The Gaming Den

Sashi wrote:

Maj wrote:

Sashi wrote:There is literally no difference between me paying insurance premiums to a company and taxes to a government

Except the whole profit thing.

Technically, since my insurance company is a nonprofit, there's not even that difference.

Most insurance companies are not non-profit .

Sashi wrote:When Fiscal Conservatives say that government "wastes" money or spends money "irresponsibly", that's code for things like Welfare and Disability. i.e. "they gave my money to poor people". Like buying beer your friend likes and you don't, it's arguably wasteful. But Fiscal Conservatives paint this like the government is buying beer and dumping it in the street.

That's remarkably one-sided and inaccurate. The government DOES sometimes buy beer and dump it in the street (in the sense that they pay money for stuff that is rapidly destroyed). But worse is when they buy stuff and dump it in their own pockets.

http://www.usatoday.com/news/washington ... ards_N.htm

When people say that government "wastes money or spends money irresponsibly", the biggest problems are literal theft/embezzlement/misuse of money by government workers, and corporate welfare (farm subsidies are a major one, but sweetheart deals to defense contractors are up there too).

There are legitimate complaints about government waste, and trying to brush them off as just a bunch of rich pricks who hate the poor is bullshit.

We actually do have a way to measure waste in health insurance systems. It's the amount of money that goes to administrative costs rather than paying for healthcare. Government run systems have lower administrative costs, and thus lower waste than private systems.

It's very cut and dried. Turning healthcare payments over to the government is cheaper and more efficient than letting private insurance companies figure out how to get things done.

-Username17

This is a load of fucking shit. Insurance and torts are respnsible for about 2.4% of US medical costs. Big fucking whoop. And the defensive medicine thing? ALSO A LIE. What's ACTUALLY happening is the doctor gets a kickback when he refers you to an MRI from the MRI operators. Blam! MRI referrals go right up - and this is the new 'improved' version after doctors are now limited from referring you to their own facility for an MRI scan.

Tort reform would reduce medical malpractice insurance costs, which would save doctors money, which would mean that they would invariably charge less for their services. It will also reduce the overall cost of health care because it would result in less unnecessary medical procedures (that is, defensive medicine). Reducing the demand for medical procedures will reduce the cost of them.

When Fiscal Conservatives say that government "wastes" money or spends money "irresponsibly", that's code for things like Welfare and Disability. i.e. "they gave my money to poor people". Like buying beer your friend likes and you don't, it's arguably wasteful. But Fiscal Conservatives paint this like the government is buying beer and dumping it in the street.

That is because Republicans are not particularly conservative, fiscally or otherwise. They are Reagan conservatives, which relates to actual conservatism in the same way that technical virgins relate to real virgins.

PR wrote:Tort reform would reduce medical malpractice insurance costs, which would save doctors money, which would mean that they would invariably charge less for their services.

Why do you believe that?

Tort Reform could reduce medical malpractice payouts, but why would that necessarily reduce medical malpractice insurance premiums? The reason the premiums are high is because doctors are required to maintain professional liability insurance and are not allowed to unionize or collectively bargain. The insurance premium rates are set by a relatively small number of private companies who in turn can charge whatever they want because the doctors are required by law to negotiate on behalf of themselves alone and are forbidden by law from rejecting whatever offer the companies put on the table.

If medical professional liability payouts go up or down, that just means that the company sees more or less profit. It doesn't necessarily have any bearing on how much the doctors have to pay.

And of course, that doesn't even scratch the surface. If doctors pay more or less for professional liability insurance, that has no direct effect on what they charge for their services. If they save ten thousand dollars, chances are pretty good that they will simply pocket ten thousand dollars. Also, malpractice insurance rates have been falling relative to inflation for the last twenty years anyway. So they obviously aren't the driving force behind medical costs rising faster than inflation no matter how you slice it.

-Username17

Surgo wrote:Not to be the bullshit "FUD guy", but doesn't the UK system have 'death panels' -- ie, if your treatment costs more than $40k or whatever they won't cover it?

I heard that from a guest lecture this term...not sure on exact numbers or if it's completely true or not.

HAHAHAHA

Sort of - the government funds the most cost effective treatment. If you want a treatment that isn't cost effective, you have to pay for it yourself. This is not the case in france.

Tort reform would reduce medical malpractice insurance costs, which would save doctors money, which would mean that they would invariably charge less for their services. It will also reduce the overall cost of health care because it would result in less unnecessary medical procedures (that is, defensive medicine). Reducing the demand for medical procedures will reduce the cost of them.

The CBO has estimated this. In the ABSOLUTELY WORST CASE MAYBE, the total cost of medical malpractice an associated insurance is 3% of total healthcare costs.

So even if you slash those costs in half you will reduce healthcare costs by 1%. Maybe.

What the fuck? It's not even an issue. Health insurance company breaucracy costs about 30% of total healthcare costs. Slashing that in half would actually make a different.

The 'tort reform' line is 100%, unmitigated bullshit.

Tort reform - in my experience - is usually pushed by the insurance companies who don't want to have to pay out.

