I live in Charleston, South Carolina, which is a regional health care center with a local medical school and a lot of doctors, some of them my neighbors. So I hear a lot of doctors bitching about their professional lives. And that bitching generally comes down to a single argument: “I’m bringing home less money than I used to: if this medical system is so out of control, why isn’t my income out of control, too?”
One of my doctor neighbors who does a lot of surgery spends $70,000 per year on medical malpractice insurance premiums. I asked him if an extra $70,000 per year in income would stop his complaining. He said it would.
So let’s save him the money. The legal and financial costs of medical malpractice in the U.S. amounted to about $17 billion in 2005. That isn’t much compared to the almost $2 trillion total cost of healthcare, but divided among the nation’s 700,000 physicians it’s over $20,000 per head.
Ultimately we patients pay the cost of malpractice anyway through medical fees and insurance premiums, which amount to around $50 per patient per year. Why not handle it, then, the same way we do uninsured motorists on our car insurance policies? Throw on an extra $30-per-year fee (we’re cutting out the lawyers, remember? so the amount can be less than $50) to handle medical malpractice.
If your surgeon comes to work drunk and takes your wrong kidney, you don’t sue him, you file a claim with YOUR insurance company. Claims get a medical vetting but awards follow standard actuarial algorithms, which ought to both mean that true costs are covered AND the insurance company makes a small profit on your pain, keeping the system stable.
Lawyers in this system would limited to going after doctors for professional sanctions and non-monetary penalties like having their medical licenses revoked. As my old dean told me, “When there is no money people fight over turf.” So in a disconnected malpractice system the professional penalties are likely to get more stern, not less.
This is not intended to let the bad docs get away with malpractice, because they’d be quickly blackballed by health insurance companies refusing to do business with physicians who cost them extra money
Politicians like to talk about tort reform, which comes down to limiting lawsuits and victims going uncompensated. It doesn’t have to work that way. Let’s just change the game to one where bad doctors — not all doctors — are punished.
Bob – why does politics have to come in the way of change? Health care reform is something we absolutely need – how is it that a govt body cannot be created to govern, without bias, what’s good for the WHOLE nation not just the chosen few that make millions and are inturn protecting themselves by brainwashing almost half the country with bullcrap about govt taking over….. i mean, look at the idiots that voted for the Palin/McCain ticket off the strength of the factless crap they saw on TV.
We’re headed nowhere fast.
“how is it that a govt body cannot be created to govern, without bias, what’s good for the WHOLE nation?”
I present two arguments:
1) It is impossible for anyone, no matter how well-intentioned, to devise from the top-down a system to allocate needs and wants for hundreds of millions of individuals. There’s too much data, and aggregation only leads to aggravation for those who end up lumped into a broader category.
2) Ask yourself this: do you trust Party X to enact a sweeping degree of control, only later to lose it to Party Y?
Put in more basic terms: Had we had these healthcare reforms under Clinton, would you have trusted Rove and Bush to NOT tinker with health records for their own benefit?
Hell… Michael Moore would have done a documentary with registered Democrats accusing Rove of moving their medical appointments to Election Day as a sneaky way to suppress their votes.
>> 1) It is impossible for anyone, no matter how well-intentioned, to devise from the top-down a system to allocate needs and wants for hundreds of millions of individuals
That’s precisely what insurance companies do today, and keep the profit. Don’t kid yourself, or us, that there really is an Invisible (and Disinterested) Hand of Mr. Market. Read Krugman on markets and health. It’s obvious, but generally ignored. The insurance industry spends hundreds of millions of dollars influencing Congress. Who is doing the same for us???? You realize that the congressmen who have control of the committees are from small states and small districts, where the largess of the lobbyists goes very much further. Kindly remove your rose colored glasses as you move down the aisle of life.
Discretionary spending on toys can be left to manipulated markets, since toys are not necessary to life. Allowing manipulated markets, whether health or high frequency trading, to steal from the many to give to the few is fascism. Brown shirts and pale skin, anyone?
A further point. The health care market is not like the market in pork belly futures. Nobody says to themselves, “Hey the hospital is having a special sale on appendectomies today. Think I’ll go get me one to save some money.” So the argument in favor of high copays to prevent “overuse” of health care is phony. In addition, most consumers are not making the decisions based on choices presented to them. The doctor says, this is what you need, and that’s what they buy. The doctor may be making the best choice for you, or he may be making the choice that gives him the higher fee (I don’t think they all do that, but I’m sure some do). Then there’s the point that the insurance companies often decide what treatments are available to you, and even which doctors you can go to. I don’t remember the exact quote, but it goes something like, “I’d rather the faceless bureaucrat making decisions about my health care didn’t have a fiduciary responsibility to generate the highest profit for his shareholders.”
