On Tuesday many Americans went to the polls to vote on local elections. Even though the elections were for local representation, two elections were getting plenty of national attention. The races for Governor in New Jersey and Virginia were both looked upon as a barometer for 2010 Congressional races. In both cases the sitting Democrat lost to their Republican challenger. While the spin was in high gear yesterday, the true impact will be seen on Capitol Hill as health care reform and cap and trade bills move forward. Even though the Democrats hold majority in both houses of Congress, those Democrats, many known as "Blue Dogs", in swing states are now taking pause to assess the ripple effect the elections have in their districts.
Rep. Gene Taylor (D-Miss.) warned that "The House leadership needs to pay attention to what happened in Virginia." Rep. Taylor's words are echoed in the Senate by Sen. Kent Conrad (D-N.D.). Sen. Conrad responded to the election results by saying, "The American people get it. They know we're on an unsustainable fiscal course." The realization by "Blue Dog" Democrats is reassuring as House Speaker Pelosi is pushing for a vote on the House's health care reform bill which is nearly 3000 pages long. Why, Speaker Pelosi is the bill so long? Health Care reform is not as complex as your bill makes it sound.
Ask yourself why not one single member of Congress in favor of the reform being looked at is not willing to participate in it by giving up their current health insurance coverage and switch to the "reformed" insurance coverage? Health care reform can be obtained without a 3000 page bill that will cost $1.2T over ten years according to the CBO. I have blogged about how to accomplish this without spending a dime but will say it again.
- Create true competition through the interstate buying and selling of health care insurance.
- Remove the anti-trust exemption.
- Phase out Medicare and Medicaid.
- Establish Medical Saving Accounts.
- Tort reform
- Require all medical record's to be computerized
- Make health insurance portable
I know it is not a 12 step plan but it will work and achieve the goals the Obama administration has for health care reform. Doing these seven things to start with will lower premium costs, save taxpayer money, and make insurance available to all. We need fiscal responsible and logical decision making when dealing with an issue that is 1/6th of our economy. Any other way will only hurt the growth in GDP obtained last quarter. If the election results gives pause to the "Blue Dog" Democrats to delay any rash voting on health care reform then American's will win. If Pelosi and Reed are able to shove through legislation that does nothing but grow government, Americans will continue to see unemployment levels north of 10%. Imagine what the unemployment rate would be if companies had not outsourced many back office duties to India, Ireland, and other locales around the world. Take a moment today to call and write your Congress member to voice your opinion and urge them to vote for sustained growth that does not bankrupt America.
What does your tort reform look like?
ReplyDeleteTort reform needs to be established to fit the punitive damages in relationship to the error made. Right now doctors, hospitals, and clinics must carry high levels of malpractice insurance. While I worked at Mystic Lake a fellow Pit Bosses wife wanted to open a clinic to offer medical services for those without insurance. The malpractice insurance required price tag meant that the four doctor clinic needed to have solid bookings for 20 hours a day just to cover the cost.
ReplyDeleteFor example, if you go in for knee surgery and the surgeon operates on the wrong knee the surgeon would be required to operate on the correct knee for free instead of paying some hefty six figure malpractice lawsuit. We need tort reform that, as I said, establishes damages or remedies relative to the severity of the error. Does that make sense?
Why is the government in a better position to establish that than the jury? That's the job of the jury to determine and no one case is alike. Isn't that more government involvment? Are you advocating caps for every type of law suit, such as product liability cases?
ReplyDeleteTort reform is needed to drive down one of the biggest cost of doing business in the health care industry. By having solid tort reform will ripple across services provided because it will lower fix costs thus the burden rate for each service provided by the hospital and clinic.
ReplyDeleteI am not advocating a reduction in class action lawsuits for product liability. The government's intrusion into our private lives will not be increased by establishing tort reform. The beef about health care is premium increases and costs, so why not attack the biggest contributor to the cost of health care - malpractice insurance which can be tamed with tort reform.
But since the trial lawyer's "donate" large sums of cash to Democrats, and some Republicans, tort reform is an attack on trail lawyers that will not be tolerated by Democrats.
