My reaction to President Obama’s speech to the AMA

in Policy | 78 responses

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American health care. Not sure the city is comfortable with that notoriety.

Here’s what Obama said:

That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That’s why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren’t drowning in debt when they enter the workforce.

Standard policy-speak about bundling payments. But, unlike the majority health policy columnists and editorials in The New York Times, he goes out of his way to blame the system, not doctors. Obviously, this is because the President is addressing the AMA, but the way to court doctors is not to wholly blame them for the health system’s ills.

Regarding primary care, the idea of simply investing more in the National Health Service Corps is grossly inadequate. First off, any improvement in primary care numbers will be seen in 5 to 10 years minimum, and second, primary care doctors are needed everywhere, not just in underserved areas.

I like that he addressed the cost of medical education, but doing something about it is another matter entirely.

Here’s what Obama said about malpractice:

I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms.

Probably the best we could have expected. He acknowledged that malpractice reform needs to go hand in hand with health reform, and admitted that defensive medicine is indeed a factor in medical decision making today. I agree that malpractice caps are a non-starter, and like single-payer, hope that cap supporters realize that it’s a political impossibility.

I hope that this could be the start of a more constructive dialogue where doctors are offered liability protection if they adhere to evidence-based guidelines. Under the current political environment, that is probably the best scenario that doctors can hope for. And, to be honest, I think it’s a reasonable compromise.

And finally, here’s what he said about the public plan option:

Now, I know there’s some concern about a public option. In particular, I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that’s based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I’ll be honest. There are countries where a single-payer system may be working. But I believe – and I’ve even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth.

Good to see him address this important physician concern, namely, a public plan option using Medicare rates, and using this approach as a “back door” to a single-payer system. It’s clear that he’ll use the repeal of the SGR formula as a bargaining chip, perhaps to get the AMA’s support of a “weak” public plan.

Right now, there are no details of what a plan would look like, so I can’t really give an informed opinion on it. A plan that coerces doctors to take it on condition of accepting Medicare, or one that pays doctors less than 130 to 150 percent of Medicare rates, are the only deal-breakers, in my view. The AMA is clearly shooting for the moon when they say they were “opposed” to the public plan, and I think both sides will eventually settle on a “weak” version, meaning, it will remain but not at a marked competitive advantage with private insurers. I can live with that.

So, in the end, I thought the President did a pretty good job. Especially with his malpractice language, acknowledgment of the practice of defensive medicine, and the fact that he’s aware that doctors are concerned about the how “our cost savings are coming off your backs.”

Will it make a difference? We’ll see. But I can say that the speech could have been a lot more antagonistic to physicians than it actually was.

