I saw it coming. At the time, I told my then father in law..."Doc (I called him Doc), your rates will drop, but very modestly. Meanwhile, the insurance companies will pay out less on claims. It is a money grab and Gov. Perry knows it." It is a sad outcome.
lol, you must have a big position in SHPGY :grin: either that or you really actually believe all this
Wrong. That does happen. There are doctors (especially new ones who are still carrying their med school debt) that get paid for recommending certain drugs over others.
While I think the whole malpractise insurance fees is blown way out of proportions, I wouldn't exactly write it off either when it comes to health care costs. To start, let me remind you that Texas is one of those courts extremely favourable to frivolous law suits, so I would say what happens there is by no means an indication of the national average. Still doesn't add up to x% of health care, but certainly higher. Secondly, it goes something like this. If you are a family practitioner, it does vary from place to place, but you're looking at at least $25K to $30K in malpractise insurance premium a year. That's even assuming you have some experience (i.e. not fresh out of residency) and have a clean record. And it goes up from their depending your degree of demand or specialization. Surgeons for example, you can expect at least $60K to $70K. Pediatrics, in between the two. Anesthesiologist (oh boy, I probably spelt that wrong), which in itself is an extremely risky profession, toss that in a high risk area, you could have premiums that exceed $100K. How is this relevant? Well, I want to remind you that the pipeline for a medical profession is an extremely long one. At a minimum, you are looking at 4 year undergrad, 2 year med school and then 3 to 5 year residency (depends on the program, also specialization, typically 3 in New York State for basic fields), so that's 9 to 11 years, just for a family practitioner. On the long end? Well, we know there aren't enough doctors in the US. So let's say you're a foreign medical grad, and you want to specialize, that's still 4 year pre-med, 2 year med, but then if you manage to get a visa, you need 1 to 2 years NON-PAID volunteer experience (requirement, after you pass your ECFMG of course), then up 5 years of residency (in which you get paid ****), then 3 years of practising at the basic level, then up to 5 years of fellowship (in which case you again, get paid ****), then voila, your specialized license. So that's a total of up to 21 years, just for the right to practise a highly specialized field. So, if after all that, you gotta put up $30K to over $100K for malpractise, how inclined do you think it would be for a prospective member to join the field? How likely is it for some foreign medical grad to practise in the US? I'm sure I don't have to tell you higher demand/lower supply amounts to higher cost. As an interesting side note after all that rant, I thought it was interesting that plastic surgery in one of those fields that you get your license after 20ish years. Guess that's why the boob job costs so much huh?
Oh, and I just want to say that I think Obama got the absolute worst possible result for the health care reforms.
First, I think you don't really know what "frivolous" means. For a suit to be frivolous, there has to be no applicable law that would recognize the claim. For instance, if I sued you because your post offended me, it is not legally cognizable. But, in Texas, a licensed physician must sign a letter stating that there has been a breach of the standard of care and that letter must be filed with the lawsuit. So Texas is not favorable to frivolity in the courts unless you assume that doctors are signing letters to allow frivolous suits to exist. Secondly, in Texas, there are some plaintiff friendly forums. Specifically the Rio Grande Valley and Beaumont. Harris County, Texas is notoriously a defendant friendly forum. Having discussed all of this at length with my ex wife's father (a neurologist), you do not have to educate me on the medical profession. I know all of what you have said. This brings up 2 interesting questions: 1. How much do the actual verdicts play into premiums versus greed or making up for bad real estate investments made by the carrier? 2. When a doctor harms somebody, they usually do a significant damage. Are you suggesting that doctors not be held responsible when they cause damage to a patient? How would that affect the care delivered? The bottom line is that you cannot have a system that lacks accountability when you legitimately injure somebody. Oh...that being said...tort reform in and of itself is a crappy way to bring down costs. We have proven that in Texas.
