AMERICAN CONSERVATISM IN 2008 AND BEYOND

Maporsche has done an excellent job in explaining the probable long term benefits of tort reform--in particular limiting tort rewards for non-expenses. He obviously understands that reducing the cost of tort insurance for medical doctor's in all 50 states, will probably lead to either lower cost health insurance in all 50 states, or to the cost of health insurance increasing less in all 50 states than it would without tort reform.

maporsche wrote:

I did point out that rates in Texas didn't increase AS MUCH in Texas as they did nationwide. That should be an important part of this discussion. If rates went up 100% nationwide over 10 years and only up 90% in Texas over the same timeline, well we should see if TORT reform had anything to do with it. Shouldn't we?

And if it did have an effect, it would be accurate to say that TORT reform helped to drive down premiums.

I have no doubt that the threat of malpractice claims will cause doctors to order unnecessary tests in order to cover their asses. But these tests are, of course, unnecessary.

Doesn't the evidence show that these tests are being performed, but there is no measurable improvement in the various health care metrics (life expectancy, etc), which suggests that the tests are not the right answer.

There are 2 reason I can think of why a doctor would perform an unnecessary test, 1) to cover his ass against malpractice, 2) to bill the insurance industry for something else.

Do you have any evidence that tort law has helped to reduce doctor mistakes?

Ordering redundant or tests that normally would not be indicated just to reduce the remote chance that something unrelated are not likely to reduce doctor mistakes.

When I go to the doctor to see why I have a sore throat, and he accurately diagnoses 'strep', I would not choose to have a whole battery of tests at the time just in case something else is wrong with me. I would like to have the option of using my money for a problem that I know I have.

Again I think most of us have come to agree that needed tort reform by itself won't accomplish a great deal to reduce costs to the individual patient, but we have shown that it can and has produced other benefits that improve overall healthcare.

At least they're willing to admit that the tort system has a direct impact on the health care decisions made by doctors.

Nationally, more than 15% are uninsured. In Texas it's nearly 24%, the Census Bureau says, the highest percentage among the states. Here in Harris County, it's 30%, according to state figures, the highest rate among the nation's top 10 metropolitan areas.

As the Houston area struggles to deal with a rising tide of uninsured, it offers a lesson for the nation: Let the problem get out of hand " to a point where nearly 1 in 3 people have no coverage " and you won't just have a less healthy population. You'll have an overwhelmed health care system.

"Texas is the case study for system implosion," says neurosurgeon Guy Clifton, founder of the Houston-area group Save Our ERs

http://righttruth.typepad.com/right_truth/2009/09/analysis-of-president-obamas-speech-to-congress-on-healthcare.html
September 10, 2009
Analysis of President Obama’s Speech to Congress on Healthcare
From Tennessee Center for Policy Research

Based on a compilation of independent sources, the Tennessee Center for Policy Research has analyzed President Obama’s September 9th speech to a joint session of Congress outlining his new healthcare plan. That analysis is below:

(1) The President Said: “Buying insurance on your own costs you three times as much as the coverage you get from your employer."

The Reality Is: “Premiums for employment-based plans are expected to average about $5,000 per year for single coverage and about $13,000 per year for family coverage in 2009. Premiums for policies purchased in the individual insurance market are, on average, much lower"about one-third lower for single coverage and one-half lower for family policies.”

(2) The President Said: “There are now more than thirty million American citizens who cannot get health insurance] coverage.”

The Reality Is: As many as 75% of the uninsured could afford coverage, meaning that less than 10 million uninsured Americans may be unable to afford coverage.

(3) The President Said: “We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it.”

The Reality Is: While Americans do in fact spend more on healthcare than any other nation, “When you compare the outcomes for specific diseases, the United States clearly outperforms the rest of the world. Whether the disease is cancer, pneumonia, heart disease, or AIDS, the chances of a patient surviving are far higher in the United States than in other countries.”

(4) The President Said: If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.”

The Reality Is: Many employers will be forced to modify their plans to meet the new government standards and still others will simply drop coverage for their employees, forcing employees to obtain their own coverage or join the government-run plan. The Urban Institute estimates that up to 47 million Americans will lose their current coverage, while the Lewin Group estimates that as many as 114 million Americans’ coverage will be dropped.

(5) The President Said: “[Insurance companies] will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies…”

The Reality Is: Forcing insurance companies to eliminate caps and cover routine treatments will drastically increase health insurance costs and compel insurance companies to skimp on important and necessary treatments. Individuals can purchase coverage for the treatments mentioned, but it should be optional, not compulsory.

(6) The President Said: “[Insurance companies] will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies…”

The Reality Is: Forcing insurance companies to eliminate caps and cover routine treatments will drastically increase health insurance costs and compel insurance companies to skimp on important and necessary treatments. Individuals can purchase coverage for the treatments mentioned, but it should be optional, not compulsory.

