Are the wheels coming off the Democratic plan to revolutionize American health care? We can only hope so. But as Republicans resist the new controls, new taxes, and new government expansion proposed by Democrats, they need to be very careful to avoid the opposite mistake: defending an indefensible status quo.
The American health-care system is a costly and inefficient quagmire. It spends dramatically more than any other health-care system on the planet, while producing (at best) only marginally better results. Wages are stagnating for middle-income Americans because of the surge in health -are costs. Fear of losing insurance deters many from switching jobs or striking out on their own. The uninsured get sicker, and the inadequately insured worry that illness will lead to financial ruin.
Many of these problems bear especially heavily on groups Republicans are generally expected to champion: small businesses and the self-employed. At the beginning of the summer, I was talking to a small-business owner and lifelong Republican who said: “If Barack Obama will take my health-care costs off my books, he can charge me whatever he wants in personal income tax—it’ll be worth it.”
What is the competing offer from Republicans?
Though you wouldn’t know it from the current debate, Republicans actually have an inventory of useful ideas to offer Americans concerned about the rising cost of health coverage. Republicans have proposed allowing the sale of insurance products across state lines, enabling people in expensive states like New Jersey to benefit from the less expensive regulatory regime in, say, Kentucky. Republicans have proposed creating health-care exchanges—like the one fashioned by former Gov. Mitt Romney in Massachusetts—to enable the self-employed to buy insurance with untaxed dollars, just as larger businesses can. The first President Bush proposed an audacious series of subsidies for the uninsured, to be paid for by taxing the benefits of the most generous employer-provided health plans.
Unlike President Obama’s grand schemes, these measures represented incremental changes to the status quo; they could have been implemented gradually, allowing everyone time to assess their effect while giving the system time to adjust. That’s the way to make big changes to something as vital and complex as American health care.
Despite these good ideas, the GOP failed to make health-care reform a priority when it held power. As a result, we Republicans forfeited our credibility on the issue. Strikingly, the Republican with the biggest health -are story to tell—Mitt Romney—declined to trumpet his achievements in the 2008 Republican primary contests, having accurately gauged that they would do him little good. (The Romney plan had trespassed conservative orthodoxy by including, among other offenses, a mandate that imposed a tax on individuals who failed to buy one of the new health policies created by the plan.)
Republicans are in danger of forgetting one of the primary rules of politics: Voters do not care what you know until they know that you care. On health care, we do not look like we care.
So as the Hydra-headed Obamacare lurches through the halls of Congress, we can be confident in our opposition; the president is overreaching horribly. He seeks to herd millions of Americans into a government-operated plan. His promises of cost control are pure assertion, fantasies based on hope and guesswork. He will pile new taxes on small business and crushing new regulations on America’s most innovative industries. He has a bad plan, deserving of intense opposition.
But if Republicans prevail, as I hope we do, then what? Can we provide a vision larger than merely inflicting defeat on a Democratic president and Congress? Can we offer a better alternative? And will we do the hard work to make health care a priority after Obamacare is beaten back, assuming it is? If Republicans can play a constructive role on the toughest of issues, we’ll have taken our first important step on the road to political recovery. If not, a victory over an ambitious president may prove an empty one, both for Republicans and for the country.
Originally published in The Week.
43 responses so far
1 sinz54 // Jul 23, 2009 at 12:30 pm
The Republicans are pursuing two lines of attack against ObamaCare, ignoring that those two lines are mutually contradictory:
One group, taking their cue from Michelle Malkin and the Investors Business Daily and RedState.com, defend our current health care system as “the finest on earth,” and ignore any of its glaring flaws. They want no government reform initiatives whatsoever–not even the relatively innocuous insurance exchange. They even defend the denial of coverage for pre-existing conditions, as the workings of a free market.
The second group has dredged up the McCain health care reform proposal, which in some ways (taxing current policyholders) is more radical than ObamaCare, and includes measures that the first group would strongly object to. At no point have they asked the Congressional Budget Office to review and score their proposal–probably because they know it’s a crock.
As for RomneyCare, Romney was forced to run away from his own health care reform achievement, precisely because he got no support in the GOP for it.
Conservative that I am, I must admit that this kind of track record proves that the GOP is not serious about this issue, and are more interested in handing Obama a stunning failure than in reforming health care. After Obama has been stymied, the GOP will just drop the issue again. Who doubts otherwise.
2 MacandCheese // Jul 23, 2009 at 3:13 pm
David,
Not maintaining or not seeming to support the status quo can be simply accomplished by focusing on reducing the cost of healthcare in its current form. That would be an easy thing to accomplish with tort reform alone. If the Republicans start laying the excessive costs of healthcare at the feet of the plaintiff’s bar and their Democratic enablers, then the fight could be engaged without any fear of it hurting the Republican agenda while at the same time exposing the Democrats for being the party most responsible for the runaway cost of private and public healthcare.
3 franco 2 // Jul 23, 2009 at 5:37 pm
Interesting. No mention of tort reform, the single biggest factor in heath care costs. Frum is not very thorough in his analysis.
4 midcon // Jul 23, 2009 at 7:03 pm
Franco, I haven’t seen data that suggests that malpractice insurance and torts are the single greatest factor. However, I am sure it is an extremely large factor and yet, as you pointed out there is absolute silence on the topic. Could it be the Trial Lawyers Association have a much better lobby than we realize?