You know, when I posted frivolous, I knew it would somehow come back to me. So fine, let me put it in context. I use frivolous in this case to mean a case in which may not necessarily have merit or at least is a judgment call. So yes, excuse my lack of proper term. I used to show distinction as supposed to the more proper meaning. And quite frankly you should not care whether or not the case is frivolous. It's quite simple. Let's assume the doctor is completely innocent and the plaintiff is a nutcase. Pretty clear cut right? Well, even if they toss it out right away, legal costs have been incurred. And if it was a borderline case... In any case, like I said, legal costs have been paid, by the insurance company. And how are they gonna recuperate that cost? Then it should be perfectly clear that doctors, especially the high demand/highly specialized ones exercise great amount of judgment every day. Even if they follow the procedure to a T (and most do), when they are spending time in court (if they indeed are), where are they not? Like at their practise maybe? If your point was that a profit motive generally increases health care costs, I agree. That is precisely the reason why I consider Obama's reforms a miserable failure due to the lack of a public option. However, that is built into the system so long as you lack a public option. My point is, knowing we've got all those warts which we cannot solve in the short-term, how do you take small actions to increase the marginal output of doctors (and thus, lower costs). What you've said essentially amounted to OK, we know we can't solve the issue at large, let's not try to fix the small one either. And regarding your second point, as I've said, the vast majority of doctors do not intend to harm somebody. You yourself said that you hear about the more questionable tort cases because they are so sensational. Well guess what, most doctors' legal trouble is not that sensational either. But quite frankly, even when you exercised good judgment, you cannot escape the potential liability to do irreversible harm to the patient. Goes with the territory. Depends on who you ask, somewhere between 15% to 20% of health care costs come from defensive medicine due to guess what, the threat of suits. I cannot vouch for the claim, but I can tell you there's way too much MRI and CAT scans and what have you. And if you refused a patient's request for one (in good judgment) but it turned out you were wrong, oh boy... To put it in perspective, a new family practitioner in Canada pays about 2 grand in malpractise. And family practitioners earn more than they do in the US. There's still a severe family practitioner shortage in Canada. What makes you think it would be better in the US, with its ridiculous costs?
You, of course, completely ignore that the insurance company has a standing contract with defense firms. Often, they do things, especially prior to settlement negotiations, at a greatly reduced rate. It is not as expensive to defend a meritless suit than you would think, especially if they are lacking the statutorily required letter. Of course, if you do away with the med mal system, how will injured plaintiffs with no means of recovery recoup the costs of missing work, etc? In 14 years of practice, my ex's father has been involved in a lawsuit exactly one time, it was tossed out and he spent exactly zero time in court. In fact, his premiums didn't even go up. It seems you are overestimating how many docs get sued and how often. This specifically deals with liability carriers and has nothing to do with single payer. If I run over a pedestrian with my car tonight, I will be liable to pay damages whether I intended to hit him or not. If we only made people pay when they intended to do something, there would be lots of injured folks with no way to be made whole by those that are culpable. Hell...I am pretty sure BP did not intend for their rig to explode and kill 11 people. It happened, and if they were negligent they will have to pay. Any assertion that the harm be intentional in order for liability to attach is frankly stupid. Guess what? Most doctors are constantly being sued and thus have no real legal troubles. Melodramatic, much? We are not talking about a situation where the doctor performed the medically reasonable course of action and it went badly. We are, by definition, talking about where another doctor has signed a letter stating that the defendant (doc) has failed to exercise the minimum standard of care. Even my ex's father, who wants tort reform to go even further than Prop 12 did, will tell you that this stat is BS. How else would you diagnose head injuries, ACL tears, etc? If you were wrong, then it turns out that the scan was necessary. If you failed to order a necessary test, it is by definition not "good judgment." When something really bad ends up happening that was preventable, who compensates the injured (or dead) for the ability to function that they preventably no longer have?