You haven't described how that ripple effect will be created. According to the jury, a six figure settlement is the proper compensation. Your proposal is to limit libality independent of what the actual libility is. If the six figure settlement is proper, which a jury determined, then the cost of malpractice insurance is set accordingly. Operating on the proper knee does nothing to ensure that the procedure is done properly in the beginning.
ReplyDeleteHow have I not explained the ripple effect? The ripple effect with be through lower premiums and costs of services provided by hospitals and clincs as the amount of malpractice insurnance required per doctor will be lower due to tort reform.
ReplyDeleteAccording to Howard Peters, excess liability is responsible for $100 billion in health care costs every year because physicians and other health-care workers feel they must go to great lengths to guard against unfair lawsuits.(www.suburbanchicagonews.com).
By reducing the overhead of malpractice, this does not mean we eliminate it, it will reduce the burden rate on services provided for the facility. The burden rate is the amount added to the cost of each service to cover overhead costs.
My point is that it's not excessive if that's what the jury decides is proper, which they are charged with, and both sides present their case regarding damages. If a jury is finding for the patient, the lawsuit is not unfair.
ReplyDeleteJuries and Americans do not understand how excessive awards translate to higher premiums and cost per services provided. There is no reason to see a six figure award for a botched knee surgery. The proper remedy ought to be a free operation to correct the error and follow up rehab.
ReplyDeleteDoesn't that make more sense? It is an educational processes. Health Care reform can be obtained without a 3,000 page bill and a $1T price tag. So, why do Americans not demand it?
No, because it doesn't compensate the victim. They still have a knee that was operated on that didn't need to be, they have additional pain and suffering, and the Dr. committed a battery and exceded the scope of consent.
ReplyDeleteEverytime someone goes in for surgery, no matter how minor, runs the risk of death. The notion of getting knee surgery to replace the defunct knee with a knee that works like a health knee. Now, if the knee replaced was already healthy, what is the person really out? Nothing.
ReplyDeleteThe proper rememdy to this example is for the doctor and hospital/clinic to fix the error by replacing the bad knee. Then after the surgery is complete, the hospital/clinic and the doctor will cover the rehab costs which the person would have had to done originally. Plus, compensation for time missed from work if any is applicable at the rate of pay they were making. Now, that is compensating the victim not awarding a six figure jackpot.
Since juries and Americans cannot use common sense when handing down the proper remedy to the error made guidelines are needed. Much like guidelines exists for other capital crimes.
The hope is that our doctors do not make mistakes, which the vast majority do not, but when/if they do we, as a society, need to apply the remedy that corrects the error. As I have dutifully pointed out, malpractice insurance is an overhead expense that must be accounted for in premiums and services provided.
But that is just one aspect of lowering cost and premiums to my 7 points above. So I ask again, why do we need a 3,000 page bill that will cost American taxpayers $1.2T over the next ten years when we can accomplish the goals - I am not convinced that the current bills in Congress will - of reducing costs, lowering premiums, making insurance available to all, and offering choice and competition.
So having unnecessary life risking surgery is nothing? What if they take the wrong kidney out? Or perform the wrong surgery alltogther? Both of which happen. How is having invasive surgery nothing? It's a crime.
ReplyDeleteAnd just because you disagree with jury verdicts does not mean that the rest of America lacks commonsense.
I think my point is being lost here. I agree that if errors made risk the health of the patient to the degree that life may be lost that punitive damages be awarded accordingly.
ReplyDeleteIf an error takes place without malice on the operating table it is not a criminal act being done by the doctor. I am not disagreeing with jury verdicts of guilt; rather the punitive damages awarded.
A study was performed in 2006 by Harvard School of Public Health and Harvard Risk Management Foundation. The findings of the study discovered 33% of malpratice lawsuits reviewed had no basis. 33%!!!! Talk about waste and fraud in the system.
As I noted above the insurance expense is $100B for doctors,now imagine if we eliminated the 33% of cases, that have no merit for a lawsuit identified by the study I referred to above,from seeing the light of day. The cost of insurance expanse could be reduced by $33M (a guess I know) thus reducing overhead and burden cost to the services provided. In turn it would reduce premiums as well thus saving you and I money.
