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Sicko Sticko Shock

It's been way too hot today (about 110) to write muchsticker_shock3.gif about anything serious. So I'll share an anecdote with you that I got via the U.S. mail this afternoon. My health insurance company sent me one of its gazillionth periodic statements for my medical care. You know, one of those purposefully indecipherable billings for which you need NSA code-breaking skills to understand. This one was for my hospitalization two months ago for heart procedures of what I would classify as moderate complexity. I underline the word moderate because its germane to this story. This wasn't open heart surgery, not even close. One procedure was done without anesthetic and other could have been done likewise on an outpatient basis but my doctor decided to knock me out for it and hold me overnight to recover. So I was in this particular hospital for a grand total of 20 hours. The bill arrives today and (without any itemization) totals up to -- are you ready?-- $116, 749.00 (not included the cardiologist fees which are billed separately-- about another $6k). I kid you not. In a column lateral to the "amount billed" I then find the "amount allowed" i.e. the amount that Blue Cross is actually willing to pay the hospital. That amount: $4730, or less than 4% of the total charge. But wait, there's a footnote appended to the amount allowed. In fine print at the bottom of the page the annotation says that the provider accepts the amount allowed as payment in full and that I, the insured, owe nothing. That news, of course, allowed my heart to start beating again after momentarily seizing up. But then you start to wondering what this all means. I saw something similar a few weeks ago when two days in the ICU were billed at about $64,000 and the hospital accepted about 10% of that amount as payment in full from my network insurer. These are my conclusions but I'm willing to stand corrected by anyone reading this who has some deeper, more nuanced understanding: First, as current insurance plans go, I have what might be called platinum coverage thanks to the USC benefits program (Fight on, Trojans!). Second, if the private, for-profit hospital (part of a chain with a rapacious reputation) accepted the $4730 from Blue Cross as payment in full for the time I was in the Coronary Care Unit, then I have to assume that the hospital is still making a profit even at that vastly reduced level. This seems inevitably the case if Blue Cross and similar carriers are covering what must be the overwhelming percentage of patients in this facility. Third, I deduce from this statement that if for some reason I didn't have insurance but still wanted the same life-saving medical procedures and, provided that the hospital would admit me (probably on the basis of my signing a lien against my house from a bed in ER), then I would have quite literally been charged the full freight of $116,000 plus -- or in starker terms, a 25-fold mark-up beyond the rate offered to mega-insurance companies. Fourth and finally, the system is absurd, insulting and inhuman. I can only be grateful that I have such comprehensive insurance at a very low cost. Grateful and privileged but nevertheless still in sticker shock. No wonder it's called the Coronary Care Unit.

81 Responses to “Sicko Sticko Shock”

  1. Chileno Says:

    The easy answer to the health care crisis is to banish health insurance entirely.

  2. Woody Says:

    I’ve had the same experience a couple of times. I went to the ER recently to deliver a kidney stone and was there for about an hour, with the biggest charge for the CT scan. (Try doing it that fast in a government facility.) The amount billed as something like $5,000+, but the amount that the insurance company had to pay was only $600 after my $100 co-pay. Blue Cross has better negotiators and leverage than do I as a private person.

    However, that in no way means that I would desire government health care. There are so many options to make private health care more affordable and allow people to have the private plans that they choose. First, limit malpractice claims, if you dare cross the trial lawyers. Second, give full health insurance deductions or credits against income. Those with zero or low incomes can have something similar, but not exactly the same, as the earned income credit for this.

    If Democrats cared really cared about this issue, they would go in that direction, but they are more concerned with seizing this major component of our economy and using it for campaign promises, both now and in the future, as they have social security.

    BTW, regarding the social security program that Democrats said that the Republicans didn’t need to save because it’s healthy, Hillary Clinton is now making proposals to save it. What changed? The program or an upcoming election?

  3. Samuel Says:

    Woody, this is a sincere question: do you really think that skyrocketing malpractice claims is really the central issue here? Or that limiting them would make any crucial improvement in our healthcare system? Same with the insurance deductions: I think it sounds good, but would this honestly be making a siginifcant difference where it counts–i.e., making decent healthcare affordable to all? I’m very skeptical, to tell you the truth. I am guessing that your response would be somewhere along the lines of “well, it’s a step in the right direction, and better than putting it in the government’s hands”, or somethign to that effect, but again, I think the private sector has screwed this one up enough. Treating healthcare as a commodity like any other might not be such a good idea, is the lesson I’m learning from the current state of affairs.

  4. Woody Says:

    Samuel, my practice was once almost entirely physicians and dentists. I watched as malpractice insurance premiums went through the roof and forced many physicians to give up private practice or stick with it paying huge premiums–which were approximately ten times what they used to pay. Why did those premiums go up? Because of greedy lawyers making cases for every claim to get their 50% and getting stupid juries to pay whatever because “after all, it’s covered by insurance.”

    Yeah, it would make a big difference.

    A couple of days ago, I read about a woman in New Zealand who was treated by the government doctor and had her little finger amputated by him for no good reason. She took her complaint to the government commissioner in charge of such accusations, and he found the doctor at fault and instructed him to apologize to the woman. No money, just apologize. The doctor did not and there is no penalty if he doesn’t follow the order. The woman said, “All I wanted was an apology.”

    There was no malpractice award, there was no inflated insurance to cover such and driving up medical costs, and there was no slick lawyer trying to make a quick 50% off of a major claim. Just defending the cases gets very expensive, and if someone has a baby born just not right, then it must be the doctor’s fault.

    If our government is in charge of health care and needs to limit costs, will they put the cap on lawsuits and awards? If so, then they need to do it now to make health care affordable for private coverage.

  5. Randy Paul Says:

    Here’s a study in Texas, the 2nd largest state in the Union. I’ll take a study over an anecdotal observation any day.

  6. Michael Turner Says:

    What I see happening here is a form of price discrimination (i.e., figuring out how to charge more in cases where people have more ability to pay.) Hospitals bill outrageously, but collect only a fraction of the billed amount EXCEPT from people who have commensurate ability to pay. And there are always a few of those, and those people help fund the rest. Marc’s case might have been done BELOW cost — subsidized by someone who payed at a high multiple of actual cost.

    Yes, it’s absurd, insulting and inhuman. There are certain things that markets just don’t price very efficiently. Health care is not an easy thing to commodify. I don’t like very much about living in Japan, but my (amazingly low) medical bills under government health insurance is definitely one of them.

    I’m not sure Woody is very far off the mark with his comments about malpractice insurance. In America, Juries tend to award punitive damages that equal or exceed previous records for similar cases, leading to an upward spiral. It’s not the least of my reservations about John Edwards that he made his nut as a little more than a high-class ambulance-chaser. Japan doesn’t have much malpractice litigation, and probably should have more. But Americans are frighteningly litigious on this count, and juries aren’t sufficiently restrained. The best system would probably be something inbetween.

