# Health care reform under Republican control **URL:** \ **Category:** Great Debates\ **Created:** [October 27, 2010, 3:58pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539 "2010-10-27T15:58:46Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![sqweels](https://avatars.discourse-cdn.com/v4/letter/s/f19dbf/32.png) [@sqweels](https://boards.straightdope.com/u/sqweels)\ **Post date:** [October 27, 2010, 8:55pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/21 "2010-10-27T20:55:54Z")
> [@Bricker](#): > > Probably. It would not be ideal, but politics is the art of the possible. The way the Republicans play it, it’s the art of making things _im_possible. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 27, 2010, 9:24pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/22 "2010-10-27T21:24:35Z")
> [@Mr\_Smashy](#): > > Of course you’ve ignored the effect of defensive medicine in your quote; from your story, $20b costs from the liberal’s estimate, $200b from the conservative’s estimate. And 5 of every 6 doctors admit to engaging in defensive (ie, partially wasted) medicine due to the threat of lawsuits, which tort reform would undoubtedly help ameliorate. So you think that a doctor that orders a test for a one in a thousand risk is going to say “well now that my liability is limited to $500,000, I am not going to order that test (paid for by insurance) because now I am only risking a $500,000 lawsuit” Really? You think THAT is what is driving defensive medicine? Doctors have not been able to identify a test or procedure that they would not have ordered if there was a cap on liability (I believe liability caps are the most popular form of tort reform these days, and perhaps loser pays in the case of frivolous lawsuits). What causes all those useless tests and procedures is taht there is noone in the room who gives a shit how much all this is going to cost. the patient will pay whatever it takes and there is no incentive for the doctor to control costs even if liability was capped at $100,000. We need to change the way doctors are compensated so that we can attract smart people and also compensate them in a way that promotes best practices. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 27, 2010, 9:26pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/23 "2010-10-27T21:26:30Z")
> [@gonzomax](#): > > The 1 percent of the health costs that are paid into law suits does not relate to malpractice insurance rates. They charge whatever they can get away with. They make huge profits. Awards in medical malpractice suits has increased about 10% in the last decade and malpractice premiums have increased about 100% in the last decade. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 27, 2010, 9:29pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/24 "2010-10-27T21:29:00Z")
> [@Bricker](#): > > And what about the costs for tests and procedures that are now ordered solely in an effort to avoid potential civil liability? Why didn’t you explore those costs? > > ETA: what **Mr Smashy** said. Which tests do you think a doctor orders under the present regime that they wouldn’t order with tort reform because here in Virginia, tort reform capping damages has not ersulted in this huge savings youa re talking about. We don’t have to guess. There are states all over the country that have already implemented tort reform, we can track the savings. They haven’t materialized. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 27, 2010, 9:31pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/25 "2010-10-27T21:31:07Z")
> [@spazattak](#): > > could you live with nationalized malpractice insurance (like crop failure insurance) in combination with liability limits? THAT wold make malpractice insurance MUCh MUCH chaeper. malpractice insurance comapnies have cornered the market ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [October 27, 2010, 9:33pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/26 "2010-10-27T21:33:15Z")
I’d like to see the Republicans resurrect and get behind this [bill](http://www.govtrack.us/congress/bill.xpd?bill=s103-1770&tab=summary) that 20 Republican Senators proposed as an alternative to the 1993 Clinton Health Care Reform. It included: \*Title I - Basic Reforms to Expand Access to Health Insurance Coverage and to Ensure Universal Coverage Subtitle A - Universal Access Provides access to health insurance coverage under a qualified health plan for every citizen and lawful permanent resident of the United States. Section 1003 - Establishes a program under which persons with low incomes (and who are not eligible for Medicaid) will receive vouchers to buy insurance through purchasing groups. Section 1004 - Requires each employer to make available, either directly, through a purchasing group, or otherwise, enrollment in a qualified health plan to each eligible employee. Subtitle F - Universal Coverage Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone. \* Of course, if you [compare](http://www.kaiserhealthnews.org/Graphics/2010/022310-Bill-comparison.aspx) it with the 2009 legislation, you might come to the conclusion that those 20 Republicans were secretly plotting a socialist takeover of the government… ---