Besides which, doctors may bitch about their malpractice premiums a lot, but actual damage payments have become a tiny part of the overall health care cost. Could it be the insurance companies are ripping off the doctors?
An appendectomy is a false example; Yes, there are many health care decisions where there is now ability to make decisions on price. However, there are many more where people could.
Pharma companies wouldn’t spend a dime on TV advertising if it didn’t lead people to ask for medications that their doctor wouldn’t otherwise prescribe. That would be fine if you were directly footing the bill, but instead, insurance or medicare does, and the costs are spread out to everyone paying taxes and insurance.
If your doctor responded to your request by saying, “well, that one costs $500 and we don’t have enough history to know how good it is. This one, which is probably just as good (or maybe better) will cost you $50”, you’d probably choose the cheaper one. The same goes for many non-urgent procedures and tests.
Your position is counter intuitive and doesn’t even make logical sense in the slightest.
Let’s allow the medical system to become another bureaucracy, like Social Security or Welfare.
As we all know, both of those American run institutions are broke and constantly loosing money. The medical system will be the exact same thing.
Another pinhead liberal that thinks he’s the smartest guy in the room. Clearly Not.
The proposed single payer system accomplishes your goal of “fair malpractice” and universal coverage.
What do the Demint constitutes think about that 😉
Fortunately Senator Jim has his own blog,
http://demint.senate.gov/public/index.cfm?FuseAction=JimsJournal.BlogHome
DeMint sure seems to be a media whore. Not like he’s alone.
When ever I question why things are, I always quote “Bloodmoney”. Follow the money!
Why does politics or any of these tags: health care, health insurance, medical malpractice, medical reform, tort reform have to come in the way of our technology column?
Bob is just trying to divert our attention away from the fact that NerdTV Season 2 is STILL NOT HERE!!!!
Will tort lawyers now give to Republicans?
I think it’s a great idea, Bob.
how is it that a govt body cannot be created to govern, without bias, what’s good for the WHOLE nation not just the chosen few that make millions and are inturn protecting themselves by brainwashing almost half the country with bullcrap about govt taking over
Would you trust such a body if it were run by a Republican supermajority which decided that, say, abortion wasn’t a medically necessary procedure?
But here’s a hint: that exactly what Mussolini wanted. And Lenin.
The proposed single payer system accomplishes your goal of “fair malpractice” and universal coverage.
But has a considerably lower cancer survival rate, and denies people cortisone shots for back pain. (I’ve dealt with Canadian single-payer, for example: Ted Kennedy would have gotten steroids to reduce the immediate inflammation and directions on settling his affairs, instead of flying to Durham and having surgery that probably extended his life by a couple years.)
Lawyers in this system would limited to going after doctors for professional sanctions and non-monetary penalties like having their medical licenses revoked.
Bob, I think you’ve hit the nail on the head: that’s why no one is proposing this.
Charlie, I really ought to read further down in the threads. You hit my point exactly.
This is a point I am injecting into the arena now, as the proponents of single-payer are under the illusion that their good-hearted elected officials will always be in power.
It’s an interesting idea, but I’m not sure the final step works. No lawyer is going to pursue a case against a physician solely for the purpose of sanctions. They want to get paid. I should note I make no value judgment in saying that – everybody wants to get paid.
A better solution, perhaps, is to peel a dollar or two off that surcharge and redirect it to the state agencies that license and regulate physicians so they can improve inspections, expand their investigative practices, better vet med school grads and out-of-state applicants, and pursue professional sanctions more rigorously. Here in TX the state boards of medicine and nursing are so behind they can’t even process applications in a timely manner.
Brilliant. Unfortunately, the lawyer loving Congress will agree with the lawyer lobby.
Bob, All very logical. One problem though is that various groups of people in the USA look at the tort system in the same way they see the lottery. Their healthy kidney that was accidentally removed is worth a hell of a lot more than what some faceless actuary says it is worth. What you propose takes away the “winning” ticket.
@Jeff,
There is a very simple answer to this problem: you lose the case, you pay the other party’s legal bill. That would eliminate more than half the claims of malpractice. But the bar associations will never allow that to happen as long as they have Congress in their back pocket. Congress can be bought. Don’t complain about the insurance industry lobby when we allow everyone else to do it too.
What no one is willing to admit is that politicians no longer have our best interest in mind. If they did they would leave us alone, stop taxing us to death and get the $#&% out of the way. Health care is a service/good. Not a right. Rights cannot be bought (life, liberty and the pursuit of happiness, for example). The Founding Fathers understood this.
Besides, I see plenty of people who dismiss going to the doctor because they just don’t want to. It’s a pain (no pun intended) to take off work, schedule an appointment and deal with the hassle, not because they don’t have health insurance.