  7. Randy Paul Says:

    My wife had outpatient surgery in 1999. I do not know what her surgeon pays in malpractice premiums (being a surgeon, I would imagine that it’s significant), but what I do know is that she employs two fulltime employees to deal with getting approvals for procedures and processing claims as well as settling disputes with health insurers.

    As for John Edwards, Michael, I suggest that you read about Valerie Lakey.

  8. richard locicero Says:

    This seems to be the month for everyone to share Health Insurance horror stories. See Jan e Hamsher over at FIREDOGLAKE discuss her bills for her cancer therapy. Then go over to KOS. When his wife went into labor there was only one anestheseologist on call at the hospital that night. Since he was not on Markos’ PPO list he was charged $1000 even though no one else was available.

    Who needs Michael Moore?

  9. richard locicero Says:

    Malpractice is the great boogie man of American conservatives. Aside from Rany’s study there is the Rand study that showed that only 2% of claims are successful. Of course here in California we had “Malpractice Insurance Reform” in the 70′s and the 80′s. The big villian was “Pain and suffering” so a cap of $250,000 was placed on those awards. Lawyer’s fees were also capped.

    Well it sure worked here! Premiums in the Golden State are among the highest in the n ation and we’re a leader in uninsured.

    Meanwhile the list of higest paid executives in the state is dominated by HMOs.

    Next!

  10. caley Says:

    I had the same USC Blue Cross health insurance up until about a month ago. One yearly checkup to my doctor, with routine blood tests and a 10-minute exam was billed to me in full at $600. $600!! All ridiculous billings aside, when I pointed out to the insurance company that my deductible was $300, the insurance company “adjusted” the rates and while I still paid my $300, Blue Cross negotiated their remainder down to $140.

    Shows you how different each person’s experience with one specific carrier can be.

  11. richard locicero Says:

    And it also shows how stupid doctors are. They used to rail agains Medicare. It was “Socialized Medicine” after all. Now docs love it because it pays them promptly without the hassle. That’s why the American College of Physicians now endorses single-payer. They like getting paid too!

  12. Woody Says:

    Randy, your study is bunk and covers a one-time increase.

    One other major cost of high malpractice claims is that unnecessary treatments are prescribed to avoid the potential question to the doctor in court, “Why didn’t you recommend this test?”

    My doctor wanted me to have a heart test when he and I knew full well that my heart had no problem, but just in case. I asked him if that was based upon medical or legal considerations. He got it.

    Premiums go up, more staff is added, paperwork increases, and costly and questionable procedures are recommended–all of which creates huge increases in medical costs and because of legal considerations.

    Democrats could fix that if they didn’t get so many contributions from trial lawyers.

  13. Woody Says:

    One correction. Randy’s Texas study was used to discuss recent spikes in medical costs (a couple of years ago), but the study covered a longer period of time. Still, the study and its data seems to have been tweaked to fit the intended results rather than the desired truth. There are so many ways to screw with the numbers.

  14. Randy Paul Says:

    Randy, your study is bunk and covers a one-time increase.

    Woody, sometimes I wonder which is greater: your stupidity or your tendentiousness. The study analyzed fourteen years worth of data:

    Using a unique, comprehensive dataset maintained by the Texas Department of Insurance that includes all insured closed medical malpractice claims for 1988-2002, the authors found that, adjusted for general inflation and population, the number of large paid claims (more than $25,000 in 1988 dollars), payout per large claim, total payout per year on all large paid claims, and jury verdicts all showed no time trend. Only defense costs per large paid claim rose significantly, by 4.4 percent per year, adjusted for inflation, leading to a 1 percent per year increase in the total cost to insurers (payout plus defense cost) per large paid claim. Their findings, with these adjustments, are as follows.
    The number of large paid claims (higher than $25,000 in 1988 dollars) per year was roughly constant. The number of small paid claims (less than $25,000 in 1988 dollars) declined sharply.
    Mean and median payout per large paid claim was roughly constant over time.
    Mean and median payouts per large paid claim in 2002 were $528,000 and $200,000, respectively, in 2002 dollars.
    Roughly 6 percent of large paid claims involved payouts over $1 million in 1988 dollars, with little time trend in this percentage.
    The number of paid claims per 100 practicing Texas physicians per year declined from an average of 6.4 in 1990-1992 to 4.6 in 2000-2002.
    The total number of closed claim files averaged 25 per 100 practicing Texas physicians per year in 2000-2002. Of these, about 80 percent involved no payout.
    In 2002, payouts to patients were about $515 million (in 2002 dollars), while Texas health care spending was about $93 billion, so payouts on insured claims equaled 0.6 percent of health care spending.
    In 2002, mean and median jury verdicts in trials won by patients were $889,951 and $300,593, respectively (in 2002 dollars) and showed no significant time trend.
    The sum of payouts and defense cost rose by about 1 percent per year. Defense costs, which grew 4.4 percent annually, drove this increase.

    Because litigation outcomes were reasonably stable, other forces must account for most of the steep medical malpractice insurance premium increases seen after 1998, most likely insurance market dynamics.

    They show increases per year, not a “one-time” increase.

    Here’s a study from Harvard’s School of Public Health:

    The authors reviewed 1,452 closed claims from five malpractice insurance companies across the country. They focused on four clinical categories: surgery, obstetrics, medication and missed or delayed diagnosis, areas that collectively account for about 80% of all malpractice claims filed in the U.S. Specialist physicians in each of these clinical areas reviewed the claims and the associated medical records to determine whether the plaintiff had sustained an injury from care. If an injury had occurred, the physicians judged how likely it was to have been due to medical error.

    The reviewers found that almost all of the claims involved a treatment-related injury. More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.

    Most claims (72%) that did not involve error did not receive compensation. When they did, the payments were lower, on average, than payments for claims that did involve error ($313,205 vs. $521,560). Among claims that involved error, 73% received compensation. “Overall, the malpractice system appears to be getting it right about three quarters of the time,” said Studdert. “That’s far from a perfect record, but it’s not bad, especially considering that questions of error and negligence can be complex.” The 27% of cases with outcomes that didn’t match their merit included claims that went unpaid even though the injury was caused by an error (16%); claims that were paid but did not involve error (10%); and claims that were paid but did not appear to involve a treatment-related injury (0.4%).

    So who to believe: Woodrow or someone who actually knows what they are talking about?

