tag:blogger.com,1999:blog-4425587034622601550.post7846725504975497668..comments2023-09-15T04:27:57.129-04:00Comments on Commentarama: RTRP: Health Care Reform, Tort ReformAndrewPricehttp://www.blogger.com/profile/11312364467936820986noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-4425587034622601550.post-4527748784802071872009-07-17T12:10:46.520-04:002009-07-17T12:10:46.520-04:00CrisD, I think the whole Obamacare is a fraud. Hi...CrisD, I think the whole Obamacare is a fraud. His rhetoric isn't even close to what the bills provide.<br /><br />I think they are listening, which is why they're so skittish about the whole thing, and why the Senate and House bills are so completely incompatible ($600 billion v. $1.5 trillion).<br /><br />I think what they are trying now is to just pass anything, so that they can get it into a joint committee where they can meld it all into one bill and then present it for a straight up and down vote.<br /><br />That's sneaky and I doubt it will work.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-48293990659558268282009-07-17T08:50:17.331-04:002009-07-17T08:50:17.331-04:00Another great post.
Come from lots of doctors and...Another great post.<br /><br />Come from lots of doctors and lawyers in families who complain that both professions are in ruins. Am comfortable with getting things "right."<br /><br />On a side note--I have been listening to a little more radio and TV lately and it is difficult to tell whether the government is listening to the large negative reaction to Obamacare that I hear.<br />President is claiming he will get HIS reforms and news says that people KNOW we are broke and can not afford boondoggle.<br /><br />What say you?<br />(Friday July 17)CrisDnoreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-35670554080635030152009-07-16T18:13:43.620-04:002009-07-16T18:13:43.620-04:00CrispyRice,
Excellent . . . you get another invis...CrispyRice,<br /><br />Excellent . . . you get another invisible t-shirt for that! :-)<br /><br />I like the idea that this is a cliff hanger, LOL!AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-85432366383277870652009-07-16T17:56:59.399-04:002009-07-16T17:56:59.399-04:00Very interesting, Andrew!
I look forward to readi...Very interesting, Andrew!<br /><br />I look forward to reading the rest. In fact, I feel a bit like I'm watching a tv show that just left me with a cliff hanger. Argh.<br /><br />And actually, I've already forwarded the link to this to both my senators and congressman when I e-mailed them to tell them NO on ObamaCare.<br /><br />"CommentaramaCare" - I dig it.CrispyRicehttps://www.blogger.com/profile/07302075204880024936noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-62542334967398837682009-07-16T17:36:20.227-04:002009-07-16T17:36:20.227-04:00Ben,
Glad you like it so far. I'll be intere...Ben,<br /><br />Glad you like it so far. I'll be interested to hear your thoughts as we go forward (did you see the Obamacare report card I did a few days ago?)<br /><br />I would definitely include mental health, because we need to address all aspects of the health care system.<br /><br />Without getting too far ahead, I am looking to replace state licensing boards with a Federal licensing board -- for a variety of reasons.<br /><br />That same "agency" would also be charged with determining if standards of care exist and to outline those standards where they are found.<br /><br />If no single standard can be found in a particular area, then no standard would be issued. Something like a best practices guide could be issued, but no standard.<br /><br />Thus, the Board should not be able to impose one theory of medicine over another.<br /><br />Moreover, these standards are meant only to outline some minimum levels of treatment, they are not meant to define every aspect of treatment.<br /><br />Thus, just because a standard exists, does not mean that is all the doctor is allowed to do. For example, if the standard requires giving aspirin, the doctor could also choose to give some other additional treatment.<br /><br />In an area like mental health, I suspect that few standards will be found, though I think that there probably could be room for standards with regard to medications provided, minimum testing requiring, etc.<br /><br />BUT, keep in mind, this will be determined by medical experts, not me and not politicians.<br /><br />Right now, doctors basically create the standards by teaching them in school and then arguing about them in court. What I'm proposing here is that for areas where it is fairly clear, that process be handed over to a panel of experts to determine in advance, rather than as a response to jury verdicts.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-30730843736553320512009-07-16T16:37:43.949-04:002009-07-16T16:37:43.949-04:00Thanks, Andrew for clarifying.
