Well Medicare would negotiate with the drug companies, the hospitals and the doctors. The costs would then be less than private medicine. I would argue that the country will go bankrupt under the present system, though I suppose you could eventually get say 100 million without insurance. This severe form of rationing might be sustainable by the economy.
Yeah, but not enough advertisement and really haven't synced up with an insurance company I believe. In fact, maybe someone can create a business model where they sell insurance a little cheaper, but most of the more expensive and long term procedures are exported to Indian and Mexico.
That still does nothing to address the cost curve. Agreed - the current system is on the way to bankrupting the country too.
I can't fix health care but here are things that can improve it. Allow most drugs like antibiotics to be sold over the counter like in other countries. Why do I need to go to the doctor all the time to get medicine for a chronic problem. Allow nurses to prescribe medicine and treat basic problems. If a nurse practitioner can do vaginal exams and set the treatment plan for my premature baby in the NICU, I don't see why other nurses can't treat other illnesses. Break up the "doctors union". Create more competition by producing more doctors. There are too many smart kids that get rejected from med school. Make health insurance mandatory. Like it or not we already have socialized medicine. When a person who doesn't have insurance gets sick, has a baby or has an accident, they can go to the hospital and get treated. Since these people normally don't pay the bill, the burden gets place on those who can pay. One of the reasons premiums are so high is because we have to cover the one third of people who go to the hospital without insurance.
It certainly does. When you have aproxiametely 30% less overhead and you pay less for drugs and medical procedures you reduce costs-- even the "cost curve".
All of these sound like good things to do. They won't be sufficeint if we still keep the useless insurance company middlemen with their 30% overhead for marketing, CEO salaries, profits for stockholders etc. but they would be good changes.
My opinions: -Tort Reform Lawsuit abuse is a big factor in rising medical care costs and is threatening future quality of care. Patients sue because they can't deal with the fact that sometimes bad things happen ("you didn't see my cancer coming several years in advance!") or with the same flimsy reasons plaguing any sector ("I turned my ankle while in your bathroom!"). No, I did not make those two examples up. Worse, hospitals many times settle cases in which they are in the right simply because it would be cheaper than contesting it, leaving the named doctors out to dry. Malpractice insurance soars, doctors are forced out of business. As annual malpractice premiums are counted in the tens of thousands of dollars and increasing out of proportion to "real" inflation of costs, that overhead has to be recouped, be it by the hospital or doctor. We have a looming crisis as baby boomers and fast food generations age with chronic self-inflicted conditions (diabetes, cardiovascular), interventionists are opting to retire early, and incoming doctors are steering clear of surgical/outlandish malpractice fields. Another side of this? Doctors/hospitals are pushing more tests (more cost) to cover themselves in case an unlikely event leads to a lawsuit. -ERs and Indignant Care Yes, the current proposal deals with this indirectly - national health care *should* deal with the issue of ER overcrowding with non-emergency issues and/or the uninsured. The unrecouped costs from this are enormous, and the stories are relatively well known: My own grandmother broke her hip in Dallas and waited 18 hours in the Medical City Dallas ER before being treated. Homeless that hang outside of Ben Taub until enough time has passed that they can go back into the ER to be "treated" for sham diseases. People that call 911 so an ambulance will give them a free ride to the hospital when they're feeling under the weather. MDAnderson (among MANY other hospitals) had to enact layoffs this past year, despite the perception that it should be economy-proof. One of the prime reasons MDACC went into the red after years of living above margin? Ike shutting down UTMB and sending its patients to MDACC. Absolutely the poor are entitled to medical care. But the laws on the books force hospitals to treat them as if they were charity and the numbers aren't adding up. Additionally, will non-citizens be eligible for a national healthcare plan? I'm of the opinion that expectations for medical care, and what everyone is "entitled" to needs to be re-examined. No one wants to be the villain accused of "healthcare only for the rich", but it simply isn't feasible for the full spectrum of health care to be free for everyone. Doctors incur hundreds of thousands of dollars of debt with their education and work 60+ hours a week - ask them to live with 80k a year in salary (leaving the 25+k malpractice out of it) and you're going to see a mass exodus. Similarly, what hospitals are going to buy Siemens' latest and great MR at a price tag of several million dollars if said hospitals are seeing heavy volumes of patients essentially on Medicare? Shoddy reimbursments eat away at the budget, capital expenditures drop, and suddenly it's not worth the money to Siemens to R&D a next generation of medical imaging equipment. Emphasis goes from improved image quality and efficiency to making equipment cheaper and more efficient. In the case of both doctors and medical technology, quality while be at least partially driven by profit....and there's nothing wrong with that. Better in this field than on Wall Street. I'd rather the carrot dangle in front of the people that save/better lives. And don't look me in the eye and hate a doctor for making $200k/a year when we all enjoy watching an 8 month basketball league where the minimum salary is $1M. Where I'm going with this - America has latched onto this (admirable, but naive) idea that medical care should be a 5 star buffet where everyone can buy in for $3. It makes no sense. This is a country where people are buying $300 cell phones and $2k HDTVs like they were crack, but cry human rights violations if they're asked to pay more than a $50 deductible for any sort of medical care. I feel that everyone is entitled to emergency Medicare and subsidized pregnancy care. I feel everyone is entitled to health clinic services. I don't feel that everyone is entitled to $30 deductible elective visits to specialists or $250 deductibles for elective surgeries. I feel that one of the very top priorities of health care reform should be the resuscitation and expansion of Medicare and the Gold Card program, not the creation of a new, more expensive and less thought out National Health Care. I feel that ERs should be given the legal freedom to refuse care to any and all non-emergency cases and send them to health clinics and minor ER operations. If the government wants a bold initiative, I would suggest a national system of Federally run and subsidized essential care hospitals. I would suggest that, like military medical scholarships, these hospitals provide medical school scholarships in return for 5-10 years of obligatory service following medical education. Sorry for the extended post.