  15. Michael Crosby Says:

    Once upon a time I was a medical insurance claim examiner and then claims manager. I certainly do not recall ever seeing a bill exceeding $100K where Blue Cross “accepted assignment” of 1/20 of the charge and could not then bill the insured for the balance. Clearly the system has changed in some fundamental ways.

    I do agree with Woody in the sense that it is pointless to discuss providing insurance coverage without addressing the factors that are driving the cost of covered medical care up. Malpractice is not a principal reason, though the secondary effect, the pressure to order arguably unnecessary tests, is one factor among many greater ones [mostly the huge profit margins for drugs, medical equipment and the like].
    However, as RLC wisely noted, California has greatly limited the damages that can be awarded in medical malpractice cases, and has also limited the contingency fee that can be agreed upon (it is a sliding scale, with the maximum allowable on the larger awards being 10%, hardly 50%).

    Perhaps we have reached the point where the hospitals and insurers will abandon the whole fee-for-service concept, as for example Kaiser-Permanente has done. If you go there, you never do get a bill, explanation of benefits or anything that purports to explain the cost for the services provided. I am sure there are some internal records kept, though, because the Permanente medical group does indeed offer its doctors bonuses based upon his/her avoidance of costs in the treatment of assigned patients.

  16. Randy Paul Says:

    Randy’s Texas study was used to discuss recent spikes in medical costs (a couple of years ago), but the study covered a longer period of time. Still, the study and its data seems to have been tweaked to fit the intended results rather than the desired truth.

    Proof?

  17. bill Says:

    “First, limit malpractice claims”
    Why doesn’t the AMA police themselves better. How come a doctor with a license revoked in one state can go destroy more lives in a different state?

    “Why did those premiums go up?”
    Insurance companies invest funds in stocks and other risky investments. When the stock market tanks like it did around the year 2000, insurance rates sored. Coincidence?

  18. John Says:

    You haven’t seen the end of it.

    The bills, itemized in painful detail, keep arriving for months.

    It’s a game. A medical task is broken down into numerous items, each of which is billed to the insurer instead of the total. Too much could be hidden in a mere total. So, costs are hidden in senseless itemizations.

    Wait until you get on Medicare. The bills are endless. They bounce around from primary insurer to secondary. You pay your portion, and next month there is another bill.

    Payments are miscredited to the items so that you get nasty notices that you haven’t paid when you have. The customer service help are morons who assure you the miscredit is ok, when it isn’t. Hospital after hospital misbills. Keeping it straight is very frustrating but absolutely essential. I’ve even threatened to complain to my state’s Attorney General on grounds of a billing fraud, which perhaps it is.

  19. Josh Legere Says:

    The system is inhumane. No doubt.

    But what is the best way to fix things? Hang on and wait for either of the major parties to take a stab at it? Good luck. You will be waiting until you are cold and stiff.

    The best thing to do is practice self induced preventative medicine. While we cannot control the toxins we breathe in on a daily basis (especially in LA), we can still eat a good diet and exercise. Avoid booze, drugs, smoke, etc… Basically avoid pleasure and conspicuous consumption (including gambling). Take care of your teeth, etc… Take vigilant care of your body and mind, nobody else will help you.

    I know the 60′s veterans on this blog that have been living groovy lives for the past 40 years cannot appreciate the idea of asceticism. But it is necessary in late capitalism to make extra ordinary efforts to take care of yourself. The state will not help, neither will the boss, nor will your broke friends and family (that are in the same boat, nor will your community. We are on our own.

    We are going to have to become monks. The only way to avoid long term debt is to get employed by someone like USC or live a life devoid of material pleasures.

  20. richard locicero Says:

    When the system breaks down completely. When 100 million are uninsured, when hospitals and, most importantly, trauma centers shut down for lack of financial resources, you’ll see action. Until then the Woody’s of the world will go on spouting their blather, serenly unaffected – till they get sick and go bankrupt trying to pay the bills incurred.

  21. Woody Says:

    When people quit dying untreated in emergency rooms of government hospitals, such as King-Drew, then what we have is better than what that window shows us.

  22. Randy Paul Says:

    More on the malpractice myth, this time from the Harvard University School of Public Health:

    The authors reviewed 1,452 closed claims from five malpractice insurance companies across the country. They focused on four clinical categories: surgery, obstetrics, medication and missed or delayed diagnosis, areas that collectively account for about 80% of all malpractice claims filed in the U.S. Specialist physicians in each of these clinical areas reviewed the claims and the associated medical records to determine whether the plaintiff had sustained an injury from care. If an injury had occurred, the physicians judged how likely it was to have been due to medical error.

    The reviewers found that almost all of the claims involved a treatment-related injury. More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls.

    Most claims (72%) that did not involve error did not receive compensation. When they did, the payments were lower, on average, than payments for claims that did involve error ($313,205 vs. $521,560). Among claims that involved error, 73% received compensation. “Overall, the malpractice system appears to be getting it right about three quarters of the time,” said Studdert. “That’s far from a perfect record, but it’s not bad, especially considering that questions of error and negligence can be complex.” The 27% of cases with outcomes that didn’t match their merit included claims that went unpaid even though the injury was caused by an error (16%); claims that were paid but did not involve error (10%); and claims that were paid but did not appear to involve a treatment-related injury (0.4%).

    Let the facts speak for themselves.

  23. jeff Says:

    Prior to the Texas study, there was a national one comparing states with and without malpractice caps:

    http://www.weissratings.com/malpractice.asp

    Basically it says, stop with the caps – by themselves they are not a solution. Its more complicated than that. Not a big surprise.

  24. JeffF Says:

    Here is another study:
    http://www.centerjd.org/air/issues/StableLosses03WA.pdf

    Medical Malpractice insurance is a heavily regulated industry. State governments have extremely good data on how much is spent on it and how much it pays out. The fact that so few people are even vaguely familiar with these facts is a great testament to the right wing media machine.

    It is likely that some small amount of good could be done through lawsuit reform, but not the ‘rich people can never loose their money’ reforms that the republican party champions.

    Heck in the 2004 election Bush claimed it would net 2% of total medical insurance premiums which is presumably the highest vaguely defensible number the denizens of right wing think tanks could come up with.

  25. JeffF Says:

    “The fact that so few people are even vaguely familiar …”

    Well not just people, of course they don’t know, but people like Woody who seem to have had a vested personal interest in the issue.

  26. bobbyk Says:

    Woody is full of it. The people of this country pay something like 400 billion a year in health care costs. The payout for medical mal-practice is below 10 billion, a fraction of the total.

  27. Cycledoc Says:

    Bobbyk–the amount spent on health care in the U.S.is about 1.9 trillion dollars!

