Our Chinese Water Torture

[Wneglia]

So Super-S - Are there any other factors affecting the cost of healthcare and healthcare insurance other than "Obamacare"? If so, what might those factors be?

Just for one, defensive medical measures to prevent malpractice lawsuits.

Obamacare does this.

Under the old system, when an American doctor makes a mistake, he can render a patient uninsurable for life. The NEXT medical problem the patient encounters could send him and his family to the poor house. So, the settlement must cover not only fixing the mistake, but future health care costs too.

Under the Canadian public system, not only is fixing the doctor's mistake covered, but the patient will never be denied coverage because of it. This is why medical lawsuits in Canada are much smaller, and doctors' malpractice insurance costs much less.

Under Obamacare the victim of a doctor's mistake - like everyone else - is covered regardless of preexisting conditions (excluding tobacco use). The doctor's mistake won't render them uninsurable.

Malpractice insurance premiums in Canada are lower than those in the United States for the following three major reasons:

•The courts in Canada have set caps on medical liability awards.
•Existing Canadian laws set a high hurdle for proving medical liability.
•The CMPA (Canadian Medical Protective Association) is notorious for vigorously defending any and all medical liability suits.
Additionally, in Canada, the losing party pays approximately two-thirds of the winner’s costs. This is a significant disincentive for bringing a medical liability suit.

The Canadian Supreme Court has established guidelines for noneconomic awards at a maximum of roughly $300,000, and the types of cases in which noneconomic awards can be made is limited. Although the number of medical liability cases in Canada has risen steadily in the past decade, the bar to prove malpractice remains high. In order to sue, the plaintiff must prove that the physician not only caused injury, but also violated a duty of care. Errors in judgment are generally not causes for lawsuit.

[rstrong]

Those caps are so low because higher amounts are not needed.

In the decade before ObamaCare, the average cost of family health insurance rose by 131% to $13,375. It was expected to rise a further 166 percent over the next decade, to $28,530 per employee. (citation) If a doctor's mistake renders someone uninsurable, then insuring them for the rest of their life starts to cost far more than fixing the mistake.

In Canada, fixing the mistake and insuring the victim for the rest of their life is already covered.

[Wneglia]

Those caps are so low because higher amounts are not needed.

In the decade before ObamaCare, the average cost of family health insurance rose by 131% to $13,375. It was expected to rise a further 166 percent over the next decade, to $28,530 per employee. (citation) If a doctor's mistake renders someone uninsurable, then insuring them for the rest of their life starts to cost far more than fixing the mistake.

In Canada, fixing the mistake and insuring the victim for the rest of their life is already covered.

The rise in health insurance premiums in US slowed dramatically before Obamacare

[rstrong]

The rise in health insurance premiums in US slowed dramatically before Obamacare

er, Doesn't that story show the rise slowing dramatically **after** Obamacare?

[O Really]

Hey, Doc - defendants win 80% of malpractice suits - higher than any other type of action. Isn't that a high enough bar for you?

Averages can be misleading, but can show some perspective: Average salary for physicians range from just under $200,000 for family practice and some pediatric people to over $600,000 for spinal orthopedic surgeons. "General Surgery" is about $350,000. Then, looking at malpractice rates, which also vary significantly by specialty and from state to state, and again using averages, malpractice insurance for a General Surgeon could range from around $28,000 to $50,000. So, still recognizing there are individual and state differences that vary widely, if we take the average salary for a General Surgeon, and the top of the average range of malpractice insurance, we get 14.3% if the doctor was actually paying for the insurance out of his/her salary, which of course s/he isn't. Now just for fun, let's compare that to a guy earning $50,000 and paying half his family medical insurance (in an employer-sponsored plan). That's about 15% of his gross earnings. I'm sure you'll excuse me for not joining in the gnashing of teeth.