Also, I wonder how much a factor the cost of medical school (and the several years of relatively low pay in interning and residency) is in the overall health care equation?
5 aDude // Jul 23, 2009 at 7:31 pm
Back in the days of “come let us reason together” politics, an interesting compromise could have been reached – elimination of personal injury and medical malpractice lawsuits in return for some form of universal coverage. I’ve seen stats over the years from groups like the AMA and the US Chamber of Commerce saying that hundreds of billions of dollars are wasted every year due to personal injury and medical malpractice lawsuits, both from actual damages and from defensive actions.
OK, let’s start with the assumption that if there is universal coverage then if you get injured by slipping on a banana peel (or surgical screwup) your medical bills for the rest of your life would be covered under universal health care coverage. Therefore, no need for either type of lawsuit. As for pain and suffering, well, get over it. But then, I never was fond of the idea of pain and suffering lawsuits back in law school.
Well, if hundreds of billions of dollars are wasted because of lawsuits, and if universal coverage costs hundreds of billions of dollars a year, it would sound like there could be a compromise in there somewhere.
Obviously, we aren’t in the age where anything like this would happen. Would medicine and business buy the idea that we will eliminate lawsuits to save them money and take it back in higher health care taxes to fund universal coverage? Not gonna happen. Would Republicans and Democrats work together to find a common solution that would require sacrifice by some of their major factions? Not if either side things it would be more expedient in the short term to score political points from calling the other side names.
Too bad, really. What’s called for here are some great moderate leaders to come forth and do what’s right for America. Of course, we’ve already been told that there are no great moderates.
6 Jim Pier // Jul 23, 2009 at 7:33 pm
Trial Lawyers a much better lobby than we realize? Owning the Democratic Party isn’t enough?
First, we are forced to primarily be heard opposing Obama’s plan, as opposed to trumpeting alternatives, by virtue of his plan being made center stage. First and foremost, his plan must be trimmed back to the bone or we will be stuck with whatever passes forever. Beyond that, we must change the perceptions of most voters about health insurance, medical care, and the proper role of the federal government. That will take years, but it is the top fiscal issue as far as the eye can see. Americans under 45 should not expect to enjoy the entitlements of today. They are unsustainable, as we all know, and that is because they at their core are not consistent with a free people.
So we need to focus on near-term alternatives, like Congressman Ryan’s, and at the same time wage a long-term education and marketing campaign so that people begin to accept the idea that health care is not essentially the province of the government.
7 sinz54 // Jul 23, 2009 at 8:00 pm
Jim Pier: After Gingrich’s Republicans took over Congress in 1994, the GOP had a megaphone for whatever they wanted to do. But health care reform wasn’t on the list. Throughout his tenure as House Speaker, Gingrich did nothing with the issue.
In 2001, McCain and Ted Kennedy co-sponsored “Patient’s Bill of Rights” legislation. It contained some modest reforms. The GOP-led Senate made sure it never made it to the floor for a vote.
I’ve already explained 10,000 times already that the free market won’t help those with pre-existing conditions; it won’t help those who are too poor to afford insurance; and competition has done nothing to reduce skyrocketing costs. Left to its own devices, we’ve been stuck with the same health care system since the 1940s.
Since you don’t want any government initiatives except to make it harder to bring malpractice lawsuits, I can only conclude that you like the health care system just the way it is (modulo tort reform).
I don’t.
8 MacandCheese // Jul 23, 2009 at 8:04 pm
Midcon,
As someone with several family members who are doctors and one who is an ENT surgeon (who took particular umbrage with Obama’s suggestion that tonsilectomies are often done rather than diagnosing a patient’s symptoms as simply allergies for the sake of profits), I think I can say that the cost of medical school, residency and fellowships has little to do with the overall cost of healthcare.
The doctors who I know do sometimes admittedly order more tests than what they might otherwise be inclined to order for the purpose of diagnosing or treating maladies, conditions or diseases. When asked why they do so — even for cases in which they are confident of the correct diagnosis and treatment — they will tell you that it is because of the ever lingering threat of malpractice lawsuits hanging over them. And so they insulate themselves as best as they can from such claims by taking all commonly expected and necessary precautions as well as some extraordinary precautions which unfortunately drive the costs up for everybody.
Therefore, major tort reform — disallowing certain types of litigation or at the least capping fees that lawyers can take to cost plus 3%-5% (instead of the cost plus 40% most take now), would lower the costs of healthcare from two directions: 1) doctors would not order as many tests or treatment procedures as they do now and 2) the cost of their malpractice insurance coverage would decrease and thus make the direct costs of hospital care and private practitioners more affordable. Those costs would presumably be passed along to the consumers.
There are obviously many other ways to bring the costs of healthcare down, but tort reform SHOULD be a part of any proposed policy and changes. Unfortunately the plaintiff bar is a very powerful lobby and will not allow the Democrats to include this in any legislation.
That said, Republicans should make an issue out of it if for no other reason than to act as a counter balance to the specious argument that doctors and hospitals conduct unnecessary tests and procedures for the sake of profit — an argument Obama advances regularly and even did so again yesterday evening.
9 sinz54 // Jul 23, 2009 at 8:25 pm
macandcheese: There’s no evidence that malpractice is the largest, or even one of the largest, drivers of health care costs.
