# Al Gore’s Health Care Plan on NPR **URL:** \ **Category:** Great Debates\ **Created:** [November 21, 2002, 3:34pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950 "2002-11-21T15:34:47Z")\ **Posts on this page:** 15\ **Page:** 3
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [November 22, 2002, 4:50pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/41 "2002-11-22T16:50:22Z")
I can suggest a couple of ways in which we could get substantially the same health care quality for much less money. –_Focus on primary and preventive care_. Our health care dollars don’t kick in until you’re either old or sick and destitute, but it’s hard to get any help to keep you from getting that way. (Not that we can keep people from getting old, but good health in the later years is largely dependent on preventive measures in the early years.) –_Learn to live with a little bit of diagnostic uncertainty_. In most countries, if the doctor can be 99% sure of a diagnosis before an expensive workup, they send the patient on his or her way and follow up as best they can. Here, if we’re 99% sure of a diagnosis before an expensive workup, we proceed with the workup. Fully half the people admitted to me to rule out a heart attack wouldn’t have been in other countries, and at least 95% of the head CTs done in our ER wouldn’t be done. And while I don’t have cites handy, those countries don’t fare any worse overall in treating that sort of thing. This can be blamed on a real or perceived litigious environment that we have to work in, but I think we do this more often because we can and because we have no connection whatsoever to what anything costs. I don’t even know what we charge for an echocardiogram, but I order them all the time. So it is possible. Dr. J ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [November 22, 2002, 5:02pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/42 "2002-11-22T17:02:05Z")
> [@](#): > > \*Originally posted by erislover \* > \*\*I didn’t know all lawyers worked for free until there was a verdict. \*\* Fine; then show me a statistically significant uptick in malpractice lawsuits, if you can. (Or did you intend to use wisecracks as a substitute for evidence?) Stepping aside from the malpractice insurance debate for a moment, I think **DoctorJ** makes some good suggestions for lowering medical costs, but I can see problems implementing those ideas. For example, which ER will be the first to cut back on CT scans? Unless they all do it at once, the first to do so is putting itself at risk of litigation for failure to follow “accepted standards.” (See? I’ll admit that fear of litigation can be part of the problem.) ---
**Author:** ![erislover](https://avatars.discourse-cdn.com/v4/letter/e/71e660/32.png) [@erislover](https://boards.straightdope.com/u/erislover)\ **Post date:** [November 22, 2002, 5:39pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/43 "2002-11-22T17:39:19Z")
**Maybe if I was fucking claiming anything I would be happy to support an implication.** Except I’m not. I’m critiquing your tunnel-view of the situation. Christ. ---
**Author:** ![Orbifold](https://avatars.discourse-cdn.com/v4/letter/o/779978/32.png) [@Orbifold](https://boards.straightdope.com/u/Orbifold)\ **Post date:** [November 22, 2002, 5:53pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/44 "2002-11-22T17:53:50Z")
**erislover** : perhaps you should step back, and remember what forum you’re in. Just a suggestion. ---
**Author:** ![xenophon41](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xenophon41/32/253_2.png) [@xenophon41](https://boards.straightdope.com/u/xenophon41)\ **Post date:** [November 22, 2002, 6:26pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/45 "2002-11-22T18:26:51Z")
> [@](#): > > _from **erislover** :_ > > I’m critiquing your tunnel-view of the situation. No. You’re not “critiquing” anything; you’re sniping. And unproductively at that. If you’re not going to take a position, perhaps you could provide clear and concise criticisms or specific questions instead of spiteful little wisecracks. Just a suggestion. ---
**Author:** ![erislover](https://avatars.discourse-cdn.com/v4/letter/e/71e660/32.png) [@erislover](https://boards.straightdope.com/u/erislover)\ **Post date:** [November 22, 2002, 6:38pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/46 "2002-11-22T18:38:52Z")
I’m sorry, I _did_ make a claim. > [@](#): > > everything would be cheaper if people didn’t make a profit on it. **spoke** insinuates that we only need look at verdicts to understand that there aren’t so many lawsuits to justify raising premiums. That doesn’t follow. **spoke** assumes that me pointing that out implies that I must be claiming that the insurance companies are justified. This doesn’t follow either. **spoke** wants evidence. My incredulity of his side somehow is supposed to imply that I don’t support questioning insurance companies. It doesn’t. I retracted a quote about something that was not pertanent to the thread. I’ll apologize for it again. I’m not going to apologize for saying “fuck” in GD about someone forcing me to have a point when my only point is that someone’s arguments are inconclusive, one-sided, and incomplete. I believe there should be universal health care. I have not seen anyone offer an implimentation of it that satisfies me. I said this. Clearly. > [@](#): > > I don’t have a problem with universal health care anymore, but I find no implementation that satisfies me whatsoever. That is my claim. ---
