on this.

Then someone told me something that really shocked me. They said, "Tort reform is a red herring. California already has tort reform...did you notice the premiums going down?"

Truly, I was shocked. I had not even realized they did this in our state. Apparently, this was initiated back in the 70's. I was in high school at the time, and more tuned into what the latest pop stars were doing than whether my state was initiating tort reform, so it's probably not a surprise I don't remember this happening back then. But, upon a little research, there it was. It was true...we already had tort reform in California.

So...why is everything so high still?

There is a problem with tort reform...a few, actually. But first, here is what one article has to say (an excerpt) about it (and I really tried to find as unbiased a source as possible--there are tons of articles way on one side or the other):
The NewStandardThe AMA reported last December that in twenty so-called "crisis" states, doctors were shutting down their practices or moving out of state at alarming rates because of the threat of lawsuits or the states’ unaffordable insurance premiums. From 2001 to 2002, according to government data cited by the organization, premiums rose at a greater rate in states without malpractice damage caps than in those with caps.

But advocates point to data from several states revealing that malpractice insurance premiums have continued to rise sharply even after the enactment of tort reforms, undermining the theory that capping damage awards could directly control insurance costs.

In Nevada, for instance, according to the consumer advocacy coalition Americans for Insurance Reform, shortly after the passage of laws limiting malpractice claims in 2002, insurers filed for rate hikes ranging from 17 to 93 percent. Similarly, the passage of California’s flagship malpractice liability reform bill in 1975 was followed by continued spikes in doctors’ premiums over the next 13 years, which tapered only after the government imposed stricter regulations on insurance companies.

A 2003 analysis by the Congressional Budget Office, a government agency that estimates the costs of proposed and enacted legislation, found scant evidence of tort litigation leading directly to a crisis in access to services or to a rise in health care costs. Moreover, the Center for Justice and Democracy reported that since the early 1980s, both malpractice insurance premiums and lawsuit payouts have consistently amounted to less than one percent of the country’s total healthcare costs.
http://newstandardnews.net/content/index.cfm/items/1896

So, this brings up two primary questions and a bunch of lesser ones: Where did the savings go if not to the consumer? (three guesses)

And...what IS contributing to the rise in costs, if not malpractice insurance as reported?

Believe it or not, I do think that there may be some benefit in tort reform, still...But, not until these questions are answered. Obviously whatever savings there are, are not making it to medical care costs OR premium costs...at least not in any amount that is helpful.

Some states did show a reduction of 4-7%. But, do the math on that for a $500 private policy and you will see that is not enough of a reduction to make any real difference to those who can't afford it. Even at a 5% reduction, that is only a $25 savings on the premium.

*If* tort reform is to be done, we must look at *how* it is to be done and it will probably require more regulation so savings are actually passed on and not simply absorbed into someone's higher profit margin...or at least made sure the extra money is "shared" fairly.

Again, this is not the silver bullet it seemed to be at first glance--at least in how its been enacted so far.


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  #9  
Old September 12th, 2009, 6:21 pm
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Re: Health Care Politics: V.2

Well, share the information with patients, too. Make the culture of the doctors change. Figure out why tort reform hasn't lowered costs. Right now, Obama's right - it's not a silver bullet. But if it is to become the silver bullet to lower costs, tort reform has to be enacted differently than it has been in Texas and California. Yes, malpractice awards have come down some...but to hold up tort reform as this panacea that will somehow fix a major part of the higher costs of the system, more needs to be done. Even though doctors have the information available doesn't mean that they practice it. Example: I know that I should exercise, but do I exercise as much as I should?

Patient education and empowerment needs to be tied in too. If patients understand the accepted best practice, then they may not push for the most expensive drugs / treatment / surgery / etc. To make tort reform work, I think that doctors need to actually enact best practices instead of just reading about it and patients need to be aware of the best practices research for any medical choice they are considering.