There is a distinction between reasonably recovering the cost of missing work legitimately and obscene cost. Yes the line is not always so fine, but we've so far crossed the reasonableness boundary that I hardly think it's a difficult to simply give a yes or not answer whether it is justified. When you've already built in the cost of the malpractise premium, it not moving up is hardly an indicator of how expensive/inexpensive it is. If you're trying to say that insurance carriers have a profit motive, yes they do. Who else has a profit motive? Doctors. Finally, the patient also have a profit motive through the controlling of expenses. Life is a story of conflicting financial incentives. Let me rephrase then. In your esteemed opinion, are the majority of doctors either intending to harm or negligent to the extent that they do irreversible harm? I did made no attempt to hide behind intent. But I think you have the clear distinction of not being able to tell negligent from simply being wrong. Know the difference? You could have followed the procedure to a T (exactly like my last post) and still be wrong. Also like I said, goes with the territory. This is what we call strawman due to your lack of reading comprehension. But fine, I'll rephrase it for you. Most doctors who actually have legal trouble (for whatever reasons) do not have legal troubles that are sensational either. Better? This is relevant how? I may not have kept up with the times, but I think there's just this bucket of money called malpractise. It's not they go and say, "well, this looks like a legit suit, let's tap the malpractise reserve. This other one looks iffy, let's kick it to settlement and toss it in the chump change pile." There's just malpractise. You use it to defend your suits, legitimate or not. Both add to the costs to varying degrees. I'm sure if the insurance company could know in a particular year it would have x legit cases and y questionable ones it would split the bucket or otherwise plan accordingly to maximize profit (instead of lowering cost for you). But since it doesn't, it just charges the doctor a high amount to cover any potential costs imaginable. I thought as much. At the doctor's discretion. Under limited threat of lawsuits so long as they performed their duties adequately. Let's ignore that fact that those procedures are not totally benign, in the real world we've got this thing called constraints, such as a financial one. When you are getting an MRI when you (let's just say for the moment) shouldn't be, you are adding to the cost of care. So you are taking time for patients who actually really need it, meaning instead of having some potential slack capacity for the number of machines available, we've gotta have more on hand, which adds to, you guessed it, cost. Quite frankly if I was able to have every single test imaginable done to me, invasive or not, I'd venture to say I'd found more than a few issues over the course of my life time. The only problem is I'll never find an insurance to do that without charging more than anyone will ever make. You went with the "what if the patient had something argument." Well, what if he didnt? You equating what could have been on a hypothetical scenario of "what if you're wrong" goes far beyond what is needed to show for good judgment, I'd say from both a legal and a pure common sense perspective. And, let's suppose you went ahead and did the scan and it turned out positive for whatever. Now let's suppose it's wrong, so you put your patient through chemo, or what have you. Or alternatively, the patient had something, but the first scan missed it. Did the radiologist show "lack of good judgment?"
That would be just fine if we were merely economic units. We aren't. We are people. When a doctor, or anybody else, cause grievous harm, they must compensate the injured for that harm. Does compensating the plaintiff only for missing work really compensate for the loss of the ability to do other things? Of course not. You totally ignored the part of that post where I directly responded to your very wrong assertion regarding doctors and court time. Duh. Now think more critically regarding the actual relation of malpractice premiums and malpractice judgments. If judgments decreased in Texas due to Prop 12 caps and premiums have not decreased, it seems like the shell game is rigged, and not by trial lawyers. Of course I do. I have stated it many times. It is...drum roll..a failure to meet the minimum standard of care. It is you, not I, who seem to have trouble wrapping the mind around this concept. We are not talking about where the doctor is wrong. We are talking about cases where another doctor is willing to attest in writing that the defendant failed to meet the MINIMUM STANDARD OF CARE. That is a HUGE distinction. And if you did, you will not have failed to meet the minimum standard of care and have nothing to fear. If the duties were performed adequately, then the minimum standard of care would be met and no suit will stand. Your understanding of how the insurance system works is rudimentary, at best. Out of that bucket of money, insurance carriers play the stock market and the real estate market. Is it any big shock that premium increases became a big issue at the same time that stock and real estate investments went belly up? These cases get triaged just like patients do. There are some that they fight and others that are settled for so-called "nuisance value." Of course, you don't even get that far unless another doctor has attested that the minimum standard of care was not met. I am sure that there are many insurance company actuaries and statisticians that would be offended by your implication that they all suck this badly at their jobs. You had a hypothetical where an MRI or CAT was not done (in good judgment) and then there was a lawsuit. For a lawsuit under this scenario, it must have ended very badly. Since these specific tests are tailored to find problems that cannot be found another way...if the patient had the problem and went undiagnosed because the doctor did not order the test, it could not have been very good judgment. As for your hypo about chemo and the radiologist...I don't know. What I think does not matter. Would another doctor attest in writing that they failed to meet the minimum standard of care? To be very, very clear...we are NOT talking about a reasonable case where the doctor just happens to be wrong. We are talking about cases where ANOTHER DOCTOR attests in writing that THEY FAILED TO MEET THE MINIMUM STANDARD OF CARE. That is a very large and very important distinction. I do not expect you to respond to that. I expect you to ignore what I have said and respond in some asinine manner of tangential relevance...just like you did last time.
