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Medical malpractice needs to be discussed as an issue because of all the misconceptions that exist about it. I frequently run into some people who believe that health care costs would drop by 50% if it were "reformed". For starters, the General Accounting Office (GA0) has studied this issue. They concluded that only about 1-2% of all healthcare costs can be blamed on malpractice lawsuits. Mind you, 1-2% of the bloated amount Americans spend on healthcare is not insignificant. Even that amounts to billions of dollars every year. However, the larger point is that if we totally abolished the right of people to bring malpractice lawsuits no one would even notice the savings. On the other hand, we would remove one of the few checks that exists in the system to try to guarantee quality medical care.
This doesn't mean individual physicians and small town hospitals don't feel pain from malpractice insurance rates. They do, the rates charged physicians in certain specialties (OB-GYN and Neurosurgery) are very high. Even this is complicated though. Malpractice insurance is very unlike car insurance. Car insurance rates are kept within some boundaries by the fact that a huge number of people pay into the same pool. With medical specialties, there are only a few people (physicians) paying into the pool. Just a couple of claims can drive malpractice insurance rates very high.
Ironically, the malpractice lawsuits we see appear to be only the tip of the iceberg. Many, many people who are injured by careless medical people choose not to seek compensation at all. The New England Journal of Medicine studied this issue and determined that over 90% of all people who were victims of malpractice never pursued a claim for compensation. This negates a common misperception that the country is "sue happy" and will bring such a claim at the drop of a hat. In reality, this seldom occurs.
I for one would not want to see the right to sue removed. California for example has some laws that set forth reasonable guidelines and caps on things like pain and suffering. They seem to strike a fair balance.
Malpractice insurance is not as exactly priced as say auto insurance, that is correct. However, rest assured that those rates are being developed by grouping claims data and not just relying upon a few claims in rate determination.
OB's and Anesthes...Neuro are all high because mistakes or just *problems* there can cripple but not kill...generating millions in "lifetime" medical costs.
I personally challenge the 1-2% number and would like to see it's derivation.
I know of a couple Chicago hospitals that had annual malpractice costs into the tens of millions and that for a physicians group it's their 2nd largest expense after salaries.
Seren, what you say is absolutely correct, in a theoretical sense. But in the real world, our health care, mediocre as it is, is bleeding us white, and a tourniquet is the first order of priority. We need to judge how much we are wiling to pay for health care, and then make sensible choices about a product we can afford. A health care apparatus can be built at reasonable cost, but first we have to commit ourselves to maintainig the reasonable cost, instead of just squabbling about who will write the final check, drawn on our aggregate (and borrowed) national balance.
[2]All graduating doctors should be required to serve in rural America for two years. Boredom and lack of the bright city lights will not kill anyone
I would like to comment on this. I believe this is do-able. We have programs that forgive portions of student loans (if not all) for teachers that agree to work in certain areas. If I'm not mistaken, there is also a program that was created or is in the process of being created for forgiveness of loans for qualified counselors in certain areas.
I personally challenge the 1-2% number and would like to see it's derivation.
I know of a couple Chicago hospitals that had annual malpractice costs into the tens of millions and that for a physicians group it's their 2nd largest expense after salaries.
Please see the following. I'll note here there maybe valid reasons for imposing some limits on malpractice liability. However, anyone believing it will lead to significantly reduced healthcare costs is simply wrong. The amounts involved are not significant enough to change the game.
While several hundred thousand dollars sounds like a lot of money, it isn't. A greeter at Walmart will make very close to a million dollars in a lifetime, from the age of 18 to 65, Ten dollars an hour comes out to almost exactly a million in a 47 years.
So any malpractice claim that effectively shuts down the income capacity of a worker, now carries a very high potential price tag in terms of lost earnings.
I think we have a debate!!!! You guys make my head spin.
