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Massachusetts senate seat

Arnock
Wed Jan 20, 2010 2:49 pm

Re: Massachusetts senate seat

The biggest problem I have with the health care bill, is the fact that it does nothing to alleviate the actual cost of the healthcare. The bill is just getting shifted to the government, and through them, back to the people or back into the ever-deepening national debt.


One of the biggest things that they could do to reduce healthcare cost is either through some sort of tort reform to reduce medical liability, or move medical malpractice from civil court to criminal court.

However, large law firms seem to have a fair amount of political/lobbying clout, and it probably wont happen for quite some time.
Roots
Wed Jan 20, 2010 2:53 pm

Re: Massachusetts senate seat

Arnock wrote:The biggest problem I have with the health care bill, is the fact that it does nothing to alleviate the actual cost of the healthcare. The bill is just getting shifted to the government, and through them, back to the people or back into the ever-deepening national debt.


One of the biggest things that they could do to reduce healthcare cost is either through some sort of tort reform to reduce medical liability, or move medical malpractice from civil court to criminal court.

However, large law firms seem to have a fair amount of political/lobbying clout, and it probably wont happen for quite some time.


Malpractice insurance and lawsuits actually only make up a very minor portion of total healthcare costs, and cutting them to zero would make little to no impact on the state of healthcare in the US
Njall
Wed Jan 20, 2010 2:54 pm

Re: Massachusetts senate seat

Arnock wrote:The biggest problem I have with the health care bill, is the fact that it does nothing to alleviate the actual cost of the healthcare. The bill is just getting shifted to the government, and through them, back to the people or back into the ever-deepening national debt.


One of the biggest things that they could do to reduce healthcare cost is either through some sort of tort reform to reduce medical liability, or move medical malpractice from civil court to criminal court.

However, large law firms seem to have a fair amount of political/lobbying clout, and it probably wont happen for quite some time.


Tort reform is not the cause of the poor cost v. performance ratio seen in the US against many other health care systems. But it makes for a convenient smokescreen and bloody shirt. The US system is simply grossly inefficient in so many ways. Pity that the useful and surprisingly cost-effective Blue Shield/Blue Cross system set up in the 1960s (as close to universal medical care the US has gotten) was completely destroyed by the creation of HMOs in the early 70s.
thegreatheed
Wed Jan 20, 2010 3:02 pm

Re: Massachusetts senate seat

Thanistor wrote:
honorshammer wrote:I thought the health care bill had already passed?


Well, the House passed one, and the Senate passed one. However, they are *not* the same Bill. So it hasn't gone on to the President yet.

So today it still just a Bill.


Each side passed a bill, but the Senate bill won't pass in the House and vice versa (my cynical side says because the payoffs and special interest spending added into each version bill doesn't buy votes in the other house). Normally, the 2 similar bills would go to committee, be reconciled, than a single condensed version would be voted on in each house. But since even in the House, with about a 70 seat majority, Pelosi can't pass the Senate bill, nothing will happen for a while.

But that's good, since Americans are decidedly against this legislation. There is some definite support for reform, but there isn't support for THIS reform. Higher taxes, restrictions on insurance companies, employers and citizens, along with nothing done to reduce costs (they've included some price controls, but price controls don't fix the rising costs, they just limit what Medicare will payout) these combined will not fix anything.
thegreatheed
Wed Jan 20, 2010 3:06 pm

Re: Massachusetts senate seat

Roots wrote:
Malpractice insurance and lawsuits actually only make up a very minor portion of total healthcare costs,


The defensive medicine that malpractice insurance and lawsuits inspire is NOT a very minor portion of total healthcare costs. When doctors are basically ordered to perform test XY and Z by either insurance or administrators, when in that's doctor's professional opinion only X is necessary, it drives up costs SUBSTANTIALLY.

Oh, and the cost of GIVING away healthcare to illegal aliens who have no tax burden nor incentive to repay drives up the cost even more.
Dorvan
Wed Jan 20, 2010 6:19 pm

Re: Massachusetts senate seat

I'd agree that tort reform isn't the be all end all solution to controlling health care costs, but that still doesn't answer the question of just how the current piece of legislation would reduce health care costs. As far as I can tell, the bill's main effect will be to cover more people by having taxpayers pay for subsidies on health care. Different people will have different opinions on whether that's a good goal, but it has nothing to do with cost. Where exactly are the cost savings?

