PDA

View Full Version : Obama-Care based on inaccuracies



TXduckdog
08-31-2009, 10:52 AM
Here's an enlightening op-ed in this mornings Wall Street Journal. The highlights are mine. This is the first really good analysis of the current healthcare legislation that I've seen. It's not done by politicians or radio show hosts but by very accomplished doctors.


In recent town-hall meetings, President Barack Obama has called for a national debate on health-care reform based on facts. It is fact that more than 40 million Americans lack coverage and spiraling costs are a burden on individuals, families and our economy. There is broad consensus that these problems must be addressed. But the public is skeptical that their current clinical care is substandard and that no government bureaucrat will come between them and their doctor. Americans have good reason for their doubts—key assertions about gaps in care are flawed and reform proposals to oversee care could sharply shift decisions away from patients and their physicians.
Consider these myths and mantras of the current debate:

• Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not. Yet it was presented as fact to the Senate Health and Finance Committees, which are writing reform bills, in March 2009 by the Agency for Healthcare Research and Quality (the federal body that sets priorities to improve the nation's health care).

The statistic comes from a flawed study published in 2003 by the Rand Corporation. That study was supposed to be based on telephone interviews with 13,000 Americans in 12 metropolitan areas followed up by a review of each person's medical records and then matched against 439 indicators of quality health practices. But two-thirds of the people contacted declined to participate, making the study biased, by Rand's own admission. To make matters worse, Rand had incomplete medical records on many of those who participated and could not accurately document the care that these patients received.

For example, Rand found that only 15% of the patients had received a flu vaccine based on available medical records. But when asked directly, 85% of the patients said that they had been vaccinated. Most importantly, there were no data that indicated whether following the best practices defined by Rand's experts made any difference in the health of the patients.

In March 2007, a team of Harvard researchers published a study in the New England Journal of Medicine that looked at nearly 10,000 patients at community health centers and assessed whether implementing similar quality measures would improve the health of patients with three costly disorders: diabetes, asthma and hypertension. It found that there was no improvement in any of these three maladies.

Dr. Rodney Hayward, a respected health-services professor at the University of Michigan, wrote about this negative result, "It sounds terrible when we hear that 50 percent of recommended care is not received, but much of the care recommended by subspecialty groups is of a modest or unproven value, and mandating adherence to these recommendations is not necessarily in the best interest of patients or society."

• The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate. Yet the head of the National Committee for Quality Assurance, a powerful organization influencing both the government and private insurers in defining quality of care, has stated this as fact.

The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness." Responsiveness has two components: respect for persons (including dignity, confidentiality and autonomy of individuals and families to make decisions about their own care), and client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). This is what Americans rightly understand as quality care and worry will be lost in the upheaval of reform. Our country's composite score fell to 37 primarily because we lack universal coverage and care is a financial burden for many citizens.

• We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices.

On June 24, 2009, the president appeared on "Good Morning America" with Diane Sawyer. When Ms. Sawyer asked whether "best practices" would be implemented by "encouragement" or "by law," the president did not answer directly. He said that he was confident doctors "want to engage in best practices" and "patients are going to insist on it." The president also said there should be financial incentives to "allow doctors to do the right thing."

Data from clinical studies provide averages from populations and may not apply to individual patients. Clinical studies routinely exclude patients with more than one medical condition and often the elderly or people on multiple medications. Conclusions about what works and what doesn't work change much too quickly for policy makers to dictate clinical practice.

An analysis from the Ottawa Health Research Institute published in the Annals of Internal Medicine in 2007 reveals how long it takes for conclusions derived from clinical studies about drugs, devices and procedures to become outdated. Within one year, 15 of 100 recommendations based on the "best evidence" had to be significantly reversed; within two years, 23 were reversed, and at 5 1/2 years, half were contradicted. Americans have witnessed these reversals firsthand as firm "expert" recommendations about the benefits of estrogen replacement therapy for postmenopausal women, low fat diets for obesity, and tight control of blood sugar were overturned.

Even when experts examine the same data, they can come to different conclusions. For example, millions of Americans have elevated cholesterol levels and no heart disease. Guidelines developed in the U.S. about whom to treat with cholesterol-lowering drugs are much more aggressive than guidelines in the European Union or the United Kingdom, even though experts here and abroad are extrapolating from the same scientific studies. An illuminating publication from researchers in Munich, Germany, published in March 2003 in the Journal of General Internal Medicine showed that of 100 consecutive patients seen in their clinic with high cholesterol, 52% would be treated with a statin drug in the U.S. based on our guidelines while only 26% would be prescribed statins in Germany and 35% in the U.K. So, different experts define "best practice" differently. Many prominent American cardiologists and specialists in preventive medicine believe the U.S. guidelines lead to overtreatment and the Europeans are more sensible. After hearing of this controversy, some patients will still want to take the drug and some will not.

