by publius
We are (knock on wood) tantalizingly close to historic health coverage reform. In the heat of today's debates, it's easy to forget just how big this is. If we enact reform, it will instantly be one of the most important legislative actions in American history -- remembered alongside the New Deal and the Civil Rights Acts.
For this reason, the political debates of '09 will live on for some time to come. And as we increasingly gain perspective on these debates, the GOP's actions are going to look worse and worse.
In fact, I predict that the Great Health Care Debates of '09 will be remembered as an intellectual ebb for modern conservatism. If nothing else, the debates will be a "clarifying moment" that illustrates to future audiences the relative state of the progressive and conservative movements at this point in history.
Health care is arguably the most important policy issue of our generation. It touches everyone's lives in a uniquely immediate way. And it has an enormous impact on our national and state budgets, among other things.
But on this most important of issues, the GOP literally -- literally -- had nothing of substance to say. Instead, they offered 100% opposition (much of it consciously misleading) in a lazy following of the 1994 playbook. That's not exactly news, but it does reflect some deeper underlying realities.
First, on the legislative side, I think the Democratic legislators and their staffs proved vastly superior to their Republican counterparts in terms of policy expertise. Despite the in-fighting, the collective sophistication of the Democratic bills far surpassed anything that the GOP proposed (either now, or since 1994). Indeed, the GOP's policy arms (think tanks, etc.) are so atrophied that I'm not sure they're even capable of producing a credible national reform bill.
On a more strategic level, the institutional GOP was once again tempted by the shiny apple of the short-term news cycle. They were too fascinated with town halls and Obama's dipping poll numbers to keep focused on the long-term. In short, winning the news cycle intoxicated them. But now that the fumes of summer drunkenness have worn off, that position doesn't seem as smart as it once did. And Obama's long-term focus seems, once again, much more savvy.
This same divide was on display in the blogging and punditry worlds as well. Personally, I think the progressive policy wonks outshone their conservative counterparts in virtually every way. The liberal bloggers (Klein, Cohn, Dayen, etc.) were engaged in the political and policy details at a level that simply wasn't matched on the Right. The conversation on the progressive side was vibrant, informed, and useful for policymakers.
With very few exceptions, I saw nothing on conservative sites remotely comparable to the expertise and engagement shown on these progressive sites. There was, instead, a lot of heat about Tea Parties and town halls and death panels. It was generally light on policy and heavy on demogoguery.
In short, the health care debate shows that the American progressive moment is in a much stronger place right now, policy-wise. It's where the interesting conversations are taking place. It has the Geist.
To be sure, all this could change quickly. Conservatives have a strong "farm team" of young smart libertarianish writers. And events can always turn on a dime. Indeed, this post will look pretty silly if reform collapses next week.
But in this debate, at this moment in time, conservatives are simply outmatched at the policy level. And that will be true even if they ultimately succeed in scaring enough Dems to defeat reform.
"But in this debate, at this moment in time, conservatives are simply outmatched at the policy level."
I'll agree with you if you mean "Republicans".
Posted by: Sebastian | October 19, 2009 at 01:19 AM
the most important policy issue is AGW/energy.
And i agree with Sebastian. The conservative bill that is being put together by democrats isn't that bad.
Posted by: yoyo | October 19, 2009 at 07:41 AM
Conservatives have a strong "farm team" of young smart libertarianish writers
...who have no real representation in congress and hence no real say in the matter.
Posted by: cleek | October 19, 2009 at 09:01 AM
"If we enact reform, it will instantly be one of the most important legislative actions in American history -- remembered alongside the New Deal and the Civil Rights Acts... And as we increasingly gain perspective on these debates, the GOP's actions are going to look worse and worse."
Maybe in the history books, but remember that the New Deal and the Civil Rights Movement had two very different political fallouts -- while opponents of the New Deal sealed their minority status for half a century, opposition to the Civil Rights bills fatally wounded* the liberal movement that brought them to fruition.
*politically (TBC)
Posted by: Point | October 19, 2009 at 09:26 AM
But TBC, having said that, I'm incredibly excited as well.
Posted by: Point | October 19, 2009 at 09:27 AM
Can we hold off on the chicken counting for the moment?
Nothing has hatched yet. It's still possible (though, I'd agree, unlikely) that no reform legislation will emerge from this process.
And it's much more possible (sometimes, I fear, even likely) that the reform legislation that does emerge will do next to nothing to address the most serious problems that face our system of healthcare distribution.