If you don't view people as economic units in this instance, how else WOULD you view them? For example, if I lose an arm due to negligence on the part of whomever, does giving me $25 million as supposed to $500,000 bring that arm back? The bottom line is you're gonna have a pretty damn hard to justify "damages" beyond potential loss of earning income from the loss of that arm because that would imply you putting a value of that arm. Quite frankly you're gonna put yourself in a lot of hot water if you cease to view, as an insurance company, the claimants as more than economic units. I didn't assert anything regarding to how often doctors get sued. You did. I'm not surprised you couldn't keep track. I asserted the cost associated when it does see litigation. How often do for profit organizations typically reduce fees hmmmm? But at a minimum you'd know they would have difficulties justifying additional increases. This no more than a mere sidetrack of the issue, as it was from the get-go. I stated the obscene cost of malpractise premiums; you say what if the doctor do irreparable harm, implying and attribution the high cost care pretty much entirely to "what if the doctors harm somebody, why aren't they held responsible;" I respond by saying most doctors do not intend and indeed are not negligent in causing the harm, they could simply be wrong; you went on a tangent. That pretty much summed it up. Read it, think about it and then come back and tell if if that's what you meant. Yet still incur cost. Not as much of course as if you were actually negligent, but cost is cost. Now this part is just funny. You lecturing me about the insurance system. Believe it or not, insurance companies need to generate enough investment income to meet liabilities. If Joe Bob buys $100 premium insurance paying $50 grand from Screw Insurance Corp in case of malpractise, if 2 years from now, Joe Bob gets sued for malpractise and loses, believe it or not, gasp, Screw Insurance Corp would not have enough money to meet its liabilities. It will have to invest the money to somehow generate that money. And believe it or not, unfortunately sometimes they lose money. Whether they lost the money due to sub-prime in the current crisis, or the S&L crisis in the 80's, or the Latin America debt crisis in the 70's is irrelevant. What I thought was funny was you lambasting them for "greed" couple posts earlier as if the insurance company was a front for an investment bank. You seem to have homed in on "minimum standard." Multiple times. I'll come back to that so I can address it in one place instead of repeatedly. The first thing any actuary or statistician worth his salt is to tell you what his assumptions are. And it is only the first thing because it is unnecessary to tell you: a) They can't predict the future b) They could be wrong Define "MINIMUM STANDARD OF CARE." And what do you have to the fact that "minimum standard of care" could vary from state to state and indeed from doctor to doctor? So what is it? The lowest common denominator? Back to that hypothetical case regarding the MRI, if doctor A says you need one and doctor B says you don't, what the minimum standard of care? You said if doctor B turned out to be wrong, he didn't show good judgment. Well, I'm sure he wish when he made the decision what "good judgment" was. So your whole premise is based on him being wrong. Well, what if he was right? What makes one instance "good judgment" and another not? That's more than idiotic. I can however, clearly tell you what the lowest common denominator is. You do the test. And quite frankly, you could ALWAYS find a doctor that says you should do the test. Which is why doctors practise defensive medicine. Duh.
You are assuming that most people could prove hard economic damages of $500,000. I do a job that I could do with only one arm...does that mean that if a doctor botched my surgery and I lost the arm that I should take nothing? How eerily odd. We put a value on all kinds of things. It really is not that difficult if you think about it rationally. Any discussion of the costs associated with med mal litigation that does not include the frequency of said litigation is a r****ded discussion at best. That isn't how tort reform is sold though, now is it? No. Those pushing the reform talk about how doctors will have their premiums decrease and then pass it along to the consumer. So you basically admitted that the case for tort reform is a flawed principle. Thanks for proving my point. No...the legal standard is the issue. You came in here and bellyached about the need for massive tort reform and how these doctors getting sued basically started the problem. Again, if you do not discuss the legal standard applied and how it affects damages in the main, you are going into the discussion without the most operative facts. In this instance it does not shock me that you find it to be unimportant. You: The doctor could just be wrong and be out all this money. Me: Not true. They have to be found to have failed to meet the minimum standard of care. You: You went on a tangent. No I didn't. I succinctly addressed your point and you cannot refute it with fact so you deflect. This is laughable. The cost to get a suit thrown out for failure to attach the required letter is miniscule. The insurance company in some instances won;t even count that as a claim against your policy. So explain to me how mutual insurance companies have managed to survive. There is an ocean of difference between making a profit and what insurance companies have done over the last two decades. Sorry you fail to see it. It is the minimum standard of care as accepted by the medical community. That's right...the doctors get to decide the standard upon which they will be judged. They've blown it. It is not from doctor to doctor. All areas of science have generally accepted principles and medicine is no different. If you fail to meet the accepted minimum standard, you run the risk of getting popped. Ask the medical community at large. They are the ones that decide this stuff, not me. And it greatly reduces unnecessary deaths. You will be hard pressed to find many reasonable people that would suggest that you not do a CAT scan or MRI for a blow to the head. The risk of a subdural hematoma is too great. Duh.
