Big Blue Interactive The Corner Forum  
Back to the Corner
 

Archived Thread

NFT: Healthcare

GiantsUA : 3/19/2017 8:39 am
Interesting op/ed from a Finnish transplant.


Healthcare other western countries vs. US - ( New Window )
Pages: 1 2 3 <<Prev | Show All |
I'm a surgeon and I've worked in  
Jerz44 : 3/19/2017 5:58 pm : link
Both the American system and an international universal system.

I think the biggest impediment to a universal plan here is the expectation of your average American. I think most people want free healthcare, but they still want the best healthcare in the world, and they don't want to wait for it.

In Australia, which has both 'free' and private insurance, the Australians are morally comfortable with a two tier system. Those who get their care for free are ok either waiting months for care and/or having no say who their doctor will be (you don't have a doctor; you have a hospital. Whoever is there that day can do your surgery and it is likely a different person from who told you you need surgery).

And it's always bandied around that "by most metrics" American healthcare is worse but that's not really true. It depends on how you're ranking and which factors you're looking at. In terms of response time and cure rate for most cancers, for example, America is way ahead.
RE: for those wondering about Medicare...  
steve in ky : 3/19/2017 6:06 pm : link
In comment 13399211 Alan in Toledo said:
Quote:
I'm just one person who's been on Medicate and the AARP supplement since I turned 65 in 1999.

A friend talked me into opting for a Medicare PPO not long after signing up. It was a mistake that I corrected after a year or two. Even though I saved a fair amount of money, the care wasn't acceptable.

The Medicare/AARP combination is the bomb -- the absolute bomb.


If you don't mind me asking what company did you use when you went with the PPO?
I'm hoping that this is becoming a situation  
Mike from SI : 3/19/2017 6:24 pm : link
where citizens on both sides of the political spectrum move towards "f*** ideology, just get a good system that works for everyone." That's pretty much where I am right now.
Major cost drivers in healthcare  
family progtitioner : 3/19/2017 6:47 pm : link
are drugs, which I don't know what to do about and hospital/end of life care. I'm a physician as well.

In my experience, the entire nursing home, rehab, hospital chain in broken and needs to be fixed. I can't tell you how many times we'd see admissions to the hospital of nursing home patients who are chronically ill, demented with poor quality of life to begin with. Then they get treated in the hospital, for a small fortune, and sent right back to the nursing home to begin the nursing home/hospital cycle anew. Of course they end up dying anyway in 6 months or so after suffering through the American hospital system. A huge strain on resources and, to be frank, a massive waste of public money.

Then there's the chronically ill elderly who enter the hospital for whatever reason and can't make it back home safely. They then go to rehab to "get strong" but of course get sick again in the rehab and go right back to the hospital. Costs upon costs upon costs all without improving anyone's quality of life or even prolonging it.

This country has a serious issue with accepting the end. Whether that means death or surrendering to the fact that your life as you knew it has changed drastically. Things are better since I began practicing with the advent of palliative care and more widespread use of hospice, but there's a long way to go.

I became so disillusioned with the system I actually left my private practice of 15 years recently and took another position to get away from it.

What can be done? Death panels? Of course not. Better education re end of life issues? Education would be a start. In med school they taught how to prevent and treat disease but barely anything about palliative care and end of life discussions. I had to learn on the job.
Learning a lot here. Thanks. Great posts.  
drkenneth : 3/19/2017 6:58 pm : link
.
My thoughts...  
EricJ : 3/19/2017 7:00 pm : link
before we can fix any of this, we need to get our arms around the increasing costs. I am talking about the cost for meds which is like legal mafia and the ridiculous mal practice law suits which drive up insurance costs for the physicians which eventually gets passed down to us. Finally, we have too many people who don't pay into the system and just walk into a hospital when they need urgent care. These costs contribute to the high cost of healthcare.

Until you fix these things, no plan is going to work well.

Unfortunately our government cannot afford to just give everyone free healthcare OR at a fixed cost no matter who you are. Not unless we begin raising that money other than from our own tax payers.
Steve in KY  
Alan in Toledo : 3/19/2017 7:02 pm : link
If you don't mind me asking what company did you use when you went with the PPO?

Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).
as a physician  
snickers : 3/19/2017 7:20 pm : link
Interesting point of view but one which can not be easily solved. Our population is aging and treatments and costs naturally rise with the aging patient. The improvement in palliative care and its expanded use is long overdue. This said, the number of physicians comfortable in this area are few and far between. I agree that patients expectations are in many cases exaggerated. Some of this is due to poor communication on the part of the mds and often unwillingness to lay the cards on the table. In my practice, I have usually been forthcoming with prognosis from the first visit lest the patient think that everything will be fine.
We expect too much and because of this our first reaction when things do not go as planned is to seek a lawyer. This endless game would be mitigated if there were not so many false hopes created by pharma, mds and others intimately involved in the health care system. We need to look at what we do and do it without fear that if all is not done, we have failed. Patients need to understand that we have a finite life span and that a point is reached where there is nothing to be gained. End of life care is important and the Europeans certainly are much farther ahead in their vision than we are in this country. Their acceptance of end of life care and its implications in terms of care provided are a model we should emulate. I believe that we must look carefully at our elderly and the care we can provide. Someone has to have the fortitude to tell patients that there is little to be gained by ongoing treatment. Only then can we accept the idea that end of life care has a real place in our health care system. This is a prickly issue but one deserving of our leaders time.
RE: Steve in KY  
ctc in ftmyers : 3/19/2017 7:28 pm : link
In comment 13399262 Alan in Toledo said:
Quote:
If you don't mind me asking what company did you use when you went with the PPO?

Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).


Alan

Turning 65 this month and went with the AARP United health plan. That the one you have?

All my cardiac issues are covered by workmens comp for a fyi.
RE: RE: I always find it interesting that  
section125 : 3/19/2017 7:39 pm : link
In comment 13398790 M.S. said:
Quote:
In comment 13398764 rebel yell said:


Quote:


these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.


Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.


Why do you think gasoline costs $8 per gallon in Europe? The extra $5 per gallon is tax to pay for social programs.

Ain't nothing free and Doctors don't make the money in Europe, ours do.

I wouldn't mind a single payer system, but I don't think you would like to find what that costs in the USA.
Love the myth  
XBRONX : 3/19/2017 7:48 pm : link
about malpractice reform. Just look at Texas
RE: The relevant part of Medicare is not the degree of coverage  
Sarcastic Sam : 3/19/2017 7:54 pm : link
In comment 13399059 Overseer said:
Quote:
(although 80% is substantial).

The relevant part is that the coverage is guaranteed. It can be counted on. That’s what its enrollees value about all else. This guarantee does not exist pre 65.

Sam has a history of being unable to discuss this subject in a fair-minded manner. He has stated that he is a specialist, which is wonderful. However his paramount concern has clearly been physician remuneration (hence his kneejerk aversion to Medicare & single payer in general which don’t pay like Cigna et al).

Now, the good physicians should of course be sufficiently and fairly compensated, but it is empirically true that outrageous price gouging and the pushing of often unnecessary fee-for-service care by them & their administrators is a massive part of crippling health care spending in the USA.


Geez.

I'd love to hear examples of how I'm not fairminded about the subject. We're all opinionated about the subject... some more than others. Based on my experience as a physician, I believe and have repeatedly argued that much of the problems with health care would not be solved if we did away with private insurance.

Medicare, while reimbursing less than many private plans, does tend to pay relatively quickly. My main issue with Medicare/Medicaid is the blatant bullying that CMS lays on the health care provider, and the factless blaming of physicians for the rise in health care costs. In that vein, we now have a preposterous train ride of acronyms to measure health care "quality"... P4P, PQRS, APM, MIPS, MACRA, etc. All of these, mandated by either ACA or CMS, all of which significantly burden health care providers for no good reason than it sounds good to the public. I started practicing in September of 2015. I was then penalized 2% by Medicare because I did not submit PQRS statements for all of 2015. Well, I wasn't practicing medicine for 8 months out of the year. Of course, I have no recourse.

