Why was Tort Reform not on the table concerning our healthcare?

[Oldguy]

I certainly understand your frustration regarding the $600 billion a YEAR that physicians attest is due to FEAR of LAWSUITS!
Obama was so fearful of tanning salons..So why was malpractice/$600 billion defensive medicine NOT addressed as fervently as "Tanning Salons"???

If 1,231 physicians...(90%) Ninety percent of physicians surveyed said
"doctors overtest and overtreat to protect themselves from malpractice lawsuits.
"Defensive medicine is when doctors order multiple tests, MRIs and other procedures, not because the patient needs them, but to protect against litigation based on allegations that something should have been done but wasn’t. according to the survey published Monday in Archives of Internal Medicine.
Besides more time-consuming appointments, patients are left with fewer services and less access to quality care as doctors either narrow their practices or leave the profession entirely."
http://www.sfexaminer.com/opinion/E...take-on-trial-lawyers-in-speech-57953202.html

In recent studies, more than 90 percent of physicians reported practicing positive defensive medicine in the past 12 months; unnecessary imaging tests accounted for 43 percent of these actions. More than 92 percent of surgeons reported ordering unnecessary tests to protect themselves.

Another study found a direct relationship between higher malpractice awards and malpractice premiums and Medicare spending, especially with imaging services. The increased spending, however, had no measurable effects on mortality.

In a recent Gallup survey, physicians attributed 34 percent of overall healthcare costs to defensive medicine and 21 percent of their practice to be defensive in nature. Specifically, they estimated that 35 percent of diagnostic tests, 29 percent of lab tests, 19 percent of hospitalizations, 14 percent of prescriptions, and 8 percent of surgeries were performed to avoid lawsuits.

Liability reform has been estimated to result in anywhere from a 5 percent to a 34 percent reduction in medical expenditures by reducing defensive medicine practices, with estimates of savings from $54 billion to $650 billion.
The costs of defensive medicine


But do you think the Press will share these stories with same intensity they pounded the The phrase in a google search "" Romney 47 percent" " found About About 53,400,000 results since Sept 2012 YET Obama's "obama electricity rates would necessarily skyrocket" google since January 17, 2008 About 11,900 results.

NO... WHAT we all have to do is keep pounding the public NOT to believe the pack of lies especially about 50 million uninsured, or "you can keep your plan"...!

But, it hasn't turned out that way in the states which have adopted tort reform:

New study: Tort reform has not reduced health care costs in Texas | www.statesman.com

 

[Mac1958]

Defensive medicine, lawsuits and insurance premiums are not solely responsible for rising healthcare costs. Corporate profits is the biggest reason.

That's a straw man argument, and those drive me nuts.

I've repeatedly said that there are multiple cost drivers in health care, and that defensive medicine is one of them. I can't make it much more clear than that.

Profit margins for health insurance companies are typically in the 3% to 7% range, and health insurance companies are generally more efficient than federal bureaucracies, especially in the Medicare space. At the same time, there are exceptions, and their profits would need to be looked at.

If we were serious, which we are not.

Neither "end" of the political spectrum can seem to get it through their heads that the magnitude of our health care/Medicare situation means that they must release their vice-like grip on their pet health care issues and utilize an "all of the above" approach to lowering health care costs. Cherry-picking one pet approach and saying "that alone won't cut health care costs" will only slow down the process. Both sides need to stop playing politics with this.

If we were serious, which we are not.

.

 

[Oldguy]

Defensive medicine, lawsuits and insurance premiums are not solely responsible for rising healthcare costs. Corporate profits is the biggest reason.

That's a straw man argument, and those drive me nuts.

I've repeatedly said that there are multiple cost drivers in health care, and that defensive medicine is one of them. I can't make it much more clear than that.

Profit margins for health insurance companies are typically in the 3% to 7% range, and health insurance companies are generally more efficient than federal bureaucracies, especially in the Medicare space. At the same time, there are exceptions, and their profits would need to be looked at.

If we were serious, which we are not.

Neither "end" of the political spectrum can seem to get it through their heads that the magnitude of our health care/Medicare situation means that they must release their vice-like grip on their pet health care issues and utilize an "all of the above" approach to lowering health care costs. Cherry-picking one pet approach and saying "that alone won't cut health care costs" will only slow down the process. Both sides need to stop playing politics with this.

If we were serious, which we are not.