Far more important drivers have been identified:
– The aging of the population, while the retirement age (at which you qualify for Medicare) hasn’t been adjusted upward in 70 years.
– The recent loosening of managed care constraints. (For a while in the late 1980s and early 1990s, HMOs were controlling costs through capitation fees and strict requirements for specialist referrals. Then the public revolted, the insurance companies relented, and health care costs started rising again.)
– The latest and most expensive new technologies. No patient is going to reject a treatment simply because it costs too much: “Oh, that treatment is too expensive. Just let me die instead.” Hence whatever treatments can improve the quality of life, and extend lifespan, are demanded as soon as they reach FDA approval.
This last point illustrates how health care represents a market failure: If we assume that a human life is infinitely precious, then there can be no cost constraints on saving that life. Hence the supply and demand curves for new technologies don’t intersect at a point that society can reasonably afford.
This is all more complex than just waving “Tort Reform” as a slogan for political spin purposes. But New Majority isn’t a blog for bumper-sticker sloganeering and canned talking-points. It’s a blog for real answers and real ideas. That was why I joined it.
10 MacandCheese // Jul 24, 2009 at 1:26 am
sinz54 — Charles Krauthamer agrees with me: http://www.realclearpolitics.com/articles/2009/07/24/why_obamacare_is_sinking_97598.html
Would you suggest that he is a bumper sticker sloganeering ideologue?
11 MacandCheese // Jul 24, 2009 at 2:05 am
By the way sinz54, I didn’t notice any “real answers” or “real ideas” in your posts above. Just assertions and some sloppy and frankly, snippy accusations.
If you do have some “real answers” to lowering health care costs, please do edify us.
12 ottovbvs // Jul 24, 2009 at 7:59 am
franco-2 // Jul 23, 2009 at 5:37 pm
“Interesting. No mention of tort reform, the single biggest factor in heath care costs. Frum is not very thorough in his analysis.”
……..I’m afraid it’s Franco who is not very thorough in his analysis …….the total annnual value of malpractice insurance premiums and settlements is around 1% of total annual healthcare expenditures totalling $2.4 trillion…….the single biggest factor in healthcare costs?…….not really
13 ottovbvs // Jul 24, 2009 at 8:01 am
midcon // Jul 23, 2009 at 7:03 pm
” I am sure it is an extremely large factor and yet, as you pointed out there is absolute silence on the topic. ”
………Sorry 1%
14 ottovbvs // Jul 24, 2009 at 8:05 am
Jim Pier // Jul 23, 2009 at 7:33 pm
“Trial Lawyers a much better lobby than we realize? Owning the Democratic Party isn’t enough?”
………It’s 1% but the fact that those atipathetic to healthcare reform are still throwing this chestnut around show just how much they know about it……1% of $2.4 trillion is a lot of dough but it’s not material
15 ottovbvs // Jul 24, 2009 at 8:12 am
macandcheese // Jul 23, 2009 at 8:04 pm
“That said, Republicans should make an issue out of it if for no other reason than to act as a counter balance to the specious argument that doctors and hospitals conduct unnecessary tests and procedures for the sake of profit — an argument Obama advances regularly and even did so again yesterday evening.”
…………The reason it’s not really any longer in the Republicans list of talking points, it was there constantly a few years ago, is that the speciousness of the argument has been revealed………and actually there have been a mountain of studies conducted to show hospitals and doctors over test, etc in pursuit of profit…….its why some medical district out in the boondocks in Texas is the most expensive medical district in the country having expenditures that are three times per capita of those incurred in the district in which the Mayo clinic sits.
16 ottovbvs // Jul 24, 2009 at 8:17 am
macandcheese // Jul 24, 2009 at 2:05 am
“If you do have some “real answers” to lowering health care costs, please do edify us.”
………At least Sinz is correctly identifying some of the problems you’re not even doing that
“sinz54 — Charles Krauthamer agrees with me:
Would you suggest that he is a bumper sticker sloganeering ideologue?”
………..Charles Krauthammer a sloganeering idealogue……..who could possibly think such a thing….outrageous
17 barker13 // Jul 24, 2009 at 8:47 am
Re: Franco-2 // Jul 23, 2009 at 5:37 pm –
Good point. (But echoing Mid… “…SINGLE BIGGEST FACTOR…???” Can you provide some authoritative backup for this claim…???)
I actually had my yearly physical yesterday and my doc and I got to talking about tort reform. I was telling him what I pay for health insurance and he told me that he pays more – about $1,500/mo. I quipped that his malpractice insurance must dwarf that and he surprised me by saying no, though at approximately $1,800/mo. his malpractice premiums are greater than his personal health insurance premiums.
But he’s a GP. Surgeons… specialists… they’re the one paying the big bucks. There’s no doubt we need tort reform and there’s no doubt Obama and the Dems broadly oppose tort reform. (*SHRUG*)
Re: Midcon // Jul 23, 2009 at 7:03 pm –
“Also, I wonder how much a factor the cost of medical school (and the several years of relatively low pay in interning and residency) is in the overall health care equation?”
HUGE!
Re: Sinz54 // Jul 23, 2009 at 8:00 pm –
“In 2001, McCain and Ted Kennedy co-sponsored “Patient’s Bill of Rights” legislation. It contained some modest reforms.”