(7) The President Said: “Under my plan, individuals will be required to carry basic health insurance…”

The Reality Is: Despite the fact that the President pledged not to raise taxes on those making less than $250,000 a year, a senior member of his own Administration admits that a mandate “will act as a very regressive tax, penalizing uninsured people who genuinely cannot afford to buy coverage.”

(8) The President Said: “An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange.”

The Reality Is: Public entities never compete on a level playing field with private companies. First, public entities have an unlimited supply of investors"the American taxpayer. Second, the public entities set the rules that the private companies must abide by, giving them an unfair advantage. A public option would actually “reduce competition by driving lower-cost private health plans out of business.”

(9) The President Said: “I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects.”

The Reality Is: Fannie Mae and Freddie Mac were also intended to be self-sufficient, but they have been bailed out and could eventually cost taxpayers upwards of $200 billion.

(10) The President Said: “I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.”

The Reality Is: Actually, the President proposes setting up a bureaucracy between patients and doctors, called the Independent Medicare Advisory Council. This new body “would enhance Medicare’s ability to deny care to the elderly and disabled based on government bureaucrats’ arbitrary valuations of those patients’ lives.”

Foxfyre wrote:

Ordering redundant or tests that normally would not be indicated just to reduce the remote chance that something unrelated are not likely to reduce doctor mistakes.

How do you know that?

Foxfyre wrote:

When I go to the doctor to see why I have a sore throat, and he accurately diagnoses 'strep', I would not choose to have a whole battery of tests at the time just in case something else is wrong with me. I would like to have the option of using my money for a problem that I know I have.

What about when your doctor inaccurately diagnoses strep when it's actually cancer?

Foxfyre wrote:

Again I think most of us have come to agree that needed tort reform by itself won't accomplish a great deal to reduce costs to the individual patient, but we have shown that it can and has produced other benefits that improve overall healthcare.

Actually, you have shown no such thing. More to the point, you have not put forward any arguments to the effect that tort "reform" has any intrinsic merit aside from its supposed beneficial effects on health care costs.

I was reading earlier this week--I wish I could remember where--that we really don't have healthcare insurance in this country anymore. And that should be part of meaningful healthcare reform if reducing costs is really a serious consideration. (I have really serious doubts whether our fearless leaders care at all about reducing costs.)

For instance, when we take out automobile insurance, it is to cover expenses that we cannot comfortably pay out of pocket; i.e. the vehicle being severely damaged or destroyed or an accident causing severe damage to somebody else. We do not expect insurance to cover normal routine check ups or maintenance, replacement of tires, windshield wipers, oil pumps, etc. and we expected to pay for repairs for damage that was less than our deductible. Automobile insurance would be prohibitively expensive for many if it covered anything and everything that went wrong with the car. Everybody hopes that they won't need to file a claim against their car insurance at all.

It is the same with homeowner's insurance. On most policies, after an agreed upon deductible, your insurance covers theft, burglary, damage to your house or liability for named perils or in 'all perils' policy you are covered for everything that is not excluded. The exclusions on most or all policies are pretty uniform and include certain business property, pre-existing damage or liability, damage from earthquake, flood, riot, war, etc. etc. etc.

You do not expect your insurance to repair the root damage to your front walk or repaint your living room, or pay your plumber for a new furnace or water heater or faucet when the old one wears out.

Health insurance used to be like that. Most people had a deductible that they rarely met and therefore paid for their annual check up, examination for that sore throat, or the sprained ankle out of pocket. They depended on insurance for those things all other insurance is for: the catastrophic or unaffordable expenses.

There are so many ways to reform our existing healthcare system to make it better, stronger, more accessible, and more affordable for everybody without tearing it completely apart and/or the Federal government taking over or controlling more and more of it.

If we would return to a true healthcare insurance system, I think we would see the costs for healthcare policies reduced significantly.

2. Return to an insurance system in which we pay for our own routine checkups and maintenance and expect our insuror to pay only the catastrophic or unaffordable expenses. For the rare mega-catastophic cases, insurers could share additional policies as they do for earthquake and flood insurance.

5. Allow healthcare providers to attach liens to property or assets of patients who cannot pay for their healthcare.

Foxfyre wrote:

2. Return to an insurance system in which we pay for our own routine checkups and maintenance and expect our insuror to pay only the catastrophic or unaffordable expenses. For the rare mega-catastophic cases, insurers could share additional policies as they do for earthquake and flood insurance.

You (and others) said so earlier.

Why don't you consider preventive medicine as part of health care? (Insurer here, especially in the private sector, trump with offers in preventive medicine - they save a lot of money what they had to pay otherwise.

Other private companies have that right Walter; of course they have to go to court to do so.

I do consider preventative medicine as part of healthcare. But if I choose to pay for it myself, why should I not have that option and then pay a lot less for insurance intended to cover what I cannot afford myself?

How is healthcare that I pay for any different than it would be if the insurance company paid for it?