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View Diary: The ACA and Our Doctor Shortage (149 comments)

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  •  And As We've Seen Since the 60's, the Cost of (27+ / 0-)

    insurance for any particular issue does not necessarily reflect the overall cost of what it's protecting you from.

    Like health insurance, medical malpractice insurance should be government single-payer or well regulated not for profit private insurance.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Mon Sep 03, 2012 at 05:59:20 AM PDT

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    •  Amen to that (9+ / 0-)
      Like health insurance, medical malpractice insurance should be government single-payer or well regulated not for profit private insurance.
    •  Don't expect such insurance w/o tradeoffs. (4+ / 0-)
      Recommended by:
      VeloVixen, FG, TexDem, peregrine kate

      Caps on p&s will more than likely be part of that mix, as it is in other countries.

      Tort reform gives us hives because we know, in absence of any other mandate, money will shift from plaintiffs to shareholders w/o much benefit to the medical community or society at large. It isn't all industry profit that is at stake here. There is a sizable medical cost burden from unnecessary testing and procedures done to stave off claims.

      Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

      by the fan man on Mon Sep 03, 2012 at 07:21:38 AM PDT

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    •  Suing (1+ / 0-)
      Recommended by:
      VeloVixen

      Has to be cut back as well.  Way too much frivolous suing.

      "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

      by bcdelta on Mon Sep 03, 2012 at 08:09:29 AM PDT

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      •  its a biased group (9+ / 0-)

        but some of the studies and statistics can be traced back to more neutral sources.

        Too many frivolous suits is a right wing talking point.  A major pillar of any right wing republican stance on medical costs, tort control.  Medical malpractice suits are rare, face significant procedural barriers in many states to even make it to a complaint stage.  

        http://www.justice.org/...

        •  I wasn't referring to (2+ / 0-)
          Recommended by:
          flitedocnm, VeloVixen

          a given study rather as people have noted some OBGYNs pay $200k per annum in med malpractice.

          This increases costs.  So it needs to be addressed along with pharma, insurance and fraud.

          Germany has half the cost per capita of the US for medical - we can get there - just have to cut the waste.

          "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

          by bcdelta on Mon Sep 03, 2012 at 09:12:50 AM PDT

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          •  Germany doesn't have (3+ / 0-)
            Recommended by:
            cocinero, peregrine kate, SoCalSal

            half the cost because of 'waste'.  Waste is another right wing word.   It has less cost because it mandates coverages, negotiates prices, and its a government managed system.  Basically all of Europe and the other more advanced industrial nations have managed health care of one form or another, socialized if you want the right wing word, that provide better coverage, by and large better outcomes  at less cost of total GDP.  Romney made a fool of himself praising the Israelis for their low ratio of health care to GDP, because they also have a managed system instead of a private system.

            Some OBGYN's when I lived in Chicago thirty years ago were also still making $500k a year after paying their insurance. Now I live in a small town in a red state, and the doctors still aren't going broke.  The family practitioners were the ones who only made around a $100k a year, emergency room physicians, direct employees of the big hospitals tend not to do as well as the private practioners here.  And its a popular area for doctors, outside the big city, near the mountains, a regional medical center.   There have been problems for doctors, but  they are caused way more by their insurers and the overhead imposed by the reporting requirements, insane distinctions over treatment codes that result in denial of benefits, than by patients suing them.

            You made a claim about malpractice suits, which is pretty demonstrably untrue and part of right wing talking points.  Then you jump to expense as a ratio of GDP and waste, again based on a fallacy and right wing talking point.

            The profit margin and market distortion of the system because of private insurance and regulatory insanity in favor of administrators/over testing/insurance profits and money not spent on patient care, is what is killing the US.  Single payer, government managed care has proven itself around the world.  We just can't have it here because of right wing nut jobs and profiteers.  

            •  Waste (1+ / 0-)
              Recommended by:
              VeloVixen

              When suing increases costs unnecessarily it makes care more expensive so it has to be addressed.

              Insurance should be non-profit like it used to be.

              When pharma blocks competition from alternative and along with doctors they treat symptoms rather than work on curing the cause....

              This is all waste, profiteering, etc.

              Now that ACA is passed the tough work needs to be done to make it actually work.

              So you have to go after "waste" in the system.

              "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

              by bcdelta on Mon Sep 03, 2012 at 10:04:16 AM PDT

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              •  but suing isn't increasing costs (3+ / 0-)
                Recommended by:
                VeloVixen, peregrine kate, slouchsock

                that, as I have pointed out repeatedly, is almost neglible in its number of occurences and neglible to the total costs.  Its is all built on lies,  repeating lies doesn't make them true.

                Now that you have defined waste to be profit taking without return of value, then yes,  there is waste in the system.

                Just because something is non-profit doesn't make it non-wasteful,  just because you don't pay money out to investors doesn't mean someone isn't pocketing a ton of money that could go to patient care, ie, the executives, administrative bureaucracies, etc. that stand between patients and actual health care providers, will take a split whether profit of non-profit.

                The ACA attempts to control that split and put the money back into patient care.

                Pharmaceuticals do need to be negotiated, but that isn't what you originally said,  you talked about frivolous suits.

                •  I want (1+ / 0-)
                  Recommended by:
                  VeloVixen

                  All areas of medicine to be more efficient so care for everyone becomes a reality - pharma, suing, insurance, tech, edu costs, fraud, more efficient records/communication, etc.