Comments

http://www.motionphr.com Jeff Brandt
Thanks for the comments. Things have to change and with change comes fear. We need more doctors to chime in.
We have a chance to make a better system in the US.
Jeff Brandt
motionPHR – Personal Health Record for the iPhone
Eric Roesler
There are a few incompatible statements in the President’s address to the AMA.
The President stated, “…the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.” Much of this has to do with lifestyles as well as genetics. Some would contend that the mortality reporting is also much better in the United States. Most of those with a higher rank pay much, much more than the U.S. and have socialized medicine.
President Obama continues, “…we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away.” However, the reality is that employers will drop coverage as soon as there is a single-payer system that they are already paying for; thus, the concept of coverage for the uninsured. Some physicians will stop practicing as the price of reimbursement is fixed to “control what the President calls, “the spiraling cost of health care in America”. Some people WILL lose their chosen physician.
The President goes on to discuss patient records. Fixing this problem does not require a single-payer system. Make no doubt that America will become a single-payer system when the existing market insurers are no longer in business. People do not like to pay for one product (nationalized health coverage) and another product to duplicate its benefits.
Preventative care is great. However, President Obama went on about quitting smoking, hitting the gym, and raising children to step away from the video games and play outside. It does not take nationalized health care to: 1. Ban smoking (if that is the desired outcome) 2. Ban fast food (should that be the design) 3. Regulations to allow only Wii and active game consuls 4. Require 12 hours of active exercise every week for every U.S. citizen. Others would decry the loss of freed, but for the sake of healthy living they are not bad ideas.
Creating tax credit for insurers who can demonstrate success with healthy lifestyle programs would be much less expensive than a nationalized system. The President goes on, “But what accounts for the bulk of our costs is the nature of our health care system itself – a system where we spend vast amounts of money on things that aren’t making our people any healthier…” This seems to indicate that our physicians are incompetently pursuing care for their patients that are not needed in order to pad their wallets. This is a red alert signal that there will be mandated cuts to what our doctors are able to prescribe or tests that can be ordered. The cost has to come down, what is the administration planning to cut out of there?
This is one of the most dangerous portions of his speech today… “We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.” Remember that the goal is to CUT health care costs. Read this portion of the speech with that mindset. Physicians are going to lose funding and the bonuses indicate that the drop in funding will be substantial in order for there to be sufficient money to pay for the bonuses. It is fair to surmise that the bonuses are not going to be NEW money that increases costs.
The President begins an introduction to his National Health Service Corps. Perhaps this is not such a horrible idea. However, it can be done as a standalone issue and does not require nationalized health care. The President then states, “We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe.” This sound like something we need to CHANGE. This part makes the whole speech very, very difficult for me to understand why we would want to destroy all that. The President and Congress should be encouraged to pursue better information technologies. This also does not require a single-payer system. He stated earlier that we need to fix what is wrong and not that which is not broken.
“And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.” Each of us must ask where the hundreds of billions in savings will be generated. It must come out of somebody’s hide. This is hundreds of billions that physicians feels is medically necessary.
“…I’m not advocating caps on malpractice awards…” The President does want to initiate reforms to curb defensive medicine without any tort reform whatsoever. Doing this miniscule amount is great and should be encouraged, but it does not require a single-payer system to accomplish. He goes on, “Health care reform must be and will be deficit neutral in the next decade.” Again, who will bear the brunt of the needed cuts and the expense? The usual suspects, the providers, taxpayers, hospitals, and corporations that provide products to the industry. GM is now owned by the union, the laborers. Is health care and physician’s practices best served by being owned by the patients?
The President then tells us about an October 1960 Harper’s Magazine article that bemoans “The Crisis in American Medicine”. If the crisis we face today is no different than 1960, we either have very incompetent medical practitioners and politicians, or we are facing a crisis of perceptions that has plagued us for half a century. We may be served better by an education campaign to correct perceptions. Health care has not collapsed since 1960 and has improved very dramatically.
The President wants a system that allows physicians more time with patients. How can we pay for this while saving money unless we drastically cut the monetary rewards to our doctors? Government healthcare is not likely to take less administrative time or paperwork.
In medicine the cardinal rule is “First, do no harm”. This should be the rallying cry for health care reform. Implement the changes that are appropriate for the federal government to work on and leave the single-payer system out of the equation. After the trillions we’ve already blown, we now need to take more measured approaches to government and ensure that we are getting a return on each dollar we invest BEFORE investing further.
Matt
If you guys are looking to the federal government to solve your problems with reimbursement and hours and such then you’re fools. The fact that Kevin is cautiously optimistic, if I may characterize him as such, is ridiculous. Who do you think is not paying you for your time now? Who do you think is cutting your reimbursements now? Are you really relying on the AMA to speak strongly for you? Honestly?
It’s truly amazing that physicians are going to allow themselves to essentially become government employees with nary a peep. You appear to already be in compromise mode, and there’s no such thing as a profitable compromise with the federal government.
Sad.
http://www.headache-treatment-options.com David
Kevin,
I think an appropriate cap for malpractice awards would be for the non-objective “pain and suffering” awards. It is here that the outrageous amounts are collected. No-limit, non-objective awards are a big factor in driving up malpractice costs. You may want to re-think the issue in that respect.
Matt
Then Sen. Obama from the campaign trail:
““Senator McCain and I have real differences on this issue. Senator McCain’s been eager to share some of the details of his health care plan, but not all of them. It’s like those ads for prescription drugs. You know, they start off, everybody’s running in the fields and everybody’s happy and then there’s the little fine print that says, you know, side effects may include. Now, first of all, we found out that Senator McCain wants to pay for his plan by taxing your health care benefits for the first time in history. Just like George Bush. That was bad enough. But ‘The Wall Street Journal’ recently reported that it was actually worse than we thought. It turns out Senator McCain would pay for part of his plan by making drastic cuts in Medicare. $882 billion worth. $882 billion in Medicare cuts to pay for an ill-conceived, badly thought through health care plan that won’t provide more health care to people. Even though Medicare’s already facing a looming shortfall. Now, this should come as no surprise. It’s entirely consistent with Senator McCain’s record during his 26 years in Congress, where time and again he’s opposed Medicare. In fact, Senator McCain has voted against protecting Medicare 40 times. Forty times he’s failed to stand up for Medicare. So what would Senator McCain’s cuts mean for Medicare at a time when more and more Americans are relying on it? It would mean a cut of more than 20 percent in Medicare benefits next year. If you count on Medicare, it would mean fewer places to get care and less freedom to choose your own doctors. You’ll pay more for your drugs. You’ll receive fewer services. You’ll get lower quality care. I don’t think that’s right. In fact, it ain’t right.” (Senator Barack Obama, Remarks, Roanoke, VA, 10/17/08)”
CattieM
Many countries have single-payer healthcare and their citizens prefer it. That is not even the system Obama is proposing, yet people are acting as though it is. I think a question during the campaign says a lot about the warring attitudes over a healthcare plan; John McCain was asked if he thought healthcare was a right, and he said no. Then-Senator Obama said yes. The majority of people opposing a government-sponsored option do not feel there is an imperative to provide health insurance for those who do not have it. They propose tax cuts or tax-free savings accounts. What good are tax incentives to people who do not make enough money to pay taxes?
I do not see how any healthcare system that includes plans run for profit will end up providing the best care, because in many cases the best care is, quite simply, more money than private insurers want to pay. That is why a few of them dropped very sick patients off the rolls in California and were fined recently.
A government option does not go far enough; we need single-payer care. It certainly does not seem to have helped Medicare much to have added a private plan (Medicare Part D).
You need to eliminate greed from the system and reduce overhead. One company running one healthcare system will cost a lot less than multiple companies, which we have now. If we can reduce the overhead systemwide, maybe it will leave more money to pay physicians more and afford better care for everyone.
Michael Kirsch, M.D.
Obviously, Obama’s speech was tailored to his physician audience. I am not optimistic for real medical malpractice reform nationally, It could never get past the trial lawyers who are now U.S. Senators. Whenver I hear (or read) an Obama speech to a particular stakeholder, the audience always feels that Obama understands their pain and their issues. It is as if there will be no losers – everybody wins? The administration will claim that the ‘special interests’ will suffer, but these folks are rarely identified. As far as the AMA goes, see http://mdwhistleblower.blogspot.com/2009/06/ama-opposes-obama-health-care-plan.html for a story that the AMA would like to forget.
We are watching the sausage-making that is called politics. It’s better not to watch the process.