Such as…??? (Specifics, Sinz… specifics…)
Re: Macandcheese // Jul 23, 2009 at 8:04 pm –
“…Obama’s suggestion that tonsillectomies are often done rather than diagnosing a patient’s symptoms as simply allergies for the sake of profits…”
(*ROLLING MY EYES*)
Folks… keep an open mind… consider the above remark and then contemplate Obama’s “stupidity of the Cambridge Police” blunder…
Could it be that Obama is just… er… stupid?
I mean seriously… forget Palin… forget Biden… in one single speech Obama opened himself up to ridicule (and worse!) TWICE.
(*SHRUG*)
Re: Macandcheese // Jul 24, 2009 at 1:26 am –
I enjoy and respect Krauthamer, but Richard Epstein is the guy I’d quote:
http://online.wsj.com/article/SB124631652544770707.html
(*WINK*)
According to Epstein…
“The U.S. cannot ignore serious reform. To be sure, medical malpractice premiums constitute well under 1% of the total U.S. health-care bill. But defensive medicine adds perhaps as much as 10%. High malpractice costs can shut down clinics that serve vulnerable populations, leading to more patient harm than the occasional case of malpractice.”
(And, bottom line… whatever a doc pays in malpractice insurance – be it $1,800/mo. or $18,000/mo., these COSTS get passed on.) (*SHRUG*)
BILL
18 ottovbvs // Jul 24, 2009 at 9:48 am
“To be sure, medical malpractice premiums constitute well under 1% of the total U.S. health-care bill. But defensive medicine adds perhaps as much as 10%”
……Ok insurance is 1% or less………….”Defensive medicine” is actually highly profitable for doctors so maybe, just maybe, it’s actually an alibi ……..another little dirty secret many perhaps don’t know is that a large percentage of doctors, probably at least a third, actually own the insurance company that provides their malpractice insurance……and no I don’t mean they have stock in Aetna……..many doctors have formed coop companies to self insure…..they then pay this company the premiums, the company lays off the risk with a reinsurer like General Re, and generally makes a modest profit which is then fed back to doctor shareholders………sometimes the profits are not so modest
19 sinz54 // Jul 24, 2009 at 11:20 am
barker13 and ottovbvs: There’s another whole component to “defensive medicine” besides malpractice, and that is: the Not Invented Here syndrome.
I had a medical test done by one hospital, and then a week later I went to see another specialist at a different hospital. He insisted on doing the exact same medical test all over again for his own edification. I even offered to get the results of the medical test from the first hospital myself, and hand-carry them to the second hospital. No dice. They did the same test again, doubling the price. Even though the levels of most blood chemistries don’t change significantly in just a week (barring some major trauma like an auto accident).
Nurses frequently complain about the waste in supplies. They order a box of bandages for one patient, each bandage individually wrapped for sterility. Then, when they need bandages for another patient, they have to order an entire new box. They’re not allowed to take bandages from one patient’s box and use them on a second patient, even though they’re perfectly sterile. Does the hospital think that the first box is cursed by the first patient’s psychic aura or something?
20 ottovbvs // Jul 24, 2009 at 12:10 pm
sinz54 // Jul 24, 2009 at 11:20 am
“barker13 and ottovbvs: There’s another whole component to “defensive medicine” besides malpractice, and that is: the Not Invented Here syndrome.”
…………What you say may be true but to honest I’ve never seen this happen in the two states where I’ve had surgical procedures…….Even if I accepted that 10% figure which I don’t and Epstein has no real data to substantiate the claim beccause he basically made it up……..a moments reflection would tell you that it’s nonsense…….Consider, if I waved a wand and banned all malpractice suits tomorrow would 10% of so called “defensive medicine ” disappear next day……or how about the next year…….because if were talking about 10%…… that’s 10% of total expenditures of $2.4 trillion which is $240 billion dollars worth of medical activity and cost (better known as revenue) which would disappear from the system pouf!………It’s nonsense……these sort of storylines are concocted for people like Barking, who are basically economically illiterate and have low numeracy and analytical skills, so they can parrot them at venues like this or in a bar somewhere.
21 ottovbvs // Jul 24, 2009 at 12:19 pm
sinz54 // Jul 24, 2009 at 11:20 am
“I had a medical test done by one hospital, and then a week later I went to see another specialist at a different hospital. He insisted on doing the exact same medical test all over again for his own edification. I even offered to get the results of the medical test from the first hospital myself, and hand-carry them to the second hospital. No dice. They did the same test again, doubling the price. Even though the levels of most blood chemistries don’t change significantly in just a week (barring some major trauma like an auto accident).”
……….Precisely the point being made by the president the other night……..these guys are not the lady with the lamp……they are running businesses…….tests and un needed procedures are revenue….every six months I get my teeth cleaned and the dentist want me to have xrays…….every 18 months is fine…..but I’m sure most people say oh yes oh yes
22 barker13 // Jul 24, 2009 at 1:00 pm
Re: sinz54 // Jul 24, 2009 at 11:20 am –
“There’s another whole component to “defensive medicine” besides malpractice, and that is: the Not Invented Here syndrome.”
OK. (*SHRUG*) I buy that. It’s human nature, Sinz. I’m not saying we should “fight” such thinking at times – and we do, with “best practices” and ISO standards and such – but bottom line, sure, I acknowledge the reality you point to. So…???
“They did the same test again…”
And I believe there should be procedures in place so that at the very least the “second doctor” would have to justify his re-ordering of the test and if he couldn’t do so “according to the book” than he’d have to “eat” the cost.
