Reversing a mistake

[ViC78]

Re: Reversing a mistake

Yes, I would. I have a life outside this forum that keeps me busy.

Seriously?? You make an assertion and then decline to back it up with links/analysis? Where did you get the information that malpractice lawsuits are responsible for the disproportionate growth in US healthcare expenses?

[Glenn Black]

Re: Reversing a mistake

Technology, drugs, and salaries are the major costs drivers for medical care.

Let's look at the salaries. Since we are speaking only financial costs, let's assume all other factors are equal. What ever trade you have (ie. plumber, reporter, doctor, musician, etc.), if all else is equal and you would earn the same in your home town as a neighbouring town, would you uproot yourself & move to the other town to earn your living? Probably not. If you can earn 10% in the nearby town, would you re-locate or commute? What about 30% premium? 100% premium?

This is what Canada faces with the US so close by, and medical training virtually identical between the two countries. You pay the salaries, or you lose the people to jobs & pay scales South of the border.

As you can see in the graph, if you aren't the highest paid in the world yet, you soon will be with the rate that US medical costs are rising.

Any system that offers something for free will suffer abuse, waste, inefficiencies, & disrespect. With partially subsidized systems, this will be partially true.

We also understand that "A stitch in time saves nine", and "Prevention is far better than a cure"

How do we combine all of this together into a sustainable social policy?

The only thing I can think of is an insurance + tax plan where government keeps track of a person's use over the years. At some point (ie. every year, or every 5 years, or retirement), the taxpayer gets some fraction of their residual taxes back as the bonus of their good, healthy living, good genes, and prudent use (ie. seeking care soon enough so that the problem is avoided or small, but avoiding hypochondria).

Currently, doctors order excessive tests because they think that is what patients expect, and to guard against malpractice. If the practitioner doesn't have to pay for the tests, why not order as many as your conscience permits? If the doctor gets paid so much per person treated, and so much per confirmed condition/diagnosis, with a physician picking up the lab costs, then our lab test costs would drop dramatically.

Currently, our medical costs= 1_Prevention + 2_detection + 3_mitigation + 4_extra cost from poor lifestyles + 5_extra costs from procrastination + 6_waste + 7_negligence&malpractice

With the proposed plan:

1 goes up,
2, 3, 4, 5, 6 goes down

[flintlock]

Re: Reversing a mistake

I can't "quantify" this, but I'd guess one of the biggest reasons for rising health care costs is the fact we have become so good at medicine. The high costs of heart transplants and MRIs were not a problem in 1898. ;) Our technical abilities in medicine have far outstretched our ability to pay for it. Imagine if we took the same attitude toward other things that we do about medicine. That just because the technology exists, that everyone is entitled to it. I would be demanding my trip to the moon. After all, we have the technology, why is it "fair" that Buzz Aldrin gets to and I don't? ( in recent Itulip.com tradition, please feel free to insert wacky arguments that the moon landings were faked.) Sooner or later, for better or worse, health care will become rationed to some degree.

Litigation costs are not the main reason, but I do think they play a role in rising costs. Often in subtle ways that are hard to quantify. How many of those tests your doctor ordered are more about covering his ass than helping yours? We may never really know. I fix electrical systems for a living. I could rationalize all day why I need to spend two days checking every connection in your home. Or I could use my best judgment and experience to go to the most likely problem in 15 minutes. But if I thought there was a high probability of being sued for missing the problem on the first try, I'd be more inclined to bill them for the two day fix. There is always a trade off. You can have great health care. You can have cheap health care. But you cannot have great, cheap health care. Typically, we want it all.

[ViC78]

Re: Reversing a mistake

http://prescriptions.blogs.nytimes.c...th-care-costs/

One critic is Tom Baker, a professor of law and health sciences at the University of Pennsylvania School of Law and author of “The Medical Malpractice Myth,” who believes that making the legal system less receptive to medical malpractice lawsuits will not significantly affect the costs of medical care. He spoke with the freelance writer Anne Underwood.