I tend to think that our model of health insurance being tied to and provided by employers is not particularly useful or effective: as the incentives of health insurance purchasers (employers) are not is exact alignment with consumers. That's not intended as a knock on employers...it seems silly to expect that a single health care plan (or even two or three as is often the case with large companies) will be suitable for all employees. I also tend to think the the current situation of fragmenting health care along state lines is unhelpful as it reduces competition.

My ideas on healthcare are still pretty malleable as I haven't spent as much time over the years thinking about it as I have on other issues, but the bill we have now doesn't seem to match up with the stated goals of our legislators for health care reform...and I for one would like to see that mismatch explained and corrected.
Fivelives
Wed Jan 20, 2010 11:25 pm

Re: Massachusetts senate seat

How do people think that medical schools (yes, even ivy league med schools) are pass/fail influences the problem?
Fridmarr
Wed Jan 20, 2010 11:36 pm

Re: Massachusetts senate seat

Fivelives wrote:How do people think that medical schools (yes, even ivy league med schools) are pass/fail influences the problem?

Which problem are you referring too?
Fivelives
Wed Jan 20, 2010 11:44 pm

Re: Massachusetts senate seat

Oh, inflated health care costs. I thought that's what we were still talking about.
Dorvan
Thu Jan 21, 2010 12:25 am

Re: Massachusetts senate seat

Fivelives wrote:Oh, inflated health care costs. I thought that's what we were still talking about.


I don't see how that's connected. How do *you* see them as related?
Roots
Thu Jan 21, 2010 8:19 am

Re: Massachusetts senate seat

thegreatheed wrote:
Roots wrote:
Malpractice insurance and lawsuits actually only make up a very minor portion of total healthcare costs,


The defensive medicine that malpractice insurance and lawsuits inspire is NOT a very minor portion of total healthcare costs.

Oh, and the cost of GIVING away healthcare to illegal aliens who have no tax burden nor incentive to repay drives up the cost even more.


Looking for the articles that prove this is wrong, because money is the primary motivating factor by a long shot for more tests, not insurance companies and admins fearful of lawsuits. Malpractice and lawsuits currently account for ~1% of total healthcare costs.

Second point is valid.
Fivelives
Thu Jan 21, 2010 9:05 am

Re: Massachusetts senate seat

Dorvan wrote:
Fivelives wrote:Oh, inflated health care costs. I thought that's what we were still talking about.


I don't see how that's connected. How do *you* see them as related?


Misdiagnoses are what started the HMOs on their kick of "oh, we require tests X, Y and Z to confirm", inflating health care costs. That's the theory in a nutshell, basically.
Shathus
Thu Jan 21, 2010 9:16 am

Re: Massachusetts senate seat

Roots wrote:I wouldn't say it's that dems can't agree on anything, but rather democrats just pick up all the view points that aren't the "republicans believe this and only this"

Because of this, republicans have a very easy time to all stand together and vote in one direction, whereas in the democratic party you have a range of views from moderates to extreme liberals.

I don't like the republican party, yet a lot of my views are considered "moderate republican" (don't hate, I'm still pro-choice/pro gay marriage, we're talking from more of a business/tax/money standpoint)


As my wife will tell you, Republicans have forgotten what it is they used to stand for, fiscal conservatives that favor small government. Which is why the health care bill (and a lot of other recent stuff) has driven us crazy. Granted, the 'public option' is a point of debate between the 2 bills as it is, but I'm not in favor of the government controlling my health care and taking up even more debt for a solution that doesn't really solve any problems.

All the talk of this being paid for with medicare cuts and whatever else was said, we knew that A) it wasn't going to be enough or B) the cost will just increase beyond what they thought it would take anyways. Granted I feel that's generally true on most political bills, whether it be the Dems or GOP.
Fridmarr
Thu Jan 21, 2010 9:39 am

Re: Massachusetts senate seat

Roots wrote:
thegreatheed wrote:
Roots wrote:
Malpractice insurance and lawsuits actually only make up a very minor portion of total healthcare costs,


The defensive medicine that malpractice insurance and lawsuits inspire is NOT a very minor portion of total healthcare costs.