**Author:** ![xenophon41](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xenophon41/32/253_2.png) [@xenophon41](https://boards.straightdope.com/u/xenophon41)\ **Post date:** [November 22, 2002, 6:47pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/47 "2002-11-22T18:47:49Z")
> [@](#): > > **spoke** insinuates that we only need look at verdicts to understand that there aren’t so many lawsuits to justify raising premiums. That doesn’t follow. See! A scalpel really does work better than a butter knife. Now **spoke** knows for sure what your objection is. ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [November 22, 2002, 8:05pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/48 "2002-11-22T20:05:05Z")
Right, and I have conceded for the sake of argument that verdicts alone aren’t the determinant (since even malpractice lawsuits that result in a defense victory cause legal fees and expenses to be incurred). And so instead, I’ve suggested looking at malpractice lawsuits filed (whether or not they resulted in plaintiffs’ verdicts). If there’s anyone here who contends that there is a genuine “malpractice crisis” caused by excessive litigation, then please show me statistics which demonstrate either: a) A statistically significant increase in malpractice lawsuits; or b) A statistically significant increase in malpractice verdicts. (I don’t expect **erislover** to provide this information since he seems to be refusing to take a position one way or another.) The insurance lobby says there’s a “malpractice crisis.” Where is the proof? Still keeping an open mind… ---
**Author:** ![erislover](https://avatars.discourse-cdn.com/v4/letter/e/71e660/32.png) [@erislover](https://boards.straightdope.com/u/erislover)\ **Post date:** [November 22, 2002, 9:10pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/49 "2002-11-22T21:10:01Z")
OR c) A statistically significant increase in the cost of a lawyer; or d) A statistically significant increase in the wages expected of people whose jobs match those in the insurance industry that aren’t lawyers but handle the information in the company that lawyers would need; or e) A statistically significant decrease in the number of doctors insured per company (thus potentially concentrating risk and making a reform on the damages possible more relevent). > [@](#): > > There is deception in the insurance lobby’s game. Quite possibly so. I am inclined to distrust insurance companies and stock brokers by virtue of their job alone. I agree that if the insurance industry is making a claim they should support it. ---
**Author:** ![jshore](https://avatars.discourse-cdn.com/v4/letter/j/b5e925/32.png) [@jshore](https://boards.straightdope.com/u/jshore)\ **Post date:** [November 23, 2002, 3:24am UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/50 "2002-11-23T03:24:25Z")
> [@](#): > > \*Originally posted by smiling bandit \* > But these gross measures do not adequately examine other factors, including the average heavier immigration, cultural differences (too many Americans on bad food leads to much of the shortened life span) and so forth. Well, sure. No measure is perfect. But, it seems to me that measures that look at results are better than measures that look at, say, how many MRI machines are available or how many other fancy tests and procedures are done (for people who have adequate health care coverage). [By the way, I think that Canada might have a higher immigration rate as a fraction of population than we do, but I’ll leave that to others to investiage.] As for bad food habits and such…Well, this raises an interesting point in my mind. I mean, Dick Cheney is sort of a poster child for the “blessed American way of life” that he likes to talk about. Sure, it is great that our modern health care technology gives us the ability to be negligent about our health in terms of exercise, dietary habits, etc. and then to get some cool fancy gizmo implanted that helps jump-start our heart if it goes into fibbulation (or whatever his device does). But, I am not sure this is my definition of an optimal health care system, defining health care in a broader, more preventative sense. > [@](#): > > Buying ourselves universal care now may mean a huge slowdown in technological advance. Well, for the difference in GDP that we pay for health care here in the U.S. and they pay for health care in Canada, we could fund a lot of technological advance. [And, I might point out that our government already funds a lot of technological advance through NIH … which the pharmaceutical companies and medical technology companies derive great benefit from. > [@](#): > > Plus Europe and some other nations are effectively stealing American money by limiting drug prices. Yes, to a certain degree, the pharmaceutical companies do seem to be milking the U.S. health care system as their profit sanctuary. On the other hand, I am not sure that is such a good thing. ---