  28. reg Says:

    Might as well pile on, although the crackpot spin from our usual suspect has already been demolished. Of course, Woody just rattles on whether there are any facts supporting his brain farts or not. As noted, medical malpractice awards total less than a half of one % of health care costs. According to the former Missouri insurance commissioner “the incurred-loss ratio for the leading 15 insurers fell by almost 25 percent from 2000 to 2004 to 51.4 percent, meaning that the companies took in almost twice as much in premiums during that time as they paid out in claims.” If there’s a problem, it ain’t lawyers – it’s guess who ? Insurance companies. Get ‘em out of health care via single payer. They’re doing nothing but screwing us.

  29. bobbyk Says:

    Bobbyk–the amount spent on health care in the U.S.is about 1.9 trillion dollars.

    You’re right, I got my number wrong. I’ve been poking around the internets and this
    web site says medical malpractice tort costs for 2005 totaled 29.6 billion dollars which seems like a lot but is only 1% of the total spent on health care in this country. This web site has some good information on the myths involved in medical mal-practice awards.

  30. John Says:

    I’m going to be up front here. I’m a lawyer, but I don’t make money suing doctors. My dad was a surgeon and my son is studying medicine. First, I strongly recommend reading “Critical Condition” by Donald Bartlett and James Steele if one wants to get a handle on this issue. Its a well written book by Pulitzer Prize winners. The price discrimination between insured and uninsured is real–I’ve seen that in my own billings. What hasn’t been mentioned here is the horrendous collection practices instituted against the uninsured by the hospitals and other care providers. Read the book to get a sense of what is really going on.

    The malpractice issue as typically framed is largely a distraction, though there are significant cost savings that can be realized by better attention to quality control issue instead of knee jerk blaming of greedy lawyers or runaway juries. Several years ago the national organization representing the anesthesiologists went through a comprehensive loss analysis and review of case histories, protocols, etc. They determined that indeed, there were problems with patients dying or suffering disabling injuries as a result of their care. They went over protocols, case management, equipment, and the like to determined what could be done to reduce morbidity and mortality. New procedures, protocols. and equipment improvements were made as a result, instead of lobbying for restrictions on lawsuits. After these were implemented, there was a significant reduction in claims and consequently, malpractice premiums went down substantially. Why–because the patients got better care, there were fewer deaths or disabling injuries. This was all reported in the Wall Street Journal. Though I could be wrong, I am not aware of comparable efforts in other areas of the health care industry.

    Another thing to take a look at–there was a study done of VA hospital claims. They found that the malpractice claims dropped significantly if the care providers simply offered a sincere apology. Its amazing what can happen if a there is a human touch involved. Unfortunately, this is not likely to happen with managed care and the horrendous number of patients which get caught in the morass.

    The malpractice cost is a miniscule percentage of health care costs. Meanwhile, administration of our non-Medicare portion of the system eats up 30+ % of the health care dollar. I’ve seen the malpractice red herring raised before–back in the 1970s, and its pretty clear that a major component of this recurring “crisis” has been financial mismanagement by the insurance companies, forcing them to raise premiums and conveniently blaming the trial lawyers.

  31. deejaayss Says:

    The insurance companies are forcing you to buy protection from inflated hospital costs. The costs are imaginary, since this money never changes hands.

    The insurance companies use this inflated number to set your deductible cost to at or above the real cost, so you end up paying for the full cost of the service.

    The insurance company gets to keep all of your monthly payments.

    Doctors still pay high malpractice premiums to the insurance companies. The trial lawyers were stopped by Tort Law Reform, but the rates still remain high. The doctors lose and the insurance companies win. The doctors should have hired the lawyers to sue the insurance companies. Too late now.

  32. Michael Turner Says:

    Well, this has been a surprisingly useful and informative discussion. What I’m hearing aligns neatly with the old saw: “An ounce of prevention is worth a pound of cure.” Anaesthesiologists look at their own practice, and see how they can prevent malpractice. Then — well, whatever HAPPENED to simply saying you’re sorry, anyway? Doctor, heal thyself — particularly thy soul! — and offering sincere apologies for bad work (or even for understandable human error) seems to make a difference. Even Josh has a point, in a way — the system should somehow be geared more toward preventing people from getting sick or injured in the first place.

    The mind boggles at some things. “Most claims (72%) that did not involve error did not receive compensation. When they did, the payments were lower, on average, than payments for claims that did involve error ($313,205 vs. $521,560).”

    Wait a minute — if I understand the use of the word “error” here correctly, this means that 28% of malpractice awards are for cases of NO malpractice, and the recipients got about 60% of what those who actually *were* victims of error got — a fair chunk of change at that? (I could do with a $313,205 lottery winning right now, thank you.) And you’re trying to tell me that this system ISN’T broken?!

  33. Randy Paul Says:

    Michael,

    Talk about cherry-picking!

    Perhaps it would be a good idea to actually read the next sentence:

    ). Among claims that involved error, 73% received compensation. “Overall, the malpractice system appears to be getting it right about three quarters of the time,” said Studdert. “That’s far from a perfect record, but it’s not bad, especially considering that questions of error and negligence can be complex.” The 27% of cases with outcomes that didn’t match their merit included claims that went unpaid even though the injury was caused by an error (16%); claims that were paid but did not involve error (10%); and claims that were paid but did not appear to involve a treatment-related injury (0.4%).

    In other words, nearly an equal percentage in which there was an error got no compensation. If you’re looking for perfection, perhaps you can find a way to tear the blindfold off the eyes of the lady with the scales.

  34. Karmakin Says:

    Well, I do happen to think that the tort system is a theoretical problem. I’m not sure of the numbers that get flung around from both sides. But it seems to me that having vigilantism by lawyer isn’t a good thing. Instead, this sort of thing should be handled as criminal cases, with large fines/prison time levied out, and the victim “made whole” out of the fine money.

    But really. It’s either single-payer or the US economy goes down the crapper.

    Your pick.

  35. Randy Paul Says:

    In fact, as the above quote indicates, a greater percentage of the cases that involved “outcomes that didn’t match their merit” were of claims that involved error that resulted in no compensation 16% and 10% involved cases that were paid without an error. Given that these numbers come from the same pool, the number of those who received no compensation for cases that involved error was far greater than those whose cases involved no error and received compensation.

    Always best to dig a little deeper, Michael.

  36. Woody Says:

    Randy, reg, and the usual suspects are nuts. Medical malpractice risks go far beyond the actual pay-outs, which is the basis of “all the studies.”

    We are treated to expensive multiple procedures and tests–just in case. Insurance has to pay out enormous sums just to defend cases that they win. We’ve also covered the administrative costs. All of this ultimately ends up being passed along to the patients in higher medical costs. Did the studies miss those?