.

I'll agree with that. Obamacare does not solve all the problems and, in fact, creates more. But, the all or nothing stance both parties have taken is hurting our chance to get it right.

This is an instance where We The People need to take the lead. WE need to be telling Congress, "Fix it!" in no uncertain terms. But, we're not doing that. Instead, we're letting them milk us for money and support like compliant sheep, completely ignoring that WE hold the power in this country and that WE can get what we want.

Too bad we're all so locked into our prejudices that we only shout at each other across the ideological divide, isn't it? The nation suffers for it. So do we, personally, and our kids and grandkids. Will we EVER to the right thing for our offspring and do whatever it takes to hand them a future which doesn't include hatred and division?

I personally don't think so. We Boomers are in control now and we grew up in an atmosphere of division and distrust. I'm convinced the nation will not prosper until we're gone and the next generation takes power. My generation has been the worst disaster for this country since the Civil War and the healthcare debate is only one example of how much damage we've done.

 

[sakinago]

Defensive medicine, lawsuits and insurance premiums are not solely responsible for rising healthcare costs. Corporate profits is the biggest reason.

That's a straw man argument, and those drive me nuts.

I've repeatedly said that there are multiple cost drivers in health care, and that defensive medicine is one of them. I can't make it much more clear than that.

Profit margins for health insurance companies are typically in the 3% to 7% range, and health insurance companies are generally more efficient than federal bureaucracies, especially in the Medicare space. At the same time, there are exceptions, and their profits would need to be looked at.

If we were serious, which we are not.

Neither "end" of the political spectrum can seem to get it through their heads that the magnitude of our health care/Medicare situation means that they must release their vice-like grip on their pet health care issues and utilize an "all of the above" approach to lowering health care costs. Cherry-picking one pet approach and saying "that alone won't cut health care costs" will only slow down the process. Both sides need to stop playing politics with this.

If we were serious, which we are not.

.

I'll agree with that. Obamacare does not solve all the problems and, in fact, creates more. But, the all or nothing stance both parties have taken is hurting our chance to get it right.

This is an instance where We The People need to take the lead. WE need to be telling Congress, "Fix it!" in no uncertain terms. But, we're not doing that. Instead, we're letting them milk us for money and support like compliant sheep, completely ignoring that WE hold the power in this country and that WE can get what we want.

Too bad we're all so locked into our prejudices that we only shout at each other across the ideological divide, isn't it? The nation suffers for it. So do we, personally, and our kids and grandkids. Will we EVER to the right thing for our offspring and do whatever it takes to hand them a future which doesn't include hatred and division?

I personally don't think so. We Boomers are in control now and we grew up in an atmosphere of division and distrust. I'm convinced the nation will not prosper until we're gone and the next generation takes power. My generation has been the worst disaster for this country since the Civil War and the healthcare debate is only one example of how much damage we've done.

See the problem with the Texas tort reform was that it didn't address the culture issue of defensive medicine in healthcare. It was a step in the right direction, but addressing the culture issue could take years to change. Just because the change is not going to happen immediately doesn't mean we shouldn't bother to do it, because it is only going to keep rising. Changing the culture of defensive medicine is still something that will lower the cost of healthcare, bringing it close to an affordable level. It isn't the only answer, but I just don't understand how you can't see it as the biggest piece of the pie. Making healthcare more affordable is a very tough problem to solve, that being said getting rid of defensive medicine (although difficult itself), is the easiest way to go about it.

Defensive medicine has gotten to the point where it is becoming harmful to patients, not just their wallets. Despite an emphasis on evidence based care, we still see almost every doc out there prescribing patients a full bottle of lower dose antibiotics, the patient takes it until they "feel" better, save the rest, and start popping them when they get sick with something else. The doc might as well be handing them a resistant strain of something in a bottle. Defensive medicine is creating an army of resistant strains out there, that are very tough, and expensive to treat. DONT even get me started about chemotherapy, I know it is one of our best treatments for cancer, but If I get a terminal diagnosis, Im saying "see ya doc, Im going to Tahiti."