Let's look at the overall physician cost burden to healthcare. I might get paid $200 for a procedure done in the hospital. The anesthesiologist charges $1000 but I don't know what they actually end up collecting. The hospital collects $4000 for an ambulatory procedure. The same procedure would cost less than $2000 at an ambulatory surgery center, but they're not credentialed for that particular insurance plan. The difference is taken up by the hospital CEO to pay for their overhead. Which begs the question... why aren't people looking at the hospital books to see where all those healthcare dollars are going?

It's just easier to point a finger at doctors who order useless tests (that I don't get paid for, but OK...) and useless procedures (even though for most procedures, I'd get paid more if I stayed in clinic than in the OR).

But Hollywood needs it's villians....
RE: Love the myth  
section125 : 3/19/2017 8:00 pm : link
In comment 13399305 XBRONX said:
Quote:
about malpractice reform. Just look at Texas


It is not the savings that people think (2%?), but it is a cost and many little cost do add up.

Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.
End of life treatment variation  
trueblueinpw : 3/19/2017 11:18 pm : link
I know there's some disagreement about the overall impact of end of life treatment as a percentage of total healthcare cost (see article linked below). But I also know there is extraordinary variation in the cost of end of life treatment across states. New York, I believe, spends substantially more than almost any other state in the union. And this probably goes to any number of points made by our BBI physicians. Some people have unrealistic expectations about chronic and fatal illness. I did notice in the linked article that end of life cost are inordinately high among Medicare and Medicaid.


End of life care costs - ( New Window )
RE: RE: Love the myth  
EricJ : 3/20/2017 7:49 am : link
In comment 13399317 section125 said:
Quote:
In comment 13399305 XBRONX said:


Quote:


about malpractice reform. Just look at Texas



It is not the savings that people think (2%?), but it is a cost and many little cost do add up.

Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.


Let me add to this...
The obstetricians are getting absolutely killed with malpractice insurance rates. It may be the highest of all medical doctors. Roughly 10 years ago the Obstetricians in NJ had some kind of march in Trenton about this. Huge numbers of them are now out of business and are working in some kind of clinic instead of their own practice.

What I was referring to before was not just putting a cap on malpractice law suit awards and hoping that insurance rates fall. I am talking about also regulating that insurance just like the government does with PMI. For those of you who have ever gotten a mortgage with less than 20% down and ended up with PMI... that insurance premium is regulated nationally and not at the state level.
RE: RE: Steve in KY  
Alan in Toledo : 3/20/2017 8:43 am : link
In comment 13399291 ctc in ftmyers said:
Quote:
In comment 13399262 Alan in Toledo said:


Quote:


If you don't mind me asking what company did you use when you went with the PPO?

Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).



Alan

Turning 65 this month and went with the AARP United health plan. That the one you have?

All my cardiac issues are covered by workmens comp for a fyi.


Exactly. My wife and I both have Plan N.

BTW, despite my handle I'm now living in Sarasota.
RE: RE: RE: Steve in KY  
EricJ : 3/20/2017 8:51 am : link
In comment 13399560 Alan in Toledo said:
Quote:


BTW, despite my handle I'm now living in Sarasota.


Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.
This thread has a lot of great posts  
njm : 3/20/2017 8:54 am : link
Congrats to most on not sinking into the sewer. A couple of points:

* As many have said, end of life is a large driver of costs and there's no easy solution/

* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?

* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.
RE: RE: News flash:  
Mr. Bungle : 3/20/2017 9:07 am : link
In comment 13398896 BigBlueinDE said:
Quote:
In comment 13398768 Sarcastic Sam said:


Quote:


European transplant reminds America of European superiority. News at 11.



Exactly. My interest in what this European blowhard has to say is between zero and none.

That's called closed-minded.
RE: RE: RE: RE: Steve in KY  
Alan in Toledo : 3/20/2017 9:22 am : link
In comment 13399563 EricJ said:
Quote:
In comment 13399560 Alan in Toledo said:


Quote:




BTW, despite my handle I'm now living in Sarasota.



Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.


Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
RE: RE: RE: RE: RE: Steve in KY  
EricJ : 3/20/2017 9:28 am : link
In comment 13399608 Alan in Toledo said:
Quote:


Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.

ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?
RE: RE: RE: RE: RE: RE: Steve in KY  
ctc in ftmyers : 3/20/2017 10:45 am : link
In comment 13399613 EricJ said:
Quote:
In comment 13399608 Alan in Toledo said:


Quote:




Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.


ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?


EricJ

Your power company would be Lee County Electrical Co-op. I attached their link so you can get the price per KWh.

Alos they just opened up the first sustainable solar city in the US on 31 called Babcock Ranch.

https://www.babcockranch.com/town/

Link - ( New Window )
RE: This thread has a lot of great posts  
Deej : 3/20/2017 11:00 am : link
In comment 13399567 njm said:
Quote:

* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?



"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.

And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).

The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.

[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]
RE: RE: This thread has a lot of great posts  
EricJ : 3/20/2017 11:30 am : link
In comment 13399717 Deej said:
Quote:

"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.


I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.

There is a scumbag at my gym...  
EricJ : 3/20/2017 11:32 am : link
an older guy. He is really smart. Ask him a question on any topic and he can give you the answer. Could probably clean up on Jeopardy. However, he chooses to spend his life trying to scam people. He has an attorney on speed dial with multiple law suits going on at the same time. Mostly mal-practice (that are hard to disprove) as well as injury law suits. The shit just has to stop or be controlled.
RE: This thread has a lot of great posts  
Deej : 3/20/2017 11:34 am : link
In comment 13399567 njm said:
Quote:

* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.


There is probably something to this. However, a few things undermine this. Most importantly, drug companies have a staggeringly high profit margin compared to other industries. Now some of that is totally deserved due to risk. But it's tough to say that US patients are subsidizing ex-US patients when what is more likely is that US patients are just providing outsized returns to drugcos.

And second, there is a lot of R&D at pharmaceutical companies that is of questionable social value. E.g. developing the 4th pill in a class, where it shows no improvement over existing drugs. Or worse, turning a 12 hour pill into a 24 hour pill and getting a whole new patent. Or isolating the left/right isomer of an existing drug and getting a patent just on that isomer.
RE: RE: This thread has a lot of great posts  
njm : 3/20/2017 11:34 am : link
In comment 13399717 Deej said:
Quote:
In comment 13399567 njm said:


Quote:



* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?





"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.

And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).

The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.

[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]


How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.
RE: RE: RE: This thread has a lot of great posts  
Deej : 3/20/2017 11:42 am : link
In comment 13399759 EricJ said:
Quote:
In comment 13399717 Deej said:


Quote:



"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.




I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.


"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
5 billion in direct to consumer Pharma advertising doesn't  
Heisenberg : 3/20/2017 11:45 am : link
help our drug costs either.
RE: RE: RE: This thread has a lot of great posts  
Deej : 3/20/2017 11:48 am : link
In comment 13399769 njm said:
Quote:

How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.


1. No one is talking about punitive damages when they refer to tort reform. The debate is non-economic damages, ie stuff other than out of pocket costs and lost income.

2. Declare your skepticism all you want, it's what study after study shows. Bigger picture, insurance across lines are not as tied to claims as one would think. Much higher correlation to stock market returns.

3. You last point is just a rejection of the idea of punitive damages generally. It's not wrong to think that (Im not much in favor of them), but our law allows them. Im not sure why we should single out doctors for special protection from them.

4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.
RE: RE: RE: RE: This thread has a lot of great posts  
njm : 3/20/2017 11:54 am : link
In comment 13399798 Deej said:
Quote:


4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.


My point was that should change.
Medical licensing boards are changing  
WideRight : 3/21/2017 9:44 am : link
but not for the better....

They are under tremendous legal threats, from those people whom they should be punishing.