                  And we're at odds on suing, but if it costs $200k for an OBGYN to pay malpractice then prices have to go up.

                  To the extent that OBGYNs are still making a ton of cash then that's another issue.

                  "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                  by bcdelta on Mon Sep 03, 2012 at 10:17:08 AM PDT

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                •  Ezra Klein has a great perspective about effects (4+ / 0-)
                  Recommended by:
                  peregrine kate, SoCalSal, TexDem, jfromga

                  of malpractice lawsuits.The direct costs of malpractice lawsuits — jury awards, settlements and the like are a minuscule part of health spending:  the AMA and the trial lawyers’ association — say $60 billion a year, or about 3 percent of overall medical spending is a good estimate.  Only a small percentage of medmal cases are actually reported and litigated.

                  The problem isn't in courtrooms so much as on the operating table. But because it's doctors who are angry about malpractice suits, most of the fixes are from their perspective. What we need is malpractice reform from the patient's perspective. That wouldn't be the system we have now, or mere caps on damages: It would be serious work, much more costly, and investment in better practices.

                  •  What about (1+ / 0-)
                    Recommended by:
                    VeloVixen

                    the cost of defensive medicine due to fear of lawsuits - is this included in Klein's #s?

                    "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                    by bcdelta on Mon Sep 03, 2012 at 10:43:23 AM PDT

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                    •  Doctors supposedly practice "defensive medicine" (3+ / 0-)
                      Recommended by:
                      bcdelta, VeloVixen, jfromga

                      because they are afraid of lawsuits.  But they are afraid of lawsuits because the insurance industry told them to be afraid.

                      At the root of it, doctors aren't really afraid of the lawsuits, they're afraid of their malpractice insurance premium going up.  

                      Frivolity is in the eye of the beholder, or, as my father used to say, "It all depends on whose ox is gored."  It's really very difficult for a truly meritless lawsuit to get anywhere.  

                      The "problem" -- if there actually is one -- is that the insurance companies encourage these so-called "frivolous lawsuits."  It's a much better business model to settle suits and raise premiums then it is to actually use the tools that already exist in the U.S. legal system to deal with meritless litigation.  

                      The insurance industry's sole purpose is to increase its revenues, not to lower medical costs.

                      We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

                      by NoMoJoe on Mon Sep 03, 2012 at 11:00:28 AM PDT

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                      •  Sounds like (1+ / 0-)
                        Recommended by:
                        VeloVixen

                        collusion between legal and insurance.  Nicely made point.

                        "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                        by bcdelta on Mon Sep 03, 2012 at 11:04:07 AM PDT

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                      •  In NYS, I'd beg to differ, certainly surgeons and (1+ / 0-)
                        Recommended by:
                        VeloVixen

                        OBY/GYN practitioners. I'd love to believe it's insurance companies making them afraid, but it's more likely the pregnant mother who threatens her physician with a lawsuit "if something's wrong with her baby". Certainly most patients aren't like this woman, the problem is too many are. (I happened to be in a room when she took an urgent call from a patient.) We're also seeing OBY/GYNs refuse to take on obese patients for liability reasons.

                        As far as insurance companies and payouts vs changing the medical system, sounds far too much like municipalities payout for trip and falls rather than fixing all sidewalks pre-emptively.

                        Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

                        by the fan man on Mon Sep 03, 2012 at 01:05:39 PM PDT

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                  •  and the cost actually paid out in suits (1+ / 0-)
                    Recommended by:
                    VeloVixen

                    can be high, but generally don't come close to what it really costs to a person's life if a permanent injury has been done or death of a parent with children is the result, etc.

                    It is hard to find a doctor who is an expert in the medical area being challenged by the patient,  to sign the expert affidavit required prior to filing suit down here.  There are few frivilous claims.  We already have tort reform that caps claims.   It just isn't saving money as they said it would on premiums, etc.

                    It really is a scare tactic by the insurance companies.

                    •  Is that in Texas? (2+ / 0-)
                      Recommended by:
                      VeloVixen, jfromga

                      There was an article about the tort reform in Texas--I wish I could remember where--that says that claims are way down, awards are way down, but insurance premiums haven't budged. More manna for the insurance companies.

                      I also read that something like 83% of all claims in TX are against something like 11% of doctors. And it's worse, the more you narrow it--45% of claims to 5% of doctors, or something similar (this is from memory!)  But TX won't take their damn licenses away. "Ambulance chasing-lawyers", another right-wing meme, are NOT the problem. Insurance vultures and a minority of bad doctors are.

                      "Maybe: it's a vicious little word that could slay me"--Sara Bareilles

                      by ChurchofBruce on Mon Sep 03, 2012 at 01:35:22 PM PDT

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      •  the frivolous suing (1+ / 0-)
        Recommended by:
        VeloVixen

        is corporations who plug up courts suing other corporations over obscure and minuscule infractions.

        If we allow them to cap p&s, it is those who were truly wronged who will suffer.

        •  Well (1+ / 0-)
          Recommended by:
          VeloVixen

          I still don't like ambulance chasing lawyers; however, there are many legitimate cases of malpractice.

          I don't understand why people are so pro parasitical ambulance chasers on a progressive blog.

          "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

          by bcdelta on Mon Sep 03, 2012 at 10:31:26 AM PDT

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