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POLITICS: Denny speaks, sort of

Who’s Denny Hastert? He’s my favorite politician. I regularly ask this question at parties, among college educated yuppies in San Francisco.  Frequently NO ONE knows — and I am not joking. Incidentally by my recollection of the constitution, he’s number 3 in line to the nuclear codes. Funnily enough he even has some limited power and influence running around after Tom Delay, and he thinks about health care, believe it or not.

What does he think about about health care? Funnily enough he too believes that the main problem in the country is that of the uninsured.  And we’re going to solve that by reducing malpractice costs, or at least I think that’s what he said…maybe it was AHPs and getting the state out of insurance regulation…yes that’s it, that’ll work! After all all those AHPs and cross-state individual plans are going to really help contain costs, and get sick people into easily affordable insurance plans — especially after we’ve driven out the 0.5% of the cost of the system that malpractice causes.

More perhaps on this later, or perhaps we’ll leave that discussion to Jon Cohn. About time I got him back, and I know he’s thinking about it

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hsfreyMatthew HoltspikeEric Novack Recent comment authors
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spike
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spike

Yeah, it’s no question that there’s tons of litigation out there. I used to run a credentialing department for an MBHO. Rare are the psychiatrists who haven’t been named in a lawsuit. It is possible that because the studies on payouts don’t take into account legal costs to keep payouts down that maybe their expenses are going up along with the premiums. If that’s the case, they’re making a very poor argument of it, because even PIAA doesn’t mention it. I would be amenable to reforms where if the judge determines a case to be frivolous that the plaintiff’s attorney… Read more »

Eric Novack
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here is link: http//www.billingsgazette.com/index.php?id=1&display=rednews/2005/08/10/build/opinion/40-guest-op.inc

Eric Novack
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Spike- this link is an interesting opinion piece.
Give me your thoughts.

Eric Novack
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Spike- I can appreciate and understand your skepticism. Though I certainly share the sentiment of “absolute power corrupting absolutely” (ie. industry monopoly or near monopoly)– I think the medical mutual companies have no motive. I can say this because the physicians who tend to be more influential in these companies would be more likely to be further along in their career– they would be unlikely to see any benefit in engaging in a many year political game of chicken– and cost themselves hundreds of thousands of dollars. The most important thing to understand about the award/ premium ratio for a… Read more »

spike
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spike

What I want to see is evidence that the reason malpractice insurance premiums went up is because of higher payouts. I know that malpractice insurance premiums have gone up. I know that this causes problems for doctors. What hasn’t been proven is that an increase in malpractice awards is responsible for the rise in premiums, mainly because there hasn’t been an increase in malpractice awards. Why are the premiums going up? I don’t know. If you were part of an oligarchy and could raise rates whenever you wanted and get away with it, wouldn’t you? Is it even conceivable that… Read more »

Eric Novack
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spike- I will respond to your comments, but first: >why is our government so insistent on taking the decision out of their [people’s] hands?< I can safely presume that you are not in favor of single payer healthcare, where government agencies decide what is in your best interests for healthcare… The data that there is a "crisis" in medical liability (remember that malpractice implies wrongdoing- something that the current system has only a passing interest in) comes in many forms. However, I continue to ask you to answer the questions (and statements) from above- they are directly related to medical… Read more »

hsfrey
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>doctors and systems would have to commit to practicing evidence based medicine.<
What makes you think that would be cheaper? Most of the cheap "alternative medicine" payers are pushing and patients are demanding, have zip evidence supporting them, and certainly none of the randomized placebo-controlled double-blind studies the payers demand for anything expensive.
And, how would such a "commitment" be enforced? Once you've determined how to enforce "commitment", why not just have doctors "commit" to practicing "good" medicine, and then the malpractice problem will disappear. Right?
Harvey

spike
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spike

haha, whoops, that first line should read “Actually, *not* everybody….”

spike
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spike

Actually, everybody can produce data to support their view. My point was that PIAA, the lobbying organization you linked to in support of your argument, couldn’t. Their data didn’t make a case at all. And now you’re talking about the justice of the tort system as a whole, instead of just the malpractice industry. I don’t feel like engaging in that one. I don’t think it’s perfect, but I think it’s important. I also think that caps on jury awards are stupid, just like mandatory sentencing for drug crimes are stupid. We have all these bright people in our country,… Read more »

Eric Novack
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Spike- let’s move past the fact that both sides can produce data to support a point of view. Let’s return to some of my basic points above: if medical liability underwriting is such a cash cow for insurers, why are there so few in so many states? Also- my liability premiums would come back to me if there were “profits”– just like they would to any policy-holder in a mutual insurance company. But, let’s move away from caps for the moment– where is the justice in a system (present in most states) that if you are found 1% responsible, you… Read more »

spike
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spike

The PIAA website has some pretty laughable data in their rebuttal. Their main claim is that the number of $1 million and above payments doubled from 1997 to 2001. $1 million is a completely arbitrary number that has no relationship to anything, it just happened to be a benchmark that was surpassed during those 4 years. If there were 10 payments of $990,000 and 1 of $1,000,000 in 1997, and 9 payments of $990,000 and 2 of $1,000,000 in 2001, that is almost no difference. These guys are trying to say it’s a huge effect. Second, they make a big… Read more »

Eric Novack
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No other indutrialized nation allows for the out of control jury awards– not based on any evidence in many cases– like the US. The most recent study that was published –http://www.centerjd.org/– from the center for justice and democracy, and quoted widely in the media– was written by an organization dedicated to fighting tort reform. It is extremely flawed. I refer you to http://www.thepiaa.org/ to see the flaws. While it is true that investment losses have an impact on insurance costs– why have we not seen similar cost increases in home, auto, and life insurance? Also- many of the largest medical… Read more »

Matthew Holt
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Eric, you seem to have missed the article in last months Health Affairs which showed that malpractice payouts were equally substantial in some of those socialist Utopias/slave states you fear so much. The URL is http://content.healthaffairs.org/cgi/content/full/24/4/903 I am in favor of scrapping the current malpractice system, and mving to no-fault system in which doctors and systems would have to commit to practicing evidence based medicine. But I have not seen any concessions from the AMA other than to ask for caps on damages. Oh, and we already have caps on damages out here in California, and I haven’t noticed my… Read more »

spike
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spike

But don’t insult our intelligence by linking the rate increases in malpractice insurance with increases in malpractice payouts. The number of cases and $ amount of payouts has remained constant for the past decade. There’s plenty of evidence which shows that the reason insurance premiums are going up is because the malpractice insurance industry lost money on investments during the past several years and had to raise rates to cover their losses. Everybody agrees on the problems caused by high malpractice insurance costs, but the source of those high costs are where we disagree. The facts show that tort reform… Read more »

Eric Novack
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Please do not confuse your readers by using the “0.5%” number. Those costs are borne by the physicians (and institutions) who actually provide care. The chilling effect that medical liability costs and fears have had on ACCESS to care is very significant. Emergency rooms do not have specialty coverage, whole counties in Arizona do not have a single OB/GYN, patients have been transferred from Tuscon to Phoenix because no one is on call to take care of hand emergencies, people who have had previous back and joint operations cannot find anyone who will even give them an appointment– all in… Read more »