I was sure you mea...Thanks, Andrew for clarifying. <br />I was sure you meant that, but I just wanted to throw out a few examples of how even a group of doctors could possibly throw wrenches in the works without realizing it. <br />I'm glad you'll be getting into more detail.<br /><br />Speaking of which, will the plan you're proposing (which is great, thus far) also touch on psychiatric health?<br /><br />If so, that would be far more complicated irt standards than regular medical care since there is many schisms in the mental health community, or perhaps I should say schools of thought, and differing philosophies and theories of the best courses of treatment (Freud, Jung, crackpots, etc.).<br /><br />In any event, should I ever require mental health services, I would do everything I can to find a conservative/classical liberal psychiatrist, because leftism is a pathology in and of itself, and I wouldn't want a leftist psychiatrist/psychologist that enables a victim attitude, which is counter to good mental health.<br />Or that doesn't value liberty.<br />Just sayin'. But that's a can of worms you probably don't wanna open yet, lol.USS Ben USN (Ret)https://www.blogger.com/profile/07492369604790651538noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-4877102259248665392009-07-16T10:44:50.215-04:002009-07-16T10:44:50.215-04:00Ben,
Standards are coming up next. One of the pr...Ben,<br /><br />Standards are coming up next. One of the problems with patient care is the lack of clear standards for many common ailments, AND a lack of knowledge about those standards.<br /><br />Right now "standards" really are "sort of" taught in med school, but are ultimately set in the court room after the fact by juries. That needs to change.<br /><br />Also, I wouldn't be worried about Congress because we're talking about the technical aspects of doctoring, but let's leave that until the next post.<br /><br />The existence of standards should not prevent any type of treatment. What it should do is to guanarantee that doctors don't ignore basic treatment methods that have been proven to have positive benefits. In other words, if BP pills are called for, it should be in the standard so that all doctors know to give BP -- that was one of the problems found in some of the studies, that doctors often didn't know what they should have done.<br /><br />Moreover, standards should provide some degree of safety to doctors. For example, if a standard calls for having an MRI done, a patient could not sue the doctor for failing to order a half dozen other tests that also could possibly, maybe, might-have found the problem.<br /><br />But none of that should keep the doctor from going beyond or doing experimental treatments.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-55324789717263691232009-07-16T06:27:31.203-04:002009-07-16T06:27:31.203-04:00I would also add that, obviously, many standards a...I would also add that, obviously, many standards are cut n' dry, such as what docs do during a code blue. <br /><br />I'm talking mainly about afflictions that may have several treatment options, including experimental if it comes to that, and weighing the side effects of those treatments, which can be worse than the malady itself sometimes.<br /><br />Also, if your doc knows what to do in any given situation, why should he have to refer you to another doc if it will benefit the patient more when time is of the essence?<br /><br />I'm sure there are more examples, but this kinda stuff will need to be hashed out. <br />Of course, docs should always communicate with their patients to the fullest extent possible, and patients need to know that they have responsibilities as well. Doctors aren't mind readers, and neither are nurses. <br />Patients should inform themselves as much as they are able. It can literally save your life.USS Ben USN (Ret)https://www.blogger.com/profile/07492369604790651538noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-7502137691429982612009-07-16T06:06:26.606-04:002009-07-16T06:06:26.606-04:00Hi Andrew,