Government trying to do anything for us is always bloated and inefficient because there are no checks and balances to keep costs down. None. Private business (up until the bailouts) must keep costs in check. Government doesn’t care about that. Why should they? So when costs go out of control they either tax us at higher rates and/or print more money.
It’s not the party that’s in power, it’s the system that it has evolved into. Have we not figured that out by now?
I don’t think bailing out a doctor living in the most exclusive area in the entire state of South Carolina (who sounds like a whiny little bitch I’d like to drop-kick in the nuts) and allowing insurance companies to determine ‘fair’ medical malpractice payouts (very funny Bob) is the key to the nations health care woes. They, along with big pharma, the AMA (nothing but a lobbying group) and many others, are part of the problem.
Hobnobbing with the elite isn’t going to give you insight into health care Bob. Take a trip up 17/701 and visit the medical communities in Georgetown, Conway and Loris (where I live). Perhaps your views on health care will change.
Don’t want health care reform? Fine, I don’t give a shit. I have double, paid coverage. I just care about people who have little or nothing. What do you really care about?
Right on Robin!
There are 3 million people employed in the “health” insurance industry who act as gatekeepers to keep people from actually receiving health care they need. In order to “reform” our health care system bob proposes increasing revenue to doctors, increasing insurance profits and raising already exorbitant insurance rates even more.
Your solution to out of control health care costs is to make everyone pay more! Brilliant!
Btw If you are really sincere about reducing the cost of medical malpractice insurance then set it up as a federal program like flood insurance. Overhead and incentive to gouge doctors would be removed and congress would have a real incentive to create a program that would properly regulate doctors and institute reasonable payout limits.
One of my professors in college said sort of the same thing. “The fights [here among the faculty] are so acrimonious because the stakes are so low.”
The way I head it was “the knives are so sharp because the stakes are so low”.
I worry that putting enforcement into the hands of the insurers, to drop
providers from receiving payments as punishment for negligence, just
gives them cover for doing more cost-shifting to the providers, forcing
them to accept lower rates or wind up on whichever registry the com-
panies would maintain of blackballed providers, since they’d sorta be
ethically bound to share this information publicly, and if it ended up be-
ing as spurious as the Do-Not-Fly list–well, no harm to the insurers
I don’t know squat about torts, but, yeah,–it seems to me a case where
the patient has so much staked on the doctor but the doctor has so
little invested in each individual patient, monetarily, that you’ve got to
have a high-stakes adjudication system. Perhaps the way to keep the
payouts fair is to insist that the contingency-fee lawyers have some
skin in the game, too: Require that any damages awarded to the defen-
dant/respondent/whatever (provider’s side) in punitive recompense for
a claim that’s deemed frivolous be meted out in exact proportion to that
of the prospective payout the plaintiff’s lawyers were looking to walk
away with, so if the court finds for defendant, the lawyers, and not just
the relatively shallow-pocketed plaintiff, end up having to stand behind
the claims they bring, at least to the extent they intended to profit from
them. Not that this won’t come out worse for the titular plaintiff than his
lawyer, but at least there’d be some incentive for the defendant and his
insurers to fight the claim to see justice served, rather than just ruin the
gullible plaintiff
A solution could be had very easily:
If Congress had to live under the same laws and regulations they create for the rest of the country; no paid health insurance, no pension after serving ONE term, if, as a condition of election, they had to do their own taxes, by hand with a calculator, if they could only accept campaign donations from the area they represent… and just for the heck of it, as a condition of election, work for one year in a minimum wage fast food job or similar… We would see some substantive changes to more than just health care.
I’m intrigued to see you advocating a non-market system whereby awards are calculated according to actuarial tables. Is the flip side of this also part of your plan — that costs be calculated according to actuarial tables. That I could get behind and perhaps even expand to all fields of risk and adventure: in exchange for accepting a fixed and reasonable profit, you are entitled to the insurance of a fixed and reasonable risk. Sounds like the treasury notes for everyone :-).
I love it when Americans constantly tell me how superior their country is to mine in every way.
And, now, after ridding the world of nuclear weapons and curing cancer, Obama is going to give Americans free health care (maybe I got the order wrong.)
Anyway, another boring health care article, because, I AM CANADIAN…
Good luck America!!!
Martijn Koldijk – I’m pretty sure you’re Dutch (The Americans of Europe). Nice try in dragging the Great White North into your comment(s) though.
Ever heard of multiculturalism? Aside from the fact that naturalized immigrants from other countries do come to Canada, there’s also those who choose to give their children names that reflect *their* culture, instead of Canada’s. I know of Sandeeps, Boskos, Konrads, etc who were clearly raised (if not born) in Canada but have “foreign” names.
Nice try.