Don't get me wrong, I want tort reform to work and to lower costs. I'm just going by the evidence - which is that it hasn't worked so far - and putting out my own theory of why it hasn't worked and what needs to be done to get it to work. Otherwise, we'll just make doctors feel a bit better without actually lowering costs.


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  #10  
Old September 13th, 2009, 8:29 am
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Re: Health Care Politics: V.2

I think, considering what Obama has pledged, that he will be the LAST PRESIDENT to dance with the issue of Health Care Reform, that it is a foregone conclusion that there will be a health care bill passed. What troubles me about it is much the same as I feel about certain levels of Science: (Obama) is so busy worrying about if he "can", he hasn't stopped to think if he "should". He is so hard put to get a bill passed that I don't think he is taking proper time to consider the long-term ramifications of his legislation.

One of the most important parts of legislation that Obama has announced he is strictly against is Tort Reform. I have said it before, and I will reiterate it again here: Health Care Reform is impossible make successful without first protecting our doctors, hospitals, and drug and device manufactures from fear of litigation for the most mundane or innocent errors. Accidents and bad calls happen. Plain and simple. But, bloodsucking lawyers drool like Pavlov's Dog the moment a mistake is made, or if an expected adverse affect occurs. It is sad, but unfortunately there will be mistakes, and adverse reactions to treatments, or faulty equipment. It happens. I am not saying, nor have I have ever said that gross negligence or willful harm should not be prosecuted either criminally or civilly. They should. But, errors or miscalculations, or "heaven forbid" the patient becomes an expected statistic should not be fair game for the lawyers.

By enacting Tort Reform and protecting these professionals we serve the Health Care System better. We won't lose our best to other countries, nor will we lose the would-be doctors and health professionals before they even go to school for fear of facing lawsuits for every little decision they might make in the future. Our health care costs will drop dramaticly when they don't have to factor in extremely expensive (often hundreds of thousands of dollars a year) insurance premiums for malpractice and liability. Nor will drug manufacturers or device manufacturers have to jack up their prices to figure in James Sokolov's and William Gee Ambulance Chasing Bottom Feeders.


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  #11  
Old September 13th, 2009, 9:37 am
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Re: Health Care Politics: V.2

Quote:
Originally Posted by rigdoctorbri View Post
(Obama) is so busy worrying about if he "can", he hasn't stopped to think if he "should". He is so hard put to get a bill passed that I don't think he is taking proper time to consider the long-term ramifications of his legislation.
How long can successive Presidents bypass issues related to the uninsured? If the President shouldn't change the system, then who can? Or is that you don't want this President and that party to change the system?


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Old September 13th, 2009, 10:04 am
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Re: Health Care Politics: V.2

Quote:
Originally Posted by rigdoctorbri View Post
One of the most important parts of legislation that Obama has announced he is strictly against is Tort Reform.
I specificially heard Obama state that they were initiating tort reform trial projects. And we have had tort reform in California for years. I haven't seen any drop in premiums.

Quote:
Originally Posted by rigdoctorbri View Post
Obama) is so busy worrying about if he "can", he hasn't stopped to think if he "should". He is so hard put to get a bill passed that I don't think he is taking proper time to consider the long-term ramifications of his legislation.
I don't see how anyone can know how long he has thought about it and what his thought processes encompassed. But I'm certain he has considered all the ramifications because he considers most issues very seriously and in depth. Most Democrats (and probably most Americans) have considered this issue for decades.


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  #13  
Old September 13th, 2009, 10:34 am
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Re: Health Care Politics: V.2

Yes, he did:
Quote:
Originally Posted by Pres. Obama
Finally, many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today....
New York Times text of speech

He's willing to look at this now. Again, if tort reform is going to be done, I'm convinced it needs to be done differently than how California or Texas has done it so far--because it did little or no good at the consumer level...and it should have. The basic idea may still have merit, but let us look at various ways to do this so we can do it right the first time and not just toss the grass in the wind and hope some grain falls out...but increase those chances.