But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice.
A.
That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail.
Q.
You said the number of claims is relatively small. Is there a way to demonstrate that?
A.
We have approximately the same number of claims today as in the late 1980s. Think about that. The cost of health care has doubled since then. The number of medical encounters between doctors and patients has gone up — and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries.

Edit: I am going to be out for a while, so apologize in advance if this post seems like a hit and run.

[c1ue]

Re: Reversing a mistake

In "modern" economies, it's the chronic illnesses of poor nutrition (plenty of cheap food, but not healthy food) that get you. These include diabetes, cancer, heart disease, stroke, obesity, liver failure, and such. These diseases often take a long time to kill, and provide much opportunity for expensive medical and pharmaceutical services and products in the interim.

While true, it is unclear whether poor nutrition is a net negative. Fat people die young - if you're 400 pounds, you aren't making 50.

Similarly smokers die younger.

Contrast this with a 75 year old Alzheimer's patient - the average lifespan of an Alzheimer's patient after onset of symptoms is between 4 and 8 years, with the latter 1/3 requiring full nursing home care or full time attendants.

Nursing homes cost $50K a year or more.

And the numbers can be staggering: 10% of those who are 65 to 74 will get the disease; half of those 85 or above will have it.

[Jay]

Re: Reversing a mistake

The main question then is what is rationed, and to who.

What is difficult is that most people have no experience with end of life issues and have no interest, time, or capacity to grasp these thorny issues. Those same people make a democratic vote to elect uneducated politicians, swayed by powerful corporate interests, to make the decisions about end of life care. There go billions right there, poof. And lots of patient pain to boot.

[Rajiv]

Re: Reversing a mistake

http://prescriptions.blogs.nytimes.c...th-care-costs/One critic is Tom Baker, a professor of law and health sciences at the University of Pennsylvania School of Law and author of “The Medical Malpractice Myth,” who believes that making the legal system less receptive to medical malpractice lawsuits will not significantly affect the costs of medical care. He spoke with the freelance writer Anne Underwood.

IMO, Tom Baker is being a little bit disengenuous. I am assuming that the litigation and malpractice insurance costs are indeed 1-1.5%. However, the threat of medical malpractice suits can bring about un-needed tests, procedures, and CYA activities that add to the total bill. It is not clear what that bill would have been without the threat of malpractice suits.

from U.S. Health Care Costs

Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1]

In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries.
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Government programs, such as Medicare and Medicaid, account for a significant share of health care spending, but they have increased at a slower rate than private insurance. Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. [3] Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may result in increased Medicaid spending figures soon.
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National Health Expenditures, 2008



Total = $2.3 Trillion

[Master Shake]

Re: Reversing a mistake

Seriously?? You make an assertion and then decline to back it up with links/analysis? Where did you get the information that malpractice lawsuits are responsible for the disproportionate growth in US healthcare expenses?

It's common knowledge. It's not the lawsuits, per se, but the practice of defensive medicine to avoid such lawsuits.

[Jay]

Re: Reversing a mistake

It's common knowledge. It's not the lawsuits, per se, but the practice of defensive medicine to avoid such lawsuits.

I am a practicing Emergency Physician and I can tell you with certainty that the specter of litigation changes the way all physicians practice, greatly. I have practiced in highly litiginous environments and in countries with no litigation fears. I know the full spectrum well. Litigation forces much more expensive care, increasing the amount of procedures done, and the time and effort spent on each patient. This can be difficult to accurately quantify but is very real.

[Master Shake]

Re: Reversing a mistake

I am a practicing Emergency Physician and I can tell you with certainty that the specter of litigation changes the way all physicians practice, greatly. I have practiced in highly litiginous environments and in countries with no litigation fears. I know the full spectrum well. Litigation forces much more expensive care, increasing the amount of procedures done, and the time and effort spent on each patient. This can be difficult to accurately quantify but is very real.

Thank you. Hopefully, Vic will read your post.