tag:blogger.com,1999:blog-7323692122514281455.post3974915865838418747..comments2024-03-18T17:51:23.018-04:00Comments on MD Whistleblower: Health Care Reform: Who Won and Who Won More?Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger45125tag:blogger.com,1999:blog-7323692122514281455.post-80075533416129870062010-04-28T14:42:07.062-04:002010-04-28T14:42:07.062-04:00I like it. Succint, yet saying nothing. Good pos...I like it. Succint, yet saying nothing. Good post Anon 2:44.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-42623767901463625542010-04-27T14:44:18.738-04:002010-04-27T14:44:18.738-04:00Anonymous, get in touch with reality...Anonymous, get in touch with reality...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-91665857924855798672010-04-06T21:27:56.589-04:002010-04-06T21:27:56.589-04:00Your link is just an opinion piece. Not a fact.
...Your link is just an opinion piece. Not a fact.<br /><br />" I can guarantee you the objective is a settlement. Yes, insurance companies do not automatically pay a claim; however, they analyze the costs of litigating vs the cost of settling. They continuously do that - and the attorneys KNOW that. "<br /><br />In a car wreck case, you might have a point, although I'd love to know the names of these insurers who are settling cases for more than a couple thousand just because a lawyer files suit. But in most med mal cases the cost of trying the case is far less than the potential damages. <br /><br />"The fact is the merits of their case are only a probability calculation (for both sides) so settlement is the name of the game. You may not like it (I surely don't) but that is the reality."<br /><br />Settlement is a reality for the insurer based on the probabilities, true, but not for the plaintiff. But the probabilities for the insurer are far more complex than you'd think, and involve lots of factors beyond just cost of defense. For the plaintiff, a recovery is the goal - how the plaintiff gets to a number they'll accept is secondary.<br /><br />"As for drs refusing to take on new Medicare patients, the CMS (in 2008) reported 29% of patients had difficulties finding a doc who would accept Medicare. For Medicaid, the figure is much worse (around 50%)."<br /><br />That doesn't tell me how many docs dropped it though. That could simply mean there are more patients on medicare/medicaid. A number that will only increase as the baby boomers age. So unless the number of physicians increases, even if no physician left Medicaid/Medicare, then it would be more difficult to find a physician.<br /><br />At the end of the day, though, the government pays 50% of all healthcare expenditures. And the health insurers set their reimbursement rates based on government reimbursement. There's only so many who can leave and still stay afloat.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-90876339570518361252010-04-06T15:07:32.805-04:002010-04-06T15:07:32.805-04:00Anon (why can't you use a screen name?)
"...Anon (why can't you use a screen name?)<br /><br />" and the fact is the ER is becoming the gateway to hospital admissions more and more - and that is litigation based."<br /><br />Because. . . you say so?<br /><br /><br />No... bcs a knowledge doc at U of Chicago has looked into this and said so (see "http://glasshospital.com/2010/01/07/the-mystic-portal-awaits/).<br /><br /><br />Clearly a statement by someone who has never filed a lawsuit. Insurers, particularly med mal insurers, don't pay just because they receive a claim.<br /><br />Wrong again. I've been involved in more depositons than most non-litigating attorneys. I can guarantee you the objective is a settlement. Yes, insurance companies do not automatically pay a claim; however, they analyze the costs of litigating vs the cost of settling. They continuously do that - and the attorneys KNOW that. The fact is the merits of their case are only a probability calculation (for both sides) so settlement is the name of the game. You may not like it (I surely don't) but that is the reality.<br /><br />As for drs refusing to take on new Medicare patients, the CMS (in 2008) reported 29% of patients had difficulties finding a doc who would accept Medicare. For Medicaid, the figure is much worse (around 50%).<br /><br />Sorry if the facts get in the way.Evinxnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-28554537199191916362010-04-05T22:29:50.235-04:002010-04-05T22:29:50.235-04:00I have a hard time believing that 30% of physician...I have a hard time believing that 30% of physicians can stop adding Medicare patients. This talk of physicians leaving the government en masse makes little sense, when you consider the govt. pays 50% of all healthcare expenditures. Where will they all go?