    Don’t be so stupid or quick to judge. You guys just want taxpayers to pay for your own insurance; therefore, you won’t admit that there is anything in the private system that can be corrected to keep the private system running. Not only stupid, but too lazy to take care of yourselves.

  37. tramplish Says:

    This is theft. The current Republican leadership should be required to wear burglar masks in public.

  38. Randy Paul Says:

    Randy, reg, and the usual suspects are nuts. Medical malpractice risks go far beyond the actual pay-outs, which is the basis of “all the studies.”

    Proof?

  39. Jose Padilla Says:

    “We are treated to expensive multiple procedures and tests–just in case. ”

    And who makes money on those procedures? The doctors do. So the doctors order unnecessary procedures, which they just happen to profit from, and then blame the lawyers.

  40. ST Says:

    You guys just want taxpayers to pay for your own insurance; therefore, you won’t admit that there is anything in the private system that can be corrected to keep the private system running. Not only stupid, but too lazy to take care of yourselves.

    Umm, my employer pays for a huge whack of my insurance, and I feel neither stupid nor lazy for allowing that to happen. Also, I anticipate that some sort of commensurate tax will be levied upon me (as I am, after all, a taxpayer) to pay for this system, so I will be taking care of myself in the sense that we will be taking care of ourselves. I know that concept makes your brain break out into tiny hammer-and-sickle-shaped hives, but seriously, relax. If we all had to pay for all of our own healthcare, we would all be broke and dead. (But fiercely independent!)

  41. freelunch Says:

    If the medical care industry wanted to pay lower malpractice claims, they would change their processes so they had less malpractice. Just adding billions in tests does not end malpractice, quality control ends malpractice.

  42. Woody Says:

    Nuts, Marc must have his filter on, as I can’t get my comments with links to go through.

  43. Woody Says:

    (One last try without the links)

    Randy, proof is your own sources, which covered just one aspect of medical malpractice claims and left out those that I mentioned. Paying claims is one cost. You also have to defend them and recommend unnecessary tests (major cost) to avoid more claims. You can find selective articles furthered by Democrats and lawyers and anti-business groups, which are just as deceitful as they are in their rhetoric.

    Type “defensive medicine” into google and see what you get. Here are two samples.

    Defensive medicine:

    “Paranoia is a strong word but accurate in the sense that physicians often take actions that may not be necessary yet, because of the fear of liability, appear justified to avoid lawsuits. This practice is known as defensive medicine. The defensive practice of medicine is the “deviation from sound medical practice that is induced primarily by a threat of liability” [4] and it includes supplemental care, such as additional testing or treatment; replaced care, such as referral to other physicians; and reduced care, including refusal to treat particular patients [4].

    “The goal of defensive medicine is to ensure that, if the patient later sues, the physician has gone above and beyond what is required. Defensive medicine is directly traced to medical malpractice law—without the threat of litigation, there would be no reason to practice defensively.”

    Survey finds 90% of Pennsylvania physicians make medical decisions based on avoiding suits:

    “Virtually all the physicians who responded to the survey said they sometimes or often engaged in at least one of six forms of defensive medicine, procedures that in many cases were likely to add to health-care costs.

    “Fifty-nine percent said they often ordered more diagnostic tests than were medically indicated, and 52 percent said they often referred patients to other specialists even though such referrals were not really necessary.”

    As usual, your position goes against all common sense and reason and is offered for political purposes only. That’s why I don’t vote for Democrats.

  44. Woody Says:

    Oh, now it is accepted, but is awaiting moderation, which will never happen.

  45. JeffF Says:

    “# Randy Paul Says:
    September 6th, 2007 at 6:31 am

    Randy, reg, and the usual suspects are nuts. Medical malpractice risks go far beyond the actual pay-outs, which is the basis of “all the studies.”

    Proof?”

    Heh, who needs proof when you have the unassailable logical argument that health care providers are massively and ridiculously overspending to avoid relatively minor malpractice costs. Why who wouldn’t spend 10 or 20, or 49 percent of total health care costs to avoid a possible cost of a 1-2%! It is the miraculous free market with its rational allocation of resources at work… err wait no its not the miraculous market… its the nasty trial lawyers, these resources are allocated irrationally because they are responding to lawsuits and it is impossible to respond rationally to lawsuits… er, kind of like superman and krypotonite. And even better reducing that 1-2% to 0.5-1% is going to eliminate the vast majority of that ridiculous, irrational ‘defensive medicine’ (sounds a bit french doesnt it? “defensive” hah! Born in the USA! Born down in a dead man’s town
    The first kick I took was when I hit the ground
    You end up like a dog that’s been beat too much… hey wait a minute, what is this song about anyway!).

  46. Owen Gallagher Says:

    If you do not have insurance and have the ability to look up what the reimbursment you can walk in and say that you have a check in hand and will write it for the Blue Cross reimbursment. To your surprise they will moist probably take it.

    I went thru some of this once with rabies shots. I asked for a price before I started. I was given a price. I was billed for 6 fold markup on the medications. The estimate was for a 1.7 markup. I paid the estimate amount and sent along a short letter questioning the ethics of the 6 markup and never heard any more.

  47. Dean's World Says:

    but: it’s only class warfare when the poor go after the rich…

    So I was in this particular hospital for a grand total of 20 hours.

    The bill arrives today and (without any itemization) totals up to — are you ready?– $116, 749.00 (not included the cardiologist fees which ……

  48. Woody Says:

    One thing that everyone agrees upon is that patients are subjected to many additional and medically unnecessary and costly tests. Why? For the sake of doctors who are forced to play defensive medicine because of the trial lawyers. Google “defensive medicine” if you want to see the real and hidden costs of malpractice claims.

  49. reg Says:

    “patients are subjected to many additional and medically unnecessary and costly tests. Why? ”

    The fact that these tests generate fees has nothing to do with it, of course…

  50. Michael Isikoff MD. Says:

    Welcome to medicine 2007. This is known as cost shifting. The vast majority of patients with insurance pay only a fraction of the hospital bill. Since there insurance company has negotiated a set fee for a given condition or procedure. Medicare does the same thing. However if you are one of the 47 million citizens without insurance and are not eligible for medicaid then you billed for the full amount, and they will go after your house if you don’t pay. In other words the working poor subsidize those people fortunate enough to have insurance. What a system!! Only in America.

  51. reg Says:

    Incidentally, if you want to play Woody’s silly Google game, try this: health insurance company profits

  52. HamR Says:

    So one incentive for physicians to subject patients to medically unnecessary tests and procedures is fear of malpractice suits.

    Can we think of any other incentives? How about the way physicians are paid by piecework? Insurers seek to drive down their costs by reducing what they pay for each procedure, and physicians respond by performing more procedures.

