Isn’t using hindsight to correct past mistakes what this entire thread is about?
On rereading the first 5 words of the OP, yes - point taken.
Punitive damages are almost never available in medical malpractice cases. Doctors win most malpractice trials. The tort system is not a significant factor in the cost of health care. The really big verdicts you sometimes hear about are usually for someone who will need a lifetime of care. It’s pretty rare.
Limits on medical malpractice verdicts save more that just the value of the claim itself. The argument is that it reduces the practice of defensive medicine resulting in greater savings.
This study placed that savings at 3 to 4% of overall health care expenditures in states that implemented such laws.
There are lots of different kinds of malpractice, and reform talk would do well to distinguish them.
If a doctor operates on your left knee instead of your right knee, even though you double-check with him before the operation, the doctor should have to pay for the damage. That’s precisely the point of the tort system.
If a doctor fails to catch your rare cancer because he never gave you an MRI, that is sometimes going to result in malpractice liability if enough experts testify that giving the MRI is the appropriate level of care.
The second category is where “defensive medicine” costs come from, not the first. And we can fix the second category without affecting the first category by making safe harbors for doctors who follow evidence-based guidelines. So, if NIH has a guideline that says it is not necessary to do regular mammograms until Age X, and a woman gets breast cancer after her doctor refuses to mammogram her at Age <X, then she can’t sue the doctor.
That’s what malpractice reform would look like if the real motivation was protecting doctors from frivolous suits and lessening defensive medicine. But the other big motivation of malpractice reform is to take money away from trial lawyers, who are mostly Democrats. Consequently, limitations on judgments are the favored approach, even though it is a one-size-fits all approach that has marginal affects on malpractice premiums but doesn’t substantially change defensive medicine.
Perhaps an actual doctor can chime in, but I would think these types of situations are too varied and multi-faceted to be covered by published guidelines.
My impression is that you have it backwards. The trial lawyers are mostly Democrats because the Republicans support tort reform. (The Republican/Democrat breakdown on tort reform is better explained in terms of the parties’ broader positions on income redistribution, attitudes towards business, and personal responsibility.)
You don’t have to handle every situation to handle the most common ones. By creating safe harbors for the most common “failed to catch it” issues, you start to carve away the motivations for defensive medicine with the added benefit of incentivizing doctors to follow evidence-based medicine.
It’s a well-worn idea. Efforts to work it out have failed for various reasons, but I don’t think the reasons have been that it is too hard to come up with guidelines that affect a large number of cases.
You’re partly right and partly wrong. The partisan breakdown of plaintiff-side lawyers is far more about the parties’ broader positions on income redistribution, attitudes towards business, and personal responsibility. Add to that list: belief in civil rights, including the role of the federal government in defending civil rights; skepticism of market-based mechanisms for solving injustice; and the general predisposition of lawyers as a whole to be Democrats, for reasons that are at this point pretty speculative.
Tort reform is a subsidiary to all those other ideological reasons that trial lawyers tend to be Democrats, and trial lawyers would still be mostly Democrats even if the GOP abandoned tort reform.
I think the most common ones are also complex. It’s not like doctors are being sued for failing to follow simple age-based guidelines such as you depicted. It’s more like being sued because he saw this-or-that x-ray/lab result and failed to be suspicious enough to order 2 other rounds of more sophisticated testing, and the issue boils down to competing expert testimony about how big of a red flag this particular x-ray was. Stuff of that sort.
OK, but that doesn’t seem to support your earlier claim.
I don’t think the presence of complexity forces us to throw our hands up and declare that there can be no guidelines that would be effective at providing safe harbor in many cases. There are well-worn disputes between experts on general principles–e.g., should community hospitals be required to use ultrasound equipment that is capable of certain advanced functions. Whether there are enough of these to make a dent is open to debate I guess, but it sounds like your objection is there aren’t enough to matter. If so, that’s not really an objection to implementing what ones there are to be found.
The broader point is that if the concern with medical malpractice is defensive medicine, then the solution should target the kinds of malpractice that are related to defensive medicine. A cap on verdicts affects lots of cases that have nothing to do with defensive medicine.
Not sure what you’re confused about. I said trial lawyers tend to be Democrats (and hence Democratic donors), so Republicans have an incentive to limit money that goes to them. You said that they are only Democrats because Republicans want tort reform. But you were wrong.
But if there aren’t enough to make a dent then you need to look for alternative solutions.