Another piece of the pie is incentives from insurance companies. As in you live a healthy lifestyle (you drink/smoke minimally, are at a healthy weight, and exercise), go to your healthy appointments, do your preventative screenings/treatments/etc, and going to the doc when you should, not when it starts to become a bigger complication, your looking at a pretty light insurance bill. Now couple that with workplaces like UPS, who have their workers exercise 30 mins a day (I could be wrong, Im not too familiar with the program), now your really talking about a low insurance bill to pay. I know Obamacare has made preventative care free, but it does nothing to get people to take the time to get it taken care off. Trying to get women/men to get mammograms/prostate checks is like pulling teeth, understandably so, but you make them say "It'll save me this much $, I guess I should go get it done." These incentives, hopefully more "enforced" by business's, will bring the price down a great deal, but only when defensive medicine has been changed to active medicine.

 

[Oldguy]

That's a straw man argument, and those drive me nuts.

I've repeatedly said that there are multiple cost drivers in health care, and that defensive medicine is one of them. I can't make it much more clear than that.

Profit margins for health insurance companies are typically in the 3% to 7% range, and health insurance companies are generally more efficient than federal bureaucracies, especially in the Medicare space. At the same time, there are exceptions, and their profits would need to be looked at.

If we were serious, which we are not.

Neither "end" of the political spectrum can seem to get it through their heads that the magnitude of our health care/Medicare situation means that they must release their vice-like grip on their pet health care issues and utilize an "all of the above" approach to lowering health care costs. Cherry-picking one pet approach and saying "that alone won't cut health care costs" will only slow down the process. Both sides need to stop playing politics with this.

If we were serious, which we are not.

.

I'll agree with that. Obamacare does not solve all the problems and, in fact, creates more. But, the all or nothing stance both parties have taken is hurting our chance to get it right.

This is an instance where We The People need to take the lead. WE need to be telling Congress, "Fix it!" in no uncertain terms. But, we're not doing that. Instead, we're letting them milk us for money and support like compliant sheep, completely ignoring that WE hold the power in this country and that WE can get what we want.

Too bad we're all so locked into our prejudices that we only shout at each other across the ideological divide, isn't it? The nation suffers for it. So do we, personally, and our kids and grandkids. Will we EVER to the right thing for our offspring and do whatever it takes to hand them a future which doesn't include hatred and division?

I personally don't think so. We Boomers are in control now and we grew up in an atmosphere of division and distrust. I'm convinced the nation will not prosper until we're gone and the next generation takes power. My generation has been the worst disaster for this country since the Civil War and the healthcare debate is only one example of how much damage we've done.

See the problem with the Texas tort reform was that it didn't address the culture issue of defensive medicine in healthcare. It was a step in the right direction, but addressing the culture issue could take years to change. Just because the change is not going to happen immediately doesn't mean we shouldn't bother to do it, because it is only going to keep rising. Changing the culture of defensive medicine is still something that will lower the cost of healthcare, bringing it close to an affordable level. It isn't the only answer, but I just don't understand how you can't see it as the biggest piece of the pie. Making healthcare more affordable is a very tough problem to solve, that being said getting rid of defensive medicine (although difficult itself), is the easiest way to go about it.

Defensive medicine has gotten to the point where it is becoming harmful to patients, not just their wallets. Despite an emphasis on evidence based care, we still see almost every doc out there prescribing patients a full bottle of lower dose antibiotics, the patient takes it until they "feel" better, save the rest, and start popping them when they get sick with something else. The doc might as well be handing them a resistant strain of something in a bottle. Defensive medicine is creating an army of resistant strains out there, that are very tough, and expensive to treat. DONT even get me started about chemotherapy, I know it is one of our best treatments for cancer, but If I get a terminal diagnosis, Im saying "see ya doc, Im going to Tahiti."

Another piece of the pie is incentives from insurance companies. As in you live a healthy lifestyle (you drink/smoke minimally, are at a healthy weight, and exercise), go to your healthy appointments, do your preventative screenings/treatments/etc, and going to the doc when you should, not when it starts to become a bigger complication, your looking at a pretty light insurance bill. Now couple that with workplaces like UPS, who have their workers exercise 30 mins a day (I could be wrong, Im not too familiar with the program), now your really talking about a low insurance bill to pay. I know Obamacare has made preventative care free, but it does nothing to get people to take the time to get it taken care off. Trying to get women/men to get mammograms/prostate checks is like pulling teeth, understandably so, but you make them say "It'll save me this much $, I guess I should go get it done." These incentives, hopefully more "enforced" by business's, will bring the price down a great deal, but only when defensive medicine has been changed to active medicine.