If the Democrats, with huge majorities in both houses of Congress, control of the White House, and as much as 75% of the American public backing a public option, still cannot pass meaningful reform it will be a terrible indictment of our political system and of our ever-so-slightly-more-progressive party.
And the fact that the GOP has performed even worse will be cold comfort, especially to the uninsured and the millions more of us whose health insurance benefits may continue to steadily shrink.
Posted by: Ben Alpers | October 19, 2009 at 09:49 AM
I'd love to agree that this is the beginning of the end, but its not like 1994 was any smarter and they hung around for 15 years so far after that. Its not like the Iraq War buildup was any smarter. Its not like the torture debate was any more honest, sincere, or intelligent.
Populism works by appealing to low information voters. Low information voters are the ones least likely to punish you for saying or doing stupid things in the past, because they're the least likely to remember that it even happened once the next generation of pundits comes along and tells them lies about the past.
Posted by: Patrick | October 19, 2009 at 09:52 AM
Republicans don't care about policy or facts or expertise. They are nihilists who are successfully running our government (into the ground) by objection, obfuscation, and lying. And making tons of money off their efforts at the same time.
Posted by: Michael L | October 19, 2009 at 10:21 AM
If Democrats are winning the policy argument so handily, then why have Americans turned against Obama's "reform" proposals? Why does President Obama feel the need to rely on so much obfuscation and outright deception to advance legislation? I'm talking about this:
http://article.nationalreview.com/?q=NjJmNjY4MjA2ZmNkZWNmZDU2ZmY1NTUwZmMzNmIxMjE=
Why can't Democrats seal the deal despite controlling Congress and the White House? Why do Democrats game the CBO by including cuts to Medicare in the Baucus bill that the CBO states clearly will probably never take place? Why are Democrats attempting to shift some of the costs of the Baucus bill onto another piece of legislation through budgetary gimmicks? Why do Democrats have no response when Republicans point out that everything that is in the Baucus bill has been tried in Massachusetts, and it is failing spectacularly to bring down costs?
I think Democrats probably will pass something by Christmas, but a future Congress will have to fix it because of the disaster it will cause.
Posted by: Tim O'Rourke | October 19, 2009 at 10:38 AM
Excuse me (and, I suppose, several other regulars here) for being less than trustful about the impartiality (not to say veracity) of the National Review.
Posted by: Hartmut | October 19, 2009 at 10:47 AM
@ publius:
Indeed, the GOP's policy arms (think tanks, etc.) are so atrophied that I'm not sure they're even capable of producing a credible national reform bill.
Well, when for whatever reason (either ideology or payoffs) you have to - or feel you have to - proceed from the position that no "reform" whatsoever is either necessary or desirable, "capability" becomes fairly irrelevant. When all you really need to satisfy one's paymasters is mindless oppositionism, why bother with formulating any policy other "NO!"?
Posted by: Jay C | October 19, 2009 at 10:57 AM
"We are (knock on wood) tantalizingly close to historic health coverage reform. "
By which you mean, of course, a historic giveaway to private insurance companies? One that will force every citizen to buy insurance from for-profit private companies, while doing nothing whatsoever to keep those companies from dropping coverage for 'pre-existing conditions' (something like 50% of terminally ill patients with insurance lose their insurance by the end of their lives, by hook or by crook), thus ensuring that the people who most need health care (the very poor and the very ill) remain uncovered?
Seriously, if you are, or have as a family member, a person who is currently uninsurable due to chronic medical conditions: after this abortion of a bill passes, that person will (1) remain uninsurable, because no insurance company will take her on, and (2) will be fined by the government for not having health insurance. Brilliant, don't you think? Catch-22: it's the best catch there is.
Posted by: mad the swine | October 19, 2009 at 11:34 AM
Patrick:
I don't agree with this characterization of populism, although it's true in many cases and certainly the case with modern-day Bush Republicanism.
What I will say is that it becoming exponentially harder to maintain this kind of faux populism--built on mendacity and relying on ignorance--in the age of YouTube, Twitter, blogs, and the permanence of Internet content. In 1994 Republicans had conservative talk radio, and liberals had... well, nothing really, aside from isolated enclaves in a then-nascent online communitity. Even five years ago, blogs were still a curious novelty that the media was pretending to have discovered, like a new species of bug.
It is silly to expect a political strategy based on the expectation of being able to lie about what you said in front of cameras to work the same way today as it did in 1994. We live in a different world.