Doc Stone
The key thing to defend is professional autonomy and liberty for patients and doctors. Defend that and the Hippocratic medicine, privacy, and ethical practice will survive. Fail to defend that and patients will be the property of the state and physicians the servants of the state, not of patients.
Would you really sell out your obligation and freedom to exercise professional judgement substituting practice guidelines just for malpractice protection? If so, you won’t get the protection you bargain for and don’t deserve it.
CHenry
I forsee a return of capitation, this time offered not by the private sector insurers but directly by the government. If there is to be a public option, it will likely be a capitated design that costs less because it rations both what is available and how much is paid. Where the difficulty comes is if this becomes the alternative to private insurance, what others have posted as that attractive alternative to employers providing insurance to employees through private insurance companies.
This could get ugly.
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Matt
There are no trial lawyers who are US Senators. Or even Representatives. Medical malpractice is a state law issue. The President can do next to nothing about it.
Sud
“I’ve also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more efficiently, and save us roughly $109 billion in the process.” : translated from political doublespeak equals “we are cutting your reimbursements nominally in addition to the huge hit you’ve taken in real terms over the past decade – best of luck to you” Face it gentlemen (and ladies) they are not interested in providing care- they are interested in saving money. I see no way in which this can end well for physicians. The more I listen, the more convinced I am that Ron Paul is right. The only viable solution for American medicine is to accept the basic truth that any third party payer subverts the physician patient relationship. Unfortunately, it also entails that we accept some underlying principles (such as medical care is a priviledge not a right, and life is not inherently fair) that we as a society are not prepared to acknowledge.
Dr. Wini
“So 60% of U.S. senators hold law degrees, and a large number of those practiced before entering politics. There are 1,143,358 lawyers in the U.S. as of Dec. 2006, or less than 1% of the population, according to the ABA. A reader yesterday made a provocative point, which seems appropriate to highlight here. “Seems to me that having so many lawyers in the Senate is clear evidence that this body is not representative of its citizens, nor is it attracting the best, brightest and most accomplished Americans, by any stretch of the imagination.”
http://blogs.wsj.com/law/2007/09/05/lawyers-in-the-us-senate-quiz-the-answers/
Dr. Wini
No senators are trial lawyers? How about the VP?
Interesting article by Jonathan D. Salant
Oct. 11 (Bloomberg) — Joe Biden has been an ally of trial lawyers throughout his tenure in the U.S. Senate, opposing every effort to curb lawsuits against businesses and doctors. The lawyers are returning the favor.
Five of Biden’s 10 biggest lifetime campaign donors are members of law firms that specialize in bringing personal-injury cases, according to the firms’ Web sites and the Washington-based Center for Responsive Politics. That ratio held up during his recent, unsuccessful run for the presidency.
While trial lawyers traditionally back Democrats, Biden, 65, the party’s nominee for vice president, has gotten more money from the leading firms than any of the 16 other Senate committee chairmen and more than any Senate Democratic leader.
“The plaintiffs’ lawyers would have an ally and dear friend in the White House if the Obama-Biden ticket wins,” said Steven Hantler, who heads the nonprofit arm of the American Justice Partnership, a business-funded advocacy group that seeks to limit lawsuits at the state level.
There are no trial-lawyer firms among the top 10 donors to Senator Barack Obama, the Democratic presidential candidate, or Senator John McCain, the Republican nominee.
Biden — a former trial lawyer himself and former chairman of the Senate Judiciary Committee — voted against attempts by the Republicans who controlled Congress from 1995 to 2007 to rein in lawsuits.
Dr KVC
I have determined that CattieM is either not a doctor, or not a very smart one. Single payer is not supported by the medical community in places where it exists. If physicians thought so much of it, why are american trained docs not heading to these countries to practice? Why are docs from these countries fleeing to practice in the USA if it is so wonderful? Health care is not a right. Never has been and never will be. Anyone who argues differently has a poor understanding of our Constitution, and what defines a “right”.
By definition, healthcare can only become a “right” through the forfeiture of the rights of others who provide the care.
First, if it is a “right” it must be guaranteed. How do you guarantee access to care? The only way is the method used in Communist Nations, where individuals are forced to become doctors and then must serve as doctors to everyone the govt mandates. Doe that sound like a system that is congruant with freedom? Without instituting such a system, how do you guarantee there will be an adequate number of physicians to serve the population. Considering most doctors are refusing medicaid, and many Medicare, how else, except through force, do you convince them to accept another govt system that underpays them for their work? This is what CattieM is really asking for, the subjection of health care providers to the will of the government.
Here is the truth about what will happen under the system Obama envisions:
1) Physician pay based on patient health outcomes will lead to decreased access to care. How? Physicians will dump any patient that is poorly compliant or who is likely to have a poor outcome as these patients will affect their ability to obtain an outcomes based bonus. From my experience, those who are less educated and those of lesser means are more likely to be non-compliant. So this population will continue to lack access to care.
2) Paying physicians on a capitated based model, which is what he implies by stating that reimbursement will be based not on services rendered, but disease processes. This will also reduce access to those who need it most. This happens because when doctors get paid the same amount regardless of how many services the patient requires, physicians decline to see those who do require a greater level of care in terms of service utilization. So these patients are left searching for a doctor who will see them because they cost a lot more to treat without any increase in reimbursement. Since there will be a severe shortage of physicians who will see these patients, they will not get the care they need. Under the current system, physicians are not reticent to see them because if they require more visits, they get paid accordingly.
3) Considering there is currently a shortage of Primary Care Physicians in this country for the currently insured population, who will serve as PCPs to the newly insured 47-million? Will these docs fall out of thin air? Will we lower licensing standards so more docs can be imported? Will Obama increase the scope of practice of mid-levels and allow them to serve as PCPs as well? Will docs be forced to increase their patient load, which will sacrifice quality?
Obama is at best untrustworthy. We have no reason to believe that this is not a Trojan Horse. Considering that he is trying to control the Auto industry, and regulate pay for all corporations, which he denied was his goal at the start, why should we believe he does not want the govt to take over healthcare based solely on his say so?
Dr KVC
Why can’t the President provide all physicians who see patients on government insurance programs the same liability protection afforded physicians who work for the military or VA? Make the government the sole malpractice insurance provider, and if someone desires to file a lawsuit, it is filed against the US Government, just as it is for the military and VA docs. The rate of lawsuits against physicians under this system are much, much lower. And payouts are much lower and more reasonable as well.
If that system is a good enough legal recourse for the Veterans and Military personnel , why is it not adequate for the rest of America?
Anyone who does not believe defensive medicine is a major contributor to the cost of medicine is naive. I can personally attest that most physicians order a lot of tests that they know are unlikely to be of any benefit, all in the name of preventing a lawsuit, or being able to prevent a better defense if you are sued. I would guess that unnecessary tests add 50% or more to ER visits. Think about CT scans for every headache, or a stress test for everyone who walks in with chest pain, among other things.
Matt
The VP was a criminal prosecutor before entering the Senate 30 years ago. Having a law degree does not make you a trial lawyer ie someone who represents injured parties in negligence actions any more than having a medical degree makes you a neurosurgeon. Again, no members of Congress have made a living as a trial lawyer. They’re far more likely, if they practiced at all, to have been prosecutors or represented large companies and their insurers. Assuming a unanimity of opinion among them makes no sense.
Matt
Since we have had states with truly draconian reform for 30 years has defensive medicine decreased significantly in those states? Or is health care significantly cheaper in California? If not then perhaps it’s not the fear of being sued that causes defensive medicine and there are no savings to be had. And if no one knows if reform works after 30 years of using it why are we still using the lack of reform as an excuse for “unnecessary” testing?
http://www.motionphr.com Jeff Brandt
The real problem is that the system is killing the host and as you all know from Chem 101. If the host dies then we all die. I pay for my families Insurance out of my pocket and it is $600/month with a $5000. deductible. I have a small business and it is hard on our finances.
Tort reform is a must. The reason that we do not have national health care today is that Truman caved to the lobbyist of the AMA after WWII when the rest of the world decided to build a national health care system.
Write your congressman and voice your opinion. We need to band together to do something to fix this broken system before the host(s) dies.
Jeff Brandt motionPHR for the iPhone
Michael Kirsch, M.D.
Read many of the comments following what I thought was a self-evident point about the density of attorneys in the Federal legislature. I thought it was undeniable, but apparently not. I dont’ think that only doctors are advocating for tort reform; the entire country is aching for it. Litigation is no longer protecting abused workers or keeping corporate America honest, though the bar still claims this is its high mission. It has become a punitive cudgel that stifles innovation and inspires fear.