New Zealand has since the 1970s had a similar but much more far reaching scheme. The Accident Compensation Corporation (http://en.wikipedia.org/wiki/Accident_Compensation_Corporation) is essentially a mandatory government insurance scheme for accidental injury (including medical malpractice, workplace accidents, sporting injuries, home accidents). Part of the deal is that in general you can’t sue for injuries covered by ACC.
I think it has worked pretty well, although there are all the predictable problems to some extent: levies creep upward, coverage creeps downward, some people exploit the system, it can be bureaucratic, some injury related costs are met with largess, others not at all.
The only problem with such schemes, when looking for cracks for crooks to sneak through, is that poor people are more likely (how much is the only issue) to get sloppy medical service since there is that lower brain stem itch in providers: “well, if I screw this up, what’s the life wages of an aboriginal janitor (substitute local lower class citizen identifier)?”.
Beyond self-interest, this is why lawyers don’t like such schemes. Which motivation motivates most is up for grabs.
You body is in the US while your brain is in some completely imaginative country where your fantasies are more likely to be adopted by the people because they are actually intelligent.
Bob, if you want to know exactly WHY things never get done properly in the US, just read the responses here. You’ll see how much cohesion and cohesiveness there is on ANY bloody subject. If your own audience can’t agree (and it never does) how far do you think your “political” ideas will go?
The problem with just leaving it to insurance companies is that they get to be judges as well (which lawsuits to contest, when to raise premiums differentiating between accidents and malpractice etc). You also don’t want to discourage doctors from taking on the hard cases when bad outcomes are more likely.
There should be an impartial body that determines the difference between fate, accidents and malpractice being consistent and fair. However once you have that, insurance can be simply done by automated rules which doesn’t leave much scope for profit.
You missed something. Not only does your doctor pay malpractice/liability insurance, so does his/her practice, so do all the people who sell equipment and supplies to them, so does the hospital and everyone who sells to them, so do the labs, so do the drug makers… It goes on an on. Then there is the defensive medicine — the extra tests, the extra specialists, the extra medications. If there is the slightest chance there could be problem with a treatment, you’ll get preventative treatment for it.
Add up what is actually being paid for malpractice, and the insurance against future malpractice, and the fact everyone in the medical industry is heavily insured — then you’re talking about real money — and a LOT of it. I’d be willing it would be in the $1000 range, per patient.
My point is, if everything in the system is heavily insured, then we probably have massive redundancy in coverage.
A few years ago we had a HMO problem and were expecting a baby. I learned a lot about the business side of an OBGyn practice. The top 3 expenses are payroll, insurance, and business write-off’s. The business write-off’s are for patients who can pay or their insurance won’t pay. To my surprise the total dollar amount of each item was very close. The insurance cost almost as much as the doctors were making. And the doctors were writing off accounts payable of almost as much too. This particular practice had 4 doctors and they had never been sued. Almost 2/3’s of the doctors fees, didn’t go to the doctors. Think about that!
I love the idea of a patient oriented insurance. It could be like term life insurance — which, by the way is not very expensive. If you want better benefits, you can buy them.
John
The whole malpractice insurance market in the country is the 17 billion. Meaning that if you added up all of the malpractice carriers in the country and looked at their revenue, it is 17 billion dollars. Including hospital malpractice, nurses, etc. That is the entire system, not just the doctors.
Defensive medicine is probably worth three times that amount in waste.
Malpractice is super expensive for OBs because lots of ladies die in child birth, as well as children. And it is emotional and therefore awards are very high. It is in fact the highest of any profession. But that is not the norm for physicians. My father is a neurologist, and his malpractice is less than $3000 per year, because people do not sue when someone dies of Alzheimers. But if you are an OB or a Anesthesiologist, look out.
As far as it goes, the system Bob has is already in place in some states. California has a medical malpractice limit on tort claims – so the costs are limited in that way. So do many other states. Some states have pools to provide malpractice insurance for their physicians so that they do not get priced out and have doctors leave the state. Having a national malpractice carrier with a limited tort amount would be an inexpensive method of addressing this issue, but would still not change the way that doctors practice medicine. They are still going to refer down the street to the Lab that they have a 20% stake it.
As far as it goes, the comments about insurance company profits are pretty amusing. Microsoft made more last year than all the health insurance companies combined. So did Exxon, Chevron, etc. Total profits for health insurance companies was about 10 billion. When are we going to redistribute their profits?
New Zealand set up a Government corporation (the Accident Compensation Commission), as the sole provider of accident insurance for all work and non-work injuries for all New Zealanders and injuries incurred by visitors to the country. But – you give up the right to sue for personal injury.
It’s funded by levies against employers, self-employed people, earners, and motor vehicle owners and users. ( For more accurate information, see https://www.acc.co.nz/ )
Interestingly, some people and business entities here periodically suggest that we move to the US model, Bob. The grass is always greener on the other side…..