I'm not arguing that defensive medicine doesn't drive up costs. I'm sure it does. I'm more concerned about what CAUSES defensive medicine. While you lay it mostly at the feet of lawsuits (a legitimate concern), I consider the effects of what I posted related to Boise, ID as well. Boise is not unique and I'm of the opinion that corporate profitability, related to Medicare payments, are as big a force in rising costs as lawsuits, if not more so.

In either case, or any case, it needs to be addressed and we're simply not doing that because we're too busy debating extremes as related to Obamacare.

On the subject of preventative medicine? It's all based upon the odds and nothing else. The ODDS are that you won't get sick and die AS QUICKLY if you do, or don't do, certain things. In the end, of course, even the person with the absolutely most perfect healthy lifestyle will die from something and there's no way to definitively quantify whether he died "early" or "late." Not knowing a persons death date beforehand, we can't say whether his lifestyle led to more days or not, can we?

The danger in preventative healthcare, as you've described it vis a vis insurance costs and UPS, is that the ultimate outcome will not be just to reward "healthy" lifestyles with reduced costs, but to punish people with "unhealthy" lifestyles, if not deny them medical care entirely. We're already seeing it in relation to smoking and, soon, junk food. Where does it stop?

Down that road lies the worst kind of government or corporate interference in our right to choose, a basic, bedrock principle of freedom and liberty. Are we really willing to allow some outside entity, government, business or otherwise, to dictate our lifestyles to us in exchange for healthcare? Should we be required to give up our most basic freedom in exchange for life?

I don't think so. And, the fact that Obamacare doesn't address that indicates that Congress doesn't think so either, at least at this time.

 

[Greenbeard]

See the problem with the Texas tort reform was that it didn't address the culture issue of defensive medicine in healthcare. It was a step in the right direction, but addressing the culture issue could take years to change.

That's a nice explanation but it misses the key factor: the volume-based payment incentives baked into the way services are reimbursed. It's not a stretch of the imagination to point out that if we pay for volume we're going to get volume, regardless of what a state's tort environment looks like. Culture is powerful but I don't think we can wait around for culture to push providers to make changes that will reduce their revenue streams.

 

[sakinago]

See the problem with the Texas tort reform was that it didn't address the culture issue of defensive medicine in healthcare. It was a step in the right direction, but addressing the culture issue could take years to change.

That's a nice explanation but it misses the key factor: the volume-based payment incentives baked into the way services are reimbursed. It's not a stretch of the imagination to point out that if we pay for volume we're going to get volume, regardless of what a state's tort environment looks like. Culture is powerful but I don't think we can wait around for culture to push providers to make changes that will reduce their revenue streams.

Again simplistic way of looking at it. Healthcare administration wants to treat people who are covered or can pay, marks up on care and staffing RN's as minimally as possible to make up for those who don't. The insurance companies want as little treatment as possible, but at the same time understand that if the doctors don't treat defensively... they would probably have a better career and future in trucking. So doctors treat defensively, (raising the cost of insurance), minimally staffed floors of stressed out RN's monitoring a larger staff of lightly educated care assistants allows mistakes to happen more frequently or not be caught in time, leaving insurance companies telling the hospital "were not going to cover that mistake, we can barely afford the MRI's for this patient," so the hospital has to eat the cost of treatment for that patient (hopefully they aren't getting sued over it). The hospital then makes up for this by mark ups in their defensive medicine; at the same time they want to avoid the mistakes previously made, so they instill more defensive medicine policies that insurance would have to pay for...not the hospital. Do you see the cycle and what needs to be stopped to break it.

See right now the insurance companies and the hospitals are locked in a liability battle, (who has to cover what, and how do you make up for that cost), making the patients and the hospital staff the victims of the battle. While lawyers are sitting back making the big bucks going after the insurance companies and hospitals who are pointing fingers at each other. The best job to get in our healthcare system is a lawyer...which isn't right.

 

[Greenbeard]

I'm not sure how that's a response to what I just said. I understand that providers fervently believe that they over treat as some sort of legal self-defense. So fervently that when the laws are changed in their favor and they don't stop over treating we're told it must just be a cultural thing, don't worry just give us a few more decades to adjust.

So what I'm saying to you is simple: if the payment structure underlying every single service or procedure offered is based on an inflationary incentive for ever-greater volume, then providers are going to over treat regardless of the tort environment. Payment reform is a much bigger piece of the pie than tort reform and likely a more reliable way to rein in costs, yet providers are hardly unanimous in their support for it for exactly that reason.