“Nurses frequently complain about the waste in supplies. They order a box of bandages for one patient, each bandage individually wrapped for sterility. Then, when they need bandages for another patient, they have to order an entire new box. They’re not allowed to take bandages from one patient’s box and use them on a second patient, even though they’re perfectly sterile. Does the hospital think that the first box is cursed by the first patient’s psychic aura or something?”
Are you expecting me to defend such asinine practices? I mean… what’s your point? If your point is that such practices are wasteful and asinine… yeah…. we’re in agreement.
(*SHRUG*)
BILL
23 Spartacus // Jul 24, 2009 at 1:52 pm
Tort reform is not a significant driver of healthcare costs. If tort litigation is such a significant factor in driving up healthcare costs, why do healthcare costs in states that have enacted tort reform continue to rise at a rate that is as high (and sometimes higher) than those states that have not enacted tort reform?
24 MacandCheese // Jul 24, 2009 at 2:39 pm
Ottovbvs — I didn’t realize that sinz54 needed someone to defend him. He seemed quite capable of taking snarky little shots at other people’s postings but if he’s so delicate he cannot defend his own accusations and you feel a compulsion to stand in for him, then perhaps he shouldn’t be posting.
If he admonishes others by inference for not offering “real answers” and “real ideas” but has offered none himself, then his analysis or his “…correctly identifying some of the problems…” as you stated, is moot in that discussion.
Now onto your rather impolite assertions about my postings — I never said that tort reform was the biggest cost associated with health care but it is an issue and a political tool which can and should be brandished if for no other purpose than to countermand the democratic argument that doctors routinely perform unnecessary procedures like removing tonsils for no reason other than to collect fees; as Obama suggested.
Obama and the democrats are in the recent habit of demonizing for political gain, professions and professionals within a field in a very broad and generalized manner, as a means of generating public anger to help move policy forward. What they did to everyone who worked on Wall Street, what they did to the auto manufacturers, what they did to energy producers and now what they are doing to the health care workers and specifically doctors, was and is disgraceful. Making an issue of tort reform now and the relationship between the plaintiff bar and the cost of health care is, as I stated from the beginning, a strategic suggestion not a solution to the costs of health care.
But you and sinz54 seem to be somewhat oblivious to the nuances and opinions of other people’s posts which suggests to me that you may not be quite as clever as you think. You are certainly not as polite as perhaps you should be.
25 barker13 // Jul 24, 2009 at 3:06 pm
Re: Spartacus // Jul 24, 2009 at 1:52 pm –
“Tort reform is not a significant driver of healthcare costs.”
Well… let’s be specific about what you mean by “significant.”
Do you accept or reject Epstein’s contention that “medical malpractice premiums constitute well under 1% of the total U.S. health-care bill, but defensive medicine adds perhaps as much as 10%?”
If you reject it do you have any data to point to? If you accept it are you saying that defensive medicine adding perhaps 10% to national medical costs is insignificant?
Do you dispute Epstein’s contention that “high malpractice costs can shut down clinics that serve vulnerable populations, leading to more patient harm than the occasional case of malpractice?”
(Just trying to get us on the same page as far as understanding each other’s views, Spart.)
“If tort litigation is such a significant factor in driving up healthcare costs, why do healthcare costs in states that have enacted tort reform continue to rise at a rate that is as high (and sometimes higher) than those states that have not enacted tort reform?”
Now THAT’S a damn fine question! (*THUMBS UP*)
I can come up with a few theories off the top of my head (as I’m sure you could, Sparky), but the point is, what does the authoritative research show? I’d sure as heck like to know.
BILL
26 Spartacus // Jul 24, 2009 at 3:32 pm
barker13 // Jul 24, 2009 at 3:06 pm wrote: “Do you accept or reject Epstein’s contention that “medical malpractice premiums constitute well under 1% of the total U.S. health-care bill, but defensive medicine adds perhaps as much as 10%?”
I don’t have any basis for agreeing or disagreeing with Epstein. However Epstein’s premise, which is if you implement caps on medical malpractice awards you will reduce the practice of defensive medicine, is highly doubtful and he did not produce any evidence to support it. California has had caps on med malpractice awards for many years and it has not slowed the rate of growth for healthcare costs. And, as I said in my initial post, the rates of growth in costs for states with tort reform is comparable (sometimes higher) than those without tort reform. That is what I meant by “not significant” (i.e. it does not produce a measurable benefit when compared to states without reform).
Intuitively, I would guess that most defensive medicine is the result of consumer demand and increased technology/new drugs. Most people are probably inclined to believe that the newest drug/technology is the best and it will better detect or treat the problem. As a consequence, both doctors and patients are probably inclined to order these new treatments, which are probably much more expensive than the older treatments.
Another reason I doubt the efficacy of tort reform in constraining costs is that you if pay attention to the debate about reform you simply don’t hear the stakeholder (doctors, hospitals, insurers, drug companies, etc.) clamoring for tort reform. Whereas, years ago before many states implemented tort reform, many stakeholders argued for, and received, med mal caps. It probably helped lower legal costs at the time, but I doubt it changed the way medicine is practiced. Are doctors in states without tort reform really practicing medicine differently (i.e., less defensively) than doctors in states with tort reform? I doubt it. I suspect most doctors in all states do what they think the prevailing research warrants irrespective of whether or not they live in a tort reform state.