    Solution: Put physicians on salary.

  53. HamR Says:

    Enough with the threadbare cliche that government can’t do
    anything well, and the private sector does everything better.

    Our medical-care system is a prominent counterexample, as described by Phillip
    Longman in his book, “Best Care Anywhere: Why VA Health Care is Better Than
    Yours”. From the book’s self-description:

    The long-maligned Veterans Health Administration has become the
    highest-quality healthcare provider in the United States. This encouraging
    change not only has benefited veterans but also provides a blueprint for
    salvaging America’s own deeply troubled healthcare system. Best Care
    Anywhere shows how a government bureaucracy, working with little notice, is
    setting the standard for best practices and cost reduction while the private
    sector is lagging in both areas. Author Phillip Longman challenges
    conventional wisdom by explaining exactly how market forces work to lower
    quality and raise prices in the healthcare sector, and how U.S. medical
    practices have a weak basis in science. The book, expanded from a widely
    praised article in the Washington Monthly, mixes hard facts with author
    Philip Longmans’ compelling human story of the loss of his wife to cancer.
    Part manifesto, part moving memoir, Best Care Anywhere offers new hope for
    addressing a major problem of contemporary society that affects all of us.

  54. Piehole Says:

    Here’s the basic reality of insurance: the larger the pool of people, the lower the costs for all included. Right? Right. So … if you have THE ENTIRE COUNTRY in the pool, doesn’t that guarantee the lowest possible costs? That’s just logical, right?

    (separate point) I, for one, am willing to pay for health insurance, whether directly through premium or indirectly through taxation. Nothing is free, every idiot understands that. You pay eventually.

    I think, I hope, the high-level debate is finally shifting toward the recognition that SINGLE PAYER (with details to be worked out) is the way to go. Man, woman, child, adult, senior … you’re going to need health care at some point in your life. Guaranteed. So why not set up a unified, SINGLE PAYER insurance pool to cover that?

    It seems rather simple actually — the only impediments being greed instead of compassion. If people want to practice medicine for a living wage, fine — do so. If you want to have three houses and a Benz and a Beemer, try another occupation.

  55. Thinker Says:

    reg,

    Looking at ‘heath insurance profits’, I find these profit margins:

    UnitedHealthcare: 5.9%
    Aetna: 6.87%
    WellPoint: 5.45%
    Cigna: 5.92%

    By comparison:

    Google: 27.48%
    Apple: 13.85%
    Bed Bath & Beyond: 8.83%

    So, just as the malpractice rant might be a conservative ‘boogie man’, profit margins are the same to the left.

    Ultimately, my hope is that we can try to really understand why costs are so high. I know it’s been said before, but it should by now be generally accepted that private markets produce higher quality at lower price. We would never believe that the federal government could produce a cheaper, higher quality computer, mobile phone, car, etc. So what is it that is different here? Would the federal government be better at home insurance? Car Insurance?

    Unfortunately, Sicko provides very little to us in this regard, and it’s one of the reasons why I find Moore’s films lacking… they don’t provide any real education. Maybe that’s not the point, but then Moore shouldn’t be out there telling us all what the solutions should be.

    Yes, I know that healthcare is, in fact, different than other markets. And I am Canadian, and have seen that a federally run system can be relatively good. But why doesn’t the private sector do better?

    I suspect that one of the biggest problems is that employers are involved right in the middle of this. This is incredibly distorting to the market, because it separates the buyer of the good from the consumer of the good – the incentives are all wrong. Plus, it just seems crazy… do you really trust your employer to choose the best health insurance for you? No way… but the tax system (and most current proposals) put an ever greater incentive on employers to become insurance brokers for their employees.

    Finally, I would suggest that the best way to see this happen would be to see states take the lead. Everyone clamours for a federal solution… why not Oregon? Or let’s learn from Massachussets. In the meantime, we should make some changes to federal law to improve the situation… an easy start would be to make health insurance premiums tax deductible for individuals. It wouldn’t solve the problem, but it’s a quick way to make things better.

  56. Marc Cooper » Blog Archive » Needled, Poked, and Tubed Says:

    [...] My post earlier this week on the racket of hospital/insurance billing got a huge response and rush of readers thanks to many incoming links. And thanks, but no thanks, to the rather universal negative experience in this category shared by the American public.  I got some great privately emailed responses on this subject as well. Here’s a taste. Jeff Huppert writes these words: I have been retired from both the Insurance and stock brokerage businesses for the last seven years. Hospitals have been notorious for this. Simply put the hospital writes off the difference between $116,000 and $4730, or $111,270.  They take t right off the top.  This has led to investigation of several hospitals in my area for over-billing patients/insurance companies. Particularly Medicare (Currently covered as of 3/14/02)  My experience was six years ago when I had gall stones and gall bladder removed. [...]

  57. Kevin Says:

    Comparing Google, and, to a lesser extent, Apple, to health care businesses is, well, stupid. The industries have absolutely nothing to do with each other, unless you think that you can get your physical over the Internet.

  58. Randy Paul Says:

    Thinker,

    Why not compare them to firms in the health care field like pharmaceutical companies?

  59. Woody Says:

    reg: In response to “patients are subjected to many additional and medically unnecessary and costly tests. Why? ” says The fact that these tests generate fees has nothing to do with it, of course…

    reg, unnecessary procedures for defensive medicine has a lot to do with higher medical costs–not just insurance. If doctors are prescribing, say 40%, more procedures simply for legal considerations, then those costs get passed along through the system and end up in the laps of the consumer. Don’t be so stupid or stubborn.

    Piehole: Here’s the basic reality of insurance: the larger the pool of people, the lower the costs for all included. Right? Right. So … if you have THE ENTIRE COUNTRY in the pool, doesn’t that guarantee the lowest possible costs? That’s just logical, right?

    You also add a larger pool of people who are going to drive up costs faster than any premiums could come down. Otherwise, insurance companies would cover them now–if these people were willing to pay instead of using money for drugs, cigarettes, booze, and fattening greasy fried chicken. That’s logical.

    Thinker: In the meantime, we should make some changes to federal law to improve the situation… an easy start would be to make health insurance premiums tax deductible for individuals.

    I agree with you. Now, why do you think that the Democrats consistently block such proposals? Why, letting people take care of themselves is not in the interests of those who want to seize power and transform this nation into a socialist disaster.

    Kevin and Randy, the comparisons of profit margins and rates of returns of insurance companies to various other industries makes a lot of sense. Insurance competes in our nation’s and global money market against all businesses for investors. In addition, the comparison gives us a point of reference when insurance companies are accused of making “excessive profits,” which are any profits to a socialist.