Short of enforcing whatever agreements are made between doctor and patient, they shouldn't be regulated at all. I'm against medical license requirements (not licenses), also all drugs should be legal and OTC. Some people fall into the trap of thinking that standards wouldn't exist if they aren't imposed by force.
Why $500,000? Why not $5 million? Or $5 grand? Or $500,001? But in any case, you've missed the point completely. Again. As I've said, there is a distinct difference between getting at least the minimum of what you should've been entitled (i.e. lost wage) versus everything under the sun. If you feel compelled for the damages argument, fine. But like I said, there's kinda of an ocean between the two. Had it been much closer, you might have found it more difficult to distinguish what the patient actually deserves. It is not close. I feel like I'm trying to hit a moving target here. You started with a diatribe on how the magnitude of tort cases aren't ludicrous and I've responded as such. Then when the argument started going against you, you started citing the frequency. Do you wish to address this instead? Clarify for me now so I can call you out the next time you backtrack. You've got a funny way of thinking. So you've got premium at say 100 bucks. Based on the way things are, let's say premium goes up to 105 bucks. Now, we changed something. We limited tort suits so instead of going up to 105, it goes up to 102, or better yet, maybe even stay at 100. What you are telling me is in your simplistic way of looking at how the world should work, we realized no savings. But if you actually wanted my opinion, I always was somewhat skeptical regarding and immediate outright reduction of premiums. Those things tend to take time. The insurance companies would likely want additional payment history prior to reducing them. And I can't say I blame them. Do you know why I find it unimportant? Because it isn't. You specifically asked me what if doctors failed minimum standard of care, aren't the patient entitled to something, did you not? To which I replied to defend the ridiculous degree of tort suits based on "doctors failing whatever standards" is sensationalistic as most doctors DO NOT fail in their duties. Otherwise you'd have a lot more revoked licenses. And you know what else? The number that do is a rounding error. So technically I shouldn't say it's unimportant. Rather that it is INSIGNIFICANT. Your revisionist history is quite frankly astounding, especially considering the posts in question occurred on this very page. In post #28 you asked me whether a patient who receive irreparable deserve something. In post #29 I responded (reading it again) rather clumsily that you are talking about an insignificant proportion of tort suits. I then stated that most of the tort suits and costs incurred are from instances in which the doctor just happens to be wrong, as I've clarified in this post. Congratulations on falling victim to the constant price theory. Clap clap. I've already address this in a previous post in which I thought any idiot would have gotten it by now, in which I said the cost is already built in. See here's how real life works. The premiums in which you get now is based on the insurance company's assessment of its payouts, investment gains, general health of the claimants and what have you. Your "minuscule cost" is already priced in. If it isn't, your premium would be lower. And likewise, if more ludicrous torts are litigated instead of settled, your premiums would be higher. Um, by making investments. I'm sorry, did you really just ask me this question? Which "medical community at large?" The state boards? Some NPO like the AMA? Wow, I must have missed the memo. Hard to believe considering that would be one big book. How to handle which patient in every imaginable circumstance. This is this huge (I'm trying to have my hands as far apart as I can here) difference between issuing general bahavioural guidelines and daily procedures. Holy crap, a blow to the head might require a CAT scan. Next thing you're gonna tell me a bullet wound to the heart requires critical are. Well, while we're pulling extremes here I'd go out on a limb and say that a paper cut probably isn't gonna require an MRI. I don't know for certain of course. Just guessing. It's always the issues in the middle that causes the trouble. As I've said, you could give every imaginable are to every patient that comes along, every day. Chances are, you're gonna reduce deaths. The only problem is, no one will ever be able to afford it.
I have spent far too long trying to educate you about the legal system, the insurance system and the tort system. It has proven to be a futile effort. Enjoy your blissful ignorance.
In my opinion, I think it is the psychological type drugs that are the most questionable like ADD, xanax, valium ect. Anything that has effects on the brain chemestry of a person is a huge gray area. What's worst about these drugs is that often times the enviornmental cause of the issue is never addressed and it is only looked at as a genetic disorder of some kind. Like, does a kid really have ADD or is he just lacking a sensible breakfast and some good old fashioned discipline at home? Nah, just throw him on the meds cuz the FDA approved it. Horse****.
Nope, they've got licenses to forcibly inhibit others from entering the profession, keeping their salaries artificially high.
