The interesting thing about your example is that you say there is a possibility that the patient has atypical cardiac related pain. So a responsible physician would order the test to protect the patient not to,protect himself from a lawsuit. But nice try.
But being on the front line, couldn't agree more. We will end up with universal health care IMO. Doctors employed by the States or Federal Government with no incentive to do more than see a limited number of patients per day, working 8 hour days instead of their current 12. See when you don't have any incentives doctors are no different than the rest of the working world. They do as little as they have to, to collect their paycheck. And hospitals and clinics and ancillary services will also likely become government owned because private ownership won't provide a viable income(or the investment can be used in another business that allows freedom of profit). How do I know this? Because we have employed physcian's to work in our practice. When we pay a straight salary, they work only the hours required, fail to apply initiative to expand their patient base and increase the practice profit minimally if it all. But when we pay a small base salary and offer a percentage on income they produce above their base salary, it all changes. The practice grows as do profits. You really can't blame the employee because in the first case they are paid the same regardless of the number of patients they see. This is exactly what happens in Countries with Universal Health Care. There is no incentive to go above and beyond. They are salaried employees earning less than the majority of other non-governed professionals such as lawyers, accountants and skilled laborers such as plumbers, electricians, home builders, and the like. This is why the majority of doctors and surgeons are advising the young people thinking about entering to only do so if income isn't important to them, because as it is, they will earn less/hour than any other professional with a doctorate or a skilled worker. Already there are fewer young people willing to go to post graduate school for 8 years including a residency, incurring $100,000's of debt only to earn a minimal hourly wage after earning their degree. Their dream of setting up a private practice slowly slipping away as the cost further increased and their reimbursements decrease. Better to treat animals or be a dentist; both not controlled by the Federal Government, free to charge any fee they want and patients forced to pay the fees or owners wanting to save their pet forced to pay more for the pets surgery(often 3-4X)more than a surgeon is paid to perform the same surgery on a human. What a crock. IMO Providers should stop accepting any form of insurance, charge a partial payment upfront that covers their costs and set up a payment plan for the remaining amount. They could then afford to charge less and earn more profit by not having the administrative fees caused by Medicare/Medicaid/and dealing with private insurance companies. The patient pays upfront and if they have insurance they file it on their own behalf, period. While benefit from lower fees being charged. And not to mention the competition that would exist. Oops forgot to mention the thousands and thousands of patients willing to pay cash for elective plastic surgery. One reason Plastic Surgeons earn the highest annual salaries. And for an example of how much physicians/surgeons would be paid under Universal Health Care one only need to look at current physician and surgeon salaries under the V.A. Hospital System. There are more part-time physicians and surgeons than full-time. Hence the patients more than often see a different doctor each time they come in for a follow-appointment. There is no continuity in their treatment. I was a G.S. 14 medical administrator for the largest and second largest V.A. Hospitals so I know what I am talking about. I quit after banging my head against the wall and chose to set up additional practices for my husband and graduating medical residents, teaching and consulting for over 30 years. This is why I continually post on the Health Care forum. Too many posters are not experienced in the field, just repeating political talking subjects. While it amazes me how many times I will post something and the mainstream or Cable news reports something similar days/weeks later. Then members here claim I am posting talking points, but not. Can't anyone believe that someone in the field could possibly no more that the news commentators or democrats/republicans and their one sided talking points?