Oh, and the cost of GIVING away healthcare to illegal aliens who have no tax burden nor incentive to repay drives up the cost even more.


Looking for the articles that prove this is wrong, because money is the primary motivating factor by a long shot for more tests, not insurance companies and admins fearful of lawsuits. Malpractice and lawsuits currently account for ~1% of total healthcare costs.

Second point is valid.
You are wrong the tests, studies have been pretty clear on that. Obama had to back off that same claim too, attempting to make doctors out to be the bad guys didn't resonate, and the data doesn't back it up. For the most part, private practice doctors don't even perform these tests themselves anyhow, they have to send you to a lab, mri clinic, hospital, etc...

The issue with malpractice isn't in its total cost as a percentage of health care, but in how much it has been driving up the costs of health care during the last couple of decades. It's not insignificant, but it's not a panacea either. However, the important thing is that tort reform doesn't eliminate the cost it just lowers it, the result is a pretty modest change, but in real dollar terms it is significant and shouldn't be ignored.
Roots
Thu Jan 21, 2010 10:00 am

Re: Massachusetts senate seat

Fridmarr wrote:You are wrong the tests, studies have been pretty clear on that. Obama had to back off that same claim too, attempting to make doctors out to be the bad guys didn't resonate, and the data doesn't back it up. For the most part, private practice doctors don't even perform these tests themselves anyhow, they have to send you to a lab, mri clinic, hospital, etc...

The issue with malpractice isn't in its total cost as a percentage of health care, but in how much it has been driving up the costs of health care during the last couple of decades. It's not insignificant, but it's not a panacea either. However, the important thing is that tort reform doesn't eliminate the cost it just lowers it, the result is a pretty modest change, but in real dollar terms it is significant and shouldn't be ignored.


I'd like to see what studies you are referencing. It's killing me that I don't have the economics papers at hand to show where my position is coming from, but summed up it came to this: Rising healthcare costs from excessive/unnecessary tests was caused by (in order of significance) A) The American consumer attitude B) Doctor's acting as businessmen maximizing profits C) Pressure to avoid lawsuits where A+B was ~90% of the cause.

Until I find it I will refrain from commenting further, in the same respect I'd like to see what you read that shows this is not the case.
Fridmarr
Thu Jan 21, 2010 10:03 am

Re: Massachusetts senate seat

Shathus wrote:
Roots wrote:I wouldn't say it's that dems can't agree on anything, but rather democrats just pick up all the view points that aren't the "republicans believe this and only this"

Because of this, republicans have a very easy time to all stand together and vote in one direction, whereas in the democratic party you have a range of views from moderates to extreme liberals.

I don't like the republican party, yet a lot of my views are considered "moderate republican" (don't hate, I'm still pro-choice/pro gay marriage, we're talking from more of a business/tax/money standpoint)


As my wife will tell you, Republicans have forgotten what it is they used to stand for, fiscal conservatives that favor small government. Which is why the health care bill (and a lot of other recent stuff) has driven us crazy. Granted, the 'public option' is a point of debate between the 2 bills as it is, but I'm not in favor of the government controlling my health care and taking up even more debt for a solution that doesn't really solve any problems.

All the talk of this being paid for with medicare cuts and whatever else was said, we knew that A) it wasn't going to be enough or B) the cost will just increase beyond what they thought it would take anyways. Granted I feel that's generally true on most political bills, whether it be the Dems or GOP.

Republicans have bought into the theory that the best way to get reelected is to get money to your district. That's hard to do while being fiscally responsible, and is a mechanism that will always favor the democrats in the current model. That tends to cause problems within the republican party. For instance, they had no problem pushing through the Bush tax cuts, but they didn't cut government spending to go along with that, which ultimately has a similar effect economically to just raising costs, albeit without the negative social impacts. The fiscal conservatives, like myself, often find that Republicans are only fiscally conservative on paper, but in practice aren't much different than the democrats, so it's a party with plenty of it's own issues.