Bob, Sounds good to me. And if you dont have lawyers mucking up things, insurance companies, doctors & hospitals might be in a better position to work together to lower the rates.
I would want the possibility of a 3rd impartial party to refer to if things dont seem to be handled right. Like a panel of 3 medical experts and no lawyers allowed at the table. This panel would have access to the history/records of the doctor as well as the patient – things could get abused both ways.
If so many people desire a single-payer system, then why hasn’t such a system been already created?
Why democrats have not created a non-profit insurer with a network of hospitals and first contact doctors to which people would sign-up on a voluntary basis?
What exactly are people who don’t want government to meddle in their medical services providers are needed for?
53% voters voted for Obama, a bit more for Democratic congressmen, let them have a single payer system if they want it so much.
As the New Zealand example mentioned earlier, shows your idea isn’t radical enough, it should extend to other accidents as well. No more billion dollar suits for spilled hot coffee, the victim’s health (&disability) insurances picks up the cost. Attorneys can aim to retract licenses, close businesses etc. It seems to work in Europe too, except from a lawyer’s income point of view, which is why it will never happen in the US.
Once again, Bob, you propose a solution that is workable because of its simplicity! The tort lawyers in Congress would never let this bone go, though; more’s the pity.
Another possibility: binding arbitration and mediation. Hearings would not allow for huge jury-swayed awards that serve as lawyer-bait. All awards go to the patient. No lawyers are allowed at the hearings. Instead the service would appoint counselors to the doctors and patients.
I’m not sure why the insurance companies haven’t rammed through such a system already.
The answer is simple. Insurance companies are able to pass through all their costs. If they spend a lot of money on law suits, they can recover it through increases in their premiums. In a similar manner, doctors are able to do the same thing. Their insurance expenses go up, they charge more, and the system of mostly insurance companies pay them more.
If anything, paying more and charging more is good for their business. They make more each year and in the eyes of Wall Street, that is good.
For us it is bad. It is choking the economy.
The problem with medical malpractice is that it exists. I am a defense lawyer in Texas, I’ve seen it, and it exists. Doctors (like all other professionals and non-professional) do mess up and somebody else gets maimed for life. To answer your next question, state licensing agencies for doctors will not do nothing where professional errors are involved.
The problem is what do we do next. If the drunk doctor takes out the wrong kidney, why should his/her victim’s insurance have to compensate the victim for the pain and problems of being hooked up a machine for the rest of their (made-miserable) life? The idea of medical malpractice is to spank the medical profession into doing it right the first time. If a third party has to compensate the victim, the doctor has no reason to get better, get re-trained, get sober, or not do the same stupid thing again.
When my wife went in for knee surgery, she had an amusing conversation with the operating room prep nurse about what knee was being operated on. The result was a series of comments written on my wife’s legs –“operate on this knee” and “do not operate on this knee” — with indelible ink. What is so wrong about making a doctor and his insurance company compensate the persons the doctor wronged? What is so wrong about the victim getting some small sum of money to try to put them back where they belong had the malpractice not been done?
Some people forget that it isn’t just the plaintiff lawyers who live off the medical malpractice system. I have spent many years testifying as an expert witness for both sides and I agree that there is malpractice. I am also very aware that the damages determine which cases get to court. I’ve seen outrageous stuff that no one was interested in because there was no money in it and emotional cases that went to trial with almost no real liability except what someone like Senator Edwards could gin up out of acting ability.
We could do a good job of health care reform and I even have an analysis of what a model might be. What we have now in Congress is a lobbyist feeding frenzy. The good news is that the AARP and the AMA will both lose what credibility they have left for selling out their members to feed at the trough.
If you’re interested in my ideas, they’re at http://abriefhistory.org/?p=400
Earlier this year I had minor surgery. So far the bills have reached $21,000 (USD). In the detail between the lines of the bills is a lot of insurance costs. There has to be a lot of redundancy in the coverage. I like the idea of having a single fund to cover liability issues. It gives me visibility to that cost and I am paying for it only once.
As for the doctors, yes there are mistakes and incompetence. Many years ago the chemical industry was at the same cross roads. Things were being released into the environment that shouldn’t. Insurance paid the damages. Nothing changed. The releases kept occurring. Then the government issued new rules that made it a criminal offense. The plant manager and company management could be held responsible, tried, and imprisoned. This put the fear of [you know who] into them and there are now a lot fewer accidental releases. My point is this — we can do a lot better job weeding out bad health care personnel (they shouldn’t be called professionals). If there were more serious legal consequences, that would help. We need to improve how people are licensed, and how medical standards and boards operate. Right now a doctor can lose his/her license in one state, and set up shop in another state. This needs to be stopped. If we computerized medical records properly, checks could be built into the system to audit treatments. Questionable practices could be identified, medical review boards could investigate, and maybe many problem doctors could be weeded out before anyone is hurt. If someone gets hurt, then the doctors have big problems.