I tend to disagree with the bolded statement. Medical clinics in Australia are generally owned by a consortium of healthcare professionals. Doctors etc are also hired at these clinics either fulltime or part time depending on the needs, but most doctors working there have a stake in the clinic. Hospitals are either privately owned or owned by the district health authority. Don't forget Australia has both private and universal healthcare running in tandem. Doctors etc work both in the private and public systems. It's quite possible to be treated as public patient in a private hospital, depending on where the surgeon practices. This was the case with my father's cancer operation. Before treatment, a doctor wouldn't know if you are being treated as a public patient or private patient, therefore you get the same treatment. After treatment when the account is being settled you either hand over your Medicare card (no similarity to American Medicare) where no money changes hands or pay on the spot (or take the account and pay later), then see your health insurance supplier for a part re-imbursement if you're a private patient. Very few Australians would see their local GP as a private patient. Private health insurance is usually reserved for those 'extras' or specialised procedures and not day to day GP consolations. To be honest, it's not always perfect. Doctor and nurse shortages, especially in rural areas are common because young graduate doctors would rather work in the cities. Also, the university requirements for medicine are very high. So over the years fewer healthcare professionals are being trained. Australia therefore sources many practitioners abroad. There is often a waiting list for elective surgery irrespective if you're a public or private patient. This is due to practitioner and bed shortages (although Australia has more hospital beds per 100,000 people than America). There was talk of universities reducing their entry requirements for doctors etc. The Australian Medical Association quickly knocked that on the head. Healthcare professionals in Australia are still at the top of salary earners by the way. Anaesthetists top the list. Even dentists are in the top four. Out of the top 20 earning professions, six are healthcare professionals. http://www.news.com.au/finance/mone...st-paid-per-hour/story-e6frfmd9-1226699999173 Australia's university loans scheme is also easier on the pocket than America. A graduating doctor wouldn't have any difficulties in paying the loan back within 10-15 years at current salaries. This is all changing as the current conservative government is making changes to the loans scheme and attempting to de-regulate universities, allowing universities to charge what they want. The last eight years is the first time my wife and I have had private health insurance, although we did have ambulance cover which isn't covered under Medicare. This is due to us working abroad. I pay mine personally but my wife is covered by her employer (almost unheard of in Australia). This policy covers me in every country, even Australia when I go home, but not in America. Since the introduction on universal healthcare in 1974, the cost per person of the national budget going into healthcare has only risen 5%. This is mainly due to our aging population and new medical technologies. Australia's healthcare budget is still around half per capita compared to America. We get exactly the same treatment in Australia as in America. It's just the payment system is different.
I am not sure what is your sources of information Here is a link The Accreditation Council for Graduate Medical Education is a private, nonprofit organization that accredits about 7,800 residency programs in 119 specialties and subspecialties. And here is an example of how it is regulating market merging with the government. http://jama.jamanetwork.com/article.aspx?articleid=182532 No matter how you twist it or turn it, the issue is that market is forcefully regulated by the government, but decisions about market is made by PRIVATE organizations. I do not care how the power is distributed, among them, it is simple economics, if market is regulated by private organizations it will be ALWAYS regulated in favor of market makers. The fact is, U.S. has extreme shortage of medical providers, the shortage is a main driver of defensive medicine, since no doctor have enough time to choose right strategy for every patient. I do not like power of lawyers as well, but unfortunately they are last line of defense against doctor's lawlessness.
Totally disagree. I have lived in countries with universal health and the doctors are just as driven as those in the USA. The big difference though is that they see a patient and think how they can best care. In the USA, they see a patient and see dollars.
Agree with most all you have said. But would like to clarify that much of the waste is on the Medicare Administration side. We providers often have to resubmit our insurance claims to Medicare 2-3 times before we are finally paid due to the Private Companies hired by the Federal Government to process medicare insurance claims. And as with the IRS, we and our patients get differing answers to our questions by Medicare Insurance Customer Support. Patients told their treatment will be covered and my office staff told it will be covered and after treatment or surgery provided, they(medicare) denies payment/coverage, forcing us to jump through hoops via numerous phone calls, submitting documentation over and over, in order to finally be paid. This process costs more and "wastes" hundreds of thousands of dollars. Everyone seems to think the waste in on the Provider side. No true, much of it is on the Government side. Physician and Facility Fraud is a small percentage of the overall waste. And compared to reimbursements a small percentage of the are fraudulent. I just love reading what those that have no first hand experience in the field post. It isn't good for my blood pressure.
Do you actually have any documentation on your fraud and waste claims. And anyone who has ever had a medical problem has first hand experience with the medical field. Maybe more than you since you never seem willing to post your actual qualifications as an expert despite endlesss claims of expertise and broad knowledge.
First, it is impossible to detect tone from a typed message. Second, your comment was, unfortunately, not any more outlandish than many of the other things that you have been writing. Thus, there is no way that anyone can tell that what you are writing is "tongue in cheek."