This is how doctors and patients make shared decisions—by considering expert guidelines, weighing why other experts may disagree with the guidelines, and then customizing the therapy to the individual. With respect to "best practices," prudent doctors think, not just follow, and informed patients consider and then choose, not just comply.

• No government bureaucrat will come between you and your doctor. The president has repeatedly stated this in town-hall meetings. But his proposal to provide financial incentives to "allow doctors to do the right thing" could undermine this promise. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.

Further, at the AMA convention in June 2009, the president proposed linking protection for physicians from malpractice lawsuits if they strictly adhered to government-sponsored treatment guidelines. We need tort reform, but this is misconceived and again clearly inserts the bureaucrat directly into clinical decision making. If doctors are legally protected when they follow government mandates, the converse is that doctors risk lawsuits if they deviate from federal guidelines—even if they believe the government mandate is not in the patient's best interest. With this kind of legislation, physicians might well pressure the patient to comply with treatments even if the therapy clashes with the individual's values and preferences.

The devil is in the regulations. Federal legislation is written with general principles and imperatives. The current House bill H.R. 3200 in title IV, part D has very broad language about identifying and implementing best practices in the delivery of health care. It rightly sets initial priorities around measures to protect patient safety. But the bill does not set limits on what "best practices" federal officials can implement. If it becomes law, bureaucrats could well write regulations mandating treatment measures that violate patient autonomy.

Private insurers are already doing this, and both physicians and patients are chafing at their arbitrary intervention. As Congress works to extend coverage and contain costs, any legislation must clearly codify the promise to preserve for Americans the principle of control over their health-care decisions.

Dr. Groopman, a staff writer for the New Yorker, and Dr. Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.

Buzz
08-31-2009, 01:26 PM
Nice to read something that doesn't refer to Nazis, Hitler, death panels, and unplugging granny for a change.

I have concerns about government developing guidelines for best practices, but I am as much or more concerned about every individual private insurer doing the same. I have been trying to get to the bottom of some health issues since around the first of the year. My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.

TXduckdog
08-31-2009, 06:00 PM
I'm right there with you Buzz on the issue of private insurers.

It may be simplistic, but I think it's really health insurance reform that is needed more than anything else. But how best to do that and still maintain freemarket enterprise? Or, is that even possible?

Jeff, I know you had some thoughts on this issue a while back. Care to re-iterate?

YardleyLabs
08-31-2009, 08:11 PM
I'm right there with you Buzz on the issue of private insurers.

It may be simplistic, but I think it's really health insurance reform that is needed more than anything else. But how best to do that and still maintain freemarket enterprise? Or, is that even possible?

Jeff, I know you had some thoughts on this issue a while back. Care to re-iterate?
I started to reply earlier but my "puppy watch" started turning into puppies and, 12 pups later, I am too exhausted to think. One comment on the newspaper column. The fact that testimony was givn before the Senate doesn't mean the information was assumed to be accurate. A lot of conflicting testimony is normally given in hearings and it tends to be taken with tons of salt. Setting standards/guidelines for care is not easy. However, for certain types of diseases, including hypertension, it is clear that defined protocols would help improve care and outcomes. One approach that Obama has hinted at is, I believe, a dead end. That is payment based on diagnostic related groups or "DRG's". Thos was attempted on an experimental basis under Medicaid waivers in several states and proved to be a complete bust. It sounds good but leads to dramatic provider abuses as some cherry pick their patients to maximize profit and the others are stuck with more complicated cases that cost more to treat.

dnf777
08-31-2009, 08:16 PM
Nice to read something that doesn't refer to Nazis, Hitler, death panels, and unplugging granny for a change.

I have concerns about government developing guidelines for best practices, but I am as much or more concerned about every individual private insurer doing the same. I have been trying to get to the bottom of some health issues since around the first of the year. My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.

Agree with both your points.
As of 2007, we comply with the Surgical Care Improvement Project (SCIP) at our hospital. This is not mandated, but rewarded at the hospital level (who makes local policies, and posts public "report cards" for compliance by physicians for care improvement. If you're a doc, you DON'T want patients seeing that you're less compliant with something named "care improvement", right?

Since we have implemented this program, our own QI outcomes tracking data shows NO improvement in surgical care! Some of the recommendations are out of line with the various specialty colleges' recommendations based on systematic reviews and outcome data.

This is not to bash the SCIP program, but as is often the case, programs are devised and implemented by people outstepping their expertises, and applied in ways never intended. (ie linking to pay-for-performance) PFP.