Clearly getting caught messing up and paying a big insurance claim isn’t clearing out the bad doctors.
A couple of comments: Your $21,000 bill probably has little to do with the amount your insurance actually paid. Most of these incidents are covered by contracts where the carrier may pay as litle as 20% of the “retail” charge. If you have 20% deductible insurance, you pay more for your 20 % than the insurance company pays for its “80%.” Medicare is even worse. We need to get back to a cash health care economy with real prices. If your doctor tries to give you a break by charging you the real price for your surgery, maybe you don’t have insurance, if Medicare finds out, he is in big trouble.
The state medical boards are mostly assigned the most junior lawyers to handle license cases. I was an expert witness for 30 years. It was a damned frustrating experience. I won’t bore you with the stories but, the worse the crook, the less chance he would be disciplined.
America is such an interesting place. We expect perfection from our doctors but shrug our shoulders when elected leaders launch a war on mistaken intelligence or spend a trillion dollars on phony economic stimulus. Of course once one realizes that a vast majority of policy makers are lawyers is makes perfect sense why they have immunity for their mistakes but seek punitive judgments against everyone else for theirs.
I am a physician (pediatrician) and registered Democrat. Go figure. There is an oft-repeated error in the argument. The cost of medical malpractice is NOT the malpractice premiums. Currently I do make enough to pay my premiums which have trippled since 1994. The cost to the nation is the vast number of studies, imaging, labs, etc that doctors order just to be able to say, “Yes your Honor. I did consider that 1/2 of 1% risk so I ordered x twice just to be sure to comfirm my impression….” It is very hard to separate out the “defensive” medicine from “the best medicine”. We have been doing this for years – and it is now the “standard of care”. So it is expected that we do this. I can’t tell you the number of needless labs and x-rays and CT’s and MRI’s I see ordered when people go to the ER. And X-rays are cummulative – some studies show head CT’s are not benign. They have costs in money and radiation exposure. There are good docs trying to do the right thing, but when they hear of a 217 million dollar judgement against an ER doc for diagnosing sinusitis in a 49 yo who ended up with a stroke, you can bet there will be lots more CT’s ordered. (the sinusitis could have caused the stroke….)
This is not an easy problem. It requires a bit more thought than what the country can muster in the middle of a financial mess. Although the Health Reform scares me (good intentions are always dangerous when done with a nuclear bomb) I am more scared of the Carbon Cap and Trade bill…. A carbon tax would be much cleaner and less susceptable to graft.
The only problem is, in order for the doctor to get his extra $70k a year then the public have to not only pay extra on their own insurance but also keep paying the money that they pay now for medicare which goes on malpractice insurance. If each person pays $30 more for insurance and $30 less for treatment then the money that you count on as going to the surgeon isn’t there to give to them.
There is no reall difference than just increasing the cost to the consumer of health care by an extra $30 at the hospital end and paying the surgeons more out of that.
Bob, it’s a good idea, and something similar was implemented in the U.S. years ago to address a similar problem, that being workplace injuries. Before the advent of worker’s compensation legislation, you had to prove your employer was negligent before you could recover. Treat medical injuries the same as workplace injuries. Take proving negligence out of it, and you have fair recoveries based on actuarial and other standards without excessive legal intervention. Start something new and Americans will squabble, but expand an already existing program and it’s harder to dispute. Worker’s compensation simply works–and attorneys aren’t completely out of the picture either, though most cases are resolved without attorneys. It would be trivial to bring medical injuries within the scope of worker’s compensation laws, and that solution would drastically reduce physician’s premiums.
Tell your doctor neighbor to move down to Florida, Bob, where there is no malpractice suits allowed, as someone close to me found out the hard way. Mistake in surgery, nearly died, lost a year’s work and can hardly work anymore. Can’t sue. Yet somehow I think FL medical practitioners will also complain that they don’t make enough (welcome to average men’s world).
Doctor: “My malpractice insurance has tripled in the last 15 years.”
Worker/Employer: “Our health premium has tripled in the last 15 years.”
Patient: “My waiting time and drug costs have tripled in the last 15 years, and yet I’m not getting any better.”
Wall Street: “We love investing in these publicly traded hospitals, insurers, and pharmaceuticals. Their value have tripled in the last 15 years.”
That is the American Way.
One of the things hanging over the head of medical professionals is this constant threat of lawsuits. I’ve known a few and that was the thing they complained about most, how it affected the WAY they cared for patients. They were instructed to say things a certain way, to go through almost ritualistic behavior to make sure that the were covered. And they said, and I’ve experienced, the result of this: they feel like cold automatons a lot of the time.