<br /><br />And correct me if I'm wrong, but don't the insurers base their reimbursements on Medicare reimbursement rates? So they're going to cut back too.<br /><br />Basically, while physicians have spent the last 5 years fighting for tort reform to benefit their liability carriers, something that only slightly affects their bottom line, if at all, the real battle has been fought and lost on reimbursement rates.<br /><br />They can't all dump the government paymaster. The reality is being a physician is getting ready to become much less lucrative.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-46585000642113434682010-04-05T18:02:02.466-04:002010-04-05T18:02:02.466-04:00Thanks for the many excellent and provocative comm...Thanks for the many excellent and provocative comments. Two items I spied today.<br />(1) In Washington state, 30% of physicians intend to stop adding new Medicare patients to their practices because of inadequate reimbursement. Walgreens pharmacy will stop filling Medicaid prescriptions because they lose money on them. <br />(2) Alan Greenspan, who knows something about budget projections, stated that the Congressional Budget Office's estimate of deficit reduction from HCR is too optimistic.<br /><br />Nothing shocking here, just some coming attractions.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-73858613167006115382010-04-05T14:03:26.411-04:002010-04-05T14:03:26.411-04:00"I am not a fan of caps on damages - though, ..."I am not a fan of caps on damages - though, I certainly have reservations about punitive damages (and that is where the beef is)."<br /><br />Not really. Punitives are rarely a factor in medical malpractice actions, unless the physician is drunk, or a hospital has knowingly (or recklessly) employed someone with a history that should have thrown up warning flags. When you say "I'm for tort reform", you're talking noneconomic caps. Plain and simple. You may also be talking caps on what one side can pay its lawyer, periodic payments, and the like as well.<br /><br />"The real benefit to tort reform (and I acknowledge this may not be what most are talking about) is it can change the way medicine is being practiced for the better."<br /><br />And yet, it hasn't. After 30 years of it. Nothing has changed, despite umpteen promises of benefits that never materialize.<br /><br />"Nothing stops lawsuits bcs the objective in the majority of case is a settlement - not a court fight."<br /><br />Clearly a statement by someone who has never filed a lawsuit. Insurers, particularly med mal insurers, don't pay just because they receive a claim. <br /><br />Lawsuits are a dispute resolution system, and we will always have one, no matter whether it's called a "lawsuit", or "flowers and candy". Physicians don't like being involved in them any more than anyone else, but we will have a system for gathering information, and presenting it to a third party to make a decision.<br /><br />And physicians are going to bitch about it regardless.<br /><br />" and the fact is the ER is becoming the gateway to hospital admissions more and more - and that is litigation based."<br /><br />Because. . . you say so?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-42860781498220731322010-04-05T12:20:39.567-04:002010-04-05T12:20:39.567-04:00"The real issue in US medical costs are the t..."The real issue in US medical costs are the toxic incomes of doctors"<br /><br />To me that is scary. Are we ever going to stop this jealousy based warfare? What is next - toxic incomes of prof athletes, movie stars, real estate moguls, lawyers? Price controls do not work - someone needs to read some economics.<br /><br />I am not a fan of caps on damages - though, I certainly have reservations about punitive damages (and that is where the beef is).<br /><br />The real benefit to tort reform (and I acknowledge this may not be what most are talking about) is it can change the way medicine is being practiced for the better. <br /><br />For those who say Drs are safe from lawsuits if they practice according to guidelines, not so. Tobacco companies get sued every day, even though there isn't a person on the planet who does not know smoking is bad for you. Nothing stops lawsuits bcs the objective in the majority of case is a settlement - not a court fight.<br /><br />BTW, some may not want to believe it, but the uninsured are not the overall problem with crowded ERs, and the fact is the ER is becoming the gateway to hospital admissions more and more - and that is litigation based.<br /><br />Dr K - when you wrote this post, did you think it was going to generate this many comments? You hit a nerve.Evinxnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-48473463413640172712010-04-04T12:26:56.703-04:002010-04-04T12:26:56.703-04:00@anonymous 12:19PM