The biggest problem I have with it is that sometimes damages really do cost a lot of money to deal with, and some of the proposed caps on damages have been so low that people with real medical problems caused by real mistakes wouldn't be able to afford to care for themselves.

The entire healthcare industry needs to be revamped from the ground up, and the first thing that needs to change is transparency.

Cthulhu: the biggest problem there seems to be cancer treatment where nothing is all that cost effective. But I could have sworn there was some amount they wouldn't go over, and that's why cancer was a death sentence in the UK

Surgo wrote:Cthulhu: the biggest problem there seems to be cancer treatment where nothing is all that cost effective. But I could have sworn there was some amount they wouldn't go over, and that's why cancer was a death sentence in the UK

And yet, cancer deaths in the UK are amongst the lowest on Earth according to Nationmaster.

Frankly, I don't believe those statistics are accurate. From what I know, the UK's cancer treatment program is abysmally bad. But it's abysmally bad only compared to countries like The US, France and Japan. For a country that only spends 7% of GDP on healthcare, it does pretty well. For a country with an actually funded Beveridge System, you'd go to Canada, where the cancer survival rates are very good.

The other thing to remember is that having a good survival rate for cancer after treatment (as the US does), is not necessarily that good if a large percentage of your cancer sufferers never get any treatment (as is also the case in the US).

-Username17

Of COURSE UHC is fiscally smart. So, let's move on.

There's still the troubling notion that healthcare expenses have been increasing greater than GDP everywhere on the planet for decades. The US has the worst healthcare system by way of financial efficiency, but in time-dependent terms even medium-cost healthcare systems will be paying out US-levels of expenses in about a decade or so, and in two+ decades they'll be in an even worse place than the US is now.

Swapping the US to a UHC system will save money in the short term, but there remains worldwide a distinct, critical underlying cost component that will remain unaddressed until, I believe, euthanasia is socially acceptable.

Why do you believe that?

The cost of insurance premiums is proportional to the potential cost to the company. Lowering this cost via tort reform would reduce insurance premiums. And yes, it is possible that the doctors will simply pocket the savings.

My point is that driving down the demand for unnecessary medical procedures will lower their costs. And even if tort reform doesn't significantly affect them in the current system, one must keep in mind that this is part of a larger, comprehensive plan of market reforms. (Please remember that insurance companies basically have monopoly power in their states right now.)

PR wrote:Lowering this cost via tort reform would reduce insurance premiums. And yes, it is possible that the doctors will simply pocket the savings.

Or the insurance companies will pocket the savings because doctors are required to carry the insurance. It's a captive audience, and thus very reliable source of income.

Psychic Robot wrote:

Why do you believe that?

The cost of insurance premiums is proportional to the potential cost to the company. Lowering this cost via tort reform would reduce insurance premiums. And yes, it is possible that the doctors will simply pocket the savings.

Or the health insurance companies will pocket the savings. I mean, the fact that as an industry they make giant profits doesn't seem to be driving down prices right now.

I mean, most companies would kill to make 20-30% profits. Literally.

If we really wanted to lower health care costs, we realize two important facts:

1. Hospitals are for profit.

2. Health Insurance is for profit.

Until both of these facts change, we are going to be over-charged for medical services. That's simple math.

I mean, there are certain problems with having the government run anything (inflexible and bound to regulations, no contest bids and cronyism, federal unions, etc), but those are known problems. That means we could just say " for health care, you can't do those things."

Tort reform is another issue entirely. Right now, the only way we can keep corporations from murdering people is our tort system. That's not a bit of rhetoric, but a simple fact. Corporations have murdered people for profits even with our tort system.... they even take that into account ("well, if we make a billion dollars on this new drug, who cares if we lose 200 million in law suits?")

I mean, corporations are already like mini-governments with rights to secrecy and few if any effective checks on their behavior.

People also forget or don't seem to know that winning a case against a major company who is killing people is really hard. Really, really hard. It's so hard that they write books and make movies when people actually do it even when people are dying (Erin Brockovich, for example).

Proving malpractice is even harder, and the payouts are not really that big because they are based on strict formulas.

When the conservatives talk about tort reform, what they are talking about is that companies want "if we lose the case, they can't win enough money to even sting us, much less make us want to stop our bad behavior."

Tort reform is good for some corporations, and bad for everyone else. It's even bad for corporations themselves because it makes it harder from one corporation from getting other corporations to stop being dicks.

People often want things that are bad for them. The trick is not let them do it.

Tort reform is to protect doctors, not corporations. I don't think that we should have tort reform in suits against corporations; I think we should have tort reform in malpractice suits. There's a big difference. Protecting megacorporations is a bad idea; protecting doctors from suits that would otherwise cost roughly $2.3 million is a good idea.

That being said, since when are health insurance companies making profit margins of 20-30%? Their CEOs are obscenely compensated, I will agree, but the last figure I saw was like 3.3%.

PR wrote:Tort reform is to protect doctors, not corporations.

In theory, but not in execution. It's pretty rare that doctors actually have to pay out for malpractice suits - that's what they have insurance for. They are required to have insurance for it.

The biggest benefit of tort reform is to the insurance companies... again.