Patient care includes sympathy and understanding, but this is blunted when the fear of lawsuit makes you afraid that saying “I’m deeply sorry” could suggest some sort of complicit admission of guilt.
It may sound strange, but removing this pressure, beyond the financial question, would reduce stress for them, and I think it would increase the quality of care we get because they could just do their job instead coping with the idea that their livelihood could be ruined by frivolous lawsuits.
Let me point out the annual $17 billion malpractice cost figure is just the direct cost. There is the indirect cost of defensive medicine to avoid malpractice claims.
If you are going to count the indirect costs of defensive medicine (a fair point), you will also have to count the indirect benefits of a penalty for mistakes. Doctors are no different than other people and can be very sloppy. A number of studies have found a high number of mistakes in hospital treatment.
An interesting idea, and already done in the UK. The NHS insures its doctors for malpractise, and the vast majority of UK citizens use the NHS. Every time the Americans discuss healthcare I think thank God for the NHS. Frankly its bloody brilliant.
Last Sunday I went to hotel, prior to a Monday meeting. Forgot my medication. Disaster! Rang NHS direct. That was 9.30pm. At 10.30pm I spoke to a doctor. At 11.30 the taxi arrived to pick me up to my 11.50pm (that is to say ten to midnight) appointment with the doctor. At 11.55, medication in hand, the second taxi picked me up to get me back to my hotel. Arrived back at 12.15 in the morning. And no, its not a sexy exciting illness, its just chronic asthma.
I didn’t pay for the medication, or the taxi directly. I do pay taxes, so does everyone else. Being fair I did pay around £4 ($6-ish) for the other bit of the prescription that they didn’t have in stock as the dispensary closed, but I didn’t need that until the next morning. Of course had I wished the taxi would have taken me to the 24hour chemists as well, on the way back, as part of the fare.
All the panicy fear-laden arguments (I mean, really, Mussolini? If that’s the problem with a government created scheme then your nation already has vastly bigger issues than healthcare) come down to this – the fear that America cannot make work what other nations already have.
I am SOOOOOO jealous.
One time, I was not working and lacked insurance. I ended up going to the public hospital emergency room to deal with a finger that I had jammed hard, and was swollen for a couple weeks and hurting a lot. I thought it might be broken. After around 12 hours of waiting, I eventually got to see a doctor, who had it x-rayed. It wasn’t broken, but he had it immobilized, and also prescribed some simple exercises to loosen it up. The visit wasn’t too expensive for an ER visit – $120, subsidized by the government.
See, we have socialized medicine in America too!
[…] I, Cringely » Malpractice Makes Perfect. A great example of a way to reduce the cost of medical care without involving the government. Just taking people’s money via taxes and giving it away to those deemed “worthy” by the “authorities” isn’t going to solve the problem. This is a much better–albeit not perfect–option. […]
I’m sure my insurance company will be perfectly willing to pay when my doctor messes up.
Bob, This is a TERRIBLE IDEA.
#1 Insurance companies don’t like paying claims. Their incentives run contrary to consumer interests. They’ll try to make the minimum payouts possible.
#2 Medical malpractice is an area where there is a lot of gray area and a lot of opportunity for administrative obfuscation. Insurance companies have little incentive to go through the lengthy and costly process of investigating medical malpractice claims. If the case is non-obvious, they will deny.
#3 Medical Malpractice Lawyer’s want to maximize payments to themselves, by maximizing payments to consumers. In other words their incentives are aligned with consumer interests. Perhaps TOO well aligned, but one of the few areas in medicine where the incentive alignment is going in the correct direction.
#4 Lawyers have every reason to try to uncover medical malpractice despite the best efforts of doctors and hospitals to cover them up; By subpoenaing records and deposing witnesses.
#5 As you note, Tort reform is not that significant(less than 2% of overall costs) Despite conservative moaning about Tort reform as health care reform, it will be as effective at minimizing health care costs as earmark reform is at minimizing national debt.
Good luck getting the trial lawyers to agree with that. John Edwards made ten million in two years suing doctors. Trent Lott is brother in law to a big trial lawyer.
I think you are understating the cost of malpractice to patients. It’s not the insurance, but the extra tests given to protect against malpractice. Many more C-sections are done now just in case.