This is one of the reasons I think it's so critically important that the Obama administration has finally started publicly treating Fox like the ideological propaganda organ that it is. One of the biggest reasons Fox has gotten away with it for so long is because of the polite lie that nearly everyone in the media and political establishments maintain: the lie of Fox's claim to "fair and balanced" journalism.
Everyone knows Fox is a Republican mouthpiece. Their ideological slant is not only out in the open, it's routinely stated by everyday Republicans as one of the things that appeals to them. It's the cable equivalent of conservative talk radio. The problem is that actually saying this is so in public, on TV and on the record, is verboten because it runs sharply afoul of the false equivalency and balance that governs the corporate media. It's uncivil. And it opens up a potential war between media entities, and nobody wants that.
Simply by saying openly what everyone already knows about Fox, the WH has changed the rules. It is now acceptable to talk about Fox's ideological agenda, because it feeds the he-said-she-said narrative that the media so loves. It's part of the story. And the more this gets repeated--"Fox isn't a real news organization", or "Fox is a mouthpiece of the Republican party"--the more this sinks in to the minds of ordinary Americans and becomes the CW.
Fox is freaking out badly about this because they see the writing on the wall. They know that their media empire, their credibility, rests on maintaining the pretense that they're a legitimate news organization, and if they lose that, they're toast. Not that they'll go out of business, simply that their credibility and influence will be damn hard to recover.
TO'R:
This first sentence, farcical from beginning to end, is all any thinking person needs to read in order to dismiss the tripe that follows.
Posted by: Catsy | October 19, 2009 at 11:56 AM
Publius:
"In fact, I predict that the Great Health Care Debates of '09 will be remembered as an intellectual ebb for modern conservatism... For this reason, the political debates of '09 will live on for some time to come."
Sure... at least until 2012. The 'intellectual ebbs' don't produce electoral ebbs. After FDR New Deal, we've had 28-3/4 years of Democratic Presidents in office, and 38 years of Republican Presidents. And after LBJ's Civil Rights Act of 1964 it's even more lopsided in favor of Republicans: 28 to 13-3/4.
And I'm certain everyone in the 50 year old age cohort now will think back with grateful fondness on the current Health Care Reform Bill (if it's anything at all like the bills now under consideration) with gratitude in their hearts when they have to depend on Medicare for their primary heath insurance, with slashed benefits, huge co-pays, reduced access to specialists, circumscribed medication lists, and waiting room lines in doctor's offices as long as those at the DMV.
Thanks Democrats!!!
"But on this most important of issues, the GOP literally -- literally -- had nothing of substance to say."
Does the term "Tort Reform" ring a bell?
"First, on the legislative side, I think the Democratic legislators and their staffs proved vastly superior to their Republican counterparts in terms of policy expertise."
I watched at least 80% of the Baucus Hearing on CSpan -- and your statement is factually incorrect in regard to the discussions there. The Democrats and Republicans were equally knowledgeable about the issues, both sides had the same amount of expertise and grasp of the subjects under consideration. That was obvious to anyone whose judgment wasn't distorted by partisanship.
"In short, the health care debate shows that the American progressive moment is in a much stronger place right now, policy-wise. It's where the interesting conversations are taking place. It has the Geist."
The progressive movement is as divorced from the truth as the conservative movement. Both of you are distorting the truth, and we -- Middle America -- are the ones suffering from your
GeistHubris.Posted by: Jay Jerome | October 19, 2009 at 12:11 PM
Yes, as a matter of fact it does. In fact, I'm pretty sure I've heard it somewhere before.
Oh, that's right: because it's yet another conservative shibboleth that gets brought up every time the subject is an issue to which tort awards are even minimally connected. Just like tax cuts, what's the answer? Tort reform!
Except that it's not, it's simply an excuse to insert a popular Republican hobby-horse into an issue on which it will have little or no effect. The cost of malpractice litigation is less than 3% of all healthcare-related costs in the United States. If by fiat we eliminated malpractice tort awards entirely today, it would not help people who cannot afford insurance now, who have lost their insurance because of unemployment or a pre-existing condition, or who are uninsurable in the first place by an accident of genetics. It will do nothing to reform the insurance industry's business practices, which after all are completely rational in a free market in which they have a fiducary responsibility to the bottom line.
In other words, tort reform is a red herring on which I have already wasted more time this morning than it merits. And if that's the best you can do when challenged to defy the assertion that Republicans have no plan for reforming our health care system, then you have done nothing but reinforce that point.