Yes it is possible to put good young doctors in rural America. Do not forgive the loan. Set the begin date for repayment 3-5 years after graduation. Provide the doctors with a nice home and subsise the doctors $100,000 for two years. These doctors see no pharmaceutical reps, receive no perks from pharma. They do not pay for malpractice insurance. They concentrate on patients and the best care..They do rounds and rotate in ER. When they leave, they will be better doctors than when they began because they will have more practical experience. You won't see Black Lung in NYC. They won't see what years of welding in a manufacturing plant does to lungs. They won't see the results of mining, farm or silo accidents. They won't see snake bites or the black flesh from a brown recluse bite. And they won't know that some of the chronic kids complaints are caused by mold and not allergies. I'd bet most of them have never seen Herpes Recurrens. The number of strange ailments that present in rural America is quite amazing.
It ridiculous to have to drive 300 miles to find a qualified doctor. Doctors need to listen. I had a doctor order 12 one-half ounce tubes of a salve at a cost of $1260.00 when all I required was 1 tube which I told the pharmacy. They mailed the other eleven tubes. I called my insurance company, the pharmacist, the doctor and the nome office of the pharmacy. This same pharmacy substituted one name brand drug for a generic that was a totally different drug. Their excuse was the normal drug was not in the PDR. Yes it was and yes it is today. Whoever was doing the search did not know how to spell the name, where to look, or what class drug it was or the manufacturer. They dispensed a generic against a doctors "no generic." order. the excuse this time was 'your insurance company requires..." This is a national pharmacy. I finally called the main office and said they desperately needed to reorganize. It was THAT bad. Needless to say I did not return. They sad part is, this pharmacy is terrific any where else in the country.
Mold is the number two killer in Illinois according to my friend who is a licensed environmentalist that tests for mold and radon in addition to home inspections Most mold is odorless, colorless and tasteless. It is in the ground we walk on everywhere in America. What makes Illinois special is it is the number two corn producer in America in a state that has nearly 80,999 farmers. The cure is so easy. Keep the windows and doors closed all year. Use HVAC to circulate the air. Buy a good filter that traps mold and the other carcinogens, and change it every month. It is the best $15 anyone can make. My friend Randy says you cannot breathe mold indie and outside and not have health problems. I've done this ever since my spouse came home from the hospital with a death sentence of two lung diseases. The most amazing thing happened. Since I started this regimen, no one in the family has had a cold, flu, sinus problem, ear aches, allergy or chronic cough.
The Community Disease? . It is ridiculous to come out of a hospital with MRSA after a 5 day stay.
It is even more ridiculous that no one including the ER, the surgeon, or any of the doctors, were smart enough to culture an infection during any of the eleven office calls in seven months before it was identified. This is another reason new Grads should work under senior physicians for two years. The is a was dirty hospital that follows no common sense preventative health measures. Oiled floors do not a clean hospital make when urinals and bed pans are not emptied. .
While I am on the subject of hospitals, I strongly feel it should not take four hours to dismiss a surgical patient whose discharge was signed 8 hours earlier.
There is a lot of fix. How do we begin to find the bottom rung? I think we should we start a new thread as we agree on a topic solution? It will eliminate confusion. Maybe. .
I appreciate your concerns about the availability of healthcare. It is true that rural America has difficulty attracting physicians. Here are just a few reasons why:
1. Rural healthcare facilities are generally older and more limited than those in big cities are. Most doctors would like ready access to a good lab, an MRI machine, and other technology that enables them to practice in accordance with the standard of care.
2. Doctors are not only in short supply in these areas, but so are nurses, phlebotomists, physical therapists, x-ray technicians, and other qualified people who assist a physician. Its hard to run a medical practice without sufficient access to these supporting occupations.
3. Income is important to physicians just like it is to all professional people. However, there are other factors besides just income. Many doctors like amenities such as a university or a college where they can attend cultural and sporting events. Their wives are like most other wives, they prefer a selection of places to shop and a vibrant community. They may want a place where private school is an option for their kids. If you see something wrong with this, I'll guarantee you that the country is full of millions of people who aren't physicians who make these same choices everyday.