Excellent post! The hardest part, if t...Hi Andrew,<br /><br />Excellent post! The hardest part, if this plan were to be initiated would be keeping the feds out of deiding what "standard" care should be and keeping it in the hands of doctors.<br /><br />No doubt the powers that be will want to control it like they control Medicare, which is an unmitigated disaster and is fast approaching insolvency.<br /><br />Leave it to the Democrats to wanna start another massive healthcare plan when they can't afford the one they have, which is run poorly and inefficiently at best.<br /><br />At any rate, when we speak of establishing standards, which is necessary, there must be some built in flexibility, I think. <br /><br />For example, a doc shouldn't be penalized if he/she has a hunch and does do more tests than may be necessary under most conditions, say in order to rule out various factors to make the best diagnosis they can based on the symptoms.<br />Unless the doc always has "hunches." <br /><br />But for the most part, I wouldn't wanna cause over-regulation in the guise of too stringent standards, because even if doctors are making the decisions about the standards of care, they don't personally know the patients, or perhaps they aren't always up on the latest trials or research. <br /><br />My doc knows me well, and knows all about my health (or lack of, at times) since he's been treating me for nearly twenty years. And he's among the best. When he has gotten hunches they almost always were proven correct, bypassing a lot of red tape the VA is usually known for and getting me the critical treatment I needed more efficiently.<br /><br />IOW's, I would hope that any standards agreed upon would take into account RESULTS. <br /><br />Certainly, I think doctors who bilk patients should be taken to task, or docs who are negligent or grossly negligent should be held accountable, but something should be said for docs who consistently make the right calls but don't always follow all the rules (or, more precisely, red tape) to get there. <br /><br />Kinda like good teachers who don't need the approved text books to teach the kids what they need to know.<br />However, I'm not sayin' docs shouldn't have to explain themselves should there be any significant problems.<br /><br />Very thought-provoking post! :^)USS Ben USN (Ret)https://www.blogger.com/profile/07492369604790651538noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-43753983405532996462009-07-15T19:35:49.178-04:002009-07-15T19:35:49.178-04:00Universal balance. . . the next democratic entitle...Universal balance. . . the next democratic entitlement?<br /><br />Party on Wayne.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-20886806860166092852009-07-15T17:38:18.749-04:002009-07-15T17:38:18.749-04:00genius.
your well thought out posts next to my ...genius. <br /><br />your well thought out posts next to my nanny-nanny boo-boo entries, balance the universe.<br /><br />party on garth.pattihttp://www.notawonk.comnoreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-27257668535110967462009-07-15T14:51:56.875-04:002009-07-15T14:51:56.875-04:00It’s far to sensible for our show pony Washington ...It’s far to sensible for our show pony Washington politicians to embrace. Another great article from Commentarama.StanHhttps://www.blogger.com/profile/07395708786509590321noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-31591565837359268632009-07-15T14:06:15.303-04:002009-07-15T14:06:15.303-04:00Lawhawk, I think that these changes would go a lon...Lawhawk, I think that these changes would go a long way toward freeing the medical profession from the threat of legal interference, while simultaneously allowing patients to receive compensation for injuries.<br /><br /><br />Stan, let me add. Right now, there is no one in DC who would trumpet this plan because they're all stuck in the same old debate. But that can change. At some point, the Republicans will need to finally come up with a real plan. This one should appeal to them. I think moderate Democrats also would be interested in this plan. So, when we're done, if you like the plan, call your reps and tell them to take a look.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-54275400464176595912009-07-15T13:51:52.998-04:002009-07-15T13:51:52.998-04:00Andrew: Like all human endeavors, this part of yo...Andrew: Like all human endeavors, this part of your plan has some nuts and bolts which may need tweaking. But so far, this is quantum leaps better than anything I've seen coming out of either party. As you know, I have a visceral dislike for the personal injury legal industry because of what it has done to the quality of lawyers and the transformation of the law into a money machine instead of a field where justice is done. For those reasons, my favorite changes are in capping damages (in a manner somewhat like yours), eliminating punitive damages entirely and reinstating the much older and more reasonable concept of "exemplary" damages, with a "sliding scale" of lawyer's fees in contingency medical malpractice cases to eliminate the incentive to file frivolous lawsuits on behalf of young people while ignoring the needs of older people. Again, these are only matters of nuts and bolts, not philosophy.