http://www.MDWhistleblower.blogspot.com
Matt
Again why does one assume a unanimity of political opinion among all those who hold law degrees? Do all physicians believe in single payer because some do? Don’t be silly.
Eric Roesler
I do not think that we have an unintelligent President. Intellectually honest? You decide.
You do not get something for nothing. Printing money or having the government cover costs is a tax. The wealthy and businesses really do not pay taxes, they pass them along. Any tax will be born upon all the people. This is particularly true of the poor and uninsured. If I sell milk and my cost per gallon (through taxes or otherwise) increases 43 cents per gallon, I will increase my price by a half dollar (I need to administer the tax or cost). My competitors will do the same. If we have people unwilling (or unable) to pay $1 for $1 of healthcare how will they be able to pay $1.40 for less care (remember, inefficiencies of government resource management)?
Government is not an efficient spender of resources, private industry is much more efficient. Therefore, if we desire efficiencies we must work toward them and we can even rely on government as a catalyst. I cannot see how increasing costs will provide a better nationalized system.
MasonMcD
And who would you rather have as a legislator – a lawyer, or someone will no legal training?
Robert J Simon, MD
Why does maintaining the wasteful insurance system “preserve” our tradition? The system was created out of the ignorance of the medical community and has become its master. The recent article on the cost per physician as a result of health plan demands ($70,000 per year) cannot be forgotten as one of the major problems with the current system. Add to this the 30% or more overhead of the private health insurers and the costs for expansion of health coverage to the 50,000,000 uninsured
starts sounding more feasible. Additionally, has anyone but me questioned the use of the CPT and ICDM coding systems? Why do we do this? Why are we spending millions of dollars a year to codify our billings so that we get underpaid for our time, efforts, and education? Who, other than the payers, are using this information? I, for one, would much rather be paid for my time than for my diagnosis.
Paul Camp
Regarding malpractice insurance specifically, Americans for Insurance Reform conducted a major study using Pennsylvania as a case study that led to two conclusions:
First, over the last 30 years, the amount that medical malpractice insurers have paid out, including all jury awards and settlements, has closely tracked the rates of medical inflation. Not only has there been no “explosion” in medical malpractice payouts at any time during the last 30 years (beyond the general increase in health costs), but payments (in constant dollars) have been extremely stable and virtually flat since the mid-1980s.
Second, medical insurance premiums charged by insurance companies over the last 30 years have not corresponded to increases or decreases in payouts.
Rather, premiums have risen and fallen in concert with the state of the stock and bond markets—insurance premiums (in constant dollars) have increased or decreased in direct relationship to the strength or weakness of the economy, reflecting the gains or losses experienced by the insurance industry’s market investments and their perception of how much they can earn on the investment “float” (which occurs during the time between when premiums are paid into the insurer and losses paid out by the insurer) that doctors’ premiums provide them.
http://medicalinformaticspublicutility.com PAT
I own and operates a medical billng and AR management company in Florida. The HMO’s in Florida pay physicans 50-90% of the Medicare allowable. If a physician doesn’t want to accept that they excluded from participation. Just getting 100% of Medicare in Florida across the board would be a savior to us. I don’t know where you practice that you get 120-150% of Medicare but you should thank your stars.
Matt
“I do not think that we have an unintelligent President. Intellectually honest? You decide.”
What he definitely is is a master politician. He’s going to throw physicians a bone on malpractice, and they’ll be so excited to chew on that little morsel that while they’re jumping up and down on that he’s going to make them federal employees.
twaw
Not to beat this dead horse but past performance is the best predictor of future performance. Health care is a “right” for those living on Indian reservations and Veterans. See anybody lining up to provide care or get care at Chenle, AZ or Rosebud, SD? Anybody want a dose of Hep C or Hiv during their colonoscopies? Oh yes, and those that do provide that high quality of care are “protected” from prosecution as Federal employees. Sounds like a fine federal system for all of us.
Dr KVC
Does anyone on here not remember that the VP candidate for John Kerry, who ran for President once again this last cycle, John Edwards made his fortune suing doctors. His career was not prosecuting criminals, but using cerebral palsy patients as a way to make millions for himself. He was a true representation of the view of most Democrats with regards to tort reform.
The fact is, ~50% of Congressmen hold law degrees. While they may not all agree, just as doctors stick together regardless of specialty, most lawyers do so as well. Most neurosurgeons will support legislation that benefits family doctors, even if it does not impact them directly. So to think lawyers are vastly different and would not support each other in the same way is ridiculous. Does the American Bar Association only represent certain types of lawyers, or all of them? They as an organization oppose tort reform.
Dr KVC
Pat believes that since doctors in Florida are stupid enough to accept poor reimbursement, everyone else should be extatctic to get underpaid as long as it is more that what Florida docs get. It is no surprise that Florida suffers from a greater lack of providers than most other states.
The fact is, every place I have looked to practice pays well above Medicare reimbursement from private insurers. My practice could not survive if all of our patients paid at Medicare rates. We would go out of business. Or I would have to see 60 patients/day as a primary care provider.
It is odd that so many people would like to relegate our entire health care system to be like Indian Health Services or the VA. As thaw mentioned above, those systems have done so well getting good physicians. (sarcasm intended) In addition, the only reason those systems haven’t imploded is because of the private system serving as back-up. Just try getting an MRI or ultrasound at a VA for any reason on a weekend or Federal holiday. It will only happen if you transfer the patient to another facility for the service.
Rationing must occur in a socialized system, and it does in all of them. How else could Canada operate with the same number of MRI Scanners as the State of Arkansas, but 10x the population. My small town with a county population of only 65,000, has more neurosurgeons than all of Calgary Canada, which has a population closer to 1-million, not including the surrounding areas.
Frank Castle
CANNOT BE TRUSTED
Kevin, it is obvious: in less than six months in his FIRST executive-level job, he has FLIP-FLOPPED on no new taxes, gay rights, the military — he CANNOT be trusted.
If your word is NO GOOD — no amount of legal contracts are sufficient. No one trusts you.
He’s done. He’s one term. He’s Jimmy Carter II.
Matt
“John Edwards made his fortune suing doctors. ”
John Edwards is not in the Senate. Hasn’t been for several years. Relevance?
“He was a true representation of the view of most Democrats with regards to tort reform.”
It’s odd because tort reform is a fundamentally Democrat position – ie. the government decides everything without regard to the facts.
“While they may not all agree, just as doctors stick together regardless of specialty, most lawyers do so as well.”
Says a guy who is not a lawyer. Hey, I think all doctors love Batman, and I once met a doctor. That must make it true. I guess the real problem with your theory is that many Senators and Reps who do have law degrees vote for this tort reform. The other problem, of course, is that it’s not a federal issue.
” Does the American Bar Association only represent certain types of lawyers, or all of them? They as an organization oppose tort reform.”
Actually, it depend on the “reform” you’re discussing with regard to the ABA’s position, but I doubt you understand or even know of the nuances. Regardless, though, does that mean you agree with all the political positions of the AMA, because you’re a doctor?
Robert J Simon, MD
Glad to hear that those of you who get fees from the insurance companies that are higher than Medicare reimbursement are in favor of leaving the system alone. After all, we are all in this for the reimbursement. The heck with the patients, the uninsured, the underinsured, etc. Oh, and, of course, let’s make sure we don’t let any of those Medicaid patients into the office when we can have the good PPO people come in with their 130% of Medicare rate reimbursement…that’s why we became doctors in the first place.
As to sticking together…that is the first time I’ve ever heard someone say that doctors stick together. Our problem, and the one that got us into this mess in the first place, is that we NEVER stick together and always have looked out for ourselves, our specialty or whatever was selfishly prudent at the time, thus allowing the insurance companies, government and regulators to stomp all over our profession.
Robert J Simon, MD
re: Paul Camp
The malpractice insurance rates may reflect the inflation in health care costs over the past number of years, but it doesn’t reflect the income of physicians for the same period. Bundling all costs together, including insurance, hospitals, medications, laboratories, imaging and then calling these “the cost of health care” is misleading. Malpractice insurance should be based on the revenues of the physicians, which have generally declined over the same periods.
Eric Roesler
“The heck with the patients, the uninsured, the underinsured, etc.” that is a pretty low blow. The uninsured get very good care in our country. That care is much better than many countries. I know of several stories of uninsured being treated for several hundreds of thousands $$ that they never have to repay.
Besides, if they cannot afford the care now – how will they be able to afford the costs under Obamacare? Again, if they were unable to pay $1 for $1 of care they will not be able to afford $1.40 for $1 of care under this system.
Paul Camp
re Robert J. Simon
“Malpractice insurance should be based on the revenues of the physicians, which have generally declined over the same periods.”
Really? Then clearly my health insurance should be based on my salary.