**Author:** ![december](https://avatars.discourse-cdn.com/v4/letter/d/838e76/32.png) [@december](https://boards.straightdope.com/u/december)\ **Post date:** [November 23, 2002, 12:11pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/51 "2002-11-23T12:11:18Z")
> [@](#): > > \*\*\*Originally posted by spoke- \*Well, [St. Paul’s withdrawal from the med mal business] _could_ be the result of an increase in malpractice verdicts, or it could be the result of bad underwriting decisions and bad management. So it doesn’t really answer the question. \*\*I’m not sure what you mean by “bad management.” If you mean that huge overhead expenses are their problem, that’s not the case. > [@](#): > > Increasing rates by an average of 24 percent this year in 27 states couldn’t save St. Paul, the nation’s largest malpractice underwriter. This month, the company chose to cut its losses because it anticipates a 271 percent combined ratio for this book of business—a 2001 underwriting loss of nearly $1 billion. A [271 percent combined ratio](http://www.naii.org/Publish/Web/Webpress.nsf/b942dec25f4185ad862569dd00596b01/62132b5847b7e70186256b290061f343?OpenDocument) means $2.71 of losses and expenses for every $1.00 of premium income. The $2.71 roughly breaks down as $0.30 expenses and $2.41 losses. > [@](#): > > \*\*The question is: > > Is there any hard evidence of a “malpractice crisis,” that is, a radical increase in malpractice verdicts. I haven’t seen any such evidence (and I’ve looked), but I’m keeping an open mind. > > Let’s see some underlying statistics which prove the existence of a “crisis,” if anyone has such stats. \*\* First of all, note that St. Paul’s withdrawal proves that they’re not exaggerating the extent of the malpractice crisis in order to make more money. They withdrew because of their humongous claims costs, and because claims costs are growing so much that the business is simply too risky. As for statistics, I St. Paul has them, but they don’t necessarily make them public. Their losses in med mal are public as indicacated above. ---
**Author:** ![smiling\_bandit](https://avatars.discourse-cdn.com/v4/letter/s/e9a140/32.png) [@smiling\_bandit](https://boards.straightdope.com/u/smiling_bandit)\ **Post date:** [November 23, 2002, 5:14pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/52 "2002-11-23T17:14:47Z")
> [@](#): > > Yes, to a certain degree, the pharmaceutical companies do seem to be milking the U.S. health care system as their profit sanctuary. On the other hand, I am not sure that is such a good thing. The key point I was trying to make, and did not reall explain, was that it IS the profitability of the US medical scene that is driving the biotech revolution. People here are willignto pay through the nose for the very, very best. And if we slow that down (by removing the incentive) in a hundred years we’ll see we’ve shot ourselves in the foot. We may even see a decrease in technology available. > [@](#): > > Well, for the difference in GDP that we pay for health care here in the U.S. and they pay for health care in Canada, we could fund a lot of technological advance. [And, I might point out that our government already funds a lot of technological advance through NIH … which the pharmaceutical companies and medical technology companies derive great benefit from. 1. But Canada has its own problems, which we would just take on, aside from the extreme chaos caused by the changeover. 2. More over, I DON"T WANT the government taking control of my insurance, period. It means higher taxes and less choice for me! I don’t believethe gov is capable of handling it to my satisfaction. 3. Hi Opal! 4. Tehnological advance won’t help if there isn’t enough of an economic incentive to use it. Gizmo X and Drug Y simply may fall by the wayside, despite being very effective, if Gizmo Z and Drug W are cheaper for the government to use. > [@](#): > > Well, sure. No measure is perfect. But, it seems to me that measures that look at results are better than measures that look at, say, how many MRI machines are available or how many other fancy tests and procedures are done (for people who have adequate health care coverage). But thes gross measurement simply don’t get any sense of the different problems facing the society they are based off of. Those are factors you cannot simply ignore, _because those results are inherently affected, often to an extreme degree, by the inputs_ Its like a mathematical formula: (in these examples, h is the total healthcare “goodness”) 1. h = x+z= 6 (I’ll say this is Europe. I don’t beleive Europre has a better healthcare system, but for this example I will accept it. 2. h = x+z = 5 (American, as per the pro-single-payer side) If I may enter a risky statement, you are sayin that #1 must be better, and would work nicely for America. In other words, you are assuming America will then become this: 2-\>3) h = y +z= 6 But you are ignoring x and z! Unlike math, real life doesn’t have to work out like a formula. The actual value of x in the USA may be totally different than in Europe, as is “our z” variable. The formula could equally come out like this: 2 -\>4) h = y +z = 4 I have not seen anything here today which would make me rethink my conclusion. I think the pro-single-payer arguments are insufficient at this time. ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [November 25, 2002, 2:35pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/53 "2002-11-25T14:35:35Z")