<br /><br />That said, it was a wise decision for you to address medical malpractice suits in the early going. They are a serious problem, but they are part of the picture largely because of their frequent notoriety. In terms of dollars wasted and rises in health care costs, they are ripples on the pond compared to the other factors which must be corrected. Keep up the good work, and we may get a plan yet--and then we can storm the halls of Congress.LawHawkRFDhttps://www.blogger.com/profile/17800255923675295515noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-2264297334844210922009-07-15T12:47:57.094-04:002009-07-15T12:47:57.094-04:00Stan, It's hard to know the specifics of any o...Stan, It's hard to know the specifics of any one case, but it is true that malpractice insurance is by far the highest for neurosurgeons and OB/GYNs.<br /><br />To give you a sense of how these reforms will help.<br /><br />(1) The Medical Board will set up a clear standard of care -- this will bot improve quality and give the doctos a legal "safe harbor" -- do this an you'll be ok;<br /><br />(2) The certificate of merit means you need to find another neurosurgeon/ OB/GYN who will certify under oath that the doctor violated the standard of care before you can even sue;<br /><br />(3) The cap means that the damages will be limited to economic harm plus $1m, which reduces the ability of guys like Edwards to make money by appealing to the jury's emotions; and<br /><br />(4) OB/GYNs likely will end up back under the hospital system, which means increased supervision (which will improve quality and it makes it harder to sue because it's hard to prove to juries that multiple doctor's screwed up).AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-35031348866045808492009-07-15T12:02:34.111-04:002009-07-15T12:02:34.111-04:00I know this is an anecdote but is relevant to your...I know this is an anecdote but is relevant to your discussion.<br /><br />"The John Edwards we know crushed [obstetrics, gynecology] and neurosurgery in North Carolina," said Dr. Craig VanDerVeer, a Charlotte neurosurgeon. "As a result, thousands of patients lost their health care."<br /><br />One of my best friends is an attorney, and recently he had some electrical work done at his home. It turns out that the guy was a MD, an OB/GYN to be specific and has quit being a doctor to become and electrician, “because of malpractice insurance ran at $10,000.00 per month,” maybe he was a bad doctor? This was directly related to the Breck girl …John Edwards. Another good article with good suggestions, I hope it’s not all mute?StanHhttps://www.blogger.com/profile/07395708786509590321noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-11273603544335272382009-07-15T10:37:03.135-04:002009-07-15T10:37:03.135-04:00Writer X, You won't be able to sue the Feds (i...Writer X, You won't be able to sue the Feds (immunity) and you can't sue a doctor for not seeing you, unless they were running an ER and turned you away.<br /><br />The caps have actually been a problem where they have been set too low. What I said about old people and poor people is happening. In one state, where the caps went to $250k, I have spoken with several attorneys who will no longer take cases without significant economic loss, and they won't touch cases involving old people, no matter how egregious. The reward just isn't worth the risk. The caps have become like a license to mistreat old people.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-62705684462392420332009-07-15T10:19:02.167-04:002009-07-15T10:19:02.167-04:00Thanks, Andrew. I wasn't aware that most state...Thanks, Andrew. I wasn't aware that most states had caps, probably because I haven't been sued/had to sue lately. And hope I never do. <br /><br />If Obamacare passes (I shudder at the thought), I wonder how much the lawsuits increase--e.g. if someone has to wait 3 years for surgery, and then dies while waiting, wouldn't his family have the right to sue, in this case, the doctor AND the federal government? What a nightmare.Writer Xhttps://www.blogger.com/profile/16505411188186283813noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-52335124487792734242009-07-15T10:09:36.016-04:002009-07-15T10:09:36.016-04:00Writer X, Thanks! Good questions.