So shouldn't the focus then be on punishing those lawyers who bring frivulous cases v. capping the damages for those valid cases? Sure, capping damages may reduce the appeal of bringing a case but it's at the expense of harming those with valid cases.
ReplyDeleteIf this is really a necessary thing to do is try and make a one size fits all government sewage pond what about creating a plan that makes sense and include everyone even those on medicaid and medicare? Why can't we create a plan and start in a couple of test sites (cities or states) and work out the "bugs" then roll it out in stages to other states. It seems to me that North Dakota might be a wonderful test site since it seems that they have only one major provider (Blue Cross) and a relativly small population. They way it stands now we are destined for financial destruction.
ReplyDeleteI will admit I am not an expert on Tort reform and do agree that placing "restrictions" or "guidelines" on malpractice lawsuits is probably another method to bring about reform. Excellent. This is the main reason I developed the blog; to discuss the topic and see where soluntions can arise as no one has all the answers.
ReplyDeleteI do not see the 7 points listed above as creating a one size fits all government sewage pond. I actually see the current bills as that. The public option and mandates in Massachusetts are failing and ration care is begining there.
In your example about NoDak, if we remove the anti-trust luxury insurance companies have it will force competition as BC/BS will no longer have a virtual monopoly.
I do feel a bit sheepish right now. I forgot to inlcude something in my list that I have been for all along as well. The missing step is regulating the industry to no longer reduce, deny or stop coverage due to a pre-existing condition.
I'd like to respond to the following statement made by "The Ardent Viper": "Now, if the knee replaced was already healthy, what is the person really out? Nothing."
ReplyDeleteThat person is out more than "nothing". Their perfectly healthy knee is no more; it's now a surgically repaired knee that will never be the same. No amount of rehab, prescription drugs or surgery skills can get that knee back to the way it used to be.
It's more than time out of work or rehab too. Even if the hospital "does it for free", the cost of those "free operations" will have to be passed along to someone else. Think of the prescription drugs, the brace, the crutches, the rehab, the time lost at work for the surgery and the 6-9 months of rehab. And then think of your apprehension at having to go back under the knife after being lucky enough to have unnecessary surgery performed on you. That might cause you a bit of stress or, dare I say, pain and suffering.
Tort reform is a joke. At its root, the focus is on saving insurance companies money. Another example of the Republicans having big businesses best interests in mind. Has anyone ever considered looking at how outrageous those malpractice insurance premiums might be?
Tort reform is like using a thimble to bale out a sinking ship. They have capped damage awards in the state of Texas(Proposition 12), but the results have been mixed from my understanding. Yes, the doctors in the state enjoy paying less in malpractice insurance. But did it really cause healthcare costs to lower? I don't believe so. It just made the physicians happy. National models to this effect were around less than 0.01% reduction in overall healthcare costs.
ReplyDeleteI agree in principle to the idea of tort reform for physicians as long as the AMA and other physician associations are willing to improve their residency requirements. I simply can not justify sloppy doctors to go unpunished(believe me they are out there!) And my argument does not ignore the fact that the only people who are really against this are the trial lawyers.
But the conservatives argument for medical tort reform as a way to improve healthcare costs is short-sighted. Thank you for allowing me to post this comment
As long as we are talking about healthcare reform...there are really no definitive arguments against single-payer coverage.
ReplyDeleteThere are definitive arguments against a single-payer coverage - look to Canada and England for reasons - ration care and long wait lines. Not to mention the tax base required to maintain it.
ReplyDeleteTort reform is not intended to boast the bottom line of health insurance rather it is to reduce the overhead cost and burden rate of services performed by doctors at hospitals and clinics. The notion then is that these savings will be passed along to the consumer. I will concede that for-profit locations more than likely not pass them along but non-for profit locations will.
I will have to dig more into the Texas law - Prop 12? I know that Illinois capped malpractice and it saw a reduction in burden rates.
