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Uninsured Rate Continues To Drop Since Obamacare Took Effect.


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2 hours ago, kicker said:

I have two very close friends that are German.   Both were physicians in Germany, and it sucked so bad for them that they both came to the US, and went through a full residency program here.  One is an anesthesiologist, the other is a cardiac surgeon, who just finished his residency and is finally practicing at the age of 42.

The US has always been the best place in the world to be a physician. No one disputes that. 

It's just not all that great a place to be a patient with little money. 

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18 minutes ago, Joremarid said:

why should they have to take any pay cut?

Realistically, solving the health care problem is going to require lowering the cost of services.  An MRI is going to have to cost less and so is the amount charged by doctors in terms of visits and tests.  That means they won't make as much money per service than they do now.  You can't complain about the high cost of services while simultaneously arguing that doctors and insurance companies can continue making the same amount of money today.  

I've heard estimates that something like 30-40% of total cost of health care paid by Americans goes to overhead (CEO pay, etc) and profits.  It's an expense that no other advanced industrial democracy pays.  

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3 hours ago, Billy Ocean said:

The US has 93 Nobel prizes in Medicine, and didn't have any until the 1930's. Germany has 16, with 5 of those coming before the US got our first. Germany has had only one since the millenia turned, past 16 years. The US has had 5 since 2013. 

It works for delivering existing medical treatments. It sucks for advancing medicine. The US R&D defined the process for open heart surgery. If you know of anyone that has had heart surgery, thank the American health system. Anyone still alive born with diabetes? Thank America. AIDS? Ebola? Cancer treatments? America R&D. 

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21 minutes ago, Leon Troutsky said:

Realistically, solving the health care problem is going to require lowering the cost of services.  An MRI is going to have to cost less and so is the amount charged by doctors in terms of visits and tests.  That means they won't make as much money per service than they do now.  You can't complain about the high cost of services while simultaneously arguing that doctors and insurance companies can continue making the same amount of money today.  

I've heard estimates that something like 30-40% of total cost of health care paid by Americans goes to overhead (CEO pay, etc) and profits.  It's an expense that no other advanced industrial democracy pays.  

Your two paragraphs seem to be arguing different points.

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2 hours ago, Billy Ocean said:

What are some methods of addressing cost that your wife and her colleagues believe would work?

I never get to interact with any doctors in a social setting, so I never get to hear them speak frankly on the matter.

Defensive medicine is off the charts, driven mostly by a CYA attitude.  Couple that with our litigious philosophy to negative health outcomes as a society.  

Then you have a serious lack of patient responsibility.  They show up late for surgery, they eat during the pre-op window which delays surgery, etc.  That drastically decreases OR efficiency.  And most public hospitals have no way of charging patients for it.  

Lastly, we need to incentivize the **** out of a healthy lifestyle.  Drinkers, smokers, morbidly obese people should be paying more.  

 

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10 minutes ago, pzummo said:

The US has 93 Nobel prizes in Medicine, and didn't have any until the 1930's. Germany has 16, with 5 of those coming before the US got our first. Germany has had only one since the millenia turned, past 16 years. The US has had 5 since 2013. 

It works for delivering existing medical treatments. It sucks for advancing medicine. The US R&D defined the process for open heart surgery. If you know of anyone that has had heart surgery, thank the American health system. Anyone still alive born with diabetes? Thank America. AIDS? Ebola? Cancer treatments? America R&D. 

We definitely subsidize the rest of the world with our R&D.  

 

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Most everything I've read indicates tort reform would have a minimal impact on costs and would mostly just serve to decrease patients' rights.

From Harvard's School of Public Health:

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Medical liability costs in U.S. pegged at 2.4 percent of annual health care spending

$55.6 Billion Price Tag Large, But Not a Key Driver of Total Health Care Spending

Boston, MA – How much do medical liability costs—including the costs of malpractice insurance, claims and legal fees and doctors practicing “defensive medicine” to avoid being sued—add to overall medical costs?

During the recent debates over federal health care reform, considerable attention focused on whether medical liability reform should be included in the package as a means of reducing costs. Proponents offered some very high estimates (as high as 10%) of how much the liability system contributed to health care costs, while opponents trivialized these expenses. In an effort to separate fact from fiction—and to provide the first academic study of medical liability system costs— a comprehensive analysis from Harvard School of Public Health (HSPH) researchers found that medical liability costs totaled about 2.4% of annual health care spending in the United States, or $55.6 billion per year in 2008.

“Medical liability costs have been in the bull’s-eye of efforts to bend the health care cost curve down,” said lead author Michelle Mello, professor of law and public health at HSPH.  “But we can’t have a meaningful debate about the potential effects of liability reform without solid cost estimates. At nearly $56 billion per year, the medical liability system carries heavy costs, and there are good reasons to want to improve it. But we should be realistic about what liability reform can achieve in terms of health care cost control.”