Denying a license to an individual who has significant means and whose livelihood depends on it creates an adversarial conflict that is a fight to the death. The afflicted have no reason not sue until there is nothing left, and there a plenty of lawyers that will take the case, challenge all the facts and ultimately the equanimity of the board and its right to deny an individual his/her right to practice. Medical boards were made to grant certifications and generally aren't very well prepared, nor organized to take on too many fights. And not fighting them all is poor jurisprudence; once that's established then the whole board can get blown up. So they concede too often, mostly for the purpose of self preservation.

Basically they are getting killed by the people they should be stopping.
Nice work on this thread  
RobCarpenter : 3/21/2017 10:03 am : link
Lots of great comments here.

My thoughts are that the main reason healthcare costs more in the U.S. than in other countries are: prices and volume.

On prices, the prices are much, much higher in the U.S. And not just drug costs, which are way higher here. Do you think surgeons make $400K in Europe?

On volume: Rates of MRIs, other imaging are higher here than in Europe. Paying for volume just increases spending, in other countries the care is more 'controlled', let's say.

With respect to the overhead/profit argument on Medicare -- much of Medicare is administered by contractors, notably the Medicare Administrative Contractors (MACs). The MACs are the ones that process the claims on behalf of the government (except for Medicare Advantage enrollees -- Medicare pays plans a monthly rate). Everyone uses the overall Medicare spending and then divides the operating costs for Medicare, to get at that 3%. But that ignores the operating costs for the MACs. And the MACs are private companies.

Deej, if you want a European  
section125 : 3/21/2017 10:36 am : link
healthcare system (model), you cannot keep malpractice/lawsuits at USA levels. Europeans are not suing at the drop of a hat and they certainly have the same medical issues/failures we have. Their court systems have much stricter requirements for lawsuits and they certainly don't allow the fishing that goes on around here. It is a total package that keeps costs reasonable or at least less than our costs. Doesn't mean that true malpractice shouldn't be compensated or the remedy to the medical issue (if possible) corrected at no cost to the patient. Doesn't mean bad doctors should not lose their licenses. But maybe it does mean the 33% plus expenses shouldn't be the standard cost of recovery.
The providers of health care are mostly in it for a profit.  
Heisenberg : 3/21/2017 11:23 am : link
The payers of health care are mostly in it for a profit. The makers of drugs and medical equipment are in it for a profit. Consumers of health care are left with a market where basically everyone is trying to make money off them. And we wonder why our health care costs are so high.
Tort reform was for decades cited ad nauseum  
Overseer : 3/21/2017 11:31 am : link
as a red herring by those who were unwilling to recognize and certainly tackle much larger problems within our health care/health insurance system.

That dynamic has now evaporated because they are now largely in power and forced to take the issue more seriously because of the previous president's efforts. Say what you want about the ACA's efficacy (which can be intelligently argued), there are several elements that Americans of all political stripes value.

It is now all but accepted as a given that health care policy must include protections for those with established conditions. This is huge. I cannot overstate that. Going back decades, this was virtually exclusively the territory of the left. Even if it's (in part) repealed, the ACA has cemented the need for that stipulation (not to mention the smaller pieces like up to 26 parents insurance). Whatever happens on Thursday and moving forward, the previous CoC's efforts are responsible for that and he should be applauded.

Getting sick or injured is the ultimate NON left/right thing. If you don't appreciate that directly, I guarantee you know someone who does. And even if you don't care about it on the individual insurance market (as the right basically forever did not) because "hey, I have a job", remember that you're not discriminated against in your group plan because of a Federal law. In other words, the Federal government told private companies, "no, you can't do that." Appreciate it like that.

I don't like the proposed legislation, especially since it's a predictable gargantuan tax cut for those who have thrived in recent years, but what is inarguable is that it is at least a more serious stab at addressing problems. A far cry, in other words, from the days of vacuous & pathetic "tort reform, across state lines, boom, done, let's grab a beer."

Meandering progress, yes. And after a horrifically ugly policy brawl for the past 8 years (or further back if you count '93), but progress still.
RE: RE: RE: RE: This thread has a lot of great posts  
EricJ : 3/21/2017 2:40 pm : link
In comment 13399787 Deej said:
Quote:

"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.


No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.

Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
McDonald's coffee  
giants#1 : 3/21/2017 2:49 pm : link
Don't be stupid and use that as an example of crazy jury's:

Quote:
Mrs. Liebeck offered to settle the case for $20,000 to cover her medical expenses and lost income. But McDonald’s never offered more than $800, so the case went to trial. The jury found Mrs. Liebeck to be partially at fault for her injuries, reducing the compensation for her injuries accordingly. But the jury’s punitive damages award made headlines — upset by McDonald’s unwillingness to correct a policy despite hundreds of people suffering injuries, they awarded Liebeck the equivalent of two days’ worth of revenue from coffee sales for the restaurant chain.


Quote:
And, to avoid what likely would have been years of appeals, Mrs. Liebeck and McDonald’s later reached a confidential settlement.


Who cares about facts!
Link - ( New Window )
more facts  
giants#1 : 3/21/2017 2:54 pm : link
Quote:

* McDonald’s admitted it had known about the risk of serious burns from its scalding hot coffee for more than 10 years. The risk had repeatedly been brought to its attention through numerous other claims and suits.
* An expert witness for the company testified that the number of burns was insignificant compared to the billions of cups of coffee the company served each year.
* At least one juror later told the Wall Street Journal she thought the company wasn’t taking the injuries seriously. To the corporate restaurant giant those 700 injury cases caused by hot coffee seemed relatively rare compared to the millions of cups of coffee served. But, the juror noted, “there was a person behind every number and I don’t think the corporation was attaching enough importance to that.”


Not the best example of a "frivolous" lawsuit.
RE: RE: RE: RE: RE: This thread has a lot of great posts  
RobCarpenter : 3/21/2017 3:59 pm : link
In comment 13401620 EricJ said:
Quote:
In comment 13399787 Deej said:


Quote:


Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...


That's a terrible example -- here's what the burns from coffee at 180-190 degrees looked like:

It's simple  
Ron Johnson 30 : 3/21/2017 6:22 pm : link
Expand Medicare for all. The end.

The US would be more competitive in the world marketplace, citizens would enjoy a better quality of life and longevity.
RE: The providers of health care are mostly in it for a profit.  
WideRight : 3/22/2017 10:54 am : link
In comment 13401307 Heisenberg said:
Quote:
The payers of health care are mostly in it for a profit. The makers of drugs and medical equipment are in it for a profit. Consumers of health care are left with a market where basically everyone is trying to make money off them. And we wonder why our health care costs are so high.



Thats too much reductionism. If all health care workers wanted was profit, they probably wouldn't be in health care. And if an organization isn't profitting, its nots going to be around very long to fulfill its mission....
I didn't read this whole thread but.....  
Tom [Giants fan] : 3/22/2017 11:13 am : link
the cost of healthcare is outrageous. My wife and I pay almost $1000 a month for us and our son. And even with that, I am having neck surgery and have to pay $2000 out of pocket for the hospital alone. That doesn't even include what copays I will have for anesthesiologist and my orthopedic. I almost cancelled the surgery because I can't afford that but hoping the hospital takes small payments per month. The rates in this country are outrageous but I also realize healthcare is expensive. I guess it won't bother me as much when I am not in so much pain in two weeks.
RE: RE: RE: RE: RE: This thread has a lot of great posts  
Deej : 3/22/2017 12:34 pm : link
In comment 13401620 EricJ said:
Quote:
In comment 13399787 Deej said:


Quote:



"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.



No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.

Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...


A doctor is grossly negligent and causes you paralysis below the waist. You're a software programmer so your ability to earn a living is not impaired. You'll have more costs in life as life is more expensive for the wheelchair-bound, so you get that as damages.