Another interesting point thus far is the focus on Tort Reform when it is just 1 of 8 steps to reform health care I suggest that will not cost tax payers money. Why is tort reform getting so much attention? Is everyone else in argeement on the other 7? Or do are there just trial lawyers reading my blog?
Are Britons and Canadians picketing in the streets for American style big business health insurance coverage? The answer is no. Either person would tell you they would far pefer their government care than the uncertainty of our insurance plans. However, no plan is perfect.
ReplyDeleteCanada actually has excellent healthcare. And by definition, it wouldn't be considered "socialized medicine", but "socialized insurance". The government has no control over healthcare decisions, physician referrals, and the like. Anybody can see any doctor they want to in Canada, at any time, and as often as they like. The govenment just pays the bill, which is taken from a payroll tax (ironically called Medicare) and adjustments are made through a separate sales tax. It actually equates to less that what we pay for Medicare tax and we aren't allow to use it.
However, like I said earlier no system is perfect. In Canada the government will not pay specialists unless a referral is made by a primary care physician. You see, PCP's are considered "gatekeepers" of the medical system. If this is the rationing of care you speak of, remember, it wasn't long ago that insurers did the same here. However, profits doubled when they dropped the requirement because specialists charged more and they could pass on the costs! Assigning a PCP to be in charge of your healthcare is actually a good way to keep costs(and waste) down. And, the Canadian government has no control over their desicions.
One of the main drawbacks is with the specialty care. Per capita, there are far fewer specialty physicians in Canada than the US. Don't use this to argue your point because it is happening here too! This does result in wait times and care that is usually granted to people who have more urgent needs first(which really is the way it should be). Rural care is the hardest hit (like in the US) where occasionally people have to be trucked hundreds of miles to visit overworked specialists. Remember, the government has nothing to do with the wait times or the lack of specialists.
So, here is the main issue with Canada currently. Right now private health insurance is actually not allowed. Conservatives in parliment are gently trying to push the public into passing an option for limited private plans that would increase the pool of money along with the government to recruit more specialists to assist with the heavier burden. I am not sure of what it entails, but, I do know that the liberal party is also starting to move that way. Remember, the Canadian public is not in favor of any dismantling of the Canadian Medicare system and allowing private insurers to take over and deny people care that they need.
I will let you respond before I trot over to the British system of healthcare. And, I will discuss tort reform is more detail as well
Again, thank you for allowing me to post
Right now the Canadian physican has a 48 hour turnaround time to see a patient when they call. Thus many Canadians phone calls go unanswered. I agree with you that no system is without flaws but I do not want to pay more taxes for a system that I cannot go see what ever doctor I wish to see.
ReplyDeleteI have read and heard from friends that live in Canada that the system is morphing away from single payer to a free market system because of wait times and poor care. I am trying to get my friend that lives in the system to come and post first hand account.
What is the root goal of health care reform? To reduce premiums and costs. I have issued the challenge and have not seen an answer that meets the ecnonomic standards to obtain the goals through adding a public option. But I don't want to muddy the waters on this string.
My ancestors did not escape European socialistic rule just to see it come across the ocean and land here. The free market would work if Congress had the courage to make it so. The suggestions I outlined originally and later adding pre-existing issue will get American health insurance reform on that path without spending a time of tax payer money or the risk of raising the deficit. Isn't that we all want in America?
I have friends in Canada that don't say that...who's right? Neither of us live in Canada.
ReplyDeleteYou know whats funny? I have friends who have had to contend with long wait times and poor care. Where do they live? The United States! If anything, my goal in this thread is for you to review the first question on your fourth paragraph..."What is the root goal of health care reform?"
My answer to that is to get everyone healthcare. We have a right to a basic education, fire protection, protection from crime, even legal representation. But not healthcare....really?
So I work hard, get my degree, and get a good paying job so I can get get decent enough healthcare? Is this really part of the deal to be sucessful?
I am not trying to being disrespectful. But with all this talk of ancestors, and socialism, free-market this, tax payer money that, why can't we have a system where EVERYONE is covered? Are you really against this? Do you believe that only some of us are entitled to a uniform healthcare standard?