Baloney.@anonymous 12:19PM<br />Baloney.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-59934129472843053292010-04-04T12:19:21.630-04:002010-04-04T12:19:21.630-04:00The real issue in US medical costs are the toxic i...The real issue in US medical costs are the toxic incomes of doctors. The doctors keep the number of graduates down to keep their disgusting incomes high. Its interesting how 'conservatives' go on about labor unions, yet allow the doctors to run the most outrageous closed shop known to man. <br /><br />Time to stop doctor control over doctor numbers - now!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-39252974062414766492010-04-01T21:52:23.912-04:002010-04-01T21:52:23.912-04:00"That may be what I have been digging for, th..."That may be what I have been digging for, the problem of frivolous suits... throw a bunch of shit out and see if anything sticks. I can see how that is a problem and an expensive one at that for all concerned."<br /><br />I can see this in a car wreck situation, where the cases are rather cheap to try. But this makes little sense in the medical malpractice arena, when the cases are prohibitively expensive, the insurers rarely offer the cost of defense, and physicians win so often at trial. From the economic perspective of a lawyer, filing a bunch of truly unmeritorious med mal cases doesn't make sense. Does it happen occasionally? Sure. Just like physicians operating drunk happens occasionally. But I don't think we need to restrict the rights of all physicians because a tiny minority are idiots.<br /><br />"His solution to the tort issue is simple, he says "loser pays" would put a stop to it. He claims that if the losing side of a suit is obliged to pay all costs of the suit it would put an end to frivolous lawsuits."<br /><br />A simple solution which is unlikely to work. First, poor people aren't going to be able to pay that cost regardless. At best, you've scared some of them from pursuing close claims. Should our legal system only be utilized for slam dunks? And what if we have a situation with contributory negligence - for example, while I'm drunk and driving but in my lane, you cross over and hit me. I might have had a chance to avoid you had I been sober, so maybe I'm 15% at fault. Who pays? The experience of those countries with loser pays is not as cut and dried as many proponents think. <br /><br />But really, loser pays is yet another way for the wealthy to prevail regardless of the merits. If you believe that Wal-Mart truck crossed the line and struck you, you still have to consider the fact that they can throw teams of lawyers at the case. What if the jury disagrees with you? Should you not have the ability to put your case before the jury simply because of your financial circumstance?<br /><br />"I'm looking for more than "Hmmm...?" and a few platitude"<br /><br />If you're talking to me, I wasn't replying to you. Perhaps if you ask a specific question though, I can give you a more detailed response. As to the Constitution reference, check out the 7th Amendment.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-5626235506271608082010-04-01T21:45:10.191-04:002010-04-01T21:45:10.191-04:00"No one aims to abrogate a deserving individu..."No one aims to abrogate a deserving individual's right to seek and receive legal redress"<br /><br />Sure you do. That's the very point of "tort reform". If you support it, that's your goal.<br /><br />" Society also has rights."<br /><br />You really want to go down that road, doc? What rights does the Constitution give "society"? Does "society" have a right to low cost healthcare?<br /><br />" If money is squandered on lawsuits that should not be filed, then society has lost resources that could have been used to serve the greater good."<br /><br />Are you really sure you want this to be your position? Think hard about this being reversed on you - I mean, what's to stop "society" from deciding that paying physicians almost twice their brethren in other countries isn't serving "the greater good". How about we stick with individual rights?<br /><br />"Had the plaintiff's lawyer read the record, I would not have become a defendant. Nearly $10,000 was incinerated that could have been used for a more noble purpose."<br /><br />Such as? Paying the shareholders of your insurer? Paying the executives additional bonuses? Is that the "noble purpose" you have in mind? Because that's what would have happened with it. You should really avoid this "societal good" argument. It does not behoove you when applied to your own profession.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-13359464583134328262010-04-01T21:43:15.517-04:002010-04-01T21:43:15.517-04:00Dr. Kirsch!