[Wneglia]

The rise in health insurance premiums in US slowed dramatically before Obamacare

er, Doesn't that story show the rise slowing dramatically **after** Obamacare?

Most feel that Obamacare had minimal impact on slowing the rise of premiums last year, and this coming year, as the major provisions don't even kick in until 2014. Covering kids up to 26 under their parents plans did not account for the slowdown.

[Supsalemgr]

I love my job and it's an honor to do it. I would do it for less as part of comprehensive cost cutting beginning with ending the 25-30% nonproductive suck from insurers like Supsalemgr.

I know you're approaching retirement Wneglia so it's a moot point, but would a younger you have done your job for less in the interests of the country and your patients?

As I have posted in the past. No one is holding a gun to Vrede's head to maintain any insurance but auto liability insurance in NC. Feel free to drop all other. Then people in my industry won't be ripping him off.

[Wneglia]

I love my job and it's an honor to do it. I would do it for less as part of comprehensive cost cutting beginning with ending the 25-30% nonproductive suck from insurers like Supsalemgr.

I know you're approaching retirement Wneglia so it's a moot point, but would a younger you have done your job for less in the interests of the country and your patients?

I would have done the same for less, as well, and I have given away millions in free health care to indigents over the years, as have my other partners.

[Supsalemgr]

Hey, Doc - defendants win 80% of malpractice suits - higher than any other type of action. Isn't that a high enough bar for you?

Which proves most malpractice lawsuits are "fishing" expeditions. The dirty little secret is the insurance companies have to pay the legal costs for the defense when they win that 80%. Now, if the losers in these cases had some responsibility for costs if they lose we would not have as many frivolous lawsuits.

Averages can be misleading, but can show some perspective: Average salary for physicians range from just under $200,000 for family practice and some pediatric people to over $600,000 for spinal orthopedic surgeons. "General Surgery" is about $350,000. Then, looking at malpractice rates, which also vary significantly by specialty and from state to state, and again using averages, malpractice insurance for a General Surgeon could range from around $28,000 to $50,000. So, still recognizing there are individual and state differences that vary widely, if we take the average salary for a General Surgeon, and the top of the average range of malpractice insurance, we get 14.3% if the doctor was actually paying for the insurance out of his/her salary, which of course s/he isn't. Now just for fun, let's compare that to a guy earning $50,000 and paying half his family medical insurance (in an employer-sponsored plan). That's about 15% of his gross earnings. I'm sure you'll excuse me for not joining in the gnashing of teeth.

[Reality]

Vred the super patriot. Who in the hell are you kidding?

The nuttiest post of the year award goes to Vred.

[Wneglia]

The rise in health insurance premiums in US slowed dramatically before Obamacare

er, Doesn't that story show the rise slowing dramatically **after** Obamacare?

Most feel that Obamacare had minimal impact on slowing the rise of premiums last year, and this coming year, as the major provisions don't even kick in until 2014...

Could be, but your own link doesn't say that as you suggested it did and it does say:

...Altman said he doesn't expect a return to double-digit increases in premiums anytime soon, especially as provisions from the Affordable Care Act kick in...

Thanks, again.

Fair enough. I assumed it was common knowledge. Here's a reference for my statement

A little perspective on healthcare costs:

[O Really]

Which proves most malpractice lawsuits are "fishing" expeditions. The dirty little secret is the insurance companies have to pay the legal costs for the defense when they win that 80%. Now, if the losers in these cases had some responsibility for costs if they lose we would not have as many frivolous lawsuits.

No it doesn't prove that at all. There may be some fishing in other areas of personal injury law where the only issue is a few dollars, but malpractice is way different. Practically all malpractice lawsuits are handled on a contingency basis. The lawyer doesn't get paid unless s/he gets an award. Doctors, hospitals, and their insurers fight malpractice claims ferociously and with substantial resources. Under what alternate universe of logic is a lawyer going to spend their own money to pursue a "frivolous" case s/he has no chance of winning? If you've got some cites that show "most malpractice lawsuits are 'fishing' expeditions," let's see them. If you have a case where any award in excess of $100,000 could by any definition be based on "frivolous" grounds, let's see it. If you have an example of a lawyer encouraging lawsuits on cases s/he knows s/he wont' get paid for, let's see it.

