What To Do About Healthcare?
 

There is a long thread on "where do you stand on universal healhcare" that prompted lots of interesting replies. Clearly some are "for" and some are "against" universal healthcare--whatever that is.

But there are a couple of problems that remain that everyone agrees need to be addressed. "Everyone" includes Democrats, Republicans, ultra conservatives and flaming liberals. The problems everyone agrees on are...

-- Healthcare in the U.S. is too expensive, and it is getting even more expensive at a rate that is simply not economically sustainable over a relatively short timeframe. Healthcare in the U.S. costs 50% more per capita than any other developed country, and the quality of care is not that much better.

-- Far too many Americans have no form of healthcare insurance whatsoever. For one of the most well-developed countries in the world to have almost 50 million people--almost 20% of it's population--with no form of healthcare insurance is not only unbelievable, but bordering on criminal.

So, presuming that regardless of our political leanings, I'm assuming that everyone here on this forum lines up with their political representatives in recognition of these two problems. The problems cited above are real and need to be addressed.

So, if you were a member of Congress, what sort of plan to address these problems would be acceptable to you? We've heard from our elected representatives ad infinitum in recent days. Their comments range from "these are the general concepts that President Obama wants in any plan passed by Congress" to "xxx makes any healthcare bill a non-starter for our party".

Recognizing the confusion of "the 545" regarding this issue, maybe we can enlighten one another with just a few important points in whatever plan we might find acceptable? Specificity would be helpful.

Let the creativity begin.

Single payor, similar to Canadian system.

Any existing models of universal health care, involves rationing. I am against rationing. Most health care is needed the closer to the end of life that we get. I am not for some snot nosed RMV caliber worker determining that I am not worth the expense. Perhaps I don't pay enough taxes? Perhaps I voted the wrong way.

Call me selfesh but, I WANT TO LIVE.

Yoda

A member of the loyal opposition

Random thoughts for starters.

First order of business - a full frontal assault on tort reform with a concentration on medical malpractice. It is obvious that these claims drive a significant part of medical costs.

Our educational system needs to increase opportunities for talented young Americans to receive their medical training in this country. Concurrently, we need more doctors to create more competition and hopefully lower costs.

Major incentives for businesses small and large to adequately insure their employees.

Restructure medicare

Stop treatment of illegal immigrants - very tough decision because it goes against the values we preach and live by. However, the drain on our system is clearly demonstrated in California's predicament. If rationing is the current administration's plan for the future of medical care in the USA, ration by taking Americans first. Their taxes support the system.

Form a special task force to work with every major drug company in America and the FDA to find creative ways to reduce costs for those in difficult financial circumstance. Explore tax incentives for those companies that participate.

Create a task force of medical professionals, insurance professionals, business and financial professionals to develop a serious single payer system NOT under government control. Government oversight? Possibly.

Excuse the hipshooting style.....this serious subject needs a lot more thought.

I think that the government's history of respecting life is not a good recommendation for overseeing a "Health" plan. The government "sanctions" sacrificing lives in war and also looks the other way when millions are aborted.
With that track record...how long do you think it would take before the elderly were expendable?:shrug:

Everything you described ALREADY exists in our health industry. I deal with 'snot nosed RMV's daily telling me it's "not medically necessary". Almost everybody WANTS TO LIVE. So the 32 year old who stuck the palm trees in your yard who is trying to start his own business has a serious injury on the job... medical bills of over 20 K. What say you?

Keedy, I cannot argue with your logic because I agree. You are succinctly on the mark. What a sad commentary on our government.

I'm not in full agreement here.

1. Health care is expensive, but it's also gotten much more sophisticated than anything else, with the highest research costs, and using the most expensive (since it's singular in distribution) delivery system there is. As long as people don't get "efficiently sick or injured," the medical services cannot dispense health care very efficiently. Sure, some care can be, but most is reactionary to an individual event.

2. Not having health insurance doesn't mean people don't get health care services. Government (federal, state and county) subsidy of health care costs for those without resources and those in special situations (Indian reservations, veterans, over-65, and a host of others) is immense, but whether the subsidy is efficiently being managed is another story altogether. Insurance is nothing more than a pooling of resources by a select population and subsequent sharing in the pool should the insured have the need. Insurance isn't a right, as who can enter the "pool" is subject to whatever restriction the insured want to place on membership.