Health care rationing is here. It always has been.
Best practice measures are here. They always have been. They used to be called "clinical pathways". The difference now is that adminsitrators are applying these old tools in new ways...ie to deny patients' care, and to deny doctor's reimbursement. This has ramped up tremendously in the past 10 years. (not a dig on Bush) Bill Frist and his family were well known for implementing many of these practices....he was NO FRIEND to physicians from his corporate seat!

TXduckdog
08-31-2009, 08:36 PM
VERY interesting points, DNF.

What is the rationale for administrators to deny patient's care and deny doctor's reimbursements?

dnf777
09-01-2009, 08:10 AM
VERY interesting points, DNF.

What is the rationale for administrators to deny patient's care and deny doctor's reimbursements?

One thing that was resolved in a class-action lawsuit against United health care was the practice of bundling and downgrading diagnoses. If a patient comes in with a hernia, COPD, non-healing ulcers, and diabetes, and ALL were diagnosed and treated, the insurance company would say, "that's all part of his hernia" and only pay for that. Those claims would not hold up, and as a result, the practice has been somwhat curtailed. If you have skin moles removed out of concern for cancer, and ultimately the path is benign, the company would say it was an unnecessary procedure. Also, they would pay for the first removal, 50% for the second, and 20% for each subsequent procedure. It was like going to the Firestone dealer and saying you'll pay for one tire, half for the next and 20% the the last two!!

Those are a couple examples, which have been partially addressed. There is a plethora of other excuses for denying care...unecessary tests, procedures, time frames,etc...

If you are a cancer patient and need a PET scan, most insurance (and MC) will not pay if you happen to be an inpatient in a hospital. Only outpatients.
Go figure??

Gerry Clinchy
09-01-2009, 08:30 AM
My doctor feels that if not for the insurance company BC/BS meddling in the doctor's decisions about what tests and what to try, we would be in a better position today. If you bring it up, he gets very vocal about it.

I would have to think this also happens with Medicare, and would happen with any plan, public or private, that involved a 3rd party payer. Once there would be a govt option, I can't imagine that the govt would wield any less power than the private insurors.

Medicare is raising its premiums on its prescription drug plan. The net result will be that those who need the expensive meds will, overall, benefit more & pay less $. Those who do not need such meds, will overall pay more, and not gain any increased benefit.

It is logic, it would appear, that as the govt plan takes on all those pre-existing conditions, they will show the same pattern of continuing to increase premiums to keep the program afloat. In that regard, it will be no different than any other third-payer insurance program. The difference will be that the govt plan will be able to subsidize its deficits with tax money, so will raise premiums less and less quickly than a private insuror. Even with a private insuror, you are looking at the whole situation in microcosm. Those who are healthy subsidize those who are not.

It also seems logical that there was a need for Medicare because the health care costs of older people will almost always (over the long term) be more expensive than for younger people as age takes its toll on the human body. For a private insuror, the costs become unsustainable. The govt could tax everyone (with no opt out), and then raise the tax as the govt saw fit to fill the needs of insufficient premiums.

dnf777
09-01-2009, 09:28 AM
It is logic, it would appear, that as the govt plan takes on all those pre-existing conditions, they will show the same pattern of continuing to increase premiums to keep the program afloat. In that regard, it will be no different than any other third-payer insurance program. .

That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

Avoid the Western Diet and live healthier regards,
Dave

Buzz
09-01-2009, 09:54 AM
That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"




Isn't this inevitable in a system that depends upon employers to provide healthcare insurance?

dnf777
09-01-2009, 10:43 AM
Isn't this inevitable in a system that depends upon employers to provide healthcare insurance?

Yes, in a way it does, but I'm not sure why. Who pays the premiums shouldn't matter in regards to coverage policy.

Morris Fishbein (JAMA editor and very influential medical administrator of the 30s and 40s) warned against employer provided coverage, and his warnings have proven true. Back then, a day is the hospital was $5, and it was more of an enticement to employment that actual significant benefits.

Providing healthcare to a population (or deciding to let it provide for itself) is probably one of the MOST complex social/governmental issues that has faced modern man. Anyone who claims to have all the answers, or even thinks its a single-faceted solution is crazy, or trying to push an agenda! One this is for sure....when there's this much money at stake, there WILL be corruption involved.

TXduckdog
09-01-2009, 11:20 AM
That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

Avoid the Western Diet and live healthier regards,
Dave



Dole out precious claim dollars= rationed health care
All are going to pay more= in more ways than we know and not all in $$$$

Fascinating discussion.....thats why its so damn important to get this health care thing right.