There are two t...Writer X, Thanks! Good questions.<br /><br />There are two things to keep in mind about federalizing this issue. First, by and large, that will vastly reduce the amount of regulation, not increase it. Everything that the Feds would do is currently being done 50 times over.<br /><br />Secondly, most of the regulation will be done at the agency level -- not the Congress. And as you will see in the next article, that agency should be staffed by medical experts -- not lawyers/Congressmen.<br /><br />What are the chances of getting the caps? I'd say that's probably the easiest thing to get out of the Congress. Most states now have caps, and it would probably be more controversial to eliminate them than keep them.<br /><br />The biggest problem with getting reform is that everyone in Washington benefits from the current system -- the lawyers, the doctors, the insurance industry, and the hospitals. So they all make big noises about reform, but then simply end up proposing minor tweaks.<br /><br />In terms of finding doctors to testify against other doctors, it's true that few doctors will testify against other doctors. But where there really was malpractice, I've found that you can usually find doctors who will testify for plaintiffs. It's the close cases where it gets really difficult to find someone, but that's not a bad thing.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-68322224153948553892009-07-15T09:53:33.583-04:002009-07-15T09:53:33.583-04:00Writer X: Ha! Good to know that we both believe pe...Writer X: Ha! Good to know that we both believe people are capitalist in nature and always looking to create a money making opportunity.<br /><br />ISadly, I could definitely see Congress trying to regulate the amount an "expert doctor" is allowed to take though.freedom21https://www.blogger.com/profile/02826191666894010323noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-36873801984695330382009-07-15T09:45:04.680-04:002009-07-15T09:45:04.680-04:00Andrew,
My question was similar to Freedom21'...Andrew,<br /><br />My question was similar to Freedom21's: How easy would it be for a plaintiff to obtain a certificate from another doctor that basically disses another doctor's medical care? Wouldn't that then create a whole industry of paid "medical experts" like we have today? <br /><br />I think you're right about federalizing the regulation, although that still gives me pause too (I have an ugly picture of Barney Frank and Chris Dodd overseeing yet another worthless committee), even though the different state regulations have become cumbersome and complicated. <br /><br />Last, since most of the politicians in Washington are lawyers and the lawyers have powerful lobbyist groups, how optimistic are you that we would one day see $$ caps?<br /><br />I wish we could see such thoughtful solutions from our politicians as you've outlined here. All we hear about are people who attend fancy summits but then leave with nothing to show for it.<br /><br />Thanks!Writer Xhttps://www.blogger.com/profile/16505411188186283813noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-16253476685144420392009-07-15T09:34:34.929-04:002009-07-15T09:34:34.929-04:00Freedom21, I saw that story. I will update my re...Freedom21, I saw that story. I will update my review of Obamacare when it becomes clear exactly what they are talking about.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-6851567201762986842009-07-15T09:30:31.061-04:002009-07-15T09:30:31.061-04:00Freedom21, I've practiced in a jurisdiction th...Freedom21, I've practiced in a jurisdiction that added the certificate of merit requirement and I've seen it work extremely well.<br /><br />They were intended to stop attorneys from filing meritless med-mal suits in the hopes of getting a quick settlement. And they've done that.<br /><br />But they aren't really a problem for legitimate cases.<br /><br />If you have a legitimate medmal case, you need to consult a medical expert anyway before you file your case (at least if you're a competent attorney). Basically, a good attorney finds an expert, has the records reviewed, and learns what went wrong before they ever file suit.<br /><br />If you've done that, then the certificate isn't a problem because you just get your expert to write their opinion before you sue rather than preparing the report after you sue. The cost is the same, the level of effort is the same.<br /><br />What's different is that the attorneys who file suits without worrying about the merits of the suit, but hoping to scare or annoy the doctor into a settlement can't do that anymore. Those are the guys who are the problem.<br /><br />As for costs, medical experts are super expensive already. But I haven't seen any increase in costs. I have seen, however, that the experts are much more concerned about being able to back up their opinions once they learn about the certificate requirement.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-21901236113542082502009-07-15T09:29:50.679-04:002009-07-15T09:29:50.679-04:00Wow. I'm sure you all saw this on Drudge, but ...Wow. I'm sure you all saw this on Drudge, but this is NUTS. T<br /><br />http://gopleader.gov/UploadedFiles/House-Democrats-Health-Plan.pdffreedom21https://www.blogger.com/profile/02826191666894010323noreply@blogger.comtag:blogger.com,1999:blog-4425587034622601550.post-65612400658137627512009-07-15T09:12:46.230-04:002009-07-15T09:12:46.230-04:00Jed, I'm glad you like it. I think these chan...Jed, I'm glad you like it. I think these changes would help. I think they would help with predictability, but would still allow injured people to get fair compensation. But most importantly, I think these changes would reduce the sense that doctors are more worried about getting sued than treating their patients.<br /><br />Unfortunately, these are the types of changes that neither party in Washington is willing to puruse for various reasons.AndrewPricehttps://www.blogger.com/profile/11312364467936820986noreply@blogger.com