So, it isn't criminal that 50 million people don't have health care insurance. What would be criminal would be if people didn't get emergency health care help - and that's not the case.

While 50 million is just under 17% of the population, the real question is where are the 50 million people located? Are they evenly distributed among all 50 states, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands and the Minor Outlying Islands (Midway, Wake, Jarvis, etc)? Are the 50 million mainly in the top 15 major cities? Are the majority massed in select jurisdictions? Do we even know?

The reason why knowing where the uninsured are is whether this is indeed a federal matter or a state one? As of late, the tendency is to make every problem of every kind a federal matter, despite the fact that Washington has a lousy record trying to manage at the local level. What works in Cleveland (OH) doesn't necessarily work in The Villages (FL), or in Round Rock (TX), or in Casper (WY) or in Tacoma (WA) and so on. If the federal government could indeed manage health care locally, the Department of Health and Human Services would have already taken over State and County health departments, set a national health care professional license registry, and literally put the states and county agencies to pasture.

When it comes to realizing the differences and uniqueness in populations and requirements among the states and territories, the best the federal government can do is determine the lowest common denominator and manage to that level to include delivery of services at that level. That's what would be considered "fair" from a spending distribution policy and anything else would be a battle-and-a-half.

We had state governments before we had a federal government. They fit the bill here, not the fed.

So, what do we here in Florida want to do about health care within the State of Florida, based on our geography, population, and local needs? The other states need to do the same, and all states recognize that Washington was never meant to be all-powerful, all-directive and all-controlling over local matters - unless we want to be satisfied with a lowest common denominator system.

ONE LAST COMMENT: The Canadian model is not a good one. We're talking about a nation whose total population is equal to California's. It's not a one-for-one comparison, as Canada, despite its physical size, doesn't have the delivery requirements the US does. Canada's system may work for selective states, but not as a US federal system.

Not having health insurance absolutely and most definitely does mean uninsured people do not get health care services. What is the first question you get asked when you call a new provider for an appointment? "what kind of insurance do you have?" Do you think the example I gave above.. the young fellow who stuck the palms in your yard... is a rare, uncommon, poor example? he can't get medicaid (makes too much), he's too old for medicare, his monthly premium for his family of 4 would be over 1000 dollars and last year he made 26 thousand.

BTW, the "pool" you refer to above has a limited amount of money. As such, those that manage the pool (aka... "managed care") will tell you what you can or cannot take out of the pool. Thus, rationing. There is only 1 group that has no rationing at all--> those that pay cash for all of their care. For that group this debate has no meaning or impact on their care.

Contacting a business (which a physician's office is) to seek services on a non-emergency basis is one thing - showing up at a hospital emergency room is another.

The "young fellow with a family of 4" scenario is indeed a true one. I've been there, too, and the choices of what to spend money on and working two jobs if necessary is a real one.

Also, if one expects his/her health insurance will cover everything all of the time, that expectation is not rational. If one won't seek health care services because "the insurance doesn't cover it," that is just plain silly. There will always be out-of-pocket costs for things, especially if you want "the best available" and not just the lowest common denominator.

Perhaps the "health care" matter can be mitigated in the same way the "legal care" matter is - mandatory or "aspirational" levies of time and/or money placed upon health care providers by their state licensing authority. As an example, the Florida Bar seeks (and has a reporting requirement covering pro bono services) member attorneys to provide a minimum of 20 hours of service to the poor, or donate $350 minimum to pro bono service agencies. Most states have similar levies on its attorneys.

If that's okay and expected of lawyers, what's wrong with the same for physicians? Why should only lawyers supposed to be "concerned with the poor geting help" as a condition of maintaining their license? (Please see: http://www.abanet.org/legalservices/...irectory.html# )

1. Tort reform. Eliminate the large settlements, force arbitration, and set a maximum allowable amount that a doctor could be sued. Eliminate bad doctors, and create subsidized insurance pools. When 40% of someones income goes to insurance, cost of medical care will never be contained.

2. Insurance payment reform. When a $20,000 bill gets settled for $2000 the system has already failed. First because the bill is so high and second because the payment is so low. Attack the cost side with number 1, attack the income side here and provide reasonable reimbursement for services provided.