Gerry Clinchy
09-01-2009, 11:37 AM
That is true. But remember, we all tend to consume more health care dollars as we age. (LIFE is a pre-existing medical condition!) As it is now, we all bring that condition to medicare, as we hit 65. The private insurance companies are no dummies, and have decided "we'll take you premiums and dole out very few precious claim dollars to young, healthy people, but we know that won't last...so when you hit 65, let Uncle Sam pick up the tag....we're done....you're no longer profitable for us"

I totally agree, Dave. The elderly, logically, become the most expensive patients. The premiums to cover their health care become unsustainable.

the whole concept of insurance, spreading the risk/cost goes out the window. We know "risk" increases with age, and they have concocted the ultimate cherry-picking scenario.

Under a public option, the private insurors will still be able to cherry-pick the "gap" coverage, as they do with Medicare. They may have to provide a policy specified by law, but will they have to charge the same premium as the public option? If not, then the govt plan would have the same problem it has with Medicare. The high-maintenance patients will opt for the the lowest cost program, which is likely to be the govt plan.

I think the Medicare situation developed precisely as a result of the premise of spreading/risk cost. In order to cover the elderly, the premiums had to get very high, even though they had lower-risk insureds to help spread the risk/cost.

I think the resulting care denials stem from the fact that even with the higher premiums we all have experienced, even though many low-cost insureds are present in the insurors' overall insured populations, the impact of just a few high-cost insureds blow everything out of the water actuarily.

That is rooted in the costs of the care as a result of medical advances (which few of us would want to give up).

NO easy answers here. But the current system is unsustainable. In the end, we're probably ALL going to pay more. Whether a little more or a lot more depends on the plan put in place, and obviously, nobody has the answer right now.

Absolutely agree. There ARE no easy answers. But there could be some logical steps to take. If tests are ordered to protect the doctor/hospital from litigation, then there needs to be tort reform & truly medically-driven "best practices". Fraud in the system (private, Medicare, Medicaid) has to be forcefully addressed. The medical profession has to effectively find a way to get the really "bad" doctors out of practicing medicine. That would mean addressing the licensing nightmare with common sense, a combined effort of govt & the profession. The legal profession could also benefit from some similar reforms :D


If the legislators attacked some of these issues with issue-specific legislation, then I think that the voters might have more faith in govt's ability to do something fiscally responsible and useful to the overall situation. These individual issues could certainly attract bi-partisan support. If a public program is inevitable, then these issues have to be "fixed" before it could deliver care any better than what we have.

I'm not in favor of sticking it to doctors and hospitals that do a good job. There is a lower limit to what costs are/will be for the care from dedicated, gifted professionals.

YardleyLabs
09-01-2009, 12:13 PM
The primary source of the cherry picking problem now is actually that portion of the population that bets that it will not require significant care and therefore chooses not to obtain appropriate coverage. When these people do become seriously ill, they become public charges either by qualifying for Medicaid or by becoming part of that group of uninsured who do not pay their bills. Most insurance companies would be happy to provide universal coverage for any group that guaranteed 100% participation. In the absence of that guarantee, the companies worry about the "moral hazard" effect (insurance jargon) under which people only buy coverage when they believe they are likely to need it. That dramatically increases the risk of insurance for the carrier.

The other gamesmanship involved in coverage decisions is deciding who gets stuck with the bill. While much of the population is uninsured, a large percentage are actually covered under more than one plan. This also makes rating decisions more difficult and plans expend a significant effort arguing over which plan is responsible for which costs.

Finally, plans compete for providers but in a manner that is sometimes perverse. One one hand, every plan wants to have enough providers in the most common specialties to make their plans attractive. However, they do not necessarily want to have a wide selection of providers in the most expensive specialties and they can benefit from provider turnover. For example, if I have a chronic ailment such as asthma, and my insurer convinces the provider the stop accepting payment, the service becomes an out of network service. The insurance company still only pays the amount they would have paid for an in network physician. However, the care is now subject to much higher deductibles and co-payments. While this type of behavior is not very common from the biggest insurers, such as the Blues, it is found among those with smaller market shares. Under a plan that I offered through my company for a period of three years, it became apparent that primary care providers were being flipped almost annually by the insurer (HealthNet).

Decisions on ways to legitimately reduce health care costs are difficult. However, one of the advantages of universal coverage and minimum plan requirements is that they would reduce the incidence of some forms of "gotcha" coverage. Individuals would not be able to play the odds on purchasing coverage making rating decisions easier. Insurers would not be able to discriminate against individuals or groups based on health need, making that type of gamesmanship less prevalent. Smaller employers would be grouped together for rating purposes, reducing risk for insurers and costs for employers.

The problem with a piecemeal approach is that it will tend to increase the opportunities for "gotcha" coverage by leaving gaps for exploitation. If there is going to be anything piecemeal, I would prefer to see a less comprehensive minimum coverage requirement while retaining universal coverage. In my mind, I do not think any significant reform is possible without universal coverage.

txbadger
09-01-2009, 12:33 PM
"• We need to implement "best practices." Mr. Obama and his advisers believe in implementing "best practices" that physicians and hospitals should follow. A federal commission would identify these practices. "

The devil is in the details which would be determined after passage.