[Note that I’m not definitively asserting that what I’ve described is the main driver of malpractice costs. But this is my strong impression based on malpractice suits I’ve followed over the years.]
What you’re saying amounts to pretty much the same thing. I said it simpler in terms of the positions on the actual issues at hand and you extended it to the underlying attitudes that drives positions on these issues. These generally tend to go hand in hand and it’s a mistake to try to split them into two different aspects, unless it’s somehow relevant, which I don’t see here.
Your original claim was that a big part of Republican motivation for tort reform was to stick it to their ideological opponents, the trial lawyers. Once you grant that the Republicans are philosophically inclined to take the same positions anyway, this is just a gratuitous assertion.
It’s like someone claiming a big part of opposition to the Keystone pipeline is the desire of the Democrats to stick it to the big energy companies . I mean, no doubt once the battle lines are drawn anyway that becomes part of the mindset, especially for the more partisan, but that’s not an underlying or important factor in the overall battle.
No, my claim was that this particular mechanism of tort reform–one-size-fits-all limits on damages–was partly a product of a desire to stick it to Democratic donors.
It is true that the GOP would probably favor tort reform regardless of whether trial lawyers are Democratic donors. They may or may not favor that particular ham-handed version of reform, which has been demonstrated to be pretty ineffective policy but does successfully keep some money out of Democratic coffers.
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Combine Medicare, Medicaid, Tricare and the Federal Employee health plan into one, and allow anyone to buy in on a sliding scale based on income.
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KEEP the mandate. You have to spread the risk.
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Allow ALL Health Care costs to be tax deductible, regardless of income. This will help de-couple health care from your employer.
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Allow private insurance companies to keep their existing plan structures. They can compete with the government plan by providing superior services, physician networks, etc. In other words - YES, you can keep your plan.
Stop there. In the future, you can look at:
A) Making it easier for health plans to sell across state lines
B) Determining what should be covered, and what should be personal choice.
C) Taking more drugs off of the prescription list, and put them onto the OTC list instead.
D) Allow the Gov Care to be a voucher, allowing the poor to “purchase” private plans with their government voucher. If a private group can offer superior care than Medicare for the same price, let people get it.
That depends a lot on whether the GOP agrees with you that this version of reform “has been demonstrated to be pretty ineffective policy”. I would suggest that they probably don’t, especially in light of reputable studies like that cited earlier by iggy, which show it to save 3-4% of medical costs (with the savings percentage increasing over time, as one might expect).
There are a lot of posters here who are fond of attributing evil motivations to their ideological opponents, e.g. “anti-abortion people are solely motivated by misogyny”. I tend to be skeptical of such claims.
This makes me nervous, as it has the potential to mean that all health plans move to the one state that has the least patient protections, meaning that even if a state wants to increase patient protections for its citizens they will be unable to do so. Much in the same way that all credit cards are based in Delaware.
Why couldn’t the law say that in order to be eligible for sales across state lines, health insurance must meet minimum standards? The ACA has mandated minimum standards (albeit imperfect ones) so why can’t these companies now sell across state lines?
I realize that this goes against the states rights argument, but if we’ve already decided that health care needs a national solution and have largely taken away state control, why allow states to tinker with the process?
Options to buy into medicare, medicaid, the VA and the FEHB as well as the exchanges.
Stronger policies to drive down medical costs and reduce medical inflation. I’m not sure what all this would entail, but I’m sure people have figured it out.
Mandate all insurance policies have an out of network limitations so people don’t go bankrupt for going to the ‘wrong’ hospital.
Mandate that insurance companies have to pay their bills. No weaseling out, if a qualified medical professional gives them a bill for a needed treatment, they have to pay it in 10 days or get massive fines. No labeling stuff as not covered, experimental, etc.
Streamline all administration and makes it universal across policies so medical professionals don’t have to waste so much time fighting with insurance companies.
Agreed - which is why I put it into round 2. I THINK there is something there, but I don’t know what it is. California is big enough to be a single market, I think some of the smaller states should band together in how they regulate to possibly get more options.
Then again, I don’t like the trend of banks getting snapped up until there are just a few “too big to fail” operations out there.
This is when my internal libertarian vs. anti-federalist instincts start warring with each other.
Enact Medicare for All as default coverage for everyone in the country. We have the infastructure already up and running.
Allow private insurance to continue much as it does in other countries; as an adjunct to Medicare.
Make providers publish their prices. Deviate from those prices, and you are fined. Do not pass go…