So it would be impossible for the State's to get together and come up with a solution to solve the state to state codes.............................
If you're conceding that the idea as proposed cannot work in the absence of uniform national standards, you're correct. But it's designed with exactly the opposite circumstance in mind. As I said, it's nonsensical and unworkable as written.
Correct me if I'm wrong, but wouldn't more participation among small businesses pooled together lower their rates instead of raise them............Corps have larger employee roles, as do Unions.............which gets them better rates than the little ones..............So why not allow greater pooling of groups to lower their rates.
Again the problems with legislation like what the RSC put out is that these approaches are incoherent, both within some of the proposals (like the across-state-lines section, as we already covered) and between provisions. The approach of the legislation is to decouple insurance from employment and get people looking on their own; the tax preference that has preserved the employer-based system for six decades is replaced with tax incentives at the individual level.
So amid that seismic shift away from the employer-based system, we're told the answer to keeping costs down is...employer groups. Each negotiating different plan options in an employer-centric, segmented market that still traps people into a particular job for the particular deal their employer got on health benefits.
These are opposite impulses and two different policy design approaches. They don't make sense together, nor do they work together.
State's such as Mississippi have engaged in Tort Reform and have lower rates as a result, but still have very large decisions on malpractice...............Something that the Medical community talks about all the time.................Lowering their Malpractice Insurance rates keeps prices lower...........As their Malpractice Insurance rates drop.
But that doesn't mean you throw victims under the bus. Tort reform allows large settlements, but also stops the lawyers from taking all the money after winning.
A few years ago Mike Enzi, the top Republican on the main health committee in the Senate, introduced a health reform bill that, among other reforms, included provisions to give grants and assistance to help states reform their own tort laws, trying new things. A variant of this worked its way into the health reform legislation that Paul Ryan, Tom Coburn, and others in the GOP pushed in 2009. And the language from Enzi's bill made it into the Affordable Care Act and is now law. As I've
noted in the past, the issue of whether tort reform should be nationalized or if it should be done at the state level has been a major schism within the GOP.
The Enzi/Ryan/ACA approach is based at the state level. This new bill obviously takes a more federal tack, but it does so with the cap approach. Most states already cap awards for noneconomic damages.
They haven't been particularly effective. So either defensive medicine is mythical, or it's going to take something other than approaches that are already in widespread use (i.e. caps on noneconomic damages) to stem it. There was a
recent paper in
Health Affairs exploring the latter (intriguing) possibility.
Previous comparisons of states with and without tort reforms (such as caps on damages, limits on attorney’s fees, and reductions in the time that plaintiffs have to file a claim) suggest that the presence of tort reforms does little to limit use of health care. This has led to inferences that the total cost of defensive medicine is low.23 An alternative explanation, empirically supported by previous work, is that the kinds of tort reforms that states have adopted to date do not appreciably reduce physicians’ level of malpractice concern,6 and it is perceived rather than actual risk that determines how physicians behave.
Policy approaches that target the underlying causes of physicians’ malpractice concerns might reduce defensive medicine more effectively than current estimates suggest. Being sued is associated with substantial distress for physicians, but tort reforms are generally aimed at lowering the cost of eventual payouts to the exclusion of other approaches. Physicians’ extreme dread of malpractice litigation may stem from their perception that it is unpredictable, uncontrollable, and potentially disastrous both financially and psychologically.6
To achieve this goal [reassuring physicians that medical injuries can be resolved expeditiously and fairly, in a less adversarial manner], reforms need to facilitate communication between physicians and patients about why adverse outcomes occurred; to explain, in some cases, that the standard of care was met; to provide reasonable compensation rapidly when it was not met; and to keep disputes from escalating into full-blown litigation. Several approaches are promising.23 Communication-and-resolution programs, in which health care institutions proactively disclose errors, apologize, and offer compensation before the patient files a claim, could reduce the numbers and costs of lawsuits and speed the process of resolution. So could expanded use of mediation.
Another, farther-reaching reform would be to replace litigation in the courts with an administrative compensation system, akin to workers compensation. Administrative compensation proposals typically suggest that patients should not have to prove that their providers were negligent, only that their injury could have been avoided in an optimal system of care. Although politically challenging, such proposals are appealing because trying to avoid the emotional distress of being labeled as negligent may drive a great deal of defensive behavior among physicians.
A final approach is to give care providers a strong defense to allegations of malpractice, known as a “safe harbor,” if they can show that they followed an applicable, well-accepted, evidence-based practice guideline. By promoting national, evidence-based standards of care, instead of holding physicians to the prevailing standard in their state or community, safe harbors also have the potential to reduce geographic variation in the provision of some services.33
These alternative approaches are the kinds of things states
would be experimenting with if the tort reform grants proposed by Enzi, Ryan, and so on and passed into law by the ACA were being funded by the current Congress. But the current House can't quite seem to muster the interest.
Direct Gov't Subsidies to high maintenance or pre existing conditions ALSO TARGETS specific areas of concern. Thus taking these out of the regular rated areas to lower those costs.
Carving out the sick and limiting their options in underfunded public pools is not a long-term solution. The ACA created temporary high risk pools as a bridge to the opening of the new marketplaces and, as I recall, they were an object of GOP scorn for years due to the well-known deficiencies of high risk pools. Now that those are getting ready to close down and everyone will be able to shop for a plan of their choice in a competitive market, suddenly these pools are the answer again?