Again we post simultaneously. What are...Dr. Kirsch!<br />Again we post simultaneously. What are the odds?<br />Again, that last post was for anon at 8:32PM.<br /><br />I recall reading your other post in December. I said to myself, "Here's a doctor with balls."<br />I would add "Congratulations" but it seems you and the lawyers have a handle on frivolous suits. <br />That may be what I have been digging for, the problem of frivolous suits... throw a bunch of shit out and see if anything sticks. I can see how that is a problem and an expensive one at that for all concerned. Finding a way to stop that practice would help a lot. <br />Your point about wasted money is well-taken. <br /><br />Atlanta's Neal Boortz is a talk show host who grates on my nerves, but he was a practicing lawyer in his early years. His solution to the tort issue is simple, he says "loser pays" would put a stop to it. He claims that if the losing side of a suit is obliged to pay all costs of the suit it would put an end to frivolous lawsuits.<br /><br />I dunno. Maybe so, but it sounds too much like the Citizens United decision which gives the advantage to the side with the biggest legal team, but I'm not informed enough to say anything intelligent about it. <br /><br />Meantime, I very much like the Anesthesiologists' approach and hope it will become a model for other groups. <br /><br />==> Here's an idea: It seems to me that any physician or practice that strictly follows the forthcoming IBAP recommendations is standing on firm new grounds for defense should the results need a legal defense.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-91774803059219597422010-04-01T21:20:39.828-04:002010-04-01T21:20:39.828-04:00That's pretty incoherent.
I'm looking for...That's pretty incoherent. <br />I'm looking for more than "Hmmm...?" and a few platitudes. <br />Anyone else?Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-19521234237512785662010-04-01T21:18:13.859-04:002010-04-01T21:18:13.859-04:00No one aims to abrogate a deserving individual'...No one aims to abrogate a deserving individual's right to seek and receive legal redress. There are, however, other rights in conflict. Innocent citizens have a right to be victimized routinely. Society also has rights. If money is squandered on lawsuits that should not be filed, then society has lost resources that could have been used to serve the greater good. I received a letter just today from my medical malpractice carrier that the frivolous suit that I was dismissed from (See blog post http://bit.ly/7FxWX9) cost $9,120.85. As detailed in my post, even my lawyer who reviewed the medical record couldn't divine an allegation against me. Had the plaintiff's lawyer read the record, I would not have become a defendant. Nearly $10,000 was incinerated that could have been used for a more noble purpose.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-8074731436625601302010-04-01T20:32:27.738-04:002010-04-01T20:32:27.738-04:00"Malpractice insurance and lawsuits are not a..."Malpractice insurance and lawsuits are not a trivial problem. Why else would the president have tossed that up during his SOTU speech? It's a political tragedy that the wall of opposition is so obdurate."<br /><br />This paragraph is odd. They're not a "trivial problem"? By what metric? Is car insurance not a "trivial problem"?<br /><br />Why would the President mention them? For political purposes. He knows that the corporate paymasters of the Republican Party, and to the extent his own party, desperately want to limit access to the courthouse. Throw them a bone. Just because a politician says something doesn't mean it's particularly important.<br /><br />As to being obdurate in support of our Constitution, it's a shame more people aren't just as stubborn in preserving individual rights. We give them away at an alarming rate.<br /><br />"And yes, litigation affects insurance premiums which affects overhead (even if you never have been sued) which affect the entire medical experience."<br /><br />So because your overhead goes up or down this affects the entire medical experience? What happens when you have to pay your nurses a little more? Does the "experience" decline?<br /><br />"Yes, tort reform is needed for a whole host of reasons - but politics prevents it. Might it have to do with the trial lawyers lobby?"<br /><br />What reasons? Might it also have to do with the Constitution? Hmmmm. . .? Might it also have to do with preserving the rights of the individual? Hmmmmm. . . ?