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Old September 13th, 2009, 3:07 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by Redhart View Post
Yes, he did:

New York Times text of speech

He's willing to look at this now. Again, if tort reform is going to be done, I'm convinced it needs to be done differently than how California or Texas has done it so far--because it did little or no good at the consumer level...and it should have. The basic idea may still have merit, but let us look at various ways to do this so we can do it right the first time and not just toss the grass in the wind and hope some grain falls out...but increase those chances.
I think on Tort reform, I would support a cap on punitive damages, not compensatory damages. Doctor's have been winning 70% of cases brought against them, but the costs to medical malpractice insurance companies and doctors is very prohibitive. I would also support a "loser pays" system where the loser of the case would have to pay all court costs and fees. That will lighten the load on frivolous lawsuits.


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Old September 13th, 2009, 3:36 pm
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Re: Health Care Politics: V.2

I don't know, so I'm asking: could the reason CA malpractice premiums didn't come down is because malpractice insurers (unlike medical insurers) insure across state lines, so CA doctors are still paying for the lack of reform in other states?

I also heard on a video (though I haven't researched it yet) that someone in CA at a town hall in CA said there were 1600 insurance companies in the US; 6 in CA. So she was asking congress to allow across state line coverage. Does anyone know if this is true? I would think that would be a huge reason for high prices in CA if it were.


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Old September 13th, 2009, 5:21 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by Chris View Post
Well, share the information with patients, too...snip

...snip...Patient education and empowerment needs to be tied in too. If patients understand the accepted best practice, then they may not push for the most expensive drugs / treatment / surgery / etc. To make tort reform work, I think that doctors need to actually enact best practices instead of just reading about it and patients need to be aware of the best practices research for any medical choice they are considering.
What makes you assume that that information isn't shared with patients? Isn't it the physician's job to communicate the standard procedure for diagnosing and treating their illness?

I just had surgery recently. My physician went through what the recommended protocols - which included following a series of non-surgical steps to see if the problem would resolve. After trying the non-surgical treatments for the proscribed period of time (longer cause I wasn't keen on surgery) and seeing no improvement we finally decided that surgery was the only option left. So I had the surgery and the problem is finally resolved. Honestly - I wish I'd done the surgery sooner but I didn;t want to go that route.

When I was pregnant and had a hiccup in the later weeks of pregnancy my doctor went through the standard protocol because I was borderline. Because of my age and the fact that I had a 2 year old at home and couldn't do bed rest and was going to jump out a window if I didn't have that baby then, we chose to induce the next day. We could have waited, and the protocols were iffy because I was borderline, but I was done, we were past 36 weeks, and so we had the baby (turns out he was 2 weeks past due cause I screwed up on my calculations - never trust a pregnant women to do math or remember where her car keys are - or shoes for that matter).

From the research I've done, best practices are pretty much established, generally accepted, and generally practiced in most areas of medicine. It's in the areas where new studies are being published frequently or where the case isn't clear cut that there aren't generally accepted practices and treatments might be over proscribed.

The Obama plan mandates that some appointed board establish best practices. I have a huge problem with that. I'd rather we leave that in the hands of physicians who actually see patients than government bureaucrats.


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  #17  
Old September 13th, 2009, 5:32 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by Den_muggle View Post
I don't know, so I'm asking: could the reason CA malpractice premiums didn't come down is because malpractice insurers (unlike medical insurers) insure across state lines, so CA doctors are still paying for the lack of reform in other states?

I also heard on a video (though I haven't researched it yet) that someone in CA at a town hall in CA said there were 1600 insurance companies in the US; 6 in CA. So she was asking congress to allow across state line coverage. Does anyone know if this is true? I would think that would be a huge reason for high prices in CA if it were.
Well wait, do you mean there are six (so-called) malpractice insurance companies in California? I'm afraid I don't really understand... you're asking if malpractice insurance across state lines is keeping costs up, but then you mentioned a woman asking Congress to allow malpractice insurance across state lines? I can't tell which part you're suggesting has contributed to high prices--insurance across state lines or a lack of it.