The study appears in the September, 2010, issue of Health Affairs.

According to Mello and her co-authors, other reforms, such as changing the fee-for-service reimbursement system that gives providers incentives to overuse services, probably hold more promise for reducing health care costs. Proponents of liability reform argue that it will address two drivers of health care costs: providers offsetting rising malpractice insurance premiums by charging higher prices and “defensive medicine,” in which liability concerns lead doctors to order more tests, procedures, and other services than are medically necessary.

To come up with their estimate of liability costs, Mello and colleagues analyzed various components of the medical liability system, including payments made to malpractice plaintiffs; defensive medicine costs; administrative costs, such as lawyer fees; and the costs of lost clinician work time. They found that the medical liability system’s annual price tag includes $45.6 billion in defensive medicine costs, $5.7 billion in malpractice claims payments, and more than $4 billion in administrative and other expenses.

While some elements of medical liability costs — such as the high amount spent on legal expenses —represent inefficiencies and could be trimmed, Mello counters claims that money spent on medical liability is waste. “We shouldn’t forget that despite all its dysfunctions and inefficiencies, the medical liability system does produce social benefits,” she said. “It makes injured patients whole by providing compensation; it provides other forms of ‘corrective justice’ for injured persons, producing psychological benefits; and it may deter future injuries by signaling to health care providers that they will suffer sanctions if they practice negligently and cause injury.  The question is, can we reform the system to enhance these benefits and get them at lower cost?”

Atul Gawande, from the Harvard School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital; Amitabh Chandra, from Harvard’s Kennedy School of Government; and David Studdert, from the University of Melbourne, were co-authors.

“National Costs of The Medical Liability System,” Michelle M. Mello, Amitabh Chandra, Atul A. Gawande, David M. Studdert, Health Affairs, September, 2010.

Michelle Mello is supported by a Robert Wood Johnson Investigator Award in Health Policy Research; Amitabh Chandra and Atul Gawande by the National Institute on Aging and the Taubman Center at Harvard University; Atul Gawande by the Harvard Risk Management Foundation; and David Studdert by a Federation Fellowship from the Australian Research Council.

 

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4 minutes ago, kicker said:

We definitely subsidize the rest of the world with our R&D.  

 

We do, and that's something I'm proud of. We make treatments and advancements available to the entire world. For free. That is a very good way to be a world leader, improving healthcare for everyone.

It is also extremely under-appreciated, without it even being considered in the world healthcare rankings. That irks the **** out of me. In my opinion, advancing medicine, finding cures, and developing ways to treat those that are suffering the most is far more important than 99% of the crap they use in those rankings.

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I'm a healthcare professional and I think that tort is vastly overrated as a factor in the high costs of healthcare. Personally, I think it's as simple as the vast majority of patients having little to no direct responsibility for the cost of their healthcare. Most don't know or care what it costs past the deductible or copay. As a result, there's no competitionin pricing so costs steadily climb. If we bought our food the same way we bought our healthcare, a loaf of bread would be $30.

We are starting to see the same mechanism in play with higher education. Grants, loans,  aid, etc are so common that students neither know nor care about true costs so the price of tuition and textbooks have climbed to ridiculous levels. Some may call it greed, but I think of it as a natural result of eliminating competition in pricing. 

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New study shows that the savings from 'tort reform' are mythical

September 20, 2014

"Tort reform," which is usually billed as the answer to "frivolous malpractice lawsuits," has been a central plank in the Republican program forhealthcare reform for decades. 

The notion has lived on despite copious evidence that that the so-called defensive medicine practiced by doctors merely to stave off lawsuits accounts for, at best, 2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're a problem that exists mostly in the minds of conservatives and the medical establishment.

A new study led by Michael B. Rothberg of the Cleveland Clinic and published in the Journal of the American Medical Association aimed to measure how much defensive medicine there is, really, and how much it costs. The researchers' conclusion is that defensive medicine accounts for about 2.9% of healthcare spending. In other words, out of the estimated $2.7-trillion U.S. healthcare bill, defensive medicine accounts for $78 billion. 

As Aaron Carroll observes at the AcademyHealth blog, $78 billion is "not chump change ... but it’s still a very small component of overall health care spending." Any "tort reform" stringent enough to make that go away would likely create other costs, such as a rise in medical mistakes generated by the elimination of the oversight exercised by the court system.

Since it doesn't appear that "tort reform" would have any effect on this spending, Carroll says, "there seems little reason to pursue it as a means to dramatically reduce health care spending in the United States."

continued at http://www.latimes.com/business/hiltzik/la-fi-mh-another-study-shows-why-tort-reform--20140919-column.html

2 to 3 percent of total annual health care spending isn't gonna move the needle much. 