3. Education reform. Help bright young people pay for college and medical school with the provision that they spend X number of years as a GP. Most doctors who graduate today will not become general practitioners. Not enough money to be made to pay for their education. So incentives to get doctors in these roles is needed. More nurse practitioners as well. Need to pay them more so they get to this role. Without addressing this issue we will have rationing of health care weather you can afford it or not.

4. Drug cost reform. It costs to much to develop a drug today. To much testing, the maintaining of a validated environment, meeting FDA rules, time from development to on the shelf, and also part of tort reform.

5. 50 million without insurance does need to be resolved. However if you are here "illegal", we need a different solution. It is not up to the American tax payer to take care of someone who broke our laws. If you are here legally and do not have insurance then we do need to create some sort of basic care and make it available at an affordable price to those in need. Clinics, pro bono work, generic drugs, some way to care for those in need.

6. Keep the government out of the solution except for these 5 things. A government run system will fail worse then the current system. I have not heard a single politician even mention tort reform and to me that is the number one problem.

I heard just this morning in order to sell his plan, Obama is offering the AMA malpractice reform. Question is, if it's good for the system, why not just do it anyway?

On forums we have spammers. In Washington we have scammers.

Excellent idea--pro bono. Following your idea... pts pay for ALL time the physician spends on their case. You know, "the meter is running" concept.... "billable hours".... phone calls, reviewing lab results, consulting with other physicians, talking with attorneys, filling out forms are all billable to the patient.... in fact, everything is billable to the patient since physicians will now be like attorneys and simply charge per unit of time, directly to the pt.... there are actually a growing # of physicians doing exactly this. When you call their office you are not asked what type of insurance you have.... instead you are told, "DR Smith does not accept any insurance.... he accepts cask, Mastercard and Visa. " Also, if we are going to "mitigate health care the same way legal care is" we need to keep the playing field level... so malpractice ins needs to be on an even plane too.

"The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.

That's the crux of the health care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health care "reform" now being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem."

This is part of an article written by a respected business writer, Robert Samuelson, and the link to the entire article is below...

http://www.realclearpolitics.com/art...orm_96997.html

I have been trying hard to get a bit of "smarts" on this subject, but it sure gets confusing.

Seems most, if not all, want some kind of REFORM, but the shape is quite a debate. There are even those who feel that the reform being touted will REDUCE the care for the most needy folks in society.

Thought I would drop this article off for comments as it was the first I had heard this particular viewpoint !

Right On The Mark, Cabo and i2
 

Thanks for the thoughtful list of what can and maybe should be "done about healthcare". Hopefully many more of our colleagues here will produce their lists to give us all something to think about. Too often we revert to doing the same things that our elected representatives do most of the time--argue about what we wouldn't do, as opposed to presenting some ideas for consideration, discussion, negotiation and maybe legislation.

If the electorate would take the time to figure out what we think is necessary as individuals, we'd be in a lot better shape when the time came to choose who we intend to vote for the next time around.

The top item on your list would be tops on mine, as well--tort reform. But as I'm remembering, that isn't among anyone's plans for reforming healthcare, is it? Or have I just missed someone's proposal?

People want $$-Limits on medical malpractice claims until they are harmed. When the GP made house calls, claims were rare, as the family patients and the GP had a relationship which provided understanding. Once the house calls ended and was replaced with the multi-exam-room approach where the patient became a "file folder with a number" and expected to endure waiting-room-itis and made to feel unimportant, the expectation of care quality jumped in response, as the "family doctor and the family" relationship deteriorated into nothingness. Physicians for the most part have forgotten that medical services is a "personal services" business, and without the "personal" factor, perfection becomes the expected occupational standard. Put "personal" back into the service equation, and claims will drop like a grand piano falling from a rooftop.

When high bills are settled for whatever, the next person billed finds their bill a little higher to make it up. That's the same in every business.

That exists already. The military has been doing that forever, and so has the US Public Health Service. If making the most money possible is the only incentive, then the Hippocratic Oath needs to be replaced with the preamble to TARP. And medical schools are businesses, too. They charge whatever the market will bear, and as long as student applications outnumber seats, it's a seller's market.

I remember Thalidomide and a host of other drugs whose performance did not match the plan. When one takes shortcuts with the scientific process (especially in the evaluation phase), the risks can become deadly.