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [October 27, 2010, 9:44pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/27 "2010-10-27T21:44:22Z")
> [@Damuri\_Ajashi](#): > > THAT wold make malpractice insurance MUCh MUCH chaeper. malpractice insurance comapnies have cornered the market I was going to suggest that, but then I wondered if it would cause excessive meddling in malpractise court cases in order to save the government money. After all, with other nationalized (or state-run) types of insurance, determination of award is not as easy to manipulate through the court system. I don’t know the answer to this (perhaps the other types of insurance would also be easy to manipulate in theory, and the fact that they’re not is evidence that nationalized malpractise insurance would work), but it is something to think about. However, that aside, if actual damage awards are only a fraction of a percent of medical costs, when you look at that versus insurance amounts, government could _make money_ at this and still make health care cheaper. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 27, 2010, 10:24pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/28 "2010-10-27T22:24:55Z")
> [@Damuri\_Ajashi](#): > > Which tests do you think a doctor orders under the present regime that they wouldn’t order with tort reform because here in Virginia, tort reform capping damages has not ersulted in this huge savings youa re talking about. We don’t have to guess. There are states all over the country that have already implemented tort reform, we can track the savings. They haven’t materialized. Virginia simply limited punitive damages. I’m not claiming that’s a bad idea, but it’s probably the least effective tort reform measure. How about limiting all non-economic damages? How about changing the usual joint-and-several liability? How about a loser pays system to eliminate nuisance suits? W. Kip Viscusi and Patricia H. Born published a study in the _Journal of Risk and Insurance_ (Volume 72, Issue 1, pages 23–43, March 2005) called “Damages Caps, Insurability, and the Performance of Medical Malpractice Insurance.” They concluded: > [@](#): > > Limits on noneconomic damages were most influential in affecting insurance market outcomes. Several punitive damages variables specifically affected the medical malpractice insurance market, including limits on punitive damage levels, prohibitions of the insurability of punitive damages, and prohibition of punitive damages awards. Certainly the savings are there – the more of these reforms a state implements, the more affordable their healthcare is. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [October 27, 2010, 10:38pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/29 "2010-10-27T22:38:21Z")
Quoth **Mr Smashy** : > [@](#): > > On another note, I’ve heard many on the right say they want to do something about portability and pre-existing conditions - that lib favorite Sean Hannity being one. And by “want do do something about it”, you mean “call anyone who actually _does_ do something about it the Spawn of Satan for daring to interfere with the Holy Free Market’s pursuit of the Almighty Dollar”, right? Because that’s what those folks are actually doing. ---
**Author:** ![Blalron](https://avatars.discourse-cdn.com/v4/letter/b/35a633/32.png) [@Blalron](https://boards.straightdope.com/u/Blalron)\ **Post date:** [October 27, 2010, 11:26pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/30 "2010-10-27T23:26:27Z")
> [@Chronos](#): > > Quoth **Mr Smashy** :And by “want do do something about it”, you mean “call anyone who actually _does_ do something about it the Spawn of Satan for daring to interfere with the Holy Free Market’s pursuit of the Almighty Dollar”, right? Because that’s what those folks are actually doing. Between 2003 and 2007, the GOP held both Congress and the White House. I’m curious why they didn’t lift a finger to do anything about these problems when they had the chance. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [October 27, 2010, 11:33pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/31 "2010-10-27T23:33:16Z")
There is a way to do tort reform in a [smart way](http://www.nytimes.com/2010/10/21/opinion/21orszag.html?_r=1&ref=peter_orszag) that will reap most of its benefits without many of its negative consequences. What we want is for doctors who are lazy or incompetent to be liable, but for those who are sensible but unlucky to not be liable. Most of all, we want doctors who make intelligent cost-benefit decisions based on evidence to not be liable because they didn’t order a test. We can do that without capping damages for the kid whose doctor operated on the wrong knee because the doctor was seeing 50 patients a day in order to support his wife’s coke habit. I suspect the GOP won’t support these kinds of smart reforms, because they’d rather have tort reform as a political boogeyman than as actual policy. And because it would mean giving Obama a bipartisan victory, and their[top priority](http://politicalwire.com/archives/2010/10/25/bonus_quote_of_the_day.html) is to make Obama unpopular. ---