Personally I can't find a whole lot of info about this online, so maybe someone else will have better luck.


  #18  
Old September 13th, 2009, 6:19 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by canismajoris View Post
Well wait, do you mean there are six (so-called) malpractice insurance companies in California? I'm afraid I don't really understand... you're asking if malpractice insurance across state lines is keeping costs up, but then you mentioned a woman asking Congress to allow malpractice insurance across state lines? I can't tell which part you're suggesting has contributed to high prices--insurance across state lines or a lack of it.

Personally I can't find a whole lot of info about this online, so maybe someone else will have better luck.
Okay, here is a medical malpractice insurance PRIMER authored by the University of Maryland. It's basically an insurance 101 tutorial.

Here is an editorial from a trial lawyer, arguing against compensatory caps, and for a mechanism that looks at lawsuit merits. It's the other side of the argument, but we need to hear both sides.

Here is a case study of the impact of high med mal rates in Washington State, especially on specialties like OB/GYN:

Quote:
Five years ago, the premium for a family physician not delivering babies and doing no surgery was
$7,547. Today, it has increased 29% to $9,768. If the family physician also practices obstetrics, the
annual premium can be as high as $37,449.
• Over the same period, premiums for orthopedic surgeons have increased 30% from $30,286 to
$39,243.
• For obstetricians, premiums have increased 39% from $37,208 in 1998 to $51,878 today.
It's complicated and a specific reform is something that can't be born out, just yet. However, I'd also be open to the idea of arbitration in lieu of jury trials.


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  #19  
Old September 13th, 2009, 6:40 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by canismajoris View Post
Well wait, do you mean there are six (so-called) malpractice insurance companies in California? I'm afraid I don't really understand... you're asking if malpractice insurance across state lines is keeping costs up, but then you mentioned a woman asking Congress to allow malpractice insurance across state lines? I can't tell which part you're suggesting has contributed to high prices--insurance across state lines or a lack of it.

Personally I can't find a whole lot of info about this online, so maybe someone else will have better luck.
You're confusing medical malpractice insurance and health care insurance. Since I wasn't clear, I'll try again.

I wondered if medical malpractice insurance could cover doctors across state lines and I thought that might be keeping those prices high if they could go across state lines and still had to cover states without reform. I wondered if those who choose to do business in CA aren't benefitting from the reform because dipping a bit of water out of one side of the pool while pouring buckets in the rest doesn't really help lower the level. I don't know; I'm just asking the question.

Health insurance (not medical malpractice) is the thing that the lady said had 6 available companies in CA and 1600 nationwide. Totally separate kind of insurance. Because of the much larger numbers of patients, being spread across state lines would not meet such different regulations and would broaden the base of healthy insured, thus (according to Monster_Mom's well-documented arguments) lower rates. That would be because of competition and the ability to have more choice.

I apologize for I'm not making myself clear. I am not a professional debater and can't always say things I want to in the best possible way. My two comments from above were talking about two different types of insurance benefitting in different ways from crossing or not crossing the state lines. I hope this helped clarify it a bit.


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Last edited by Den_muggle; September 13th, 2009 at 6:47 pm.
  #20  
Old September 13th, 2009, 6:44 pm
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Re: Health Care Politics: V.2

Quote:
Originally Posted by Morgoth View Post
How long can successive Presidents bypass issues related to the uninsured? If the President shouldn't change the system, then who can? Or is that you don't want this President and that party to change the system?
I never said that The President should not take action, but I am worried that Obama is trying so hard to make good on a campaign promise that he might forget about good sense, and push through anything without the benefit of foresight. For any plan he passes there will be no pain felt by the masses for years to come. It will take that long for all the bureacracy to bubble to a point that the pot can't hold it.