27 barker13 // Jul 24, 2009 at 5:56 pm
“…Epstein’s premise, which is if you implement caps on medical malpractice awards you will reduce the practice of defensive medicine, is highly doubtful…”
Hmm. Perhaps. Setting that aside, *my* premise is that malpractice insurance premiums are an expense passed ultimately to patients and thus a factor in the cost of medical care. Agreed?
“California has had caps on med malpractice awards for many years and it has not slowed the rate of growth for healthcare costs.”
The growth could be coming from other expenses that are “unique” to California. (In other words, perhaps the caps actually HAVE slowed what would otherwise be the rate of growth in healthcare costs, only this savings has been canceled out by comparatively faster growth in other California cost factors?) (*SHRUG*)
“…as I said in my initial post, the rates of growth in costs for states with tort reform is comparable (sometimes higher) than those without tort reform.”
I’d like to look over the data for myself. Would you be so kind as to provide a link? Thanks!
“Intuitively, I would guess that most defensive medicine is the result of consumer demand and increased technology/new drugs.”
And I wouldn’t disagree. But this brings us back to the disconnect between what individuals demand and what individuals are willing to pay for and how our present system of “extended warranty type service” with deductibles and second/third party billing artificially creates demand – or… at the very least… creates less incentive for patients themselves to want to look at medical expenses as they do other expenses, cost/benefit wise that is.
“Another reason I doubt the efficacy of tort reform in constraining costs is that you if pay attention to the debate about reform you simply don’t hear the stakeholder (doctors, hospitals, insurers, drug companies, etc.) clamoring for tort reform.”
I hear it. (*SMILE*) Shall I send you links…???
“Are doctors in states without tort reform really practicing medicine differently (i.e., less defensively) than doctors in states with tort reform? I doubt it.”
I don’t know. And I freely stipulate, I certainly don’t think you’re irrational to doubt it. It’s a fair question, one I’d like to know the answer to.
BILL
28 ottovbvs // Jul 24, 2009 at 6:51 pm
macandcheese // Jul 24, 2009 at 2:39 pm
“Now onto your rather impolite assertions about my postings — I never said that tort reform was the biggest cost associated with health care but it is an issue and a political tool which can and should be brandished if for no other purpose than to countermand the democratic argument that doctors routinely perform unnecessary procedures like removing tonsils for no reason other than to collect fees; as Obama suggested.”
……………It’s a totally unimportant issue but by all means hang your case on it if you want to it just makes it more easy to dismiss which is why it’s disappeared from the Republican talking point list ……..and that doctors perform unneeded tests and procedures to produce revenue was I would have thought was one of the worst kept secrets in medicine……Sinz actually provided a personal example ……some like Barker or at least his source say it’s defensive medicine and amounts to 10% of total expenditures…..that’s almost 2% of GDP if you believe him…….Why else would some med district in the boondocks of Texas be spending three times what they are spending in the Mayo clinic district
…………As for the your suggestions the Obama admin demonized Wall Street……you don’t think that had happened before he was even elected…….Clearly you think the entire healthcare industry, the financial industry and the energy industry are paragons of virtue……they’re not……and basically the Obama admin has rescued the auto industry and wall street and the AMA and nurses organizations have endorsed some of bills coming out of congress so I’m not sure where you’re coming from with this one…..bash Obama with a political tool let’s not worry about the facts I guess
“But you and sinz54 seem to be somewhat oblivious to the nuances and opinions of other people’s posts which suggests to me that you may not be quite as clever as you think. You are certainly not as polite as perhaps you should be”
…………given the nature of your posts you don’t really need to be very clever (which I’m not) to figure them out……Personally I’m somewhat addicted to fact based analysis……if you wish to advance weak propositions you must expect to see them questioned
29 Spartacus // Jul 24, 2009 at 8:21 pm
barker13 // Jul 24, 2009 at 5:56 pm
Medical malpractic premiums are certainly a cost component that gets passed on to the payer along with all other cost components. So, yeah, if you slow the growth in med mal premiums you will slow the growth in healthcare costs, but that’s also true for pencils, office furniture and iodine. The issue is whether med mal premiums are growing faster than inflation as is the case with healthcare costs. The links below suggests that (1) tort reform did, for a time at least, slow the growth in med mal premiums, and (2) med mal premiums did not grow as fast as inflation, in fact for a period of time med mal premiums actually went down and healthcare costs continued to rise.
http://www.gao.gov/new.items/d04128t.pdf
http://www.insurance-reform.org/StableLosses2007.pdf
I’m not opposed to med mal caps as a part of healthcare reform. I simply opposed to the red herring of tort reform as a significant component to controlling healthcare costs because (1) premiums are only 1%, (2) healthcare costs have risen even during periods of time that med mal premiums have gone down, and (3) there’s no evidence that it leads to less defensive medicine.
I’m still looking for a link about the growth in healthcare expenditures in states with tort reform vs. states without it. I heard that a conference so I don’t have written substantiation.
30 sdspringy // Jul 24, 2009 at 9:37 pm
Sinz54:…
– The latest and most expensive new technologies. No patient is going to reject a treatment simply because it costs too much: “Oh, that treatment is too expensive. Just let me die instead.” Hence whatever treatments can improve the quality of life, and extend lifespan, are demanded as soon as they reach FDA approval.