Bottom lne is 85% of the people have health insurance and the attempted power grab with limited details, no real proof of how to fund it nor what'll be covered was doomed to fail.

My solution of open enrollment into the Federal employees plans with the enrollee paying the gross cost. Pick the plan you want, which for record are private insurance plans, pay the premium and enjoy. Then We may have the same coverage as Our employees.

Gerry Clinchy
09-01-2009, 01:02 PM
The problem with a piecemeal approach is that it will tend to increase the opportunities for "gotcha" coverage by leaving gaps for exploitation. If there is going to be anything piecemeal, I would prefer to see a less comprehensive minimum coverage requirement while retaining universal coverage. In my mind, I do not think any significant reform is possible without universal coverage.

Just for clarity, I am not suggesting a piecemeal approach to health care coverage.

However, I fail to see how tort reform in advance would interfere with a universal coverage package, if the latter does result. Tort reform encompasses many fields, like product liability.

I don't see how correcting the licensing nightmare would interfere either. Or seeking out fraud and abuse, and doing something really meaningful about that.

Even when someone might come up with a universal coverage idea that is promising, these other issues could be addressed now.

Just saw that Massachusetts is having to temporarily cut back on its med coverage for legal (that is legal) immigrants (with green cards for less than 5 years). This is to help their budget deficit problems.

YardleyLabs
09-01-2009, 02:44 PM
Just for clarity, I am not suggesting a piecemeal approach to health care coverage.

However, I fail to see how tort reform in advance would interfere with a universal coverage package, if the latter does result. Tort reform encompasses many fields, like product liability.

I don't see how correcting the licensing nightmare would interfere either. Or seeking out fraud and abuse, and doing something really meaningful about that.

Even when someone might come up with a universal coverage idea that is promising, these other issues could be addressed now.

Just saw that Massachusetts is having to temporarily cut back on its med coverage for legal (that is legal) immigrants (with green cards for less than 5 years). This is to help their budget deficit problems.


I actually have no problems with the theory of tort reform. It's the reality that makes me hesitate. Right now I believe that managed care companies and pharmaceutical companies get too much of a free pass and that doctors and hospitals are left holding the bag. In some areas we have entire classes of care that are financed largely if not primarily through legal settlements. An example of this is care for children with cerebral palsy. Much of the lobbying for tort reform comes from the drug companies and managed care companies seeking to preserve their protected status. With respect to physician malpractice, tort reformers tend to want to limit the payout even when costs are real. Neither of these approaches addresses the real issues. Universal health coverage would actually take some of these issues off the table. Health insurance programs should not be able to limit coverage for items such as birth defects that may require lifelong care. By requiring everyone to be covered, the cost is spread widely. That would reduce the scope of damage awards in a manner that would make stricter adherence to demonstration of gross negligence more feasible and would also limit attorney fees paid for recovery of direct care costs.

In cases where gross negligence is involved, I believe patients deserve their day in court. My ex was involved in a case where a quadriplegic who had enough mobility in a few of his fingers and in his head to be able to to control a variety of equipment. That allowed him to, among other things, attend college. While being transported, his chair was not secured, the doors of the vehicle were not fully closed, and the driver drove with rapid starts and stops. Finally, his chair flew out the back the back of the vehicle and his neck was broken again. He lost all the movement that had previously permitted him to live his life. The insurance company argued that he was a quadriplegic before the accident and a quadriplegic afterward so there was no real injury other than medical bills that were paid by Medicare. Happily, the jury did not agree.

Gerry Clinchy
09-01-2009, 07:54 PM
his chair flew out the back the back of the vehicle and his neck was broken again. He lost all the movement that had previously permitted him to live his life. The insurance company argued that he was a quadriplegic before the accident and a quadriplegic afterward so there was no real injury other than medical bills that were paid by Medicare. Happily, the jury did not agree.

This does not sound like a medical malpractice suit, which would have been part of the health care coverage topic.

I don't think that anyone would be against removing all tort options for people, but there is surely a need for laws to prevent frivolous suits.

In the real world, defending oneself against even a frivolous suit is so costly, that the defendant just "settles". The attorneys have to be the worst at policing their own in the matter of frivolous lawsuits. Even though Pennsylvania has such a law, it doesn't get used much because of the cost of pursuing such a suit.


That would reduce the scope of damage awards in a manner that would make stricter adherence to demonstration of gross negligence more feasible and would also limit attorney fees paid for recovery of direct care costs.


That may be more of a "guess" than fact. Until the attorneys are penalized directly for bringing the frivolous suits, they will continue to throw their hats in the ring ... they have nothing to lose.