That’s not the point, and you are being far too parochial. The point is that insurance companies are using your premiums to invest in the markets. When the market is in the weeds, your premiums get raised to cover the losses, not to cover lawsuit payouts. You’re paying the freight for their bad investments.
Re: Dr KVC
The VA has the best health care outcomes of any system in the country, and surely outcomes are all that matters. See, for example, here:
http://www.washingtonmonthly.com/features/2005/0501.longman.html
This is primarily Bill Clinton’s work.
MasonMcD
The uninsured get very good care in our country.
In the Emergency Room.
That care is much better than many countries.
Nice standard you got there.
Robert J Simon, MD
MasonMcD is right…ER care is not good medical care…it’s last minute catch-up care without continuity, prevention, or any of the other factors that make care “good.”
As to “how will they pay for it?”…..that is exactly the problem. Right now we are paying for the care of the uninsured, whether they are needy or not. Why not make the system official and spread the funds around to take care of everyone. I, for one, am paying over $1200 a month for my POS plan, which limits care big time. I would rather pay an extra $10,000 in taxes toward a legitimate health care system and save the difference. Strapping already over-burdened emergency departments and clinics with the care of people who have no where else to go is not the answer. Ask a Brit if he would give up National Health with all of its barnacles and warts and you’ll get a distinct “NO!” Even the Canadians, whose plan is somewhat weaker, would not forfeit it for insurance like ours which promises much and delivers little. The goal of healthcare is not convenience, it’s health care. Americans are spoiled and expect too much from their physicians. We need to provide what is necessary to maintain health…even it means not spending most of our money on the last months of life or on procedures that are inneffective.
Dr KVC
Matt: Show me evidence that lawyers are different from EVERY other profession out there. They all, in general, stand up for their profession regardless of the area within it. If you want to understand it, talk with Dr Palmisano, MD, JD. He is a lawyer and recent President of the AMA. I have personally spoken with him about the issue. I have a lot of friends who are lawyers and have spoken with most of them about this, and they admit that they support legislation that protects their colleagues, regardless of its impact on them because they want support when something comes up that does affect them. this is no different than Teamsters supporting the UAW. Doctors are some of the few lawyers who support legislation that is harmful to other lawyers.
If you really want to know who opposes tort reform, just look at the votes in Congress when the issue comes forth. Why do Dems get so much more from trial lawyers than Republicans? Why are most doctors in Congress Republicans, and most lawyers Dems?
The ABA has a history of opposing any reform that is bad for a lawyer’s pocketbook, regardless of if it is beneficial for their clients. This is evidenced best by the fact that the ABA opposes arbitration. The State of Utah had passed legislation a few years ago allowing physicians offices to require patients to agree to binding arbitration for any malpractice case. This only applied to offices and not ERs and emergency situations. Lawyers quickly came out in force to overturn this law.
Studies show that patients on average get more when a case goes through binding arbitration as opposed to going to court, it cost much less to litigate, but lawyers get much, much less.
Why would the ABA oppose a system that was more beneficial on average to their clients? The only reasonable explanation is that they care more about their own pocketbooks than their clients.
One question: Why do states with good Tort reform laws have lower malpractice insurance rates than those without it? This makes no sense if these laws are not beneficial.
Dr KVC
Paul Camp- Tell that to the recent victims, I mean patients at Walter Reed. Tell that to those who are worried about having obtained an infectious disease from colonoscopies. Tell that to all of my Veterans patients who choose to see me instead of a VA doctor, even though they incur some extra costs. Tell that to my dad who had to go to a private ENT because the VA can not get enough physicians to work for them. Even if it were free, I would not go to a VA because as a physician who has worked there, I know the truth about what goes on.
Expecting anyone to believe the VA outperforms the UPMC, Mayo, Harvard, Barnes Jewish, or any other major health system, let alone the community health systems is laughable. And please name which VAMC that has been shown to provide excellent trauma care, or has a Level 1 designation. Oh wait, the VA does not handle trauma, it is too expensive and they can’t get the docs to do it, so they ship it all out. Interesting.
Dr KVC
Robert Simon-
Why should doctors work cheaply after obtaining the highest level of education that exists in our society? Why don’t e deserve to be compensated at the highest levels of society?
You are deluded if you think medicine is not a business, and doctors don’t want to make money, just like everyone else. We do care about helping people, but my student loan debt is higher than the average US mortgage, and if I make a mistake, or even if I don’t and there is a bad outcome, the patient or their family may try and take my home and livelihood. I am suppose to take such a risk for wages that are comparable to auto workers, long shoremen, or air traffic controllers who may have little or no education?
Do you think it is mere coincidence that the most popular specialties, and most difficult residencies to enter all happen to be among the highest paying specialties or ones that offer the best lifestyle? This occurs because people care about money, even doctors. This is the case despite the fact that medical schools have lowered standards for admissions in an attempt to enroll students they believe are more likely to serve the underserved and enter primary care. Yet, the numbers entering primary care has not improved. I say this as a Puerto Rican Family Physician who sees medicaid patients. The truth is that if I saw a large amount of medicaid, my office would go bankrupt and then I would see no one.
I would like to see evidence that people are indeed dying due to lack of health insurance. This is a popular talking point, but it is not based on any facts whatsoever. Who in particular died because they did not have insurance that would have lived if they did? Are there any verifiable examples? Which children’s hospital is turning away sick children whose family can’t pay?
You question the willingness of doctors to help the poor, but the better question is are the poor willing to help themselves? Will they sacrifice their cigarettes, cell phones, or cable TV (which many do have) so that they can afford healthcare for themselves and their family? My patients have shown that they won’t. My experience has also shown that medicaid patients are also the least compliant on average and no show at a higher rate.
Read my posts above which explain why Obama’s plan will actually lead to decreased access to care.
MasonMcD
You question the willingness of doctors to help the poor, but the better question is are the poor willing to help themselves? Will they sacrifice their cigarettes, cell phones, or cable TV (which many do have) so that they can afford healthcare for themselves and their family?
So you require the poor to be more noble than the rest of us?
Paul Camp
Dr. KVC apparently believes in the power of anecdote over data.
See Jha, et. al., Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care, New England Journal of Medicine, Volume 348:2218-2227, May 29, 2003, Number 22 which compares VA care on 13 measures of quality with fee for service Medicare. VA “siginificantly outperformed” fee for service on all 11 examined quality indicators in every year from 1997 to 1999, and on 12 of 13 similar measures in 2000.
See also Kerr, et. al., Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study, Annals of Internal Medicine, 17 August 2004, Volume 141 Issue 4, Pages 272-281 which compares the VA to commercial managed care systems on 7 measures of of quality care of diabetes patients. The VA wins on all 7 measures.
In addition, the National Committee for Quality Assurance ranks health care plans on 17 different quality measures. Employers would like to know what they are paying for. Winning the NCQA seal of approval is the current gold standard in health care. In 2005, the winner was . . . . Johns Hopkins? Harvard? The Mayo Clinic? Dr. KVC? No, it was the VA.
But Dr. KVC knows someone who has a gripe. What do vets generally think? In the latest independent survey of veterans, 81% express satisfaction with the care they received, compared to 77% in fee for service Medicare.
The Institute of Medicine notes that the VA’s “integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.”
It was once horrible. It is no longer so. The VA runs circles around Medicare in both cost and quality. Dr. KVC complains about the lack of trauma care. Health care in America is not measured solely by trauma care. In fact, for the overwhelming majority of us, trauma care is thankfully not a significant factor. We need help with wellness, with managing chronic diseases such as diabetes, with dealing with the thousand infirmities of old age. The VA kicks Dr. KVC’s butt on these measures.
The best health care in America is provided by a government bureaucracy.
Anonymous
“Show me evidence that lawyers are different from EVERY other profession out there.”
They aren’t. Like physicians, architects, engineers, their opinions on political issues is as varied as any group’s. Look at the preeminent healthcare issue, single payer. There is no unanimity among physicians.
This legislation isn’t harmful to lawyers. It’s harmful to those injured by negligence of physicians. A talented med mal lawyer is a talented lawyer, and there are plenty who will pay for his services. It’s just less likely that he’ll help someone like you, as opposed to a large company that doesn’t have what it can pay him capped by lobbyists. The subset of lawyers who do this work successfully is extremely small.
“Why do Dems get so much more from trial lawyers than Republicans? ”
Because money talks. Why does any group get traction from Congressmen? Because of money. Really, trial lawyers in particular should be a natural Republican group, given that tort reform is really a liberal “government knows best” theory. Although I’m not sure why we’re discussing federal legislators with respect to a state law issue.
“This is evidenced best by the fact that the ABA opposes arbitration.”
Where is the evidence that arbitration is good for individual plaintiffs? What study are you talking about? And the only way the lawyer gets less with arbitration, if they represent the plaintiff on contingency, is if the client gets less. Your claim doesn’t make sense from the perspective. Is it possible to get money faster? Perhaps, it depends on the speed of your local docket.