Again, I am not trying to be disrespectful. I will read your 8 points again, but, I hate politics and I think that changing the system with these half-baked ideas of both parties is not better than replacing the whole thing with one uniform system.
Here is the deal. If you give away something for free nothing is accomplished but a freeby. Then again it is not free. In order to pay for it means that each of us will have less money in our pockets at the end of the day because we have to pay for the one uniform system.
ReplyDeleteI appreciate your respectful and honest responses. I will concede, as you have, that neither one of us lives in the Canadain system. I am not against everyone being covered that wants to be covered.
But let's not mortgage America to get it. Plus, health care is not a right nor should it be. Does it make sense for a civilized society to offer affordable health care? Yes. But it is still not a right. I am confident that if Congress looked to implement the 7 steps I liste originally and add the pre-existing elimination will achieve the goal we all want.
It will reduce cost, reduce premiums and ultimately make health care insurance affordable to all without overt government intrusion or a public option. By opening up competition through interstate buy/sell and removing the anti-trust exemption in the health insurance industry enjoys, the choice and competition will move the supply side enough to reduce the equilibrium price which is something the public option cannot do.
Don't play the BS socialism card. This has nothing to do with socialism. That's a term the right wing casually tosses around to scare the same people who you said lack common sense. Is Canada socialist? Is England? This is about making sure as many people are covered as possible not the government running a country wide health care system. Is our public school system socialist?
ReplyDeleteAnd actually, what's wrong with true socialism? "Socialism refers to various theories of economic organization advocating public or direct worker ownership and administration of the means of production and allocation of resources, and a society characterized by equal access to resources for all individuals with a method of compensation based on the amount of labor expended." Equal access to all sounds like a pretty good deal to me. People compensated for what they do, sounds good to me. Public ownership sounds like we all have a part in what goes on.
Different Anonymous here. I do believe that there is a big problem with socialism. Universal healthcare would simply not qualify as socialist. I simply do not agree with you that healthcare is not a right, and in reality, thats what boil our discussion down. Now, I have a concession, which could be discussed, to the different kinds of healthcare which are not a right, but my interest is simply in basic healthcare. I'm sorry...but that should be taxpayer funded with everyone allowed to use it, much like public education.
ReplyDeleteI am not interested in mortgaging America either, healthcare would be a drop in the bucket compared to all of the other government waste and pork out there.
I am very interested in free-market solutions, however, for healthcare that would mean that those without the means will not get it. I simply do not trust the free-market for issues like this...sorry.
Universal healthcare could be done. The problem, to me, is just an issue of pride. The American public just hates the idea of their tax money going for the public good.
Thanks for your time.
The free market will give all access to affordable health care for the basics if certain changes are made to the current system. In addition to that, those who are truly ill-equiped to purchase basic health care programs exist already.
ReplyDeleteI agree with the last commentator on government waste and pork will start as a drop in the bucket with health care but it will not stay that way. I wouldn't turn to public education to push a public health care system because the government has proven that they can wreck any well intended program.
Just by Congress passing bills that enact steps 1 and 2 listed in the original entry will establish the basis for choice, competition and reduce premiums without raising taxes or mortgaging America's future. So why are Democrats in Congress against it? I am still waiting for anyone to explain to me how adding just one option (public option) will push the economic needle to reduce premiums.
"If Pelosi and Reed are able to shove through legislation that does nothing but grow government, Americans will continue to see unemployment levels north of 10%. Imagine what the unemployment rate would be if companies had not outsourced many back office duties to India, Ireland, and other locales around the world."
ReplyDeleteHow is it shoving legislation through? Just because they have the votes? That would indicate to me that a majority wants it and that's not shoving. The bills have been discussed, debated, and rewritten for months now. How much time do you think is necessary? It seems clear both sides know where the other stands. Let's put it up to a vote and move on.
And what does outsourcing have to do with it? Isn't outsourcing the very same free market you seek at work?
Anon...Here is what I mean by shoving it through.