**Author:** ![LouisB](https://avatars.discourse-cdn.com/v4/letter/l/dfb087/32.png) [@LouisB](https://boards.straightdope.com/u/LouisB)\ **Post date:** [October 27, 2010, 11:34pm UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/32 "2010-10-27T23:34:38Z")
> [@Squink](#): > > Snerk! > Just as soon as they get the deficit under control! 😃 Well, once they cut taxes, that problem will solve itself. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 28, 2010, 12:34am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/33 "2010-10-28T00:34:48Z")
> [@Hampshire](#): > > So then what happens? Are they really going to press forward with their own version of a reform bill or are they just going to repeal the current one, put us back to square one, and then sit on their hands and do nothing about it for another x years? This. Making health care more efficient is one of the most important things we can do to keep the nation solvent over the 21st century. The health bill, despite being imperfect, tried to do this. So it isn’t just a UHC bill it is a bill designed to reduce the % of GDP we spend on health care by bending the cost curve. The GOP has no meaningful or real solutions and interest to either the lack of access/affordability in health care, or in long term solvency of our system. Their only agenda is to try to remake reality so it matches their ideology. Supply side tax cuts + small government = utopia. Solutions and pragmatism be damned. The GOP of the 90s, despite being labeled radical by Barry Goldwater (he had no idea how bad they would get) proposed health reform that was largely identical to the reform Obama just passed. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [October 28, 2010, 12:51am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/34 "2010-10-28T00:51:52Z")
> [@Brown\_Eyed\_Girl](#): > > After plenty of deliberation, I’ve come to the conclusion that **Mr. Smashy** ’s intelligent discourse to noise ratio pretty much sucks, so I won’t be commenting on that. > > As to your question, [insignificant](http://www.kevinmd.com/blog/2010/09/defensive-medicine-saves-money-physicians.html), in the grand scheme of things. There are much better places to focus cost savings, like say, oh reducing administrative costs associated with exponentially varied billing processes for an umptitude number of insurance providers. :rolleyes: Good Lord, you used figures like 2% of healthcare costs and 3.6b. Your own source talked about numbers like 20b and 200b (by the way, from 1.5 yrs ago, got anything more recent?). I merely pointed it out. Since it’s at odds with your argument though, you have my permission to conveniently ignore it, and blame my _(whatever)_ ratios. Beats having to admit that you’re wrong I guess. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [October 28, 2010, 1:04am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/35 "2010-10-28T01:04:16Z")
> [@Chronos](#): > > Quoth **Mr Smashy** :And by “want do do something about it”, you mean “call anyone who actually _does_ do something about it the Spawn of Satan for daring to interfere with the Holy Free Market’s pursuit of the Almighty Dollar”, right? Because that’s what those folks are actually doing. I’m just saying what I heard on the guy’s show one time. I know I may have messed up by not putting it in emotional terms that a liberal would understand. 😉 He said (something to the effect of) healthcare reform is needed in this country, but shoving an omnibus Obamacare bill down the throats of the 60% of Americans who didn’t want it, without bipartisan support, was not the way to do it. Then he specifically mentioned the requirement to do something about pre-existing conditions. Would he recommend a more market-based approach? Probably, and so would I. The way it’s set up now, there is almost no appetite suppressant built into the system. Read this column in the [USA Today](http://www.usatoday.com/news/opinion/forum/2010-10-19-column19_ST_N.htm) for more details. > [@](#): > > We’re going to get into trouble because of the kinds of coverage that the new law mandates. There are no brakes on the system. Co-pays and deductibles will be kept low, and preventive services will have no co-pays at all. That sounds like a good deal for patients, yes? But without at least a pause to consider necessity and/or cost, expect waiting times to increase, ERs to be clogged and longer lead times needed to make an appointment. > > Patients with new Medicaid cards who can’t find a doctor will go where? To emergency rooms. The escalating costs of these visits (necessary and unnecessary) will be transferred directly to the American public, both in the form of taxes as well as escalating insurance premiums. ---
**Author:** ![Mr\_Smashy](https://avatars.discourse-cdn.com/v4/letter/m/2bfe46/32.png) [@Mr\_Smashy](https://boards.straightdope.com/u/Mr_Smashy)\ **Post date:** [October 28, 2010, 1:06am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/36 "2010-10-28T01:06:52Z")
> [@Blalron](#): > > Between 2003 and 2007, the GOP held both Congress and the White House. I’m curious why they didn’t lift a finger to do anything about these problems when they had the chance. Um… wasn’t Part D passed in 2003 and kicked in in 2006? You don’t call that healthcare related? ---