Posted by: Catsy | October 19, 2009 at 12:32 PM
"The cost of malpractice litigation is less than 3% of all healthcare-related costs in the United States."
That is dramatically more than the price impact on healthcare-related costs in the US of the difference in drug prices between here and Europe. Yet that seems to capture attention all the time. Does that make it a red herring?
Posted by: Sebastian | October 19, 2009 at 12:38 PM
Sebastian, I'm not clear on what that question has to do with anything we're discussing. None of the bills moving through Congress right now have a significant focus on drug price differences between here and Europe. The extent to which they deal with drug prices directly at all is mainly where it concerns the government's ability to negotiate said prices. And more to the current point, it has bugger-all to do with the question of whether or not there is currently a meaningful Republican alternative to Democratic efforts to reform our health care system.
So yes, saying "what about tort reforms?" in response to a statement that the GOP has "nothing of substance to say" about health care is a red herring from top to bottom. And while it was probably not your intent, so is throwing out a tu quoque rejoinder about drug prices in response to pointing out said red herring.
Posted by: Catsy | October 19, 2009 at 12:53 PM
catsy: "it's simply an excuse to insert a popular Republican hobby-horse into an issue on which it will have little or no effect. The cost of malpractice litigation is less than 3% of all healthcare-related costs in the United States."
Only 3%? Then I guess you think regulating the insurers (profit average 3%-5%) will have little or no effect. So let's let them slide too.
Why do you want to exempt Tort reform from the discussion? Because it's a Democratic sacred cow? Most of the single-payer countries held up for the US to emulate for their low health care costs have limits on medical malpractice suits. Canada has a cap on damages. So does England, where the highest award in a malpractice case is the future costs of care. In Miami a neurosurgeon pays $237,000 a year for medial malpractice insurance. In Montreal the same coverage costs $20,600; in Vancouver $10,650.
That's money saved that goes go back into those respective health care systems.
In other words, tort reform is a red herring on which I have already wasted more time this morning than it merits
Spoken like a true Democratic partisan.
Posted by: Jay Jerome | October 19, 2009 at 12:57 PM
"The cost of malpractice litigation is less than 3% of all healthcare-related costs in the United States."
Is it, really. The cost of malpractice litigation is the cost of unnecessary procedures and the shortage of primary care physicians and much much more.
The failure of this congress is its inability to recognize and address un(intended) consequences and the harm done by ends justifying the means.
There's got to be a piece of Publius that cringes when he writes these posts that he knows deep inside are just wrong.
Publius knows.
Posted by: blogbudsman | October 19, 2009 at 01:06 PM
More on this: "The cost of malpractice litigation is less than 3% of all healthcare-related costs in the United States."
National health spending is expected to reach $2.5 trillion dollars this year -- and 3% of that ain't chicken feed.
Posted by: Jay Jerome | October 19, 2009 at 01:11 PM
I think I have a broader view of on-topicness than some commentors. I'm not trying to discount your dismissal of the malpractice issue. I'm using your invocation of a particular level of spending to decide what is trivial.
You decided that an impact of about 3% of total costs counts as trivial.
That triggered in my head the fact that we spend endless amounts of time around here wrangling over drug prices, while the difference in prices makes less of an impact than that. The time to point that out would be now, when your focus is on the empirical level of 'trivial', not later when your focus is that you don't like high drug prices.
And it isn't tu quoque, because I'm not using it to attack your idea on malpractice. You are right to dismiss it if it falls below trivial levels of expenditures.
I'm fairly conservative on a blog with very liberal commentors. If I waited until six months from now to link the points, it frankly wouldn't have the impact that it does to point it out now when everyone else is on your side. I have to point it out NOW while you are making an argument about what counts as trivial in the health care debate. If I do it NOW there is a small chance that you'll remember it later when we revisit the issue because you are invested in the argument. Six months from now your investment in the argument about what counts as trivial isn't as likely.
Maybe I said it in a particularly annoying way. I'm sorry about that, and I'd be happy for advice on how I can make my point without waiting six months when you won't care what you said here unless I've already made the point.
Now I'll be frank. I'm socially inept sometimes. So I'm open to correction on this point.
Posted by: Sebastian | October 19, 2009 at 01:12 PM
...this makes no coherent sense whatsoever. Regulating health insurers has nothing to do with their profit margins per se. All you've done is taken two entirely different things, found a number that appears in both of them, and removed both entirely from their context in order to present them as if they had any equivalence or anything at all to do with each other. It is an argument constructed of pure gibberish.