 

[sakinago]

I'm not sure how that's a response to what I just said. I understand that providers fervently believe that they over treat as some sort of legal self-defense. So fervently that when the laws are changed in their favor and they don't stop over treating we're told it must just be a cultural thing, don't worry just give us a few more decades to adjust.

So what I'm saying to you is simple: if the payment structure underlying every single service or procedure offered is based on an inflationary incentive for ever-greater volume, then providers are going to over treat regardless of the tort environment. Payment reform is a much bigger piece of the pie than tort reform and likely a more reliable way to reign in costs, yet providers are hardly unanimous in their support for it for exactly that reason.

My response was explaining that doctors, hospitals, and especially insurance companies do not want over treating (defensive medicine is a better phrase) to take place. Lawyers are not only after the hospitals, but also after the insurances companies who are covering the cost of defensive medicine and the liability battle by raising prices on coverage, limiting it, and looking for ways to say "your documentation shows that the hospital kept so-and-so too long/this complication arose while so-and-so was in the hospital/or so-and-so did not need xyz test/treatment...we are not going to pay for that, the hospital does." The hospitals goal is to get people in and out as quickly as possible so it is covered by insurance...while at the same time covering their ass so not only would they have to eat what insurance doesn't cover, nor have to deal with an expensive lawsuit. It is not ideal to order over-treatment of a patient because that requires asking more of the hospital staff, which you either need to increase staffing (raising payroll) , stretch staffing thin (risking mistakes, liability), or minimally staff RN's and increase lower educated staff like CNA's (increase in payroll, and increase in mistakes)...as long as over treating that patient would indeed be covered by insurance. To cover for over treating, hospitals have to decide between shelling out more money to hire 8 more RN's on each floor and 50,000 a pop, buy another couple MRI's with another 10 x-ray techs and a radiologist so the hospital isn't gridlock and they can get the patients out before insurance stops paying...or increase the lesser qualified, lower paid staff, and make the RN's in charge and liable for them, and hope that not to many mistakes happen. The liability battle cycle continues on. This is just the battle between insurance and hospitals, it does not include healthcare as a whole i.e. pharmaceutical companies, medical manufacturing, medical research, etc. all of whom are also needing to mark up prices to cover liabilities.

Your looking at it in volume, and that there is nothing from stopping the hospitals from giving unnecessary treatments, like I said very simplistic way of looking at our healthcare system. This is not the case, the insurance companies ride the hospital, and the hospital rides the insurance companies in turn. Lawyers ride both parties and are not held accountable to anyone. Does this make more sense?

 

[Greenbeard]

The hospitals goal is to get people in and out as quickly as possible so it is covered by insurance...while at the same time covering their ass so not only would they have to eat what insurance doesn't cover, nor have to deal with an expensive lawsuit. It is not ideal to order over-treatment of a patient because that requires asking more of the hospital staff, which you either need to increase staffing (raising payroll) , stretch staffing thin (risking mistakes, liability), or minimally staff RN's and increase lower educated staff like CNA's (increase in payroll, and increase in mistakes)...as long as over treating that patient would indeed be covered by insurance.

The hospital's goal is to fill beds, period. Whether it's financially "ideal" to provide more and more services depends on payment policy. If the hospital were getting some lump (bundled) sum for each episode of care or was receiving a fixed global payment for all the care its patients might need, then sure it wouldn't make sense to devote more of its resources to providing additional services of dubious value to the patient because that would directly cut into the hospital's bottom line. But if they're operating in a fee-for-service environment and getting a margin (above and beyond marginal labor costs, etc) on every additional service provided, then it can and does make sense financially to provide additional services, regardless of their value to the patient and the payer.

Yes, the payer (insurer) would ideally be able to work to contain that, but as we've seen in any number of markets (and any number of annual premium increases) they are often not well-positioned to play that role effectively; better incentive structures--than insurers just cracking the whip--are preferable anyway. And, as we know from the tort reform debate, the provider community isn't shy about admitting that financial considerations on their end can and do trump patient safety. At least, they admit it when they're fishing for legal changes that will benefit them. There's nothing wrong with that, they're economic actors like anyone else. Which means the incentive structures need to change around them if we want them to act differently. Part of that may be some sort of tort reform (though the implicit suggestion in these discussions that tort reforms haven't been enacted in states across the country for the last 25 years is just patently false) but tort reform is unlikely to change much if the underlying financial incentives baked into the way providers are reimbursed don't change.