For the whole article go here:
http://blogger.huffingtonpost.com/mt.cgi?__mode=view&_type=entry&id=91781&blog_id=3
For the segment of interest to your doctor friend:
IT IS IMPOSSIBLE FOR DOCTORS TO BE PERFECT, MECHANICALLY OR MENTALLY IN THEIR DECISIONS, ALL THE TIME. THE HUMAN BODY IS STILL TOO COMPLICATED TO DEMAND PERFECTION FROM PEOPLE EVEN THOUGH THEY SPEND NEARLY TEN YEARS GETTING TO THE POINT WHERE THEY START TO PRACTICE. EVEN GOOD DOCTORS MAKE MISTAKES AND CAN BE SECOND GUESSED. HEART SURGEONS GET PATIENTS WHOSE LAST CHANCE TO LIVE DEPENDS ON THE DOCTOR PERFORMING A MEDICAL MIRACLE. SUCH TALENT SHOULD NOT BE LOST WHEN THE PATIENT DIES ON THE OPERATING TABLE; SOMETIMES WHAT IS OBVIOUSLY A “NO CHANCE” PROCEDURE GETS GRADUATED UP TO “NOTHING LEFT TO LOSE SHOT“ WHICH SOULD BE MADE CLEAR TO THE PATIENT AND RELATIVES OF SAME.
I WOULD IMMUNIZE ALL DOCTORS FROM MALPRACTICE SUITS, provided doctors would throw the well known bums in their profession out. No more restraints of trade suits. Gone. Just like the incompetent doctor. If doctors do not live up to their end of the bargain, the world can always go back to the old way. Sue or be sued. And as a professor in college once lectured to my organic chemistry class: SCIENTISTS PUBLISH THEIR MISTAKES, DOCTORS BURY THEIRS. That will remain the same.
Doctors would start a fund, say twenty-five cents–or some nominal sum–for every patient they see in the course of their practice, every time they see the patient, and such money collected would go ONLY to pay for the medical expenses incurred in trying to make up for the MEDICAL harm any doctor had done in treating a patient. Thus, doctors would be hiring other doctors to correct, if possible, or alleviate as well as could be done, for what might otherwise have ended up as a malpractice suit. NONE OF THE MONEY WILL BE USED TO PAY FOR MENTAL ANGUISH AND PAIN.
For people who feel abused for not being allowed to sue the doctors, I suggest that INSURANCE COMPANIES offer policies to the PUBLIC that allow collection of monies to compensate for pain and suffering and loss of income and whatever else the INSURANCE COMPANY wants to offer. This way PEOPLE can hire LAWYERS to sue the INSURANCE COMPANY, go to court or settle out of court, BUT THE DOCTOR(S) INVOLVED WITH THE PATIENT WOULD NOT BE THE OBJECT OF THE SUIT OR NEED TO PARTICIPATE IN IT.
Until we as a nation decide that we will teach our children that the American dream is not greed and acquisition of material, and that government BY the people and FOR the people rather than by the rich and for the corporate interests, and doctors remember what the Hippocratic Oath is, and that government is not evil when it is competent and effective, then we are destined for third-world status with ignorant dolts leading the way. Both political parties are full of these dolts and the real change we can believe in will be throwing THEM out of office and a true progressive majority taking their place. The current “reform” process is simply rearranging the chairs on the Titanic, something Congress has become adept at…
Did your sawbones tell you if his malpractice carrier has had to go to the mat for him. I’ve been
poorly treated by many doctors in my lifetime and have never considered suing any of them.
On the other hand, the behaviour of some hospitals and the way they go to the extreme to
save an extra buck or not properly train their personnel borders on criminal neglegence and is totally a another matter.
There are some great ideas in this article, and this could happen very quickly in the private market. Something like this:
* New insurance company offers plans at lower rates and the contract waives all rights to sue the doctors, and the malpractice payout algorithms are disclosed.
* Doctors agree to accept this plan and charge lower fees accordingly
* Malpractice insurance companies reduce charges to doctors based on the percentage of non-tort patients he has
* Patients just have to call 1-800-TORT-FREE to sign up.
* Some patients won’t like the algorithms of 800-TORT-FREE and chose another company’s plan based on their algorithms.
Everybody participates voluntarily and, as you show, the efficiencies are there. I’d jump at this.
But, wait, our governments make this kind of competition illegal.
We sure do need government healthcare reform – in the form of getting out of the way.
If they prefer in-person, then you can consider other ways to provide an in-person experience while minimizing cost considerations. ,
the healthcare song
https://www.youtube.com/watch?v=xyDcfbebbtw
The lyrics reflect experiences of folks I know who either work in the
healthcare industry or have experienced firsthand the frustration of dealing
with HMO’s
The song is intended to be a call to action for the folks who will be
affected by the healthcare legislation being considered by congress
To that end these links are provided so people can contact their
congressional representatives andor the president to voice their thoughts
on what healthcare legislation should include and if applicable what it
should not
Contact your congress rep andor the president today while there’s still
time to have your say and let’s put the care back in healthcare
to contact your congress rep
https://www.congress.org/congressorg/directory/congdir.tt
the president
https://www.whitehouse.gov/CONTACT/
I read a really good blog post I go ahead and do a few things:1.Forward it to all the relevant friends.2.Bookmark it in some of the popular sharing sites.