This last point illustrates how health care represents a market failure: If we assume that a human life is infinitely precious, then there can be no cost constraints on saving that life. Hence the supply and demand curves for new technologies don’t intersect at a point that society can reasonably afford.
Isn’t this the dirty little secret of healthcare reform. The government determining which life saving mearsures will be allowed. How else, or where else are all those Medicare saving going to be realized.
The other dirty little secret is once the government runs your health care, don’t they also run your life. Do they not then dictate which life styles, ie.. smoking, drinking, drive thrus, BFI, (body fat index) is appropriate.
The reason the USA spends more than anyother country on healthcare is because we can and we want to. Same with cars and the nunber of miles driven by US citizens is greater than anywhere else. You may think that is selfish and that I should not have that, dare I say, freedom.
But that is my personnal responsibility to determine where and how my money is spent. Now some people say other people cannot afford healthcare. That is not necessarily true. They can always get some sort of healthcare policy. May not be the same as the guy across the street but no where in this country is he denied the opportunity to improve that condition.
If government run healthcare becomes a reality, nobody will have the freedom to make those decisions.
31 Spartacus // Jul 25, 2009 at 7:21 pm
sdspringy // Jul 24, 2009 at 9:37 pm wrote: “Now some people say other people cannot afford healthcare. That is not necessarily true. They can always get some sort of healthcare policy.”
Apparently, you’re not very familiar with the way healthcare works in this country. Many people cannot get insurance no matter how much they’re willing to pay. If you are sufficiently sick, no insurer will offer you insurance because the amount of care you will require will cost way more than the insurer could ever collect from in in the form of insurance premiums.
You also wrote: “Isn’t this the dirty little secret of healthcare reform. The government determining which life saving mearsures will be allowed.”
You’re right about this, but your question implies that currently the patient or doctor determine what life saving measures will be allowed. That, however, is not the way things are. Currently, the insurer (not the patient or the doctor) determine what measures are allowed. So the question is, is it better to have a profit-motivated insurance executive or a bureaucrat at a Federal Reserve-type agency make that determination? They both have potential incentives for making decisions that may conflict with the wishes of either the doctor or the patient. Equally important, should the patient or the doctor be able to force either the insurer or the government to pay for a treatment for which there is no evidence it will be effective? No health insurance policy requires an insurer to do this.
You wrote: “The reason the USA spends more than anyother country on healthcare is because we can and we want to. ”
Well, you’re only half right. We certainly want to spend all the money we spend, but we certainly can’t afford to, which is why so many companies are dropping coverage for their employees and it’s also one of the biggest reasons why the U.S. has such a large budget deficit.
32 sdspringy // Jul 25, 2009 at 9:49 pm
Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.
Health insurance covers the majority of cancer treatments, transplants, and other wide range of procedures. The possibility of lack of coverage however does not prevent the patient for seeking treatment through other financial means. The question about government run healthcare is, even if the medical procedure is covered will individuals be denied access. Being deemed not appropriate because of the patients age.
And the US budget deficit has absolutely nothing to do with healthcare. Unless you are willing to blame Medicare and Medicad. Which should enlighten those who think a government provided healthcare can reduce cost.
33 ottovbvs // Jul 26, 2009 at 10:49 am
sdspringy // Jul 25, 2009 at 9:49 pm
“Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
…………..I’m unfamiliar with HIPPAA perhaps you’d like to tell us what it is……….but the notion that it’s possible for someone with a pre-existing condition to obtain health insurance at an economic prices indicates that your either totally ignorant of reality or spinning…….as for this statement:
” The possibility of lack of coverage however does not prevent the patient for seeking treatment through other financial means. ”
……….Perhaps you’d like to tell us what those are exactly
34 ottovbvs // Jul 26, 2009 at 11:03 am
sdspringy // Jul 25, 2009 at 9:49 pm
……….Just for kicks I went to one of these legal forum websites where people can ask for advice when they can’t get coverage for pre-existing conditions………follow this link to learn what a minor problem it is:
http://www.expertlaw.com/forums/showthread.php?t=13173
…….btw reading this jogged my memory on what HIPPAA is……..it’s the legislation Clinton passed in the mid 90’s to tidy up the state and fed law on job changes etc…..to be honest I didn’t know it was called HIPPAA
35 barker13 // Jul 26, 2009 at 11:29 am
Re: Spartacus // Jul 24, 2009 at 8:21 pm –
“…if you slow the growth in med mal premiums…”
I don’t want to just “slow the growth;” I want to reverse the trend. That’s why I favor tort reform.
“I’m not opposed to med mal caps as a part of healthcare reform.”
(*HANDSHAKE*)
Re: Sdspringy // Jul 24, 2009 at 9:37 pm –
“If we assume that a human life is infinitely precious, then there can be no cost constraints on saving that life.”
Exactly.
Re: Sdspringy // Jul 25, 2009 at 9:49 pm –
“The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
And the Springster hits one out of the park!
(*THE CROWD GOES WILD*)
Anyway…
ONE
MORE
TIME
What we need is affordable catastrophic care insurance coupled with affordable regular healthcare accessibility.
The FORMER is an INSURANCE issue.
The LATTER is more about “re-educating” the American People to accept the reality that government policies from the ’40’s (WW-2 wage/price controls and using health benefits as a tax free carrot) are what got us in to this mess in the first place.