I am entirely in favor of a National Health Care System that allows private options, but President Obama needs to do the right thing. He needs to take wisdom of past failures, and apply them to his decisions. I just don't think he is doing that.

Quote:
Originally Posted by ComicBookWorm View Post
I specificially heard Obama state that they were initiating tort reform trial projects. And we have had tort reform in California for years. I haven't seen any drop in premiums.

I don't see how anyone can know how long he has thought about it and what his thought processes encompassed. But I'm certain he has considered all the ramifications because he considers most issues very seriously and in depth. Most Democrats (and probably most Americans) have considered this issue for decades.
As a One-Term Senator (less than a full term) and that being his only foray into the Federal Legislative System as a decision maker, I don't think he was privy to all the facts about the intricacies of the system. As President his eyes are constantly being opened by information coming in from Commerce, Health and Human Services, Treasury, Interior, Justice, Homeland Security, etc. that he is probably seeing the same brick walls previous presidents have run into. Except, I fear he is choosing to go through the walls rather than around them, and damn the consequences. He hasn't been President for a year yet, 8 months in fact. For such a major overhaul even large corporations take more time to put forth a plan.

Quote:
Originally Posted by Redhart View Post
Yes, he did:

New York Times text of speech

He's willing to look at this now. Again, if tort reform is going to be done, I'm convinced it needs to be done differently than how California or Texas has done it so far--because it did little or no good at the consumer level...and it should have. The basic idea may still have merit, but let us look at various ways to do this so we can do it right the first time and not just toss the grass in the wind and hope some grain falls out...but increase those chances.
I had not heard this speech, but clearly it is a break from his earlier position. And a good one.

Quote:
Originally Posted by USNAGator91 View Post
I think on Tort reform, I would support a cap on punitive damages, not compensatory damages. Doctor's have been winning 70% of cases brought against them, but the costs to medical malpractice insurance companies and doctors is very prohibitive. I would also support a "loser pays" system where the loser of the case would have to pay all court costs and fees. That will lighten the load on frivolous lawsuits.
As the plaintiff's lawyers generally shoulder the costs for their end of the lawsuit, and only get paid if they win, then I doubt they would find a way to change to a Loser Pays system. It would completely change the way lawyers could get paid, and lessens the risk plaintiff lawyers take for poor trial work. Since plaintiff lawyers shoulder the costs, they are required to produce results. If that burden is lifted, then they can do shotty work and still get paid.

Quote:
Originally Posted by Den_muggle View Post
You're confusing medical malpractice insurance and health care insurance. Since I wasn't clear, I'll try again.

I wondered if medical malpractice insurance could cover doctors across state lines and I thought that might be keeping those prices high if they could go across state lines and still had to cover states without reform. I wondered if those who choose to do business in CA aren't benefitting from the reform because dipping a bit of water out of one side of the pool while pouring buckets in the rest doesn't really help lower the level. I don't know; I'm just asking the question.

Health insurance (not medical malpractice) is the thing that the lady said had 6 available companies in CA and 1600 nationwide. Totally separate kind of insurance. Because of the much larger numbers of patients, being spread across state lines would not meet such different regulations and would broaden the base of healthy insured, thus (according to Monster_Mom's well-documented arguments) lower rates. That would be because of competition and the ability to have more choice.

I apologize for I'm not making myself clear. I am not a professional debater and can't always say things I want to in the best possible way. My two comments from above were talking about two different types of insurance benefitting in different ways from crossing or not crossing the state lines. I hope this helped clarify it a bit.
I am afraid the Tort Reform enacted in California, and perhaps in Texas (I haven't researched Texas's reforms) are token changes, that were meant to show John Q. Public changes, but were more of a smoke and mirrors act. It lowered the liability, but not to the extent that it actually protected the doctors. The lawsuits seem to be brought just as regularly.


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