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3 minutes ago, Gritzblitz 2.0 said:

I'm a healthcare professional and I think that tort is vastly overrated as a factor in the high costs of healthcare. Personally, I think it's as simple as the vast majority of patients having little to no direct responsibility for the cost of their healthcare. Most don't know or care what it costs past the deductible or copay. As a result, there's no competitionin pricing so costs steadily climb. If we bought our food the same way we bought our healthcare, a loaf of bread would be $30.

We are starting to see the same mechanism in play with higher education. Grants, loans,  aid, etc are so common that students neither know nor care about true costs so the price of tuition and textbooks have climbed to ridiculous levels. Some may call it greed, but I think of it as a natural result of eliminating competition in pricing. 

Competition, healthcare accounts, isn't this part of the solution the GOP has been preaching for a while?  

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16 minutes ago, Gritzblitz 2.0 said:

I'm a healthcare professional and I think that tort is vastly overrated as a factor in the high costs of healthcare. Personally, I think it's as simple as the vast majority of patients having little to no direct responsibility for the cost of their healthcare. Most don't know or care what it costs past the deductible or copay. As a result, there's no competitionin pricing so costs steadily climb. If we bought our food the same way we bought our healthcare, a loaf of bread would be $30.

We are starting to see the same mechanism in play with higher education. Grants, loans,  aid, etc are so common that students neither know nor care about true costs so the price of tuition and textbooks have climbed to ridiculous levels. Some may call it greed, but I think of it as a natural result of eliminating competition in pricing. 

BO's last link mentioned $78 billion.  

Easy math, there are 800,000 physicians practicing medicine in the US.  

That's only $96k per physician.  Peanuts!

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1 hour ago, Porkins said:

Wow, that is peanuts. Especially if you're living in a HCOL area. And if HCOL physicians are then making more to compensate for their location then that means other physicians are making far, far less. 

I think you misinterpreted my post. The cost of defensive medicine per physician is $96,000 a year (using BO's link).  That's roughly half of what the average doctor makes.  Apparently that's an insignificant number?

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That article also says "any 'tort reform' stringent enough to make that go away would likely create other costs, such as a rise in medical mistakes generated by the elimination of the oversight exercised by the court system.  Since it doesn't appear that 'tort reform' would have any effect on this spending, Carroll says, 'there seems little reason to pursue it as a means to dramatically reduce health care spending in the United States.'"

Even assuming, then, that the figure is accurate (and there is reason to think it is not, such as the prior link BO provided that pegged it at $56 million, not only for "defensive medicine," but in fact for all liability costs such as malpractice insurance, etc., costs that would not go away even if you passed the most draconian tort reforms), it seems there are greater priorities in reducing costs.  Making this the keystone of public policy in reducing costs only insulates doctors from the costs of their malpractice while shifting those costs to their victims.  It does not reduce healthcare costs.

Frankly, the only reasonable basis I've yet seen for medical tort reform proposals across two states is to insulate doctors from liability that literally everyone else in the country faces.  If you hit the doctor with your car, he can sue you.  If he cuts off the wrong leg, oh, well, medical costs are just too dang high for these poor put upon doctors to have to pay.  

Elitism is a bad basis for law.

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39 minutes ago, JDaveG said:

That article also says "any 'tort reform' stringent enough to make that go away would likely create other costs, such as a rise in medical mistakes generated by the elimination of the oversight exercised by the court system.  Since it doesn't appear that 'tort reform' would have any effect on this spending, Carroll says, 'there seems little reason to pursue it as a means to dramatically reduce health care spending in the United States.'"

Even assuming, then, that the figure is accurate (and there is reason to think it is not, such as the prior link BO provided that pegged it at $56 million, not only for "defensive medicine," but in fact for all liability costs such as malpractice insurance, etc., costs that would not go away even if you passed the most draconian tort reforms), it seems there are greater priorities in reducing costs.  Making this the keystone of public policy in reducing costs only insulates doctors from the costs of their malpractice while shifting those costs to their victims.  It does not reduce healthcare costs.

Frankly, the only reasonable basis I've yet seen for medical tort reform proposals across two states is to insulate doctors from liability that literally everyone else in the country faces.  If you hit the doctor with your car, he can sue you.  If he cuts off the wrong leg, oh, well, medical costs are just too dang high for these poor put upon doctors to have to pay.  

Elitism is a bad basis for law.

I thought the proposed tort reform was more about capping the awards for damages, not protecting doctors from being sued.  

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1 minute ago, pzummo said:

I thought the proposed tort reform was more about capping the awards for damages, not protecting doctors from being sued.  

What do you think the effect of capping damages on the most meritorious lawsuits would be?

The truly frivolous cases with minor damages already are not brought, because those do not justify the $50K-100K cost to bring them to trial.  So if you put an arbitrary damages cap on the most meritorious cases with the greatest damages, that means fewer suits are brought.  For insurers, this allows them to plan better, because they know they will never have an award greater than $X.  For consumers, it means it sucks to be you if your damages reasonably exceed $X.

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