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-16724587124557861322010-04-01T19:43:56.247-04:002010-04-01T19:43:56.247-04:00You should have put off your blog post a few days....You should have put off your blog post a few days. Today would have been perfect for an explanation about how everyone wins and no one loses under the Patient Protection and Affordable Care Act. Come to think of it, April 1 would also have been the perfect day for President Obama to sign the act that bears such a name.Michael Endershttps://www.blogger.com/profile/15894626514847673764noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-50192153947231243302010-04-01T17:39:57.071-04:002010-04-01T17:39:57.071-04:00The sole goal of tort reform is limiting the acces...The sole goal of tort reform is limiting the access of the individual to the courtroom. Period. The modern tort reform movement was begun by the tobacco industry and is largely funded by that industry and other industries who stand to benefit from restricting that access. Note that no one wants to make it harder for business to sue, even though most lawsuits are businesses suing businesses. And no reform proposal tries to restrict what the defense can pay their lawyer, just the plaintiff. Why do you think that is?<br /><br />Physicians have been pushing their brand of reform for a couple decades now. They promise all sorts of things from lower healthcare costs to more access. Yet it never comes true. <br /><br />The truth is most physicians have no idea how many suits there are but they're all convinced there are too many. They also claim to want less government in medicine except they want more govt in malpractice. It makes no sense. How can you decide there are too many and we need to change when you have no idea how many there are?<br /><br />At the end of the day physicians won't like any system that reviews their actions. They'll bitch no matter what. But we shouldn't discard the constitution and weaken individual rights just so some insurers have their exposure limited. Because that's all tort reform is about.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-64707350208059638212010-04-01T16:09:22.289-04:002010-04-01T16:09:22.289-04:00@ Evinx:
I'm curious. You bring up two good po...@ Evinx:<br />I'm curious. You bring up two good points, legal forms of other countries and out of court settlements. <br /><br />Please don't take me to have made up my mind. In the case of medical malpractice the arithmetic is easy to measure, but I have a feeling the measurements have only to do with actual judgments. I think "settlements" may well be outside those metrics. As far as I can tell "tort reform" is a code term for damage settlement caps. I note Dr. Kirsch used the term "made whole," which may have a different implication. <br /><br />What is the actual meaning of "tort" in the medical sense? <br />And what is perhaps a broader meaning to "reform" than damage caps?<br /><br />(I can dig into these questions for myself, but I want to better understand how they are viewed by those opposing the new law. Help me with that connection.) <br /><br />I take issue with this...<br /><i>the ER has become the gateway to hospital admissions bcs of the fear of litigation.</i><br /><br />I understand the argument but I submit that the ER is the gateway to hospital admissions more to uninsured people who have learned to use that portal in place of primary care. In metro Atlanta we have a situation where people actually call in advance to two or three hospitals before they come to see which has the smallest waiting line! What kind of "emergency" can that be? Everyone knows that ER's can't refuse treatment, so a large and growing population has learned to take advantage of that. <br /><br />You are right about the phone messages for established patients. In fact, living phone nurses are probably trained to give the same advice. And fear of litigation is very likely part, if not most of the reason. <br /><br />Some years ago my wife required back surgery. But before we got to that point it was necessary to go through at least four unrelated orthopedic practices on the way, all of which offered no help other than pain medicine and PT. <br /><br />At one practice the doctor looked straight at us and said "I can tell you this. I'm not going to operate on you. My partner and I have decided that the insurance for both of us is too expensive, so he is the one with the coverage. If you receive surgery HE will be the surgeon."<br />This happened over twenty years ago and I'm sure premiums have gone up considerably since then. <br /><br />Malpractice insurance and lawsuits are not a trivial problem. Why else would the president have tossed that up during his SOTU speech? It's a political tragedy that the wall of opposition is so obdurate. Barack Obama seems to be throwing himself on his sword every chance he gets. That SOTU reference and his most recent consideration of off-shore oil drilling are just two examples from a growing list. <br /><br />How will tort reform play into the new law? And what modifications, additions or deletions might correct the problem?Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-52359544979373896012010-04-01T14:44:40.746-04:002010-04-01T14:44:40.746-04:00Fascinating how those who compare our system to th...Fascinating how those who compare our system to those of some other country, never compare our legal/tort system to that same country.<br /><br />Tort reform (not just caps) will have a profound effect on medical practice. Face it - the ER has become the gateway to hospital admissions bcs of the fear of litigation (due to exams/test results being performed elsewhere).<br /><br />Fear of litigation (not so much the trial but the tremendous amount of time + money involved for a system that tugs at heart strings not science)determines how patients are told to go to an ER if they should arrive with a medical issue like bleeding from the ear or eyes.<br /><br />Fear of litigation even determines the voice greeting when you telephone a Dr office - "if this is an emergency, hang up and go. . . " <br /><br />And yes, litigation affects insurance premiums which affects overhead (even if you never have been sued) which affect the entire medical experience.<br /><br />Tort reform can do much to change the dr/patient culture -- and those who know the trial attorneys are the biggest donors to Dems understand why. Every litigator (plaintiff or defense) knows the phrase "slam-dunk" -- and regardless of the facts, your case is never a "slam-dunk." So SETTLE - the fastest + easiest way for the lawyers to make a buck.<br />And settlements drive up the costs of insurance in your specialty regardless of how clean your personal record may be.<br /><br />Yes, tort reform is needed for a whole host of reasons - but politics prevents it. Might it have to do with the trial lawyers lobby? Hmmm.Evinxnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-1401118979212345922010-04-01T07:31:44.322-04:002010-04-01T07:31:44.322-04:00Cafeterias are something like buffets, but there a...Cafeterias are something like buffets, but there are a few differences. Cafeterias separate servers from the public for two reasons: sanitation and portion control. Buffets, on the other hand, are self-service. (No one stops a kid from picking up something, taking a bite and returning it to the display if he doesn't like it. Or the patron who serves himself more than he can possibly eat either to see if someone else wants more or to save a future trip to the buffet.)<br /><br />You can see where this is going. <br />This is where the poetry starts...<br /><br />Q. What is the difference? <br />A. Pricing and quality.<br /><br />No need to go into details about menu mix, price points and the like. Some people like one system, others prefer another. But the point I make has to do with how delicately balanced the equation is between medical risk and financial risk.<br /><br />There is no quick, one-size-fits-all solution. But the new law makes two important changes. First, it levels the playing field for insurance companies by making them all play by the same rules, eliminating some of their most egregious limitations on (their own) financial risks in return for compelling the entire market to get in the boat one way or another. And second, it returns medical risk management to medical professionals in a way that allows them once again to go about their mission without having the insurance industry looking over their shoulder. <br /><br />"But the government is doing the same thing," you say. <br /><br />Yep. That's correct. It's called reform or regulation or whatever else you want to call it. We have seen that "the system" (see above) has had three decades to work and the result has been runaway health care cost inflation unmatched by any other country. The system is dramatically broken. A free market approach as resulted in a medical financial train wreck which is unsustainable and a new model has to be tried. <br /><br />I am optimistic that the medical pros will do a helluva lot better job at managing medical risks than insurance companies have done. And the insurance people will finally be allowed, along with their colleagues in the field of law, to apply their professional expertise as they should, unencumbered by trying to assess medical risks because their professional colleagues in medicine will have that covered. <br /><br />Dr. Kirsch, please excuse my long comments. We live in a time when everyone wants soundbites and quick summaries. And I'm sure I don't need to tell a physician how hard it is to explain something to a patient in fifteen minutes all the medical reasons that led you to a diagnosis. Thanks for reading.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-26230817170754183842010-04-01T07:27:38.496-04:002010-04-01T07:27:38.496-04:00Then I'll be the poet.