But is this a federal problem? The fed cannot manage local use programs. There are many ways to resolve this without more inefficient federal programs which only reward politicians and appointees.

If the federal government is involved 1%, they control things 100% - every businessman who has ever dealt with federal regulation knows this painfully well.

Malpractice insurance matches the expectation of care standard, and physicians have screwed themselves on this by dehumanizing their relationship with their customers. When the customer is treated as less-than-important, the expectation of perfection rises accordingly. When physicians stop treating their customers impersonally, the playing field changes big-time. Attorneys, accountants and other professionals who are in a competitive environment know this and nurture their client relationship, and the insurance costs reflect this business practice.

And the medical profession does use the "taxi meter" approach now. Try to get a physician to spend longer than the 10-minutes-per-examination-room - they follow the meter, and ration the time to match the money. The exception are those on the per-session basis.

Have I Got This Right, Steve...
 

...your proposal is that the federal government do nothing about the "healthcare problem", whether real or just perceived.

You also suggest that some part of the issue appears to be for the individual states to resolve. But government being government, when it came to that, would we want to keep state government's fingerprints off of healthcare, as well?

I agree with a lot of what you write, but not this time. These problems have been festering for decades. Doing nothing--something our Congress is really good at--has been the easy way out for Congress for a long while. Things aren't getting any better. Healthcare costs and the resultant insurance premiums have skyrocketed to the point that the number of uninsured Americans is far more likely to increase than decrease. Medicare is going broke.

These don't seem to be problems that "doing nothing" will fix. The free market approach has lead us to this point. Is it reasonable to believe that letting the free market work will ultimately correct them?

If the government had an ounce of common sense or competency (let me rephrase that) a gram of common sense I’d maybe say let’s give it a go and see if we can fix this.

Problem is, the government AWAYS makes it worse. They NEVER fix anything. Everyone knows that even if you don’t want to admit it.

VK says...

"The top item on your list would be tops on mine, as well--tort reform. But as I'm remembering, that isn't among anyone's plans for reforming healthcare, is it? Or have I just missed someone's proposal? "


Maybe....

"Daschle: Tort Reform "On The Table"

"As if taking his case to the most powerful physicians group in the United States to push his controversial health care proposals wasn't a big enough headline, a New York Times report says President Obama has been working behind the scenes to protect doctors from malpractice. lawsuits.

"Tort reform is going to be on the table," Mr. Obama's initial nominee for Health and Human Services Secretary and former Senate Majority Leader Tom Daschle told The Early Show Monday."

http://www.cbsnews.com/blogs/2009/06...y5088733.shtml

:agree:Fee for service or a financial incentive to get paid more for doing more procedures is an invitation for trouble

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Healthcare providers exist in a price controlled environment, dictated by government payers and private insurance companies. You get what they say you get...period.
For those of you that have owned your own business, how would this fly for you...to be told what you could charge and what you would be reimbursed for you goods and services?

"Malpractice insurance matches the expectation of care standard". I'm not clear what you mean by that. The "standard of care" is supposed to be defined and set by experts and deviation from that standard which results in damages MAY expose the physician to malpractice. Here's the problem: In an adversarial setting (the courtroom) you have a lay jury listening t experts for the plaintiff and defendent. These "experts" are often "hired guns" whic means they make their living as 'physicians' testifying in malpractice cases. The are paid typically in the thousands of dollars per hour to give an opinion. So, one side says the standard of care was met, the other side says it wasn't. The lay jury has to figure it out. Emotion usually makes the decision.

Finally, Some Info From Someone Who Knows
 

Thanks, Serenity. It's always good to hear from someone who have first-hand knowledge of some of the things we discuss here. All too often, we wind up trading the soundbites provided by others far less knowledgable and experienced.

The purpose of my original posting was to get all of us thinking about what changes in our healthcare system would be important to each of us. Once each of us had a few such thoughts, I thought it would be far easier for us to understand and assess the plans being circulated by the various members of Congress or other entertainers, many of whom have special interests that we all don't share.

Thanks again for the insight.

VK,

My comments were not directed to you at all. It is a very timely post and certainly worth discussion in detail. I think I am also voicing some frustration at the folks that make unfounded assumptions and present them as fact, without an inkling of what truly goes on behind the scenes. I am also troubled by the attitude of "I'vr got mine, you worry about yours" attitude from many that are blessed enough to have good healthcare coverage.