 

[Jimmy_Jam]

Again very simple way of looking at the problem. The rising cost did not necessarily come from suits and torts, it comes from policies (as in running a gambit of expensive tests, expensive procedures, ordering very expensive treatments for when it is not necessary) and malpractice insurance that MD's, RN's, and hospitals all have to pay for.

If you are ever in the hospital, chances are you will be given Omeprazole, very expensive treatment, costs about $900 a month (taking it just once a day, at the hospital you will usually be taking it at least 2x daily). What for? For gastric reflux, possibly induced by the stress of being in the hospital, whether you have a history of gastric reflux or not, and whether or not gastric reflux can be considered a complication or minor inconvenience in your situation, whether or not you probably wont even suffer from gastric reflux while being in the hospital. So now you wipe out your stomach acid, your normal intestinal micro-biota has changed, also changing your bowel movements. Now the hospital is worried that there is a chance you might have contracted a noscomial infection like VRE. So the hospital puts you on very expensive anti-biotics to combat VRE, and very expensive broad spectrum anti-biotics, while they charge you (or your insurance) to run tests to rule out VRE. Now your normal flora all over your body is severely wiped out and you can only hope that this does not lead to an actual nasty, expensive and tough to treat noscomial infection.

This is just one example of the consequences of torts, and they chain reaction that they have caused in our healthcare system, and why the cost is rising so much. I can give you 20 different more examples like this off the top of my head alone, all of them consequences of our tort system.

Well done, you obviously have some background in this.

.

Nonsense.

Omeprazole is just Prilosec.

LOL

And, tort reform is just another way of screwing over the little guy.

So it is, but you may have missed the point. The point is that it is prescribed in hospitals often as a means to prevent malpractice suits. He was merely using it as an example of one thing that increases healthcare costs for which tort law may be at least partially the cause: fear of litigation. That Omeprazole is Prilosec has nothing to do with it.

It is an interesting topic. I must admit I am undecided on whether or not tort reform is a good idea. It is a complicated issue. So far I tend to believe that the benefits are not worth it, but I feel far from certain.

 

[sakinago]

The hospitals goal is to get people in and out as quickly as possible so it is covered by insurance...while at the same time covering their ass so not only would they have to eat what insurance doesn't cover, nor have to deal with an expensive lawsuit. It is not ideal to order over-treatment of a patient because that requires asking more of the hospital staff, which you either need to increase staffing (raising payroll) , stretch staffing thin (risking mistakes, liability), or minimally staff RN's and increase lower educated staff like CNA's (increase in payroll, and increase in mistakes)...as long as over treating that patient would indeed be covered by insurance.

The hospital's goal is to fill beds, period. Whether it's financially "ideal" to provide more and more services depends on payment policy. If the hospital were getting some lump (bundled) sum for each episode of care or was receiving a fixed global payment for all the care its patients might need, then sure it wouldn't make sense to devote more of its resources to providing additional services of dubious value to the patient because that would directly cut into the hospital's bottom line. But if they're operating in a fee-for-service environment and getting a margin (above and beyond marginal labor costs, etc) on every additional service provided, then it can and does make sense financially to provide additional services, regardless of their value to the patient and the payer.

Yes, the payer (insurer) would ideally be able to work to contain that, but as we've seen in any number of markets (and any number of annual premium increases) they are often not well-positioned to play that role effectively; better incentive structures--than insurers just cracking the whip--are preferable anyway. And, as we know from the tort reform debate, the provider community isn't shy about admitting that financial considerations on their end can and do trump patient safety. At least, they admit it when they're fishing for legal changes that will benefit them. There's nothing wrong with that, they're economic actors like anyone else. Which means the incentive structures need to change around them if we want them to act differently. Part of that may be some sort of tort reform (though the implicit suggestion in these discussions that tort reforms haven't been enacted in states across the country for the last 25 years is just patently false) but tort reform is unlikely to change much if the underlying financial incentives baked into the way providers are reimbursed don't change.