I can personally testify to a pattern I've seen in small towns in my own state. The towns are able to attract physicians initially. The problem is that they can't hang onto them. They put in a short time in these places and they realize just how much on their own they really are. Patients get sick or injured 24/7 and often they have no back-up when this occurs. Anyway, the same doctor the community struggled for a year to recruit than leaves the community after two years. Its a revolving door and it should be apparent after six physicians come and go that the problem is not the physician, its a deeper systemic issue.
Another problem is that often people in these areas are farmers, ranchers, or small businessmen. If you've studied this issue, you'll know that these are among the groups in America that are least likely to have health insurance. You're more likely to see insured people in cities and metropolitan areas. Maybe we need subsidized health insurance for these people or some other means to get them covered, but until it does doctors will continue to see this as a drawback of practicing in rural areas.
The problem I have with most of what you suggest Linicx is that it will involve increasing costs. If we agree to take over loans for new physicians, the government must pay. If we agree to buy a nice house for new physicians, the government must pay. If we agree to provide more doctors in sparsely populated areas, the government must pay because its unprofitable to do so. I appreciate your concern about mold and lung disease. Its undoubtedly an issue. I can tell you right now though that even though I didn't hear you mention it that the number one cause of fatal lung and heart disease is not mold its cigarette smoking. What's disappointing about this is that despite all the effort that has gone into smoking cessation, millions of people still voluntarily make a choice to engage in a deadly and costly behavior. Want to avoid billions in healthcare costs? End cigarette smoking. Its that simple. Won't happen though.
Not blaming you, but what I seldom here in a discussion of healthcare costs are realistic ways that we can reduce some of the staggering costs. That's how we got into this predicament.
People who choose to live in small rural communities accept as a fact of life that they do not have access to the economy of scale that applies to larger urban centers. They have to buy their groceries at non-competitive monopoly prices or drive to a city. Their kids go to schools that lack many extracurricular perks. The snowplow doesnt get to their road until the afternoon. Their drinking water may not meet minimum standards. It's a $100 tow to get their disabled car to a garage. There is no cable or hardwire interent. When the power goes out, it is out for days. Forget about theater and dining, unless you like Sonic.
Nobody asks for the government's help in redressing these problems, because it is understood that it will not be forthcoming, and that is discounted in the cost-benefit ratio of country living. Why should health care be any different?
I personally challenge the 1-2% number and would like to see it's derivation.
I know of a couple Chicago hospitals that had annual malpractice costs into the tens of millions and that for a physicians group it's their 2nd largest expense after salaries.
Please see the following. I'll note here there maybe valid reasons for imposing some limits on malpractice liability. However, anyone believing it will lead to significantly reduced healthcare costs is simply wrong. The amounts involved are not significant enough to change the game.
The refer to the study but don't show it. I'd be interested in seeing the actual details in terms of what items went into the numerator and denominator. For example, most Chicago hospitals have self insured retentions of $5million and they are not required to report payments to any "central database" like insurance companies are. Not sure how they'd get any self-insured data.
Additionally, they refer to TOTAL medical costs. Well, since they are including medicare\medicaid etc. that waters down the malpractice costs relative to premiums paid. To word it another way, you are assuming that if the correct overall number is 2% that the costs of malpractice are equal across the various age demographics (I can assure you they are not). So the burden on someone actually BUYING health insurance could be signifanctly larger than the "average". (Old people have a lot more medical costs and get A LOT less money from malpractice claims)
Just pointing out how complex the determination of this sort of thing can be and where the costs can fall out into various segements.
People who choose to live in small rural communities accept as a fact of life that they do not have access to the economy of scale that applies to larger urban centers. They have to buy their groceries at non-competitive monopoly prices or drive to a city. Their kids go to schools that lack many extracurricular perks. The snowplow doesnt get to their road until the afternoon. Their drinking water may not meet minimum standards. It's a $100 tow to get their disabled car to a garage. There is no cable or hardwire interent. When the power goes out, it is out for days. Forget about theater and dining, unless you like Sonic.
Nobody asks for the government's help in redressing these problems, because it is understood that it will not be forthcoming, and that is discounted in the cost-benefit ratio of country living. Why should health care be any different?
Good post. Economies of scale and perhaps more importantly, competition help to lower costs to the consumer.
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