Was involved in my first and only real estate suit a couple of years ago. Generated about $60,000+ in legal fees. End result: the complainant was dead wrong. Took a year and a half to get in front of a judge. The judge saw the truth very quickly. There was a "settlement". The compainant's attorney actually made the legal error himself! He collected about $25,000 of those fees. Cost the complainant total $40,000 or more for his attorney's error. Unconscionable!

YardleyLabs
09-01-2009, 08:18 PM
This does not sound like a medical malpractice suit, which would have been part of the health care coverage topic.

I don't think that anyone would be against removing all tort options for people, but there is surely a need for laws to prevent frivolous suits.

In the real world, defending oneself against even a frivolous suit is so costly, that the defendant just "settles". The attorneys have to be the worst at policing their own in the matter of frivolous lawsuits. Even though Pennsylvania has such a law, it doesn't get used much because of the cost of pursuing such a suit.



That may be more of a "guess" than fact. Until the attorneys are penalized directly for bringing the frivolous suits, they will continue to throw their hats in the ring ... they have nothing to lose.

Was involved in my first and only real estate suit a couple of years ago. Generated about $60,000+ in legal fees. End result: the complainant was dead wrong. Took a year and a half to get in front of a judge. The judge saw the truth very quickly. There was a "settlement". The compainant's attorney actually made the legal error himself! He collected about $25,000 of those fees. Cost the complainant total $40,000 or more for his attorney's error. Unconscionable!
It was medical malpractice because the ambulance company was providing a medical service paid through health insurance. The defendant ws a company, not a doctor.

Been there, done that on frivolous lawsuits. In my case it was a wrongful termination suit with violation of "liberty" rights and due process with a personal potential liability of $1 million. The case lasted five years, ending with a jury trial. In that case the judge posed more than 50 questions to the jury with respect to the facts and in every case the jury found in my favor. In this case the plaintiff had actually been ordered to pay legal costs of an employer when she had filed a similarly frivolous employment suit ten years earlier. We were not allowed to introduce that into evidence because it was deemed prejudicial and not germane. In that case the judge wrote that in his entire career he had never witnessed a more perjurious individual or a more abusive use of the courts.

Buzz
09-01-2009, 08:31 PM
It was medical malpractice because the ambulance company was providing a medical service paid through health insurance. The defendant ws a company, not a doctor.



I didn't see that it was an ambulance company in the original post.;)

dnf777
09-01-2009, 09:30 PM
I didn't see that it was an ambulance company in the original post.;)

In Pennsylvania, 90% of malpractice cases going to adjudication are found in favor of the phyisicain. Doctors and their insurers usually admit and made amends when a true mistake is made. If a doctor was wrong or 90% of his patients died, how long would the state allow him/her to keep their license??

Not all bad outcomes are the result of malpractice. Most are due to disease processes, trauma, or poor health choices.

On a somewhat related note, I find it amazing that juries STILL find in favor of plaintiffs in tobacco related illnesses! Older folks, veterans who got cigs in their field rations (courtesy of tobacco companies and the military) are one thing. Someone who began smoking in the modern era of warnings on the cigarette packs is another. At what point are people responsible for their own decisions?

Gerry Clinchy
09-02-2009, 07:14 AM
It was medical malpractice because the ambulance company was providing a medical service paid through health insurance. The defendant ws a company, not a doctor.

Thanks for the clarification on the transporter's identity, as to why it was classified as medical malpractice. Not a good performance by either the ambulance company or the insuror.

Again, I don't think anyone wants to see true malpractice or negligence go without penalty when penalty is merited.

Been there, done that on frivolous lawsuits. In my case it was a wrongful termination suit with violation of "liberty" rights and due process with a personal potential liability of $1 million. The case lasted five years, ending with a jury trial. In that case the judge posed more than 50 questions to the jury with respect to the facts and in every case the jury found in my favor. In this case the plaintiff had actually been ordered to pay legal costs of an employer when she had filed a similarly frivolous employment suit ten years earlier. We were not allowed to introduce that into evidence because it was deemed prejudicial and not germane. In that case the judge wrote that in his entire career he had never witnessed a more perjurious individual or a more abusive use of the courts.

In this latter instance, is the perfect reason why tort reforms are needed; not just for medical malpractice, but covering a much greater spectrum of abuse as well.

Now, I also wonder if the attorney who took the second case for this woman has done this before. I also wonder what the chances are that the woman ever paid for those court costs.

In the case I was involved in, we were told that in PA legal expenses are paid by each party. "Court costs" may be separately defined.