This is exactly what people said in Texas - yet the results of capping malpractice awards, 6 years afterwards, have been decidedly mixed (at least for consumers). edit: also, btw, that study you linked too is pretty dubious, it's by the hard right wing manhattan institute/heartland instiute so that's no surprise,as they are blood enemies of the plaintiffs bar; otherwise it's very light on causation/correlation, it simply assumes many of its conclusions without making any effort to tie-in to them.
I haven't read the rest of your post but this is not the reason health insurance goes up. how do insurance companies make money, they take incoming revenue, invest, pay out claims. what has happened to equity, bond, etc markets over the past decade? all insurance has gone up for the exact same reasons edit: posted this in a thread two months ago I have a link to a study that debunks the malpractice claim. Its basic claim is that insurance overall leaped in the times that malpractice insurance leaped, because all insurance companies make their money on investments. so when the overall market is not returning as much on investment, all insurance rates jump. they have a few charts to back this up. They also match the the amount of money paid out during these period. The number of malpractice payments to doctors fell 16,682 in 01 to 14,441 in 04. The 04 number of actual payouts in 04 is only 5% higher than payouts in 91. * from source Now, this doesn't refute that fact that Malpractice Insurance is a leading cost inbeded in healthcare costs, it refutes the claim that more people are suing. but these number are interesting, unfortunately this is from 06, no recent data.
I'm not talking about health insurance directly - I'm talking about overhead costs for doctors and hospitals, which are absolutely passed on.
Malpractice premiums, defensive medicine (ordering excessive tests), and related care provider costs are high and frivolous lawsuits and excessive claims are a major reason why. Tort reform would help lower health care costs (and in turn health insurance costs/premiums). I stand by that statement, and I think you would find most physicians would as well. I'll agree to disagree.
no one says malpractice costs aren't going up, the reason isn't because of lawsuits the increase is in insurance costs across the board because insurance companies like everyone else have lost their arses in the market. they have to raise premiums to cover the loss in investments. no matter what those doctors say. the number of malpractice payments fail from 01 to 04. and sidenote, I'm not arguing with the rest of your post, lawsuit claim is a red herring
Regarding lawsuits, the number one problem is that the AMA and the various state licensing boards have done a terrible job at reprimanding doctors who screw up repeatedly. Too often, you see the same doctor screw up over and over again, yet nothing is done. These are the doctors that are responsible for the majority of all malpractice claims - I did a quick Google search and and read that between 3-5% of doctors are responsible for 50% or more of malpractice claims (percentages vary from region to region). That's ridiculous and suggests to me that the AMA and state licensing boards aren't doing their jobs. Normally, this is where the courts could come into play - a doctor who screws up over and over again should have a long legal record that any potential client should be able to access. Unfortunately, the system is set-up so that all parties benefit the most from confidential settlements - the doctor keeps his screw-up under wraps, the insurance company avoids court costs and the potential for a massive jury award, and the victim gets financial compensation without having to go through the costs and agony of a trial. The problem is that any future clients of the doctor aren't going to know that he has a record of screwing up - a confidential settlement keeps those details out of the public view. So the crappy doctor keeps getting clients even though he's clearly a quack. You could argue that confidential settlements should be done away with in medical cases, but I don't think you're going to get anyone to agree to that. So brings me back to the AMA and state licensing boards. As unpopular as it would be with doctors, I think they have to start policing themselves better. Any doctor who is sued should be forced to undergo a rigorous review by the AMA and state board. Past lawsuits should be taken into account and if a doctor shows a history of screw-ups, he/she should lose his/her license immediately. The state boards should also be vigilant against granting licensing to any doctor who has lost his license in another state. If they can start weeding out the bad doctors more effectively, there should be a drop in malpractice insurance. As for frivolous lawsuits, most attorneys on both sides will tell you that most frivoulous lawsuits are thrown out early on in the legal process. You naturally hear about the more outrageous ones, but they are anomalies. So tort reform won't make much of a difference in malpractice premiums because
The point about the lawsuits and tort reform is that we shouldn't really be fighting about tort reform now.- that's a scrum between the plaintiffs lawyers and doctors and insurers over who gets a pot of money - consumers don't really win either way (unless they are the victim of malpractice..) The's little to no evidence that costs that are now passed on to consumers are going to go anywhere but doctors and insurers pockets if they are eliminated, and furthermore, there's little to no evidence that tort awards are driving increased medical costs. In short, it's all a great big red herring, that interest groups are trying to tie to health care reform as part of their own agenda.