It's not dirty and it's not a secret. The insurer has in the policy that legal costs are covered. That's why people buy insurance. BTW, unless there is a settlement or award of some kind, the "loser" lawyer does have responsibility for costs.

You wouldn't happen to have an example of a malpractice lawsuit you consider "frivolous," do you? You do know there is a legal definition of "frivolous" and if the case is, the judge can toss it, right?

[Supsalemgr]

Which proves most malpractice lawsuits are "fishing" expeditions. The dirty little secret is the insurance companies have to pay the legal costs for the defense when they win that 80%. Now, if the losers in these cases had some responsibility for costs if they lose we would not have as many frivolous lawsuits.

No it doesn't prove that at all. There may be some fishing in other areas of personal injury law where the only issue is a few dollars, but malpractice is way different. Practically all malpractice lawsuits are handled on a contingency basis. The lawyer doesn't get paid unless s/he gets an award. Doctors, hospitals, and their insurers fight malpractice claims ferociously and with substantial resources. Under what alternate universe of logic is a lawyer going to spend their own money to pursue a "frivolous" case s/he has no chance of winning? If you've got some cites that show "most malpractice lawsuits are 'fishing' expeditions," let's see them. If you have a case where any award in excess of $100,000 could by any definition be based on "frivolous" grounds, let's see it. If you have an example of a lawyer encouraging lawsuits on cases s/he knows s/he wont' get paid for, let's see it.

It's not dirty and it's not a secret. The insurer has in the policy that legal costs are covered. That's why people buy insurance. BTW, unless there is a settlement or award of some kind, the "loser" lawyer does have responsibility for costs.

You wouldn't happen to have an example of a malpractice lawsuit you consider "frivolous," do you? You do know there is a legal definition of "frivolous" and if the case is, the judge can toss it, right?

Yes, the cost of the defense is covered by the policy. Therefore, legal costs can be very significant even when there is judgement for the defense. So, even when the insurance compnay wins, they also lose. As for the losing atorney having costs, yes their costs, not the cost of the defense.

[Wneglia]

Wneglia, with all fondness, are you high today? Neither of your 2 articles nor your graph support:

The rise in health insurance premiums in US slowed dramatically before Obamacare

They dispute it.

Going from double digit annual increases to 4% is not significant?

[Wneglia]

Which proves most malpractice lawsuits are "fishing" expeditions. The dirty little secret is the insurance companies have to pay the legal costs for the defense when they win that 80%. Now, if the losers in these cases had some responsibility for costs if they lose we would not have as many frivolous lawsuits.

No it doesn't prove that at all. There may be some fishing in other areas of personal injury law where the only issue is a few dollars, but malpractice is way different. Practically all malpractice lawsuits are handled on a contingency basis. The lawyer doesn't get paid unless s/he gets an award. Doctors, hospitals, and their insurers fight malpractice claims ferociously and with substantial resources. Under what alternate universe of logic is a lawyer going to spend their own money to pursue a "frivolous" case s/he has no chance of winning? If you've got some cites that show "most malpractice lawsuits are 'fishing' expeditions," let's see them. If you have a case where any award in excess of $100,000 could by any definition be based on "frivolous" grounds, let's see it. If you have an example of a lawyer encouraging lawsuits on cases s/he knows s/he wont' get paid for, let's see it.

It's not dirty and it's not a secret. The insurer has in the policy that legal costs are covered. That's why people buy insurance. BTW, unless there is a settlement or award of some kind, the "loser" lawyer does have responsibility for costs.