You are completely on point about the special interests, and unfortunately their influence appeals on emotion and popularity basis.

This is indeed a multifaceted problem, but there are inherent simplicities also.
Malpratice is out of control and a gigantic player here. Estimated costs of overhead in health care are 30% at large. Lack of not only maintainence care but self accountability from patients contributes greatly to cost (read compliance with medication, smokers, obesity etc etc). We are innapropriate and inneffective as a society with regard to end of life care and appropriate utilization of resources. As a society we want the best of everything and we want it yesterday in medicine, but is has to be paid for.

As usual you have raised a timely topic in an articulate manner and as always I appreciate it.

My point is, when there was a human-to-human relationship between the family physician and the family members, there were no lawsuits. The family physician, even if he screwed up, was known for having tried his best, was at the wake, and cried at the funeral as loud as any mourner - and meant it. Once health care delivery became an emotion-free action, and "Mr. Jones and Mrs. Smith and young Johnny" became "the patients in Examining Rooms A, B & C," whose relationship with the physician was a brief encounter after an hour in a waiting room, the physician became as faceless as the insurance company, and given the same amount of leeway.

The medical industry, in finding a way to be more profitable by greater "office efficiency," also acquired an additional liability in that the leeway given to the Dr. Welby's of old was lost in the bottom line. It was a perfect example of "for every action, there is an equal and opposite reaction." A "wall" was created between the physician and the customer/patient where that "have a cup of coffee after the home visit - which friends do" was replaced with the medical experience having as much human sensitivity as an oil change at Jiffy Lube. That "wall" between health care provider and recipient is the problem - and it's that "wall" that has made medical malpractice as much of an item on the health care scene as Viagra commercials.

And VK - yes I think the health care matter is one for the states, not the fed. There is nothing wrong with different states trying different ways to better the lives of their citizenry. Several states already have health risk pools for uninsurables (see http://www.healthinsurance.org/risk_pools/ ), several also have either enacted or in the process of enacting their own version of health care reform (see http://www.kff.org/uninsured/kcmu_statehealthreform.cfm ), and the experiences from these efforts give the rest of the states an opportunity to see what's best for them based on real data, and not just on political hyperbole. The fed always ends up with a "one size fits all" solution, and it usually fits no one other than those within the DC beltway who get rich off it. So, unless we want another TARP and bailout "the bill is too long and confusing, so I'll just vote for it and hope for the best," the states are still the best bet to get it right for what works with their constituencies. And since the states already are in the medical oversight business via licensing and other regulation, it's better to work within one existing body of law than try adding more layers.

Thank you, Dr. Serenityseeker. Your post is outstanding. And it comes with great credibility. Your points are excellent. You are speaking from the reality zone, not the comfort zone.

Boomer

Couldn't agree more. It simply becomes a theatrical contest between sides, and the attitude in today's society is "somebodies gonna pay" regardless of whether any real malpractice occured or not. Whoever puts on the best show wins.
Lawyers know this and manipulate the system, even making good living on lawsuits without merit, because the insurance companies and the lawyers all know it is cheaper to give up a settlement than to fight in court. It is a sickening game in a perverted system and there is no end in sight. Without meaningful change there is no hope of improving the healthcare system.

Nuts
 

the great general once said in ww11

Unfortunately this is change you can't believe in.... lawyers control Congress.

The notion that "if we all were like Marcus Welby" malpractice would no longer be a problem is completely foolish. The highest claims in malpractice are in neurosurgery, orthopedics and OB-GYN--the surgical specialties. Orthopods and neurosurgeons often have their first contact with a pt in a trauma setting, the pt is busted in pieces and unconscious. The patients only concern should be the technical competence of the surgeon. That aside, there is good data to support the notion that pts who "like" their doctors are less likely to sue. The multimillion dollar lawsuits that hit neurosurgeons and the other surgical specialties are unlikely to be mitigated by a Marcus Welby personna ( a fictitious TV creation). BTW, I grew up in the 50's. My family doc didn't take appts... first come, first serve... waiting room often spilling out into the streets.... lots of penicillin shots... ave time face to face with the doc--- I recall about 1-2 minutes....not the TV image of the paternal Marcus Welby siting down for a casual hand holding chat... not sure if he was ever sued back then... it wasn't part of the culture. Now that is the culture.