“Why do states with good Tort reform laws have lower malpractice insurance rates than those without it?”
Where is the evidence that they do? Is there a comparison of average insurance premiums across those states that adjusts for lower salaries and cost of living too? Please, point me to it. Although I’m not sure that it really proves anything if true, other than that physicians support tort reform because they believe it puts more money in THEIR pockets, not because of any savings to the patients or other benefit to the patients. And certainly no benefit to the patients injured by a physician’s negligence – which you may or may not believe ever happens.
And you accuse the lawyers of supporting legislation in their own financial interest?
Anonymous
” I am suppose to take such a risk for wages that are comparable to auto workers, long shoremen, or air traffic controllers who may have little or no education?”
The average salary of a physician in this country is $150,000, and a surgeon $250,000 according to the Dept. of Labor. Which of the above average that kind of money – and would you really trade places with a auto worker these days?
“and if I make a mistake, or even if I don’t and there is a bad outcome, the patient or their family may try and take my home and livelihood.”
Silliness. Putting aside the fact that it’s ridiculously rare that a physician ever pays out of pocket on a claim, almost all states make your house judgment proof. You should focus more on actual risks.
Dr KVC
Paul Camp- You can cite your faulty, VA run studies all day long. You won’t even see those who run the VA choose its care over the private sector. Why did Dick Cheney, who was entitled to use Walter Reed had he wanted too, go to George Washington instead to get his defibrillator placed? I have worked at the VA as a Resident. If the VA did not have Residents, it would collapse like a house of cards in a mild breeze. In addition, take away the VAs access to all non-VA facilities and physicians and lets see how well they do, and how well the care is rated. That includes not allowing Veterans access to trauma centers unless they are operated by the VA.
It is easier when you can use the private sector as your back-up. Imagine if every hospital operated like the VA. Where would trauma go? Which facilities would perform the more complicated surgeries that the VAs don’t? Where would babies be born? Who would see the patients because of the increased shortage of physicians? Where would patients be sent when the wait to see a physician is long? Nowhere, because there would be no back-up anymore. Considering residents make up a large portion of the VA staff in an effort to reduce costs, where would all the new staff come from? Would we keep doctors in residency longer just to provide cheap VA staff? Would we decrease standards for liscensure so more foreign trained doctors could practice since they can’t get enough American Docs at VAs?
You simply fail to acknowledge that the VA uses the private system to get by. Without that private system, the VA would either go into bankruptcy attempting to increase its level of services to that which is necessary, or people would just die, like they do in other nations. Look at what is happening in Japan. Ambulances cannot find hospitals with the capabilities to treat the patients they are transporting. Patients die in the ambulance waiting for an accepting facility. In one instance, an ambulance contacted 49 facilities before finding an accepting facility. 49!!
With a nation full of VAs, we will have the same problem. Hospitals that cannot treat trauma, even in large cities because the VA doesn’t do trauma. Look at the door to Cath times at the VA versus community hospitals as well. You will find they suffer there as well. How about stroke protocol? Just try getting TPA at a VA. You are out of luck because they won’t have a neurologist or neurosurgeon anywhere nearby in the middle of the night.
Most VAs cannot accept reach a full capacity not because of physical space, but due to lack of adequate staff. And where again is the patient who needs an MRI or Ultrasound during a holiday or weekend going to go when all hospitals operate like the VA and close those services at that time. I guess in your world, “saddle anesthesia” is not a neurosurgical emergency. In your world, Cauda Equina Syndrome can wait, in mine it cannot.
So cite all the studies you want, it does not change the fact that the VA only survives because we have an excellent private system that they take advantage of, and depend on.
LACE
Obama is good at talking, but if I were you I would look at his actions. Thus far he has not honored many of his campaign promises. If I were a physician, I would be worried about my future salary and the amount of people I would have to see in order to obtain that salary. Oh, and the taxes I will have to pay to ensure this wonderful health care plan will continue. Beware of President’s bearing gifts.
Dr KVC
Mason- We are noble, but why should I see a patient for free who refuses to sacrifice cigarettes in order to pay me for my services. I even have heard medicaid patients complain about a $1-2 copay. If they value my services so little, why should I provide them? Is it noble to enable unhealthy behaviors, like smoking, by subsidizing them with tax money, or providing discounted services so that they can continue those behaviors. Should we be subsidizing cell phones and cable TV by allowing people to keep them, even if they are on government welfare programs?
What is wrong with requiring those on public assistance programs to divest themselves of those items that are not necessary, including cigarettes, cell phones, and cable TV, as a condition of receiving assistance? If they can afford those items, why are they not able to pay for their own health care costs, or at least a portion of them?
It is not a question of nobility, it is about personal responsibility. Doctors should not be required to sacrifice because their patients are not willing to do so themselves.
Dr KVC
Anonymous- I assume you are a lawyer. You must be. And as for there only being a small group of Med Mal lawyers, there are at least 30 in my town of 65,000 who advertise Med Mal in the phone book.
The overwhelming majority of physician lobbying organizations have opposed a single payer system, as have a overwhelming majority of physicians in Congress. Actually caps on pain and suffering are harmful to lawyers, because if the plaintiff gets less, they get less. Can you rationalize why non-economic damages should be allowed to get into the millions? And if lawyers are so concerned for the plaintiffs, why do they oppose caps on contingency fees? Wouldn’t that lead to more in the pocket of “victim”?
In Utah they argued that “victims” would have trouble finding a lawyer that would take a case if they could “only” make $150,000 profit on a case. Why would $150,000 profit for one case, with a possibility of more, after all actual expenses were paid, be inadequate for an attorney, and not enough incentive. Why do the top, high profile malpractice attorneys only take cases where they expect to make millions? Why won’t they help those whose cases have less economic potential? Are those people not equally deserving of top notch representation?
You show ignorance of how arbitration usually works. In most cases it is not contingency based. Instead, the attorneys are paid based on an hourly rate. Because of this, a huge award does not lead to more money for them. They get paid the same amount regardless. Because of this, there are no huge pay days for arbitration attorneys. In addition, arbitration is less likely to see a plaintiff win based on emotion instead of medical facts. This would doom the John Edwards crowd, who make millions off of trotting bad outcomes around the court and making jurors feel bad for families, even when no negligence occurs. This is how billions have been won from Cerebral Palsy cases, despite the scientific evidence showing that physician negligence is rarely, if ever responsible for the condition. Lawyers bank on jurors being willing to compensate a family out of pity, even when negligence is not present.
As for evidence that tort reform matters, why do states see decreases in insurance premiums, or decreases in the rate of increase after good tort reform is enacted? Take Nevada for example. And California actually has some of the lowest rates, especially when adjusted for cost of living. They have had reform for a long time.
FYI, I don’t deny I am looking after my financial best interests, but I look after my patients as well. Many lawyers will pursue a case even when they KNOW negligence has not occurred. They will utilize “shotgun” tactics and name every physician ever involved in the case in an effort to get more money, or in hopes of finding someone they can get money out of when their case is weak. They file lawsuits before thoroughly investigate.
The case of lawyer Thomas Henry in Texas is evidence of that. The suit’s defendants included Janssen, Columbia North Bay Hospital, a nurse practitioner, and eight physicians—among them Smith, Low, two radiologists, and a pathologist. It was a classic shotgun suit, in which an attorney sues anyone mentioned in the medical record and then searches for evidence to find a truly liable party. This was a lawsuit based solely on a stroke blamed on a specific prescription drug. So how could all of the physicians named been responsible for the prescribing of one medication? The suit accused the hospital and physicians of prescribing Propulsid. Later on, the suit listed 16 allegations against the health care providers, one of which faulted them for inadequately monitoring Henry White’s heart condition. The suit didn’t state which defendant committed what act, another shotgun-lawsuit tactic. The fact is these tactics are not unusual, but they are unethical, with the sole purpose of using them being laziness before filing and greed.
I don’t know of any doctor who is treating patients for conditions they KNOW they don’t have all in the name of making more money. I don’t know of any doctor who is or would purposely commit negligence, but don’t do so because of the fear of a lawsuit. I do know lots of doctors who order expensive tests that they know will reveal little, if any important information, all in the name of avoiding a lawsuit, or providing a defense if one is brought. These tests are not done to make more money, as it is highly unlikely the ordering physician will make 1-dime off of them. Billions of dollars are spent on these defensive medicine practices every year. All because practicing evidence based medicine is not enough with attorneys who see a huge pay day lurking around every corner.
So don’t act self-righteous. Most malpractice lawyers care about one thing only, money. And they will file knowingly non-meritous suits if they think money can be made. If they were ethical, they would never file a lawsuit if they knew there was no evidence of actual negligence. Considering most Med Mal cases filed lack actual evidence of true negligence that caused harm, it is obvious lawyers lack this ethical standard.