**Author:** ![Leaper](https://avatars.discourse-cdn.com/v4/letter/l/4bbf92/32.png) [@Leaper](https://boards.straightdope.com/u/Leaper)\ **Post date:** [October 28, 2010, 2:58am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/37 "2010-10-28T02:58:27Z")
Time or Newsweek (I forget which, and I can’t seem to find this on their website) was skeptical about the GOP’s ability to repeal, and their willingness to shut down the government again. We’ll see what happens, I suppose. ---
**Author:** ![Happy\_Fun\_Ball](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/happy_fun_ball/32/17664_2.png) [@Happy\_Fun\_Ball](https://boards.straightdope.com/u/Happy_Fun_Ball)\ **Post date:** [October 28, 2010, 3:36am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/38 "2010-10-28T03:36:21Z")
> [@Mr\_Smashy](#): > > Um… wasn’t Part D passed in 2003 and kicked in in 2006? You don’t call that healthcare related? Well, yeah, that was health care related. It is also probably a more expensive health care bill that the one Obama passed. From Wikipedia on [Obama Care](http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Deficit_impact): > [@](#): > > According to CBO estimates, the legislation will reduce the deficit by $143 billion[5] over the first decade and by $1.2 trillion in the second decade, as compared to current legislation.[84][85] For [Medicare Part D](http://en.wikipedia.org/wiki/Medicare_Part_D#Program_costs) we have this: > [@](#): > > As of the end of year 2008, the average annual per beneficiary cost spending for Part D, reported by the Department of Health and Human Services, was $1,517,[18] making the total expenditures of the program for 2008 $49.3 (billions). Projected net expenditures from 2009 through 2018 are estimated to be $727.3 billion.[19] But you’re right, Medicare Part D was a much better deal for taxpayers, a real example of fiscal responsibility. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 28, 2010, 3:52am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/39 "2010-10-28T03:52:01Z")
> [@Bricker](#): > > Virginia simply limited punitive damages. I’m not claiming that’s a bad idea, but it’s probably the least effective tort reform measure. How about limiting all non-economic damages? How about changing the usual joint-and-several liability? How about a loser pays system to eliminate nuisance suits? > > W. Kip Viscusi and Patricia H. Born published a study in the _Journal of Risk and Insurance_ (Volume 72, Issue 1, pages 23–43, March 2005) called “Damages Caps, Insurability, and the Performance of Medical Malpractice Insurance.” They concluded: > > Certainly the savings are there – the more of these reforms a state implements, the more affordable their healthcare is. No they didn’t. They capped damages on pain and suffering (i.e. non-economic damages). Changing joint and several liability so that a negligent party can minimize their liability at the expense of an injured party if one of the liable parties is judgment proof? You went to law school, you took torts, you know the policy rationale behind that argument. Loser pays systems have similar policy stumbling blocks. Its one thing to have loser pays in frivolous lawsuits but a general loser pays rule shuts the door to the courthouse for those who seek redress against those with more resources. You’re a lawyer, Do you care at all about justice in this country? And like I said there are plenty of state examples and there is simply not enough evidence that you will see the effect you are talking about. Heck its barely perceptible never mind worth shutting the under-resourced out of the justice system. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [October 28, 2010, 3:54am UTC](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539/40 "2010-10-28T03:54:56Z")
> [@Richard\_Parker](#): > > There is a way to do tort reform in a [smart way](http://www.nytimes.com/2010/10/21/opinion/21orszag.html?_r=1&ref=peter_orszag) that will reap most of its benefits without many of its negative consequences. What we want is for doctors who are lazy or incompetent to be liable, but for those who are sensible but unlucky to not be liable. Most of all, we want doctors who make intelligent cost-benefit decisions based on evidence to not be liable because they didn’t order a test. We can do that without capping damages for the kid whose doctor operated on the wrong knee because the doctor was seeing 50 patients a day in order to support his wife’s coke habit. > > I suspect the GOP won’t support these kinds of smart reforms, because they’d rather have tort reform as a political boogeyman than as actual policy. And because it would mean giving Obama a bipartisan victory, and their[top priority](http://politicalwire.com/archives/2010/10/25/bonus_quote_of_the_day.html) is to make Obama unpopular. Well that’s not really tort reform because it doesn’t put lawyers out of business. I posted earlier that tort reform doesn’t change doctor behaviour. [Previous page](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539.md?page=1) [Next page](https://boards.straightdope.com/t/health-care-reform-under-republican-control/558539.md?page=3)