Great post. Thank you

The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

Sorry, when it comes to who "jurys hate most".... the lawyers are in good company. See attached.

http://www.times-standard.com/davestancliff/ci_11971293

Simply put you are wrong, and with all due respect out of touch with the subject as it exists in todays world.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

To generalize all physicians in this matter is innaccurate and irresponsible. Do you have any idea why wait times are long, why visits are rushed, and why so many doctors are leaving the fold? No, you obviously don't. And your movie reference is a great example of people being swayed by the media and making poorly informed decisions based on such.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

"All"?? That statement in and of itself deprives the post of credibility. Again, no disrespect, simply stating the facts. Absolute statements are rarely accurate, and unless you have struggled to survive in this environment you have no accurate basis for such an outlandish claim. Tens of thousands of people involved in this legal morass/lottery system live every day with the reality that no matter how good they are, how thorough or compassionate, there is ALWAYS an attorney willing to scrounge nuisance money from health care providers and insurance companies. That is reality, that is truth. I have seen many colleagues mowed down by this process, most of them kind, caring and empathetic physicians. And good interpersonal relationships don't hold a candle to jackpot money. Patients have even apologized to physicians as they stated they knew the doc did no wrong, but this was their chance for money.

Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Not sure where you get that, I can't even begin to fathom. Access how, and with who, and who would pay for all this etherial support? Give me a break.


As someone that appears well read and very intelligent I expected more from you. Little or none of what you say above has basis in fact, it is conjecture and anectdotal, with a lot of idealized memories. If you truly want to accurately comment and contribute do some research, talk with and spend some time with those you so freely castigate. Walk a couple of miles in the shoes of health care providers so that you may accurately comment.
Why do I even care? Because frankly you insult me and many of my colleagues that do what we do with honor and compassion every day. We have and continue to sacrifice personally, emotionally, spritually and financially in an effort to truly personify what a physician should be, and we are NOT the minority. I also will not stand by while more and more misinformation on such an important subject is bandied about.

But the real problem for all - and I do mean "all" - is when the lovers/haters march into the jury box. So, the goal should be to eliminate the reason for litigation before it gets to that point.

The point is still, how can the medical profession give the "litigious public" the confidence in its professional actions so suits don't occur? When that happens, malpractice claims drop, and insurance premiums accordingly.

You were dead on the money with which medical specialties get tagged the heaviest with claims, and most of those claims are based on exigent circumstance actions with nobody ever having met the other, and the patient/family having to make on-the-spot decisions with nothing but the do-it-or-else advice of a stranger. All of this is a recipe for litigation when perfection doesn't occur.

My comments about tort reform not solving the litigation problem is knowing full well that litigators can and do get around dollar-limit restrictions. California has had a $250K cap on medical malpractice claims for years, but that hasn't stopped jury awards of amounts much higher, and eventual collection by the suing party of amounts much greater than $250K. So, if tort reform doesn't prove to be the "silver bullet" (and it hasn't where in effect), what else?

I too am tired of health insurance premiums of over $1k/month for my family, and know full well that malpractice claims constitute a measurable chunk of that $1k. I also know too well why people sue, and the medical profession not accepting the "human factor" as a major reason why lawsuits happen is unrealistic and arrogant. There are many ways, especially for those one-contact specialties, to radically increase its public trust factor (and thus reduce lawsuits), but those ways require time and effort to educate the public and nurture (yes, nurture) trust. Until that happens, the lawsuits will happen with regularity and nothing ever changes.

I'm the first to admit how often I can be wrong. But, just a little, you may not be totally right, either.

However, I do know why people sue. When the technical jargon is stripped away, the underlying story is almost always the same - disrespect, disbelief and lack of trust.

The "jackpot" mentality does exist, but why? How does one convince a population that there is going to be no gain to such suits because the suit will fail due to jury empathy with the physician? And until the medical profession can regain that public confidence, juries will continue to see the suing party as one-of-their-own and the physician as the outsider. That is not right in any sense of the law, but it is what happens.

Are there attorneys who encourage and take cases they shouldn't? Yes! No profession is perfect. Just as there are physicians who perform needless tests for no medical reason, but do so as back-up evidence in case they are sued, and that small minority of others who practice money-collection rather than medicine. We all wish we could rid ourselves of the scurrilous minority in the professions who gets the bulwark of the publicity and we all defend against.