I dont know if you have had much experience with hospitals, but any hospital's goal is to get the patient out of there as quickly as possible, many times before the patient is ready. Not because they want to replace them with another patient, but because insurance is not stupid and rides the hospitals to get them out. Your thinking of hospitals like a restaraunt, where they want many customers, and they want to upsale those customers alcohol/bigger steaks etc. Insurance companies do not allow overtreating like you are thinking of, they do have to allow defensive medicine. Overtreating like your thinking of is very medical unethical, and docs could get sued big time coercing patients to do so. A hospitals goal is no mistakes, and make sure insurance can cover it. Defensive medicine is different from overtreating, it is the culture of our healthcare system. You really only see overtreating in cancer patients, which is a different story. I absolutely agree that changing culture is difficult, but we've seen it happen a couple times in healthcare over the last decade.

I also strongly agree with incentives, but those are not going to have much of an effect in a defensive medicine, especially when we have 3 generations where incentives are a little too late for them.

 

[Jarlaxle]

It was and is the best way to drop the cost of healthcare, and has also been a major contributing factor into the rising cost of healthcare.

So, lets hear it?

Because you can't limit a doctor's liability until you can limit the amount of damage that doctor can cause by malpracting.

And the percentage of medical costs as a result of fraud are negligible

When a doctor cuts off the wrong leg, he/she should lose his/her license to practice for at least five years. A lot of the stupid shit would stop happening. There also needs to be some process in which we can limit the number of lawsuits that have no merit. Too many people bring lawsuits that they know they are unlikely to win, but that get settled out of court because it is cheaper than going to trial. Unfortunately, I'm not sure what the solution would be for this. One suggestion is to have the person bringing the suit pay for all attorney fees if they lose. The problem with that is that most people would never be able to afford that and would be unable to bring forth a suit in the first place, even when it was legitimate.

Or they just don't have two nickels to rub together to start with, so they just don't care.

 

[OohPooPahDoo]

Defensive medicine has gotten to the point where it is becoming harmful to patients, not just their wallets.

Doctor's practice so called "defensive medicine" so they can make more money off of your insurance company, it has little to do with torts. Its no different than the oil change shop guy telling you that you need to have your radiator fluid flushed every 10,000 miles - he's not doing it because he's afraid he'll get sued, he's doing it to make more money.

 

[Gadawg73]

Defensive medicine has gotten to the point where it is becoming harmful to patients, not just their wallets.

Doctor's practice so called "defensive medicine" so they can make more money off of your insurance company, it has little to do with torts. Its no different than the oil change shop guy telling you that you need to have your radiator fluid flushed every 10,000 miles - he's not doing it because he's afraid he'll get sued, he's doing it to make more money.

You hit it right out of the ball park Babe. Exactly.
Doctors have equipment that needs to be used and billed to the insurance company and when confronted with that by the insurance companies that know that the down time for this equipment is multiples higher than other countries the "We had to do do it as defensive medicine" is the BS excuse.

 

[Gadawg73]

Why was Tort Reform not on the table concerning our healthcare?

Out of a total of 435 U.S. Representatives and 100 Senators (535 total in Congress), lawyers comprise the biggest voting block of one type, making up 43% of Congress. Sixty percent of the U.S. Senate is lawyers.
Enough said. 37.2% of the House of Representatives are lawyers.

Anything else need be said?

Lawyers have little to do with bringing a medical malpractice case. All they do is file the paperwork and fund the cases for the victims. Insurance companies have billions and it takes about 125K of the plaintiffs' lawyers $$$ to get a med/mal case to trial and the success rate is less than a third.
You have to have a doctor or team of doctors to submit a detailed finding in an affidavit with the filing of the med/mal case and the doctor(s) have to testify in court that the other doctor was negligent.
Without the doctors NO med/mal case can be filed anywhere in this country.

 

[sakinago]

Defensive medicine has gotten to the point where it is becoming harmful to patients, not just their wallets.

Doctor's practice so called "defensive medicine" so they can make more money off of your insurance company, it has little to do with torts. Its no different than the oil change shop guy telling you that you need to have your radiator fluid flushed every 10,000 miles - he's not doing it because he's afraid he'll get sued, he's doing it to make more money.

You hit it right out of the ball park Babe. Exactly.
Doctors have equipment that needs to be used and billed to the insurance company and when confronted with that by the insurance companies that know that the down time for this equipment is multiples higher than other countries the "We had to do do it as defensive medicine" is the BS excuse.