Should you get damages for the fact that your life is now way shittier, you cant play sports like you used to, can fuck your wife, you cant take her to small romantic restaurants, you cant pick up your daughter like other fathers, everything physical task takes longer and is harder leaving you exhausted, and you end up depressed because of your shittier life? Because that's what is at issue. Should the victim eat that, or should a doctor (who has insurance for these very reasons) eat that?
RE: Deej, if you want a European  
Deej : 3/22/2017 1:29 pm : link
In comment 13401233 section125 said:
Quote:
healthcare system (model), you cannot keep malpractice/lawsuits at USA levels. Europeans are not suing at the drop of a hat and they certainly have the same medical issues/failures we have. Their court systems have much stricter requirements for lawsuits and they certainly don't allow the fishing that goes on around here. It is a total package that keeps costs reasonable or at least less than our costs. Doesn't mean that true malpractice shouldn't be compensated or the remedy to the medical issue (if possible) corrected at no cost to the patient. Doesn't mean bad doctors should not lose their licenses. But maybe it does mean the 33% plus expenses shouldn't be the standard cost of recovery.


Why? what are the "levels" of med mal spending you perceive. Plaintiff and defendant costs plus payouts are about $10 bn (2010). I dont think there is much growth either -- I've seen that med mal filings are shrinking a lot of places. So $10 bn in a $3.2 trillion industry. I really fail to see the materiality of that.

Then you get to defensive medicine. Some estimates are as high has $50 billion give or take. But you have to buy into the notion that litigation is causing defensive medicine. Doctors certainly say fear of suit leads them to unnecessary testing. But the studies dont back it up. E.g. the RAND study of ERs before and after "tort-reform" showing no difference in testing levels.

Im not saying there arent any changes you can make to the tort system, but it's very functional. Monied interests, notably the AMA (doctors), insurance companies, US Chamber of Commerce (anti-damages suits by consumers, find doctors get more public sympathy than corps), and the GOP (self interest since trial lawyers support Dems) hammer at you on this tort reform issue in ways you dont even realize. They done a good job convincing people that "tort reform" is some big money saver for the system and needed to cure some scourge (I guess of dumb citizens siting on juries??). Dont buy the hype. It's bullshit. The data doesnt lie.
Link - ( New Window )
Can someone provide an example  
Ron Johnson 30 : 3/22/2017 3:11 pm : link
Of the free market serving a nation well? There are many examples of single payer working very well
RE: RE: RE: RE: RE: RE: This thread has a lot of great posts  
WideRight : 3/22/2017 4:53 pm : link


Should you get damages for the fact that your life is now way shittier, you cant play sports like you used to, can fuck your wife,

I'm confused. What do you want damages for?
As someone mentioned here  
Matt M. : 3/22/2017 4:57 pm : link
I'd like to read more about Sweden. We hear a lot about the Scandinavian countries. But, the most oft mentioned ones are socialist countries with universal healthcare. I don't think that will ever fly here (although I am not completely opposed to it). So, it would be interesting to see how another capitalist nation handles this type of healthcare.

Realistically, wouldn't we have to move to a fully socialist economy in order to move to fully universal healthcare and education in this nation?
Of course not  
Ron Johnson 30 : 3/22/2017 8:41 pm : link
We already have Medicare.

But it doesn't matter. The Koch's are withholding millions from reps who vote no
A couple of points simply as they relate to Drug Prices  
bhill410 : 3/22/2017 9:05 pm : link
since that is really the only area I can speak with any degree of competence on.

- As was referenced earlier, yes the US does fund the R&D expenses for the rest of the world. This is partially in relation to a "one payer" system many of the European countries have. Also one of the biggest reasons against having a one payer system as many forms of medication are not available in some countries because of how they negotiate.

- Drugs are approximately 10% of the cost of healthcare, which is no where compared to hospitals, physicians's ect. Included within that 10% costs are RD & Marketing associated with manufacturers/innovators and then a very large percentage attributed to distributors (cardinal, mcckesson) and retail chains (cvs, rite aid, etc.). Manufacturers obviously garner the most attention but look at the market cap of the distributers and you will realize they all make more money than any pharma company.

- Product liability is a massive driver of the cost of drugs. The amount of money paid in litigation costs and settlements is staggering. Some of those cases are nefarious but the vast majority are simply a reflection of the way tort law is currently set up and Levine v. Wyeth. You reform product liability tort and you could probably lower drug prices 5%.
Pages: 1 2 3 <<Prev | Show All |
Back to the Corner