The "walk a couple miles in my shoes" comment goes both ways. I've seen the public after-the-litigious-event and am only sharing what I have received. Of course there are dedicated medical professionals, as there are dedicated all-kinds-of-professionals (including lawyers). However, not wanting to recognize why a problem exists usually results in no change in the situation - or worse.

There was never an intent to insult. And I'm sure your comments regarding lawyers were not meant either as a castigation of the entire legal profession. We all need to examine our professional worlds for where they work, are out of kilter, and where change is necessary for the betterment of all. We are indeed proud of those within our profession - and that is a large majority - who perform ethically and admirably every day. We also loathe those who put us in the position of having to purge them from our ranks and explain to a confused public why these slugs have licenses.

So, if the medical profession sincerely wants to reduce malpractice claims, talk to those to whom the claimants come for the why and how of these claims. When we work together, and willing to amend how we do business accordingly so claims are prevented versus litigated, then costs are indeed affected for everyone.

Never said I was totally right, wouldn't be so delusional as to think so.

Never once did I castigate the entire legal profession.

I also know very well that greed and sloth are bigger reasons for lawsuits than non compassionate or non empathetic physicians. I live and breath in this world every day, and know very well of what I speak. It is pie in the sky mentality to think that if all physicians could somehow have behavior reform that this plague would be arrested. Perhaps (and likely) in the past those were bigger reasons for suits, that simply is not the way it is in today's world. You don't have to agree, but speaking with the experience I have accrued and continue to accrue it is the truth to a great degree. One only need look at all of the commercials promising money for malpractice and drug reactions. It is a part of our culture at this point. That being said, poor communication can increase one's odds of being sued, it simply is no longer the primary reason by any stretch.
I have seen countless patients come in after minor fender benders, slight slips in walmart, and a plethora of other "non injuries" becuase "my lawyer told me to come get checked out". Most of these will get a small settlment to make them go away.
I have seen families sue for expected poor outcomes on terminally ill patients, sue for normal post op complications, nearly all of them without merit and simply for a quick settlement check. Thats the real world. I really hope everyone takes the time to do a little research before making blanket pronouncments that simply are not accurate.

Probably as important as anything else in all of this is what it shows on a larger scale. The problems with health care in general are broad and complicated in some ways. People with little experience or knowledge of the inner workings of this mess will ultimately not take the time to be open minded and the effort to learn. They will base opinions on what the media, politicians, and other ill informed sources offer. It really takes patience, effort , and an open mind to begin to view other aspects of the bigger picture at large. I don't purport to know everything, but I will speak of what I do know without hesitation and with honesty, and hope that it affords people that are willing to learn a little insight they might otherwise have missed. I have found that when I partake in others real world knowledge and experiences I am enlighted in ways I might have otherwise missed.

Boo
 

Obama got booed by the AMA today. Looks like he's going to learn what it's like to not be worshipped by everyone he steps in front of. He put the nail in the coffin today with the AMA. I seriously doubt that anything will change in healthcare. Politicians , including Obama, pander so much to special interests that this healthcare fiasco will follow the same demise as Clintons.

And there is no single "fix" or pie-in-the-sky action that will resolve the health care debate. As usual, several actions can contribute to a better situation, but depending on one or two without the rest is false hope.

That's one of the blessings and curses of getting to our ages. We can remember better (and worse) times, and have seen many of the situations we have discussed develop an-inch-at-a-time over time, and know the odds of quick reversals to better circumstances are very long indeed. We see things as they are now, and know it's just not right.

The advertising in the marketplace, whether for drug reaction to the negative or anticipated drug reaction to the positive (the long list of potential side effects notwithstanding), definitely muddies the waters. People today seem to have simultaneous expectations of miracles and no personal responsibility -all fostered by a moral climate centered on "me first, and you never." In our respective professions we can patch some of the holes, but the societal pot has definitely been turned into a moral colander.

We are knowledgeable and experienced in our respective areas. I agree with you that open minds - and the willingness to share our respective knowledge and experience - makes the potential of "fixes" to some degree possible.

As always, the first $1.75 Margarita at LSL happy hour is on me....