Surgo wrote:Cthulhu: the biggest problem there seems to be cancer treatment where nothing is all that cost effective. But I could have sworn there was some amount they wouldn't go over, and that's why cancer was a death sentence in the UK

According to the NICE wiki article its "As a guideline rule NICE accepts as cost effective those interventions with an incremental cost-effectiveness ratio of less than £20,000 per QALY and that there should be increasingly strong reasons for accepting as cost effective interventions with an incremental cost-effectiveness ratio of over £30,000 per QALY."

Quality Adjusted Life Year

Health care always has death panels as alarmists like to call them. Try reading this bit from Ben Goldachre's blog.

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The biggest benefit of tort reform is to the insurance companies... again.

Of the legal changes proposed by tort reformers, this study found that states capping payouts and restricting non-economic damages saw an average decrease of 17.1% in malpractice insurance premiums.[25] Similarly, Klick/Stratman (2005) found that capping economic damages saw an increase in doctors per capita.[26]

Tort reform isn't some giant conspiracy to screw the little man over.

Psychic Robot wrote:

The biggest benefit of tort reform is to the insurance companies... again.

Of the legal changes proposed by tort reformers, this study found that states capping payouts and restricting non-economic damages saw an average decrease of 17.1% in malpractice insurance premiums.[25] Similarly, Klick/Stratman (2005) found that capping economic damages saw an increase in doctors per capita.[26]

Tort reform isn't some giant conspiracy to screw the little man over.

Where is that study from? If it's a conservative think-tank, I think we can safely ignore it. Wikipedia has a long history of being rewritten by conservatives when it won't support their ideological views....

Conservative think-tanks always have findings that match their ideology (unsurprisingly).... they even fire and blacklist academics who EVER have findings that don't support their ideology.

I mean, all I can find on the authors is that they wrote some anti-abortion stuff.... so it sounds pretty fishy.

Doctors in the United States are required to have professional liability insurance. The actual tort payments by actual cases are completely meaningless to them. It's distressing to be involved in one of those cases, win or lose, but the actual award caps don't make any difference.

Tort caps are caps on how much the insurance company has to pay. And even if the caps were taken down low enough that the doctors could pay the awards themselves, they'd still be required to carry professional liability insurance.

Yes, tort reform is a conspiracy to keep the little man down. All it does is cap the amount of money that giant insurance companies have to pay to people whose health has been negatively impacted by operations gone wrong. Doctors are completely unaffected, as are the costs entailed by individuals in the healthcare system.

It might have some effect on doctors' willingness to practice in other countries where they are expected to bear the burden of court cases themselves - but in the US the tort awards have absolutely no effect on the doctors themselves. Only giant faceless corporations benefit.

-Username17

FrankTrollman wrote:

Surgo wrote:Cthulhu: the biggest problem there seems to be cancer treatment where nothing is all that cost effective. But I could have sworn there was some amount they wouldn't go over, and that's why cancer was a death sentence in the UK

And yet, cancer deaths in the UK are amongst the lowest on Earth according to Nationmaster.

Frankly, I don't believe those statistics are accurate. From what I know, the UK's cancer treatment program is abysmally bad. But it's abysmally bad only compared to countries like The US, France and Japan. For a country that only spends 7% of GDP on healthcare, it does pretty well. For a country with an actually funded Beveridge System, you'd go to Canada, where the cancer survival rates are very good.

The other thing to remember is that having a good survival rate for cancer after treatment (as the US does), is not necessarily that good if a large percentage of your cancer sufferers never get any treatment (as is also the case in the US).

-Username17

Yes, the UK's cancer program isn't very good. However, they are very good at other stuff.

Overall, it's pretty good. The UK is what you get when you design a system to be as cheap as humanly possible. It delivers good overall outcomes for 5 dollars an a pizza coupon. If you want health insurance ontop of the NHS, you can just do that too - many UK citizens do.

FrankTrollman wrote:Yes, tort reform is a conspiracy to keep the little man down. All it does is cap the amount of money that giant insurance companies have to pay to people whose health has been negatively impacted by operations gone wrong.

This.

What do you think happens as a result of malpractice? Do you think it's something that a cap at, say, $250k is appropriate for?

So if you get some serious complication from malpractice that affects you for the rest of your life to the tune of $20k/year in surgeries or medicine, you're only good for 12.5 years until you're out-of-pocket?

And from the data: even though insurance rates can (but don't always) go down as a result of tort reform, healthcare costs to the consumer universally do not.

Trying to make the middleman more efficient is still more expensive than having no middleman at all.

Why do you need to have forms filled out twice (once by the private industry, once by the government), when it could be done just once and have the same result anyway? Heck, having two form-fillers just increases the likelihood of wastage and fraud.

I gotta hand it to PR, very few troll are this successful.

As far as the general subject of tort reform, something probably will have to be done about the cost of malpractice insurance. I personally know one family physician who wanted to take on a young doctor in his practice (he practices alone), but couldn't because the increase in cost of malpractice insurance was just that much. And aside from personal knowledge, I know that he's not the only one having trouble with that (I understand it's egregiously bad in Pennsylvania).