It is a mistake to co...Then I'll be the poet. <br /><br />It is a mistake to conflate <b>medical</b> risk management with <b>financial</b> risk management. That was the original hazard of the HMO model when it was <a href="http://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973" rel="nofollow">conceived in the Seventies</a>. <br /><br />Insurance companies manage financial risks none of us can live without them. But the HMO model vividly showed what happens when medical issues conflict with financial challenges. The original HMO model was a study in failure, but it didn't take long for the insurance industry to come to terms with the challenge. What evolved was a two-tier system with group insurance at one level and the open market at another. <br /><br />Group policies are straightforward. Non-insurance companies arrange for an insurance company to administer their group plan as a TPA (third-party administrator) charged with handling claims, EOB's and other technicalities. The TPA then sends the company a bill which includes an over-ride for their services. The arrangement is tax-advantaged so everyone is happy. <br /><br />The open market is a more hazardous place for the insurance company, partly because they don't want to insure risky clients but mainly because the risk is not shared by more manageable company groups. Each case is separate and represents a financial ticking bomb which in financial terms can explode in a case of cancer or some other expensive outcome. (Whence commeth rescissions, lifetime caps and exclusions of pre-existing conditions.)<br /><br />How's that for poetry?<br /><br />In the same way the security companies do not prevent burglaries or robberies, medical insurance cannot prevent medical problems. In both cases all they can sell is "peace of mind." Life insurance salesmen know this better than anyone because in the case of life insurance getting dead is a certainty. In the end (to coin a phrase) the only distinction made in life insurance is between term policies and those that collect premiums until the end. And the actuarial experts, (good at stats but poor at medicine) hold all the cards. <br /><br />For the first time since the advent of Medicare the new law returns the power of medical risk management to medical professionals. Readers are urged to do some homework on how MEDPAC (a non-partisan independent panel of medical experts) has been rebranded as IBAP. My windy comment above (March 29, 2010 6:47) refers to that change. <br /><br />The problem with the current system is a perfect reflection of a similar (though less critical) challenge I faced in the food business. I'm no expert in medicine, law or insurance. With undergraduate study in history and music I don't even have the advantage of academic creds. I'm just an old guy blogging in retirement. But several decades in the labor intensive cafeteria business dealing with many thousands of the great American public has taught me a lot about business and how the marketplace works. <br /><br />in fact, a lot of business benefit plans are called "cafeteria plans." The FEHB insurance offered to federal employees is such a plan.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-74511963687986640292010-03-31T23:00:48.775-04:002010-03-31T23:00:48.775-04:00Now, I'm sure someone is going to come on and ...Now, I'm sure someone is going to come on and wax poetic about how that's not the "reform" they're talking about. They have some other kind they are thinking of, and it's fairer and so on and so forth. <br /><br />That may be true. But I'm talking about the legislation that EXISTS. That is likely to become law. Not some highminded plan which will never see the legislative light of day.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-84239923633913173192010-03-31T22:59:27.350-04:002010-03-31T22:59:27.350-04:00"And the higher the judgment the higher malpr..."And the higher the judgment the higher malpractice insurance premiums will be charged by insurance companies."<br /><br />If one believes insurance is only determined by dollar in premium less dollar in payouts, this might be true. But that's not how the industry works. Most casualty insurance is written at a loss on that basis alone. The money in insurance is in the float. <br /><br />". But defensive medicine has expanded almost to the point of overkill."<br /><br />And as I mentioned above, whenever we have tried the "reform" that is supposed to fix defensive medicine, it never works. So why are we lamenting that the same old "reform" is not in the latest round of legislation? <br /><br />The truth is, tort reform is about protecting large companies against the individual. So when one supports it, they should ask - how does this benefit me? Unless you are an executive for a large insurer or other corporate entity, the short answer is that it doesn't. It only limits your rights.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-79271908876788716212010-03-31T22:56:09.111-04:002010-03-31T22:56:09.111-04:00"We categorically do not aim to benefit finan..."We categorically do not aim to benefit financially at the expense of our patients' health. This is a blasphemous allegation and I hope you will reflect upon it. "<br /><br />Perhaps that's not your goal. However, it is the goal of the legislation you support. There is no other reason to support damage caps, which are the centerpiece of virtually every tort reform legislation. Why do you think the tobacco industry started the tort reform movement? If you don't like being associated with that goal, then stop supporting the legislation?<br /><br />". Separate from this, we need to reform a system that targets innocent physicians routinely, which is the stimulus for billions of dollars of defensive medicine. "<br /><br />This "stimulus for defensive medicine" claim keeps being made, yet we've tried your cure, again and again for decade. And it has not been shown to reduce costs or "defensive medicine" (a notoriously difficult thing to identify in practice). Texas has been cited as the holy grail of your "reform", yet costs are no less. Your payment model is the reason costs are so high, not lawsuits. <br /><br />The facts speak for themselves, Dr. Kirsch.Anonymousnoreply@blogger.com