I find that both sides operate primarily out of their own self interests, over that of the nation at large. Obama was able to get a lot of votes out of the belief that he was different in that regard. That whether your agreed with his policies or not (which he portrayed as far more centrist than the evidence suggests), the intent was always for the best of the country. There's probably some truth to that, I find him to be more of an idealist, but for the most part I disagree with his ideas. However, Presidents don't write laws Congress does, and he's been allowing his party in Congress come up with legislation that is definitely more about expansion of power and control which will dramatically help them down the road, than it is about solving the problems. Pelosi's been clear that she's willing to live with giving up the majority to get this done. She knows the bill is very unpopular so there will be a backlash, but also because it sets them up for regaining that majority and maintaining a strangle hold on it in the future, it's worth the short term hit. It's also why they actually tried to write language into the bill that suggested it couldn't be repealed in any way. Apparantly, the constitution be damned when it gets in the way.

There has even been talk that the democrats want the house to approve the senate version of the bill, circumventing the newly elected senator by avoiding another senate vote on the issue. That seems unlikely to happen, but it's certainly a pretty shady idea. Regardless, I have no interest in turning over my healthcare to these people. I'm all for reform and getting reasonable coverage to those who can't currently afford it, our current model certainly has issues, but the current bills aren't any better.
Fridmarr
Thu Jan 21, 2010 10:07 am

Re: Massachusetts senate seat

Roots wrote:
Fridmarr wrote:You are wrong the tests, studies have been pretty clear on that. Obama had to back off that same claim too, attempting to make doctors out to be the bad guys didn't resonate, and the data doesn't back it up. For the most part, private practice doctors don't even perform these tests themselves anyhow, they have to send you to a lab, mri clinic, hospital, etc...

The issue with malpractice isn't in its total cost as a percentage of health care, but in how much it has been driving up the costs of health care during the last couple of decades. It's not insignificant, but it's not a panacea either. However, the important thing is that tort reform doesn't eliminate the cost it just lowers it, the result is a pretty modest change, but in real dollar terms it is significant and shouldn't be ignored.


I'd like to see what studies you are referencing. It's killing me that I don't have the economics papers at hand to show where my position is coming from, but summed up it came to this: Rising healthcare costs from excessive/unnecessary tests was caused by (in order of significance) A) The American consumer attitude B) Doctor's acting as businessmen maximizing profits C) Pressure to avoid lawsuits where A+B was ~90% of the cause.

Until I find it I will refrain from commenting further, in the same respect I'd like to see what you read that shows this is not the case.

I don't have links, though I'm sure they are online. Look up Kessler and McClellan, I'm not not sure on the spelling but that should be close. I believe Harvard did some further work with that study as well.

My wife is a Labor and Delivery RN at a high risk hospital, so I try to keep myself fairly educated on this part of the issue, because L&D is a huge source of malpractice.
Dorvan
Thu Jan 21, 2010 10:19 am

Re: Massachusetts senate seat

Fivelives wrote:
Dorvan wrote:
Fivelives wrote:Oh, inflated health care costs. I thought that's what we were still talking about.


I don't see how that's connected. How do *you* see them as related?


Misdiagnoses are what started the HMOs on their kick of "oh, we require tests X, Y and Z to confirm", inflating health care costs. That's the theory in a nutshell, basically.


...and what does that do with pass/fail grading in medical schools? You're going to have to provide some more support than that. The causality chain looks very flawed, but I'm hesitant to post a full rebuttal when you haven't laid out your reasoning. Here's a short one though:

http://blogs.wsj.com/health/2009/05/20/ ... b/article/
Shathus
Thu Jan 21, 2010 12:18 pm

Re: Massachusetts senate seat

Fridmarr wrote:
It's also why they actually tried to write language into the bill that suggested it couldn't be repealed in any way. Apparantly, the constitution be damned when it gets in the way.


That crap pissed me/us off. Like you said, how is it even constitutional?! Which to me, just proves even more that they know it's not right (the bill) and want to get it in so no one can come in later and get rid of it again.
thegreatheed
Thu Jan 21, 2010 1:41 pm

Re: Massachusetts senate seat

Shathus wrote:
Fridmarr wrote:
It's also why they actually tried to write language into the bill that suggested it couldn't be repealed in any way. Apparantly, the constitution be damned when it gets in the way.