In the settlement I was involved with, the judge deftly structured the settlement so that the complainant paid a higher purchase price for the property than originally contracted, essentially covering the legal expense incurred by the defendant. The E&O attorney, who deals in real estate law statewide, said it was unheard of for the purchaser to end up paying *more* for the property than originally in the contract. However, the defendant still lost $. They could have received an even higher price, 18 mos. sooner, (from another buyer) if the lawsuit had not been filed.

dnf777
09-02-2009, 09:14 AM
In this latter instance, is the perfect reason why tort reforms are needed; not just for medical malpractice, but covering a much greater spectrum of abuse as well.

Now, I also wonder if the attorney who took the second case for this woman has done this before. I also wonder what the chances are that the woman ever paid for those court costs.

In the case I was involved in, we were told that in PA legal expenses are paid by each party. "Court costs" may be separately defined.

In the settlement I was involved with, the judge deftly structured the settlement so that the complainant paid a higher purchase price for the property than originally contracted, essentially covering the legal expense incurred by the defendant. The E&O attorney, who deals in real estate law statewide, said it was unheard of for the purchaser to end up paying *more* for the property than originally in the contract. However, the defendant still lost $. They could have received an even higher price, 18 mos. sooner, (from another buyer) if the lawsuit had not been filed.

I'm no lawyer, but this is getting into legal semantics. Non-physicians can be tagged for practicing w/o a medical license, but only licensed physicians can be tagged with medial malpractice. An ambulance company or crew does not hold a license to practice medicine, and therefore cannot be sued for malpractice. If there's a medical director of the ambulance company, he may be liable if there was direct patient care, or a duty to treat established.

YardleyLabs
09-02-2009, 09:43 AM
In this latter instance, is the perfect reason why tort reforms are needed; not just for medical malpractice, but covering a much greater spectrum of abuse as well.

Now, I also wonder if the attorney who took the second case for this woman has done this before. I also wonder what the chances are that the woman ever paid for those court costs.

In the case I was involved in, we were told that in PA legal expenses are paid by each party. "Court costs" may be separately defined.

In the settlement I was involved with, the judge deftly structured the settlement so that the complainant paid a higher purchase price for the property than originally contracted, essentially covering the legal expense incurred by the defendant. The E&O attorney, who deals in real estate law statewide, said it was unheard of for the purchaser to end up paying *more* for the property than originally in the contract. However, the defendant still lost $. They could have received an even higher price, 18 mos. sooner, (from another buyer) if the lawsuit had not been filed.
The case I was involved with was both a labor law case and a civil rights case. It was in NYC and had fairly high political visibility. The plaintiff had four attorneys working on a pro bono basis. The whole situation was fascinating from a political and legal perspective (less so if your own house was on the line:confused:), but not germane to this thread except as an example of what can happen when the legal system is abused.

Henry V
09-02-2009, 10:04 AM
I don't think that anyone would be against removing all tort options for people, but there is surely a need for laws to prevent frivolous suits.

In the real world, defending oneself against even a frivolous suit is so costly, that the defendant just "settles". The attorneys have to be the worst at policing their own in the matter of frivolous lawsuits. Even though Pennsylvania has such a law, it doesn't get used much because of the cost of pursuing such a suit.

That may be more of a "guess" than fact. Until the attorneys are penalized directly for bringing the frivolous suits, they will continue to throw their hats in the ring ... they have nothing to lose.

Was involved in my first and only real estate suit a couple of years ago. Generated about $60,000+ in legal fees. End result: the complainant was dead wrong. Took a year and a half to get in front of a judge. The judge saw the truth very quickly. There was a "settlement". The compainant's attorney actually made the legal error himself! He collected about $25,000 of those fees. Cost the complainant total $40,000 or more for his attorney's error. Unconscionable!
Gerry,
Several states have implemented serious tort reform regarding medical malpractice. Can you please point to any of these states where it has resulted in an appreciable deceleration in health care costs? As far as I can tell the experiment has been done and it has had little effect. It is a red herring in the grand scheme of things. Malpractice insurance currently is about 2% of health care costs. A rounding error compared to drug company and insurance company profits.

dnf777
09-02-2009, 11:01 AM
Gerry,
Several states have implemented serious tort reform regarding medical malpractice. Can you please point to any of these states where it has resulted in an appreciable deceleration in health care costs? As far as I can tell the experiment has been done and it has had little effect. It is a red herring in the grand scheme of things. Malpractice insurance currently is about 2% of health care costs. A rounding error compared to drug company and insurance company profits.

That is what the trial lawyers put out, and want to believe. As someone who orders tests on a CYA basis, I can tell you it's MUCH more than 2%!

And those are just direct care costs. Like I pointed out before, that does not include physicians' and administrators' time spent in depositions, planning committees, etc....all for defensive practices.