At Anonymous
Do you know how many extra hoops a physician has to jump through when obtaining privileges or looking for a new job if they have been simply named in a lawsuit? Even if they win. Did you know it cost on average $60,000 for a physician to successfully defend a suit?
Why do lawyers oppose a loser pays system? If the plaintiff wins, the defendant ends up covering the legal fees for the plaintiff through the award. If the defendant wins, why shouldn’t the plaintiff pay their legal costs as well? Isn’t that fair. Why should it cost a doctor, or their insurance which passes the costs back to the physicians in premium costs, so much if they are found not liable?
Matt
“Actually caps on pain and suffering are harmful to lawyers, because if the plaintiff gets less, they get less. ”
They’re only harmful if you assume that med mal lawyers can do nothing else but try med mal cases to make a living. That’s a silly assumption.
“Can you rationalize why non-economic damages should be allowed to get into the millions?”
Sure. If a child’s quality of life is completely ruined but they will live their full measure, I don’t see why $1 million or more is out of whack. Of course, we both know those cases with noneconomics that high are extremely rare. Can you rationalize why it should be limited to $250,000, or roughly what the surgeon who caused the injury makes in a year?
” And if lawyers are so concerned for the plaintiffs, why do they oppose caps on contingency fees?”
Why should the lawyers of one side have their fees capped but the other side doesn’t? Is that fair? Physicians have signed on for contingency fees in their class actions against the health insurers, why shouldn’t everyone be allowed to freely negotiate contracts with their attorneys?
As for Utah, without seeing the quotes, it’s hard to know exactly what was said, but as a general proposition, why should people not be allowed to contract freely for services? Particularly when the other party to the case has no such limit?
“Because of this, there are no huge pay days for arbitration attorneys.”
The vast majority of arbitrated cases are commercial litigation cases, and are generally billed hourly. Who knows how much they get paid? Certainly not you. And actually some commercial cases are taken on contingency and arbitrated and the lawyers do get huge fees. And the contingency fee was freely negotiated. Wonder why no one wants to regulate those fees?
“This would doom the John Edwards crowd, who make millions off of trotting bad outcomes around the court and making jurors feel bad for families, even when no negligence occurs.”
Of course, since you’ve never seen a bit of evidence in Edwards’ cases, you really don’t know what you’re talking about, right?
“Lawyers bank on jurors being willing to compensate a family out of pity, even when negligence is not present.”
Again, you illustrate your ignorance. Juries find for the physicians 3/4 of the time.
“And California actually has some of the lowest rates, ”
Because. . . . you say so?
“Many lawyers will pursue a case even when they KNOW negligence has not occurred. ”
Again, you claiming things doesn’t make them true. Most of your post is simply assumptions apparently extrapolated from one case you heard about. That’s why you cite no source for any of your claims beyond your anecdotes and “I know a guy who knows a guy”. And if it was a Propulsid case it was probably a class action, which has little to do with a garden variety malpractice case. But hey, you’re the lawyer.
“. I don’t know of any doctor who is or would purposely commit negligence”
Negligence by definition does not involve purposeful action. It’s a mistake. I don’t know a driver who purposely wants to run over someone, but that doesn’t excuse them from paying for the harm they cause when they do. And FYI, just because you don’t know something doesn’t mean it doesn’t exist.
” I do know lots of doctors who order expensive tests that they know will reveal little, if any important information, all in the name of avoiding a lawsuit, or providing a defense if one is brought. ”
Well, does it work? Does doing all those tests avoid a lawsuit, or provide a defense? Surely if you’ve been doing that all this time you know.
“Did you know it cost on average $60,000 for a physician to successfully defend a suit?”
Actually, the insurers claim it costs $100K to go to trial. It costs the physician nothing. But of course, it also costs the plaintiff that much, which undercuts the argument that it makes economic sense filing non-meritorious claims just so a jury that decides against you 3 out of 4 times might be swayed by emotion.
“Why do lawyers oppose a loser pays system? If the plaintiff wins, the defendant ends up covering the legal fees for the plaintiff through the award.”
Two things. Most states have loser pays, for one. Two, in a malpractice case, the jury does not award attorney’s fees.
“Why should it cost a doctor, or their insurance which passes the costs back to the physicians in premium costs, so much if they are found not liable?”
How often is a doctor sued in their career where they take a case all the way to trial? On average? It’s probably not even once. But let’s say it is one time, and over the course of their lives paying premiums of $20K a year their insurer pays $200,000 defending them successfully. Well, why would your insurance go up? If you practice for 30 years, and your rate never goes over $20K a year, you’ll have paid the insurer $600K. They’ll have made a $400K profit on you in premiums alone, regardless of investment income. Seems like the better question is why your premiums would go up.
Michael Kirsch, M.D.
Physicians are trained to seek out the truth. We are obligated to be honest with patients. Attorneys have a different mission. They are not seeking truth. They are trained and paid to defend their clients’ interests, which often conflict with the truth. I believe that our mission is the more noble. I would not want to be in an occupation where I could be attacking an innocent person’s reputation and resources, even if the process is legal, in order to serve someone else’s interest.. Those who defend the current tort system are generally contaminated with self-interest. This is much less true for physicians, most of whom readily admit that our health care system is deeply wounded and needs to be reformed. http://www.MDWhistleblower.blogspot.com
http://www.motionphr.com Jeff Brandt
MasonMcD,
Good point there are many MDs (I am not one) that help many just like other citizens. My wife donated her time working on the EMR at Volunteers I Medicine.
I once was a part owner in a wine business and I tried to help a divorced mother of two to quite smoking by offering here $1/hr raise to quite. She refused. She also did not want to contribute $50 per month for our Health plan. The state paid for her health because of her child. She did have plenty of tats, newest cellphone, and nails but could not pay part of her health care.
I hope that the government forces everyone to contribute to their health care cost.
Jeff Brandt
motionPHR for the iPhone
myMedBox for Android
Matt
“We are obligated to be honest with patients.”
And yet, when you make a mistake, you clam up and your insurers do the same. So apparently that obligation is put aside quite easily.
“I would not want to be in an occupation where I could be attacking an innocent person’s reputation and resources, even if the process is legal, in order to serve someone else’s interest.”
Of course, that assumes the other side is always innocent, doesn’t it? Both sides usually believe they are the virtuous one. The system’s job is to determine who is right, as best it can. For some reason, physicians struggle with the concept that theirs is not the only view of a situation.
“Those who defend the current tort system are generally contaminated with self-interest.”
As are those who attack it.
Matt
““Those who defend the current tort system are generally contaminated with self-interest.”
Incidentally, one of the major funders behind the tort “reform” movement are the tobacco companies, which seeded many of these state tort reform associations via their chief law firm, Covington & Burling. You can confirm this at any of the websites that published all the tobacco docs. Interestingly, one of the partners at that firm, which has a bunch of Fortune 500 clients and functions also as a lobbying firm, is Philip K. Howard, the head of Common Good, which is pushing backdoor caps via health courts.
So tell me, who exactly is contaminated with self interest?
Dr. KVC
Matt- Your ignorance abounds. If you practiced medicine you would know better. It does not matter if a case goes to trial. The minute I am named, for the rest of my life I have to divulge and explain to any hospital I seek privileges from, or to a prospective employer the entire situation behind it. In some cases a job opportunity is lost because either the group or hospital is so skittish, they don’t want any risk. this is because hospitals are now getting hit if a physician gets sued fro malpractice because they gave that physician privileges. They are becoming partially responsible.
By the way, how do you know anything about my legal knowledge. The fact is I have studied the law intensely, especially with regards to med mal. I am well versed on case histories involving John Edwards and other cerebral palsy cases. Most were won not based on evidence of negligence, but sympathetic juries who saw a family with years of medical bills and costs that they could not afford. That has nothing to do with negligence.
Maybe you should familiarize yourself with what is legally necessary to prove malpractice.
Doc99
How is what Obama said about Med Mal any different from what Bush said? And how are we to believe Obama will succeed in Med Mal reform where Bush failed?
Matt
” In some cases a job opportunity is lost because either the group or hospital is so skittish, they don’t want any risk. ”
How many doctors, simply because they were named in a lawsuit, have lost a job as a result? As a percentage? Or is this another one of your “because I say so” claims? Given that physicians are getting jobs even after multiple judgments, it seems that there is still a market for their services. In my state, a physician went to the federal pen for child porn, and has gotten jobs paying well over $100K in several places since. So I look forward to your stats!
“I am well versed on case histories involving John Edwards and other cerebral palsy cases.”
Excellent. What were the names of the parties, case numbers and counties they were heard in of the cases you got copies of the evidence and transcripts in? Perhaps we can discuss them in more detail if we both know which ones.
“Maybe you should familiarize yourself with what is legally necessary to prove malpractice.”
I actually do know, but apparently you think it’s just a sad story. What are the elements required to prove a malpractice claim, in your opinion?
Michael Kirsch, M.D.