**december** wrote: > [@](#): > > A 271 percent combined ratio means $2.71 of losses and expenses for every $1.00 of premium income. And like I said, that may well be the result of bad underwriting decisions or poor cost control by St. Paul’s. In other words, it may be a case of St. Paul’s own negligence in choosing to insure bad doctors, or in mishandling claims. (I suspect the former. Good doctors should not pay to keep bad doctors in business.) Because St. Paul’s losses may be attributable to bad decisions on their part, we really have to look at broader indicators to find out whether there is really a “malpractice crisis.” Which is why I have asked (several times) for statistics which tend to show that there has been some significant increase in malpractice litigation. You can bet that if such statistics existed, the insurance companies would be trumpeting them to the high heavens. I’m sure our own **december** has googled his little heart out looking for such stats. I’ve looked myself, and can’t find any. Seems to me they simply don’t exist. In fact (looking at the studies referenced in my earlier link), it looks like personal injury litigation in general has declined. All of that makes it look like any losses suffered by St. Paul’s are not the result of any mythical malpractice explosion, but rather the result of poor business decisions by St. Paul’s (either bad ubnderwriting decisions or poor cost control). But as **december** says, St. Paul’s doesn’t make public the stats that would be needed to discern the truth of the matter. Hmmm. ---
**Author:** ![december](https://avatars.discourse-cdn.com/v4/letter/d/838e76/32.png) [@december](https://boards.straightdope.com/u/december)\ **Post date:** [November 25, 2002, 2:58pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/54 "2002-11-25T14:58:15Z")
> [@](#): > > \*Originally posted by spoke- \*And like I said, that [$2.71 of losses and expenses for every $1.00 of premium income] may well be the result of bad underwriting decisions or poor cost control by St. Paul’s. In other words, it may be a case of St. Paul’s own negligence in choosing to insure bad doctors, or in mishandling claims. > > (I suspect the former. Good doctors should not pay to keep bad doctors in business.) St. Paul has by far the widest medical malpractice data base, the most years of data (several decades worth), and the most research. These are reasons to think that they ought to have been the very best at underwriting. > [@](#): > > You can bet that if such statistics existed, the insurance companies would be trumpeting them to the high heavens. They do, in fact, present just such statistics when they file rates for approval by various state insurance departments. These filings are public record, although they’re not on the internet AFAIK. If anyone wants to visit various state capitals, they could check it out. Thirty years ago, I headed the underwriting operation of a company that did a lot of malpractice insurance. It’s very difficult to distinguish “good” doctors from “bad” doctors. Claims experience is too sparse. Underwriting mostly involved selling insurance in a state or not. Large hospitals do have enough claims for a good analysis, but there are two difficult problems:[ul][_]Loss Development – Claims take many years to finally settle, so one doesn’t really know the cost of a recent year’s claims. The cost can only be estimated.[_]Trend --Claims costs sometimes change over time. So, when pricing insurance for the coming year, the cost may be quite different from prior years. Again, this can only be estimated.[/ul]BTW, a company would be considered strong and solvent if had a net worth or “policyholeders’ surplus” equal to its annual premium volume. If such a company had a combined ratio of 271%, it would be sustaining operating losses of 171% of its premium volume. These losses reduce policyholders’ surplus. So, the company would become totally bankrupt in less than a year. ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [November 25, 2002, 3:23pm UTC](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950/55 "2002-11-25T15:23:16Z")
Simple question: If stats exist which show an explosion in malpractice claims, why isn’t the insurance industry publicizing those stats? They certainly have a financial incentive to do so. Answer: Such stats do not exist, because **there has been no explosion in malpractice claims.** (Note: loss ratios filed with the states are not the same thing, **december**. Again, those stats may reflect bad decisions by the insurer. Quit trying to hide the ball.) [Previous page](https://boards.straightdope.com/t/al-gore-s-health-care-plan-on-npr/137950.md?page=2)