The practice guidelines for trauma imaging is changing as we speak. It is evolving to the point where ANYONE coming into a trauma bay will be "pan-scanned", meaning CT scans of the head, c-spine, chest, abdomen, and pelvis, so as to not miss even a clinically insignificant injury, leading to a lawsuit. (ie a cracked rib, that anyone who's played high-school football has probably had, and requires no treatment....but if not diagnosed, seems to be worth tens of thousands of dollars!)

States where tort reform has occured HAVE seen a decrease in malpractice premiums for physicains. It has also allowed insurance companies to start writing new policies, where before they did not. It has also resulted in a small, but significant increase in the number of physicians retained in state after training. Not a big deal, unless you can't find a doctor taking new patients I suppose.

No tort reform that I'm aware of has sought to reduce payment to injured parties. It is to reduce non-economic damages that have no limit currently in many states.

Someone who eats twinkies and Dr. Peppers all day long, then sues their doctor because their pannus doesn't hide their gall-bladder scar to their liking after surgery is what needs to be curtailed.

Gerry Clinchy
09-02-2009, 12:48 PM
Gerry,
Several states have implemented serious tort reform regarding medical malpractice. Can you please point to any of these states where it has resulted in an appreciable deceleration in health care costs? As far as I can tell the experiment has been done and it has had little effect. It is a red herring in the grand scheme of things. Malpractice insurance currently is about 2% of health care costs. A rounding error compared to drug company and insurance company profits.

PA is one of the states that has a law that an attorney who files a "frivolous" suit can be sued himself for this kind of abuse. But it does not surprise me that the law's impact has been negilgible

However, you better have the $ if you want to sue him. I discussed this with the E&O (Errors & Omissions) attorney representing the insurance company that provided the E&O insurance. He mentioned the law to the complainant's attorney, but admitted to me that the likelihood of such a suit resulting was negligible.

The insurance companies are unwilling to dump more money into a case such as that even though, IMHO, it would send a message to attorneys who think they have nothing to lose by filing these frivolous suits.

The law exists in PA but the logistics and finances needed to make the law serve its intended purpose seems to preclude it being meaningful. That being said, it would make more sense for the judges in such cases (since they have heard all the testimony & seen all the depositions) to cite the attorneys, & at least assess a fine to them. OTOH, judges are attorneys as well ... and must continue to work in their judicial districts.

The question remains how to create meaningful tort reform to preclude frivolous litigation.

Jeff mentions that his complainant's attorneys were working pro bono. However, if a large settlement had been received, I'm sure they would have gotten a piece of the pie.

dnf777
09-02-2009, 01:06 PM
PA is one of the states that has a law that an attorney who files a "frivolous" suit can be sued himself for this kind of abuse. But it does not surprise me that the law's impact has been negilgible

However, you better have the $ if you want to sue him. I discussed this with the E&O (Errors & Omissions) attorney representing the insurance company that provided the E&O insurance. He mentioned the law to the complainant's attorney, but admitted to me that the likelihood of such a suit resulting was negligible.

The insurance companies are unwilling to dump more money into a case such as that even though, IMHO, it would send a message to attorneys who think they have nothing to lose by filing these frivolous suits.

The law exists in PA but the logistics and finances needed to make the law serve its intended purpose seems to preclude it being meaningful. That being said, it would make more sense for the judges in such cases (since they have heard all the testimony & seen all the depositions) to cite the attorneys, & at least assess a fine to them. OTOH, judges are attorneys as well ... and must continue to work in their judicial districts.

The question remains how to create meaningful tort reform to preclude frivolous litigation.

Jeff mentions that his complainant's attorneys were working pro bono. However, if a large settlement had been received, I'm sure they would have gotten a piece of the pie.

There was a case in W. Virginia where a surgeon was erroneously involved in a case, and the attorney refused to drop him. He refused to settle, as he never even saw the patient-plaintiff. It took him 12 years and over $100,000 to successfully acquit himself and counter sue the attorney for malicious prosecution. It took him two years to find an attorney willing to take his case, as it would not likely result in large monetery rewards. He did ultimately prevail, but admitted himself, it was not for the weak of heart.

The hospital system I work for has a very good approach to risk management, that I wish would become a model for the country. Our system hired two of the best malpractice attorneys in town to be on our team. We have a RM team that assesses all cases, and offers compensation that is reasonable to appropriate parties. It comes with a letter explaining that they will get fair compensation, NOW. If they have a frivilous claim, their attorney is sent a letter from our legal dept stating as a policy, we do NOT settle ANY case out of court that we feel is defensible. In other words, we're shootin straight from the hip, and playing fair...but no Bull%h!t!

We pay honestly for honest mistakes, deal with substandard care in house (and it is very, very rare, given the credentialling process) and are basically left alone from frivilous crap.