  60. Woody Says:

    Nuts. The moderation filter has caught me again. I’m going to try this without any html codes.

    - – - -

    reg: In response to “patients are subjected to many additional and medically unnecessary and costly tests. Why? ” says “The fact that these tests generate fees has nothing to do with it, of course…”

    reg, unnecessary procedures for defensive medicine has a lot to do with higher medical costs–not just insurance. If doctors are prescribing, say 40%, more procedures simply for legal considerations, then those costs get passed along through the system and end up in the laps of the consumer. Don’t be so stupid or stubborn.

    - – - –

    Piehole: “Here’s the basic reality of insurance: the larger the pool of people, the lower the costs for all included. Right? Right. So … if you have THE ENTIRE COUNTRY in the pool, doesn’t that guarantee the lowest possible costs? That’s just logical, right?”

    You also add a larger pool of people who are going to drive up costs faster than any premiums could come down. Otherwise, insurance companies would cover them now–if these people were willing to pay instead of using money for drugs, cigarettes, booze, and fattening greasy fried chicken. That’s logical.

    - – - -

    Thinker: “In the meantime, we should make some changes to federal law to improve the situation… an easy start would be to make health insurance premiums tax deductible for individuals.”

    I agree with you. Now, why do you think that the Democrats consistently block such proposals? Why, letting people take care of themselves is not in the interests of those who want to seize power and transform this nation into a socialist disaster.

    - – - -

    Kevin and Randy, the comparisons of profit margins and rates of returns of insurance companies to various other industries makes a lot of sense. Insurance competes in our nation’s and global money market against all businesses for investors. In addition, the comparison gives us a point of reference when insurance companies are accused of making “excessive profits,” which are any profits to a socialist.

  61. Woody Says:

    One last try to get around the moderation filter, as Marc rarely checks and approves those moderated comments. I’ll try it in stages.

    - –

    reg: In response to “patients are subjected to many additional and medically unnecessary and costly tests. Why? ” says “The fact that these tests generate fees has nothing to do with it, of course…”

    reg, unnecessary procedures for defensive medicine has a lot to do with higher medical costs–not just insurance. If doctors are prescribing, say 40%, more procedures simply for legal considerations, then those costs get passed along through the system and end up in the laps of the consumer. Don’t be so stupid or stubborn.

    - – - –

    Piehole: “Here’s the basic reality of insurance: the larger the pool of people, the lower the costs for all included. Right? Right. So … if you have THE ENTIRE COUNTRY in the pool, doesn’t that guarantee the lowest possible costs? That’s just logical, right?”

    You also add a larger pool of people who are going to drive up costs faster than any premiums could come down. Otherwise, insurance companies would cover them now–if these people were willing to pay instead of using money for drugs, cigarettes, booze, and fattening greasy fried chicken. That’s logical.

  62. Woody Says:

    Second part of comment:

    - –

    Thinker: “In the meantime, we should make some changes to federal law to improve the situation… an easy start would be to make health insurance premiums tax deductible for individuals.”

    I agree with you. Now, why do you think that the Democrats consistently block such proposals? Why, letting people take care of themselves is not in the interests of those who want to seize power and transform this nation into a socialist disaster.

    - -

    Kevin and Randy, the comparisons of profit margins and rates of returns of insurance companies to various other industries makes a lot of sense. Insurance competes in our nation’s and global money market against all businesses for investors. In addition, the comparison gives us a point of reference when insurance companies are accused of making “excessive profits,” which are any profits to a socialist.

  63. Woody Says:

    Second Part – Part A

    - –

    Thinker: “In the meantime, we should make some changes to federal law to improve the situation… an easy start would be to make health insurance premiums tax deductible for individuals.”

    I agree with you. Now, why do you think that the Democrats consistently block such proposals? Why, letting people take care of themselves is not in the interests of those who want to seize power and transform this nation into a socialist disaster.

  64. Woody Says:

    I give up trying to get this entire comment accepted.

  65. Piehole Says:

    Woody: your flip dismissal of putting everybody into the same insurance pool seems cruel to me. I *personally* know people who do not use drugs, smoke cigarettes, drink or eat junk food who can not *afford* the premium for a health insurance policy that is worth anything. (by “a policy that is worth anything”, I trust you know what I mean). One friend in particular, who is self-employed and who has long-running health problems, would benefit tremendously if she had the kind of blue-chip, employer-provided health insurance that I have. Actually, I find it personally insulting that you enter this part of the argument armed with such ignorant confidence. You’re not speaking from the experience of many Americans, or on their behalf!

  66. Woody Says:

    Piehole, I think that you’re the first person that I’ve ever insulted at this site. You should have seen the list of people that I didn’t mention.

    If we force insurance companies to accept the currently uninsurable, either the rates of those people will be astronomically high or everyone else will have to pay higher premiums to cover what they do not pay. Sure your friend with long running health problems would benefit. But a friend who is in great health would have to pay extra just for her. Nothing is free.

    When there is a problem, I wish that liberals would seek solutions other than taking money from other people.

  67. reg Says:

    Woody – you missed the biggie here on why extra procedures and tests are prescribed and I’m the “stubborn, stupid” one ?

    The usual WoodPecker standard of sloppy analysis, half-assed argument and last resort to ad hominem….

  68. Piehole Says:

    Woody: I don’t know you from Adam, so I say this in the freshness of my innocence: you seem woefully lacking in common sense.

    #1 – “forcing insurance companies to accept the currently uninsurable” is a phrase that can only come out of the mind and heart of somebody who loves corporations more than people. People, like you, who operate out of that worldview, are a huge problem in this world of ours. Please accept my sympathy for your condition.

    #2 – Who is in great health throughout their life? Virtually nobody. That part of your argument rests on a straw man, easily dismantled by you in your rush to prove your larger point. Which is what, again? That people are expendable and corporations must be protected at all costs?

    #3 – Says Woody (paraphrase, but accurate): “The sole liberal solution to any problem is to take money from other people.” As a simple rebuttal to that odious worldview, I give you the fruits of progressive/liberal politics down through the ages:

    * Inherent, universal rights of individuality and humanity rather than kingly/divinely “allowed” (and revocable) rights
    * end to child labor by law
    * the concept of a time-limited work week, with time off
    * the right of women to vote
    * the freeing of black people from slavery, and their right to vote
    * the idea of a minimum wage (a step up from real slavery to wage slavery, but still a step up)

    … why do I go on? Y’know, you’re not a serious person to be in a conversation with. Best of luck with your droll worldview, which is carrying our culture and times further down the slippery slop to the Swamp of Isolated Selfishness and Ruin, on a daily basis. Good luck with that!