Im sorry but this is not what the medical world is like. A majority of doctors are in private practice for starters. On top of that "over-treatment" in the sense that you are thinking does not occur, A. because it is unethical and medical licences will be lost left and right, B. Insurance companies are not going to cover the over-treatment that ya'll are thinking of. Patient centered care (which almost all hospitals are about) is putting the patients in the driver seat, meaning the patient types in their symptoms online and tells the doc what they are worried about, so the doc has to cover his/her ass with a test or medication with what the patient is worried about; this is one type of over-treatment you will see. Another type of over-treatment is in the treatment of cancer patients, this is a whole different story, and chemo happens to be a big source of revenue in the hospitals; again this is a whole other issue.

Whats really going on in the hospitals is we have defensive medicine. Where the doctors are afraid to give a specific diagnosis until all the tests are back, while they are waiting for the tests they are treating a couple other possibilities, on top of going through the hospitals SOP making sure the patient does not go through any complications during their stay at the hospital. This is where it gets expensive (or more expensive than it needs to be), and this is defensive medicine. Active medicine is what you see at places like cleveland clinic (mentioned in the presidential debates) where you get a team of healthcare workers who all look at you at the same time, come up with a diagnosis, test and treat it.

And those who think that the doctors have some sort of monopoly in the healthcare industry where they can upsale treatments as much as they want, are not looking at the healthcare industry as a whole. Turn on your TV and look at who is getting sued in the healthcare industry, its all drug manufacturers and medical equipment manufacturers (if you took so-and-so drugs, or had so-and-so knee implant/mesch etc. and have any one of these vague general symptoms; you are entitled to money). These guys get hit with the 4 billion dollar suits, which they have to make up for some way.

So if the insurance companies know that defensive medicine is going on, and it would be much much cheaper for them to entice hospitals to practice active medicine, then why are they not doing it? They know that the hospital needs to cover its ass, doctors need to cover their ass; all it takes is that 1 out of 100 patients that they take care of every week where everything goes wrong for that patient, the doctor failed to cover his/her ass and now is getting sued loosing the hospital and themselves money, as well as their licence. Doctors are very good at covering their ass, thats half of med school, RN's responsible for lightly educated assistants have a harder time of doing this, and this is where you see most of the malpractice suits. I dont see how the fear of lawsuits is not the underlying cause of defensive medicine.

 

[jillian]

Actually less than 2% of costs (?), but there is some in there, care guidelines that make sueing harder.

Well if Pubs had cooperated IN ANY WAY, could have happened. Add it on anytime, along with a national exchange, ya lying POSs...LOL

to bring a malpractice suit, in many states (i don't know about all), you have to go through a merit panel before you can pursue a lawsuit. if the action is frivolous, it doesn't go any further.

realistically, though, it costs about $50,000 for a law firm to bring a malpractice case... so that acts as a restraint on the frivolous in most instances.

and as you pointed out, it's less than 2% of insurance company costs. it's just another way the right tries to keep people from being accountable for the damage they cause to others through negligence.

 

[OohPooPahDoo]

On top of that "over-treatment" in the sense that you are thinking does not occur, A. because it is unethical

LOL!



In that case frivolous lawsuits never happen either, because they're unethical and lawyers would get disbarred left and right.

So we're all good!

 

[OohPooPahDoo]

On top of that "over-treatment" in the sense that you are thinking does not occur, A. because it is unethical

It doesn't happen because its unethical.

Got it.

Fuck you're dumb.

Where the doctors are afraid ...

How you know how the doctors in the country feel?

So if the insurance companies know that defensive medicine is going on, and it would be much much cheaper for them to entice hospitals to practice active medicine, then why are they not doing it? They know that the hospital needs to cover its ass, doctors need to cover their ass; all it takes is that 1 out of 100 patients that they take care of every week where everything goes wrong for that patient, the doctor failed to cover his/her ass and now is getting sued loosing the hospital and themselves money, as well as their licence. Doctors are very good at covering their ass, thats half of med school, RN's responsible for lightly educated assistants have a harder time of doing this, and this is where you see most of the malpractice suits. I dont see how the fear of lawsuits is not the underlying cause of defensive medicine.

Doing something just to cover your ass in unethical, if doctors did that - in your words - "medical licenses would be lost left and right".

You said so yourself - its just not possible for doctors to do anything unethical because it would be unethical for them to do it.