*Sigh* Anything is possible (that was the point of my example). It is possible that a man who comes to the ER with bad flatulence may be having a heart attack. The point that I was trying to make is that there is a "standard of care" that physicians are supposed to adhere to. That standard of care does not entail physicians to be more omniscient and omnipotent than G-d Almighty. The example that I used of a healthy 35-year-old man who had reproducible musculoskeletal chest pain after bench pressing was to supposed to illustrate the massive problem that the broken civil legal system is inflicting on our medical system. In a perfect world, this patient would be examined by a physician in the ER and (maybe) have an EKG. After a normal EKG and unremarkable physical exam, the patient would have been reassured by the physician that his chest pain is secondary to muscle soreness due to bench pressing. This is considered the standard of care (e.g. a physician providing the appropriate diagnostic workup after obtaining a history and physical). However, because of our messed up civil legal system, the "standard of care" doesn't really exist, and this patient would likely have undergone multiple lab tests and possibly even a CT scan of his chest because it is "possible" that his chest pain may be due to a pulmonary embolism or heart attack not detected by the EKG (e.g. NSTEMI). As I said before, anything is possible. There is a possibility (albeit very small possibility) that this healthy 35-year old who was bench-pressing and had reproducible muscular chest pain is having a heart attack or pulmonary embolism. The point that I was making is doctors are not omniscient, and even if this 35-year old male had a 1 out of 50,000 chance of having a heart attack or pulmonary embolism, the odds are not low enough to make most physicians comfortable (I alone probably have 10,000 patient encounters every year). Thus, as long as our broken system allows greedy ambulance chasers to sue doctors for every conceivable bad outcome (regardless of whether or not the doctor was the cause of this bad outcome and whether or not if the doctor adhered to the standard of care), doctors are forced to order every test imaginable to protect themselves and lower the odds of being sued. Why you are still advocating for this insanity is beyond me.
So you are basically saying physicians pay no attention to the standard of care. And The reason some of us are still advocating " this insanity" is that there is Absolutly no evidence that tort reform will have any significant impact on medical cost while it will probably eliminate the only protection consumers have against incompetent doctors and hospitals. Of course if you have anything that meets even a reasonable standard of evidence feel free to post it and maybe you could change some minds.
Here is what happens in medicine due to the continuous threat of lawsuits. An 81 year old man with low blood sugar felt faint so the doc sends him for an EEG that even the EEG tech knows is not necessary.
You want to save money? Close the American markets to drug and device companies until they forced the European single payers systems to start picking up R&D costs. Ah hell that wouldn't' work. If Europe had to pay the real cost of its health care instead of forming a cartel, which is all single payer is, and dumping the R&D cost on the American consumers all of Europe would be bankrupt in a month.
Duh, you have accidentally , i am sure, said something that is true. Now if you want to claim it is defensive medicine that causes unnecessary testing you will actually have to provide some evidence. Note that tort reform in Texas, which is not exactly a liberal state, made no difference in medical costs.
I am obviously stating that physicians are forced to go far beyond the standard of care to the level of absurdity. I feel like I'm in the Twilight Zone. Look back at essentially every post that I've written on this thread, and you will find a plethora of evidence. Heck, even the stuff that YOU have cited (e.g. the CBO in Post #67) is evidence that buttresses the argument that even the most meager tort reforms will save $11,000,000,000 per year. You have ignored all the evidence that I have presented already. You have even ignored the evidence that you have presented from the CBO, so it appears that your tactic here is to put your head in the sand and ignore all evidence that goes against your ridiculous argument. It's your choice to live life in ignorance: I think this "debate" is over.
Actually the only evidence I remember is physician surveys which given their vested interest renders the evidence irrelevant. And the Texas tort reform law proves very conclusivly proves that tort reform doesn't reduce medical costs.
You must be reading only lib outlets like HuffPo or ThinkProgress. http://www.heritage.org/research/reports/2013/07/ten-years-of-tort-reform-in-texas-a-review 10 Years of Tort Reform in Texas Bring Fewer Suits, Lower Payouts http://www.insurancejournal.com/news/southcentral/2013/09/03/303718.htm
If you actually bothered to read the two sources you posted neither claims or documents any cost savings whatsoever. And the reason supporters of tort reform use to argue their case is medical cost reduction and the Texas law has shown zero reduction in medical costs. In other words no proof of reduction in " defensive medicine" or unnecessary testing. Nice try but a fail.
Not sure what you don't understand about 'Fewer Suits, Lower Payouts'. Well, the point of the legislation was to give more access to doctors which it did. Doctor have doubled since then and are growing at the fastest rate in the country. So if you double doctors but reduce frivolous claims, the relative costs are reduced though the total costs may not change due to more doctors. In effect, it actually does reduce health care costs.
There is zero evidence that medical costs have decreased which was the whole rational for tort reform. And in actuality there is no evidence to prove that tort reform in responsible for the increase in the number of doctors. As a matter of fact if you increase the number of doctors the total spending on healthcare will increase not decrease. As an example the number of doctors where I live in Florida has increased astronomically in the past years without any tort reform. The increase was due to a hugh population growth drawing doctors and a massive increase on foreign trained doctors.