You wouldn't happen to have an example of a malpractice lawsuit you consider "frivolous," do you? You do know there is a legal definition of "frivolous" and if the case is, the judge can toss it, right?

Claims, Errors, and Compensation Payments in Medical Malpractice Litigation

"Several previous studies have investigated the relationship between the merits and outcomes of malpractice claims. The findings vary widely, with 40 to 80 percent of claims judged to lack merit and 16 to 59 percent of claims without merit receiving payment."

[Wneglia]

Claims, Errors, and Compensation Payments in Medical Malpractice Litigation

"Several previous studies have investigated the relationship between the merits and outcomes of malpractice claims. The findings vary widely, with 40 to 80 percent of claims judged to lack merit and 16 to 59 percent of claims without merit receiving payment."

I can't say for sure but I'd guess that a lot of that variation would be eliminated by single payer, as rstrong argues. Without it, I just don't see the likely modest, if that, malpractice reforms making much of a dent in national healthcare costs.

I am not aware of any studies comparing suits filed by commercially insured patients vs. Medicare (single payer). I agree that the malpractice reforms have not had a big influence on healthcare costs. I think that defensive medicine is now in the DNA of all physicians out of fear. I saw a patient with lung cancer complaining of headaches last week and got a CT of the brain, just in case.... It was negative, and the headaches eventually went away. I have heard that any kid with a bump on the head who goes to the ER gets a CT scan. Maybe that is an overstatement, but things like this dramatically increase medical costs.

Malpractice insurance makes up a small percentage of the practice expenses in our group. Part is due to the fact that Oncology is a lower risk specialty than Neurosurgery, Orthopedics, or some others that get sued on a regular basis. One thing we do is have mandatory semi-annual seminars for our physicians in risk reduction covering topics like informed consent, standards of practice, documentation, and how not to screw up. We have about 20 physicians, and our group has had less than a dozen suits filed against us in 25 years. (Knock on wood-I have never been sued, probably good luck as much as anything. )

[O Really]

Claims, Errors, and Compensation Payments in Medical Malpractice Litigation

"Several previous studies have investigated the relationship between the merits and outcomes of malpractice claims. The findings vary widely, with 40 to 80 percent of claims judged to lack merit and 16 to 59 percent of claims without merit receiving payment."

Thanks, Doc - looks interesting. I'll read it in detail later. Nobody questions that litigation is expensive for everyone; nobody has set forth a workable alternative to deal with medical "product liability." The Canadian example is a good one, but as was pointed out, it works largely because getting the error fixed is also covered by their national plan. Defence of a potential malpractice claim seems to start at the point of complaint - e.g., I got a flesh-eating infection because somebody didn't follow cleaning procedure. The argument starts with, "no, you didn't get it here, and if you did get it here, it wasn't our fault, but we'll fix it for you for a bunch more money, and if you don't like our answer, here's our lawyer's number"

[Supsalemgr]

I am curious exactly how "single payer" would reduce malpractice cases. Would Vrede be so good to enlighten us about this?

[rstrong]

I am curious exactly how "single payer" would reduce malpractice cases.

Under the pre-Obamacare system, when an American doctor makes a mistake, he can render a patient uninsurable for life. The NEXT medical problem the patient encounters could send him and his family to the poor house. So, the settlement must cover not only fixing the mistake, but future health care costs too.

Under Canada's single-payer system, not only is fixing the doctor's mistake covered, but the patient will never be denied coverage because of it. This is why medical lawsuits in Canada are much smaller, and doctors' malpractice insurance costs much less.

[O Really]

BTW, Super-S - you are/were in insurance, right? According to a (slightly dated) 2009 study, the average profit of medical malpractice insurance companies is higher than 99 percent of all Fortune 500 companies and 35 times higher than the Fortune 500 average for the same time period; and malpractice insurers have seen their profit margins range from 5.9 percent to 74.8 percent, with an average of 31.2 percent.

What's your problem with the cost of litigation?