  69. Woody Says:

    Marc must have a filter on me, so I’m going to try to post this one more time iand n two segments and then give up if it doesn’t work. Where’s Mark York and steve so that we can commiserate.

    Piehole, you didn’t say anything that I haven’t fought off before. You want government to do your bidding and I want government to leave me alone, because I can do a better job without its interference.

    BTW, corporations are extensions of individuals. Corporations are the vehicles that create wealth for collective investors, of which a great part is made up of retirement plans. I guess you don’t want grandpa making any money from his stock as long as someone else gets something for nothing.

  70. Woody Says:

    Part B:

    reg, I’m so disappointed, but my moderated comments had links for you, but I gave up after three or four times trying to post them. The extra procedures and related costs are simply due to defensive medicine. People are more motivated to avoid losing money than they are in making it. Plus, enough lost suits and a doctor loses his livelihood.

    Remember this example of what drives up costs?

    “Survey finds 90% of Pennsylvania physicians make medical decisions based on avoiding suits:

    “Virtually all the physicians who responded to the survey said they sometimes or often engaged in at least one of six forms of defensive medicine, procedures that in many cases were likely to add to health-care costs.”

    Thank the Democrats and their friends the trial lawyers.

  71. Woody Says:

    P.S. I gotta love Piehole’s play with words. Maybe he’s really Dan Rather.

    Says Woody (paraphrase, but accurate)

  72. Michael Crosby Says:

    Woody, maybe you’re right. No more medical malpractice lawsuits. No more “defensive medicine,” at least not that practiced to create a record as a defense to lawsuits. That will knock a little bit off medical insurance premiums.

    But it will also leave the people injured and incapacitated by negligent medicine practiced by good and bad doctors alike without any recourse. If the injured person didn’t have health insurance, s/he will have to pay not only the provider’s bill for the injurious treatment, but the subsequent bills for the next 1-100 years of treatment that will be required.

    Moreover, the negligent doctor will be permitted to proceed happily along to the next patient, without a care, knowing that his/her bad practice has no practical consequences. Woody’s worries that “enough lost suits and a doctor loses his livelihood” would be no more! In other words, in WoodyWorld, once one gets the M.D. degree, it’s a worry-free professional life for all except the patients.

    The costs of the tort system must be measured against the compensation they provide victims as well as the economies and improved practices that the system encourages by making the failure to implement good practices costly.

  73. Forward to Yesterday - Bob Westal Classic Film, Movie, & Television Blog Says:

    [...] something deeply rotten in our health care system needs to read this fairly brief post by Marc Cooper. Cooper, who is blessed with unusually good health insurance thanks to his teaching gig at [...]

  74. Woody Says:

    MC, your options are not options at all. I’m not asking for no malpractice settlements, and I want people compensated for real rather than hyped up claims by lawyers. However, I think that caps on malpractice claims are not unreasonable. Also, the AMA polices the medical profession, so there are no worry-free lifetimes of practice. Your alternative medical world is not mine and is a totally false presentation

  75. Healthcare Economist · Why not shop around? Says:

    [...] a blog post (”Sicko Sticko Shock“), Marc Cooper discusses his recent hospital bill for a heart procedure of “moderate [...]

  76. Redwretch Says:

    Ummmm…Hey guys, why don’t you ask a Canadian? Surely you know one.

    We don’t get pushed into bankruptcy when a family member gets ill, unless massive amounts of drugs need to be taken daily.

    Woody, you just don’t get it. Single payer is peace of mind. Remove the profit motive to deny care, regulate the costs so that doctors and hospitals must justify outrageously large bills to people with experience in handling medical costs, and cover everyone, even smokers and fast food eaters.

    Healthy non-smoking vegan joggers still get cancer too. Cover everyone, and let the law of averages do its thing.

    Single payer is ethical, responsible, and provides more value to the customer…which is why no Republican will ever be for it. No one tells you what doctor you have to go to, and you can go to any hospital, not just the ones your insurer has a prior relationship with (Single payer has a relationship with them all).

    With everyone covered there’s plenty of work for health care professionals to do, you know, care.

    By the way, industry groups (doctors, insurers) will always be on the wrong side of this issue. Don’t let them stop you or scare you. It’s your country too, and if it’s so bad they leave the profession it’s probably because they’re close to retirement anyway.

  77. Commonsense Says:

    I am having problems with what I see as a logical fallacy in Woody’s argument.

    Woody argues that extra procedures and related costs brought on be defensive medicine are responsible for much of cost of the health costs.

    “Defensive” medicine is a right wing buzzword – people used to talk about preventative medicine. In one example cited by Woody, his doc wanted to do a heart test on him, even though “they both knew” he did not need it. I guess A) this means Woody has diagnostic equipment at his house; and B) his doctor is incompetent.

    However, what if the doctor had found something, worked quickly to treat it, thereby precluding more costly treatment. In this case, hasn’t the “Defensive” practice of medicine saved money?

    Furthermore, given what appears to be relatively undisputed evidence – in the studies linked to, and apparently unchallenged by Woody himself – that the actual payout of MedMal claims is only 1-2 % of health care costs, and caps really don’t seem to make a difference in premium costs; isn’t it really paranoia by ins companies and doctors driving up costs, rather than the actual prospect of litigation? That is, all this defensive medicine is being performed based on the spectre of lawsuit, rather than any sort of reality based assesment of the chances of getting sued and/or liklihood of success. Ergo, isn’t this problem brought on by ins. co’s and doctors, not the hated “trial lawyers.”

    If Woody is right, why hasn’t the capping of damages in at least 19 states made no appreciable difference in premiums?

    Maybe the issue for Woody isn’t the size of the jury award, byut the prospect of being sued at all. If so, Woody is asking for far more legal protection for doctors than anyoen else inn society. Anyone can sue anyone for anything. Period. Whether it survives a motion to dismiss the next day is another matter. You still have to hire an atty to defend it. Ergo, if this is Woody’s argument, he is saying that doctors should be precluded from being sued in the first instance. In fact, in my state, you have to have at least one doctor opine that malpractice has occured before the suit can be filed. No decrease in premiums that I have seen.

    Lastly, can anyone think that profit based health care ever benefit the patient. Profit based health care means simply that the service provided will be the one with the greatest profit – generally, the cheapest to produce but which costs the most.

  78. Health Care and Economic security « I need a blog title! Says:

    [...] to go to the emergency room theres a very good chance that you’ll be financially ruined. Marc Cooper complained that he spent ONE day in the hospital and was recieved a bill for “$116, 749.00 [...]

  79. Butalbital Says:

    Virtually all the physicians who responded to the survey said they sometimes or often engaged in at least one of six forms of defensive medicine, procedures that in many cases were likely to add to health-care costs.

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