That crap pissed me/us off. Like you said, how is it even constitutional?! Which to me, just proves even more that they know it's not right (the bill) and want to get it in so no one can come in later and get rid of it again.


The current health care bill also does something that has never been done before in this country. It MANDATES a purchase by private citizens.

No, car insurance isn't the same thing. You don't HAVE to drive a car, it is a choice. But the current iterations would MANDATE every citizen buy health care if they do not qualify for Medicare. It may be a backwards way at looking at things, but isn't a MANDATE to purchase a product, provided by a private company, seem a little fishy to anyone else?

I know the Democrats play the role of hating big business and specifically the insurance companies, but considering most campaign rhetoric is just that, it makes me wonder They are the party that bailed out Wall Street, banks, and our car companies.
Roots
Thu Jan 21, 2010 1:53 pm

Re: Massachusetts senate seat

thegreatheed wrote:They are the party that bailed out Wall Street, banks, and our car companies.


Bush signed the bailout bro. Obama's second bailout isn't even half spent yet.

Your mandatory point is the biggest problem I have with the bill as well. Especially in a situation where lower income rates aren't ramped accordingly, but rather tiered with some pretty steep steps in between.

Fridmarr wrote:Look up Kessler and McClellan, I'm not not sure on the spelling but that should be close. I believe Harvard did some further work with that study as well.

My wife is a Labor and Delivery RN at a high risk hospital, so I try to keep myself fairly educated on this part of the issue, because L&D is a huge source of malpractice.


The closest references I could find were circa '03-'04
http://www.factcheck.org/president_uses ... ts_of.html
Takes a quick look at the Keller/McClellan paper in reference to the healthcare debate (using the website for references to the papers themselves, not the comparisons drawn by factcheck.org), but even then the 5-9% does not represent a 'significant reduction' based solely on malpractice lawsuits and defensive medicine.
Seems the CBO and GAO question the paper as well, but I take that part with a grain of salt.

Harvard did do a study: http://www.hsph.harvard.edu/faculty/mic ... gation.pdf
Our findings point toward two general conclusions.
One is that portraits of a malpractice
system that is stricken with frivolous litigation are
overblown.
sic
Our findings suggest that
moves to curb frivolous litigation, if successful,
will have a relatively limited effect on the caseload
and costs of litigation.
Fridmarr
Thu Jan 21, 2010 2:04 pm

Re: Massachusetts senate seat

thegreatheed wrote:
Shathus wrote:
Fridmarr wrote:
It's also why they actually tried to write language into the bill that suggested it couldn't be repealed in any way. Apparantly, the constitution be damned when it gets in the way.


That crap pissed me/us off. Like you said, how is it even constitutional?! Which to me, just proves even more that they know it's not right (the bill) and want to get it in so no one can come in later and get rid of it again.


The current health care bill also does something that has never been done before in this country. It MANDATES a purchase by private citizens.

No, car insurance isn't the same thing. You don't HAVE to drive a car, it is a choice. But the current iterations would MANDATE every citizen buy health care if they do not qualify for Medicare. It may be a backwards way at looking at things, but isn't a MANDATE to purchase a product, provided by a private company, seem a little fishy to anyone else?

I know the Democrats play the role of hating big business and specifically the insurance companies, but considering most campaign rhetoric is just that, it makes me wonder They are the party that bailed out Wall Street, banks, and our car companies.
Yup I mentioned that earlier, and I don't see how that would be constitutional either. However, I think that is only in the House version, yes?

Roots, I'm not sure what you are getting at. My point is that defensive medicine is in large part due to litigation concerns, the data supports that. Tort reform isn't a panacea, but it is significant. Healthcare carries a huge price tag, and if you can reduce continued (and remember it's still growing) cost inflation by 5-9%, I'm not sure how you ignore it. More than that though, it's just the right thing to do. Many jurisdictions have already seen significant drops in doctors willing to perform certain specialties, just because of frivolous lawsuits. My wife has to deal with that shortage daily.
Roots
Thu Jan 21, 2010 2:18 pm

Re: Massachusetts senate seat

Fridmarr wrote:Yup I mentioned that earlier, and I don't see how that would be constitutional either. However, I think that is only in the House version, yes?