ReplyDeleteA. The Baucus Bill was a "vapor" bill that passed from committee void of any legislative language. Now Reed is merging the bills behind close doors. Thankfully though the Senate is a bit wiser and appears to be willing to give more time. Plus they are losing key votes to prevent a filibuster with the addition of a public option.
B. The House Bill is being changed as we speak with an additional 800 pages.
Why won't the House wait for legislative language to be completed and scored once all the addtional pages and amendments are added? Instead Pelosi wants to limit debate to 4 hours and then vote on it. That is shoving it through.
My point to outsourcing was an aside. I don't disagree with outsourcing as companies move globally but imagine what the unemployment rate would be if they had not. That is all I was saying. Besides the 10.2% unemployment rate does not include workers who have taken part-time work, gone back to school, or have been unemployed for more than 4 months.
Did you read the article that states that the public option would cover a whopping 2% of the uninsured? Its all lip service. The public option just allows democrats to say "we did something to cover everyone".
ReplyDeleteI'm actually not in favor of another entitlement program either, but that is the problem with this debate. Why is the government THAT inefficient? For all the hand-wringing you do on this blog about your anger to the government, can we at least agree that big business(esp the healthcare insurance corp) have been far and away more inefficient. Your argument to counter this is that it doesn't have to be, I know, but we've been facing these problems for years!
I contend that the government at least tries to help. Big business has been punching us in the face for the last 20-30 years. What we really need is a more strict regulatory government and big business that is will to do more for the public good rather than the bottom line. Will that happen? Probably not.
Now, about your points as I have stated I would re-read. I agree firmly with items 2-7, but good luck with that. Especially the humourous point about the anti-trust exemption. The first point would do nothing. It is the republican trumpeting point that would just allow insurance companies to operate and sell insurance from an area in the country where the regulation is the least (Delaware, anyone?)
Again, I am not trying to be disrespectful. Like you I am a free-market person, but I have lost my way. Unlike you, I don't think anyone in congress should be blamed for at least trying to help. You may not agree with them, but being angry about a 1000-page bill is not going to prove that it won't work. Pelosi and Reid are no different that Bohener(sp?) and McConnell in that they are politicians who are playing to their base.
However, I am just not convinced that free-market solutions are a silver bullet for healthcare problems because the reality is that people get left out of the equation. That invites the government to pick up the slack.
Research what Germany does and get back to me. It is a good mixture of public and private insurance and very few get left out. Again, thank you for your time.
Yes, I saw the article about 2% being covered. I actually touched on that briefly in todays blog entry. Right now health insurance industry enjoys an anti-trust exemption that gives them the upperhand in most cases. By removing that exemption and opening up interstate insurance commerce will achieve the goals of reducing premiums and make health care coverage affordable to all that want it through increased competition.
ReplyDeleteThe beauty of our government, that the Founding Fathers established, was to make government move slowly when passing legislation to ensure proper vetting is done. Big Business is operating within the parameters set forth by regulators and until the anti-trust exemption is removed it will not change; unless of course we pass the public option which will lead to a single payer system and higher taxes for all.
I have read a bit on Germany's system as Der Speigel and Der Zeit are two dailies I read on a regular basis. They are moving away from their single-payer socialized medicine to a hybrid of public and private with the goal of moving toward a portable private option. That is the other key to this equation being sucessful.
By making health insurance care portable, employees can then negotiate with their employer to either take the employer insurance plan or have the employer pay them that dollar amount to be used on the portable market.
An aside...I do not see anything in your comments that would be disrespectful. I appreciate your comments and look forward to your future additions to the conversation.
I'm only partially through it, but here's another reason for the high cost of medicine in the US: http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?ref=magazine
ReplyDeletecmh
Great article. As I read it, all I could think of was the processes I went through in obtaining my Six Sigma Green Belt certification. Also, I do like the idea of the employer giving the employee X$'s to make their own choice on health care and then being able to keep the remainder if any exists.
ReplyDeleteI know Six Sigma is creeping into the Health Care Industry and they can benefit from it to root out noise and establish processes with little to no variation. Thanks again for the article CMH.