No matter how many multiple threads – one after another… day in, day out… week by week, month by month – Frum and his “contributor’s throw on this site and no matter how many (literally!) thousands upon thousands of reply posts we post in response, it really does come down to that.
BILL
36 ottovbvs // Jul 26, 2009 at 12:26 pm
barker13 // Jul 26, 2009 at 11:29 am
“I don’t want to just “slow the growth;” I want to reverse the trend. That’s why I favor tort reform”
……..The innumerate rambles on…….total malpractice premiums and payouts are 1% or less of total healthcare costs…….if half of it disappeared tomorrow it wouldn’t make a dimes worth of difference to slowing growth let alone reversing the trend……….. Duh!
37 sdspringy // Jul 26, 2009 at 7:39 pm
Otto:
There exist many links explaining HIPAA and the insurance reform for preexisting conditions. Just do alittle reading.
As always this debate will evolve into who will take care of me. And of course someone else is supposed to pay for it.
Insurance is always available, you may not like the cost of the premium, but that is usually directly proportional to the cost of care you want. Which is why any reference to Medicare or Medicad should point out that they are budget busters. Huge expenses, and nobody want to pay for them. You will not be able to tax the upper 5% to cover the cost of healthcare for the remaining 95%.
38 Spartacus // Jul 26, 2009 at 9:41 pm
sdspringy // Jul 25, 2009 at 9:49 pm wrote: “Spartacus, you have some misconceptions. The 1996 HIPPAA prevents the denial of coverage based on preexisting condition.”
Thanks for the response, but you are very, very wrong. Most states in the East do not allow insurers to deny coverage based on preexisting conditions; most states in the West and elsewhere. Please see the link below for indisputable proof that California, the largest insurance market in the country, permits insurers to deny coverage based on preexisting conditions.
http://www.insurance.ca.gov/0100-consumers/0070-health-issues/ind-health-insurance-underwriting-ab-356.cfm
I hope this does not sound offensive, I truly do not intend it to be, but does the fact that you’re very wrong about an extremely basic concept in health insurance cause to consider that you probably don’t really know much about problems in the healthcare market and, therefore, you probably should not form any firm opinions one way or another until you learn a little bit more? Also, would this fact not strongly suggest that when in the process of learning more, you should probably pay more attention to those who’ve been right more often than those who’ve been wrong more often?
39 Spartacus // Jul 26, 2009 at 9:43 pm
Sdspringy, I just noticed I failed to complete the first sentence in the 2nd paragraph of my post. I meant to say that most states in the West and elsewhere do permit insurers to deny coverage for preexisting conditions.
40 barker13 // Jul 26, 2009 at 10:09 pm
Re: Spartacus // Jul 26, 2009 at 9:41 pm –
Hmm… (*NOD*)
OK. I started out by following your link. According to your link… you’re right! No doubt about it! Call me Obama for automatically taking Sdspringy’s assertion regarding HIPPAA as gospel.
My bad…!
But then I turned to researching HIPPAA.
Now THIS is weird – and I’m guessing it’s not the only disconnect I’d find if I were to go looking:
From YOUR link:
http://www.insurance.ca.gov/0100-consumers/0070-health-issues/ind-health-insurance-underwriting-ab-356.cfm
“What health conditions will cause a health insurance company to automatically refuse or deny my application for insurance?”
Among the MANY conditions listed… they specifically include “Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;”
Now… contrast this with:
http://library.findlaw.com/1999/Jun/1/127540.html
From paragraph #4 –
“Another significant feature of HIPAA is the fact that it prevents pregnancy from being treated as a pre-existing condition. Pre-existing condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous coverage. Additionally, a pre-existing condition exclusion cannot be applied to a newborn, adopted child under age 18 or a child under 18 placed for adoption, as long as the child became covered under the health plan within 30 days of birth, adoption or placement for adoption, and provided the child does not incur a subsequent 63-day break in coverage.”
Weird, huh….???
BILL
41 Spartacus // Jul 27, 2009 at 7:37 pm
barker13 // Jul 26, 2009 at 10:09 pm
I’m guessing that when Congress enacted HIPAA it wanted to specifically address the issue of pregnancy as a preexisting condition. As you probably remember from your high school civics course (assuming high school had been invented by the time you were a teenager:)), Congress has the power to preempt state legislation. Maybe HIPAA preempts state rules regarding the classification of pregnancy as a preexisting conditions.
42 barker13 // Jul 28, 2009 at 9:26 am
Re: Spartacus // Jul 27, 2009 at 7:37 pm –
“Maybe…”
“Maybe…???” What are you – the POTUS? (*GIGGLE*) A congressmen or Senator? (*SMIRK*)
“Maybe” doesn’t do us much good, Spart. (*WINK*)
Oh… and speaking of what I remember… I seem to remember some sort of technology which allows revision of… oh… laws and such… when certain sections no longer apply.
(*GRIN*)
BILL
43 becks71 // Aug 10, 2009 at 5:55 pm
Reversal of Republican Values?
“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. This is not a way of life at all in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. ”
Dwight D. Eisenhower, April 16, 1954
Yet we can afford to be the policemen for the world and support dictators and despots. We can triple earmarks for unneeded projects. We can do all those things but cannot afford health care reform? I have the answer and its not Republican.
Or is it not invented here syndrome ?
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