Roots, I'm not sure what you are getting at. My point is that defensive medicine is in large part due to litigation concerns, the data supports that. Tort reform isn't a panacea, but it is significant. Healthcare carries a huge price tag, and if you can reduce continued (and remember it's still growing) cost inflation by 5-9%, I'm not sure how you ignore it. More than that though, it's just the right thing to do. Many jurisdictions have already seen significant drops in doctors willing to perform certain specialties, just because of frivolous lawsuits. My wife has to deal with that shortage daily.


Sorry could have clarified: My argument is that litigation+defensive medicine costs is overstated (as both the CBO/GAO have rebutted the Kessler-McClellan paper; studies in other areas of medicine saying 3/10ths of 1 % instead of 5-9%) and should not be a primary issue for cutting costs in healthcare. That doctors are less willing to perform said specialties is certainly an unintended consequence, but does not have to do with cutting costs.

The Harvard paper I linked also agrees that these litigation and defensive medicine costs are overstated.

Personally I think medicine should adopt a more statistical method (which people will probably crucify me for) similar the Chicago's system for ER response to heart complaints. Another idea is a chapter in Freakonomics that explores information sharing within a given hospital that reduced wait times and improved efficiency thus cutting costs by a far greater percentage.

More though, I'm enjoying one of the first conversations about healthcare that hasn't turned into a party flame war.
Shathus
Thu Jan 21, 2010 2:21 pm

Re: Massachusetts senate seat

(frivolous) lawsuits in general are a big problem in today's society as well. Not just in the medical fields. I would hate to be a teacher today and dealing with a lot of t he crazy parents out there. "Oh no, Tommy isn't special and got a C, I'm gonna get this teacher in trouble" and stuff like that. I remember when I played little league sports, my parents would drop me off at practice, and come back 2 hours later to pick me up. Now parents set up shop at the practices the entire time, now this isn't a bad thing by itself, safety issues, etc. But when they do this, then yell at the coaches and/or complain about how their kid isn't getting enough playing time, while the kid is sitting in the back eating grass ticks me off.

Ok sorry, I went off on a tangent there. Back to your regularly schedule health care reform. Back when the .... House? was try to pass the bill and the 60th voter from South Dakota or wherever was holding out, and basically got whatever he wanted put in the bill so that he would sign, how is that what's best for the country? Things like that are the problem with politics, dem or rep they all lie anyways.
Fridmarr
Thu Jan 21, 2010 2:34 pm

Re: Massachusetts senate seat

Yeah, I believe you are referring to Senator Ben Nelson from Nebraska. That has caused a lot of heartache among states including potential lawsuits from states suing the federal government for violating interstate commerce among other things. Yes, that is an example of some of the problems with the process. I agree that tort reform in general needs to be looked at.

Roots wrote:Sorry could have clarified: My argument is that litigation+defensive medicine costs is overstated (as both the CBO/GAO have rebutted the Kessler-McClellan paper; studies in other areas of medicine saying 3/10ths of 1 % instead of 5-9%) and should not be a primary issue for cutting costs in healthcare. That doctors are less willing to perform said specialties is certainly an unintended consequence, but does not have to do with cutting costs.

The Harvard paper I linked also agrees that these litigation and defensive medicine costs are overstated.

Personally I think medicine should adopt a more statistical method (which people will probably crucify me for) similar the Chicago's system for ER response to heart complaints. Another idea is a chapter in Freakonomics that explores information sharing within a given hospital that reduced wait times and improved efficiency thus cutting costs by a far greater percentage.

More though, I'm enjoying one of the first conversations about healthcare that hasn't turned into a party flame war.

Don't get confused with overall cost versus the increase in cost we've seen in the last decade or two. We are seeing litigation having more and more of an effect on driving up costs. It is overstated for sure, people seem to think with tort reform it goes away compeletely, but of course it won't, but it's not insignificant. And no, I don't trust a word that the CBO is spewing at the moment, you can't keep revising your data every time you get called to the principle's office and expect anyone to trust it when the principle is finally happy with it. Never mind the fact that their cost model is based on legislation that does not exist, and likely won't which seems to violate their fundamental reason to exist.

I dislike both parties quite a bit, but I am conservative, so my comments tend to come from that angle, versus a party loyalty.