To suggest that the medical community is contaminated with sefl-interest is absurd. Nearly every lawyer I know, as well as their professional societies, believe that the current tort system works well and should be maintained. The rest of the country disagrees with them. In contrast, nearly every physician I know, and all of our professional societies, admit that our health care system is wounded and needs repair. The rest of the country agrees with us. While a partisan ideologue could parse my words and search for exception, I believe that most reasonable readers would make the proper judgment. My own blog, http://www.MDWhistlelblower.blogspot.com, offers many criticisms of the medical profession. Perhaps, this means that I am contaminated with the public interest.
Eric Roesler
Now that we agree that the uninsured have access to quality health care, we can also agree that we need to devise (from the funds that are used for the ER visits) clinics that operate next to the ERs or other fix. This does not require a total destruction to the current system, nor does it require a single payer system.
The U.S. is hands down the best, state-of-the-art health care system. I see no reason to change that. Improve, perhaps. Improvement is done piece-by-piece and precept-upon-precept.
Matt
“To suggest that the medical community is contaminated with sefl-interest is absurd.”
Why? You mean the medical community DOESN’T support tort reform to save some money on their liability insurance? Really? How do you even type that without smiling?
“In contrast, nearly every physician I know, and all of our professional societies, admit that our health care system is wounded and needs repair.”
Yeah, in the sense that you think you ought to be paid more. Read your blogs. The vast majority of complaints center around tort reform and reimbursement rates, and constant threats that if the public doesn’t pay you more or give you immunity you will disappear!
“The rest of the country agrees with us.”
You should be careful making claims about what the rest of the country thinks and using that to justify your position. It might turn out that the rest of the country thinks single payer will be the cure for what ails healthcare. Does that make them right?
You can prattle on about your love of the public all you want, but when a member of that public is injured by a physicians’ malpractice, you’re nowhere to be found for help.
Susan H
Personal injury lawyers are like mortgage loan originators in the ’90s…there is only vast financial incentive to create business, and no meaningful deterrent for misrepresenting facts on application for business.
Can anybody name a single successful(that is, having recovered a damage award of cost breakeven) ‘malicious prosecution’ or ‘abuse of process’ lawsuit by a doc against a lawyer?
Can anybody cite case law of legal malpractice which awarded monetary compensation for pain and suffering or loss of consortium?
Doctors need to make public aware of the bizarre protections attorneys enjoy, in that there is no practical recourse available to victims of their professional malfeasance.
Michael Kirsch, M.D.
As far as your pejorative and inaccurate comment on physician blogs, my own blog doesn’t seem to fit into your skewed categorization. Yes, I support the medical profession, but I also criticize it for its excesses.
Did you notice that the New York Times reported this morning that a whopping 44% of the country approve of Obama’s health care plan? So, it doesn’t seem that ” rest of the country thinks single payer will be the cure for what ails healthcare”, as you suggest.
The vindictive tone of your corresponsdences detract from whatever legitimate points might exist underneath.
http://www.MDWhistleblower.blogspot.com
Pat
The legal realities of medicine are not pretty. For example: most radiologists will no longer read mammograms. Mammograms are not a good tool for finding breast cancers and any attorney can find one in retrospect on a mammogram. However the good tools available are not reimbursed for routine screening by insurance or medicare (digital mammograms and breast MRI).
Susan H
Why are judges immune from civil malpractice suits? How is it different, when a judge’s professional opinion is overturned on appeal, from a doctor’s opinion being ‘overturned’ by a hired expert witness?
Matt
“my own blog doesn’t seem to fit into your skewed categorization. ”
My comment is not inaccurate, but it is a generalization. I have not read yours, so if it does not apply to yours, then please disregard.
“So, it doesn’t seem that ” rest of the country thinks single payer will be the cure for what ails healthcare”, as you suggest.”
Perhaps not, but if the number were 51%, would that change the merits? That’s my point – simply because the majority thinks something does not make it a good idea.
“The vindictive tone of your corresponsdences detract from whatever legitimate points might exist underneath.”
I am simply responding in kind. When you accuse others of acting not based on principle or any actual legitimate position, but solely out of financial self interest, what reaction do you expect? If you want a respectful tone, I am glad to offer it.
“However the good tools available are not reimbursed for routine screening by insurance or medicare (digital mammograms and breast MRI).”
It would seem, then, that physicians would get together and push for reimbursement for these things when they sign those contracts with the insurers, or direct their lobbyists in Congress with regard to Medicare. That is not a legal reality, it’s a medical reality.
Susan H
See, nobody cares whether breast tumors are efficiently found and treated, and the subtle aspects of that issue.
Society apparently values its legal practitioners more highly than its medical practitioners, as evidenced by the protections afforded its legal members and its willingness to let doctors become extinct,
But…is society aware of this? Or is it simply happening because predator lawyers are more vicious and numerous than prey physicians?
Matt
“Society apparently values its legal practitioners more highly than its medical practitioners”
Given the average salary of medical practitioners is 50% higher than legal practitioners, it would seem otherwise. Lawyers can be sued for malpractice, same as physicians.
Susan H
Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award
Pat
When an HMO knows your practice has enough of their patients to be a critical volume of your business, upon annual renewal they will offer you a new contract which pays significantly less than the old one. They surmise that you cannot afford to drop their plan. If you protest the answer is take it or leave it. Are you suggesting that if doctors unionized they could achieve higher reimbursements through a union negotiated contract?
Susan H
Pat, society does not care about doctors. Society is letting doctors be extingushed by lawyers. Society is allowing HMOs and insurance plans and government to set rates which do not allow medical providers to break even.
Doctors (and don’t forget nurses, the new prey) can’t survive, union or no union. Maybe all docs and nurses need to move to offshore boats (International waters and civil law) or Indian Reservations (Tribal civil remedies) and operate cash-only practices.
My belief is that healthy members of society will let a point of crisis be reached before addressing inequities that fostered the crisis.
Matt
“Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award”
Can’t. It would have had to go up on appeal, and I don’t follow the appeals court unless it relates to cases in my areas of practice. The only reason we know so much about physician legal issues is because they are trying to get tort reform.
And, most of those are settled, and settlements are confidential.
Susan H
Matt, cite a case of meaningful sanctions against any attorney for frivolous medical malpractice litigation.
Or is it your contention that all medical malpractice charges are meritorious?
Matt
Susan, sanctions typically won’t be reported except in the state bar magazines. I don’t recall one related to med mal, but I’m in a small state and don’t read the monthly bar magazine every month.
I would never contend that all med mal suits are meritorious. Nothing involving humans is perfect.
Susan H
Matt, you must recognize the disparity between treatment of alleged legal and medical professional malpractice is skewed in favor of lawyers. And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.
Ultimately, anyone smart enough to get through medical school will realize that law school is faster, cheaper, and the back-end is safer and better rewarded.
Matt, you had claimed that: “Given the average salary of medical practitioners is 50% higher than legal practitioners,…”
I looked on PayScale.com to compare hourly wage rates, and found the following, which contradicts your assertion:
Median hourly wage rates for lawyers were higher than the median hourly wage rates for doctors by 100% in the category 20+ years experience, higher by over 18% in the 10-19 years experience range. Zero to 9 years wages were higher for doctors that attorneys but not 50% higher.
Matt
” And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.”
Susan, I’m not sure how you define frivolous, but the vast majority of lawsuits are filed by businesses suing businesses. Tort filings are down over the last 20 years, so this explosion you’re claiming doesn’t exist.
As for the disincentives, there are clear economic disincentives for filing dog cases, especially on contingency, because you don’t get paid by the hour, plus you’re fronting all the expenses. You’d quickly go broke under that economic model.
Here’s your median compensation for physicians from the DOL:
http://www.bls.gov/oco/ocos074.htm#earnings
Here’s your median for attorneys:
http://www.bls.gov/oco/ocos053.htm#earnings
Not even close.
Pat
Setting aside the litigation issues. Cost is the driver here. The one real thing Obama is proposing is to require open architecture for EMR. Jay Rockefeller has a bill before Congress that will require open architecture and establish a medical informatics public utility (not government) to house EMR. See a demo at medicalinformaticspublicutility.com.
Doctors and hospitals will retain their independence and will be able to competet on the basis or results.
http://www.privatepractice.md Rich
Kevin,
I agree with your comments in the recent NY Times article, http://roomfordebate.blogs.nytimes.com/2009/06/18/better-medical-care-for-less/#comment-92293, that state that physician payments need to be divorced from patient volume. I once worked in a practice that booked a patient for almost the same time slot (5 minutes apart) as I had exam rooms assigned to me. It was all to keep up the practice’s revenue as reimbursements declined. Needless to say I left that practice and now, I’m sure, deliver much better medical care at a reasonable pace. I certainly have more time to listen to the patients, and my own blood pressure is better!

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