No, because as I already explained, it is a minuscule part of our overall health care spending, has no relationship whatsoever to the predatory business practices of the insurance companies or the inability of the unemployed and uninsured to get the care they need, and is 100% orthogonal to the question of whether or not there is a viable Republican alternative to Democratic plans for health care reform. Tort reform is not a plan for health care reform.
In a way though, I have to thank you for illustrating the Republican response to health care reform in a microcosm: specious arguments that when closely examined prove devoid of any actual solutions to the real problems that people care about.
Posted by: Catsy | October 19, 2009 at 01:19 PM
One reason why Americans are more litigious over things where a neutral point of view says no one is really "to blame" - because accidents happen - is because the US does not have a national health care system, and health care insurers have a profitable habit of denying insurance to people with expensive health care needs.
If a doctor makes a mistake, and harms a patient, and the patient from then on has expensive health care needs, in the US system, it doesn't matter if the mistake wasn't the result of malice or incompetence on the part of the doctor: the patient has got to sue the doctor for malpractice in order to get the money the patient will need from then on in order to get the healthcare they require.
In the UK, because we have the NHS, a patient who is harmed by a doctor can afford to wait and see how far they feel the doctor was to blame, how much blame the doctor should carry, if the doctor is likely to repeat the mistake.
Suits have been avoided, in the NHS, when the doctor admitted the mistake to the patient, apologised to the patient, the hospital/Trust and the doctor explained the circumstances, and told the patient she or he was free to sue if they wanted to. But the patient was not at any point at risk of losing their healthcare or getting worse healthcare or having to declare bankruptcy because their healthcare bills had got too large to pay, or being forbidden to declare bankruptcy because it's illegal to do so for healthcare debt, or any one of the myriad things that the US healthcare system causes.
Want less litigation over malpractice?
Adopt a national health service.
Now why didn't Sebastian think of that?
Posted by: Jesurgislac | October 19, 2009 at 01:24 PM
casey: "Tort reform is not a plan for health care reform"
Tort reform would be a health care cost reform. To, you know, lower the overall cost.
So why aren't you in favor of it? Are you a lawyer, who wants to protect a possible source of income for yourself?
Posted by: Jay Jerome | October 19, 2009 at 01:37 PM
"Want less litigation over malpractice?
Adopt a national health service."
Here in the USA (B) wouldn't lead to (A) without legislation to insure it...
Posted by: Jay Jerome | October 19, 2009 at 01:52 PM
You are not paying attention.
If anyone were making a credible argument--supported by evidence and hard facts--that tort reform would have any meaningful impact on the cost of health care, I'm sure you'd be able to get a lot of us on board. By all means, let's get it in there. Bring your numbers to the table.
But tort reform has nothing to do with health insurance. It has nothing to do with the market incentives that drive the predatory behavior of insurance companies. It does nothing to fix the way health insurance is linked to employment in this country, and the effect that has on our health and the ability of our businesses to compete in a global market. And it does nothing--nothing whatsoever--to help those who are uninsurable or whose claims are being denied for corporate profit instead of on the basis of what's medically best for the patient.
You know all this full well. Hell, I've explained it in detail for two comments in a row now. You have yet to explain how tort reform will address any of those things. You have yet to demonstrate how tort reform is a viable alternative plan of any sort for reforming our health care system, as opposed to potentially being one small piece of an overall reform package.
And bringing it up still does nothing to refute the assertion that the Republican Party does not have any serious ideas to offer for health care reform. If anything, your narrow pursuit of validation for tort reform only reinforces that point. If that's the best you can do, it pretty much speaks for itself.
As I pause to explain to my coworkers why I'm laughing so hard--boy, you /really/ aren't paying attention. :)
Posted by: Catsy | October 19, 2009 at 01:57 PM
Here in the USA (B) wouldn't lead to (A) without legislation to insure it...
Yes, but setting up a national health service in the US requires minimal legislation: just erase the words "over 65" from the Medicare legislation, so that everyone in the US goes on Medicare, which is proven to operate more cheaply and more effectively than any private health insurance system.
Presto: no one has to sue their doctor to get healthcare, and, furthermore, the need to sue people other than doctors for damaging/expensive mistakes also goes away.
There is no need in the long run for legislation removing a person's right to sue: but a national health system would remove a large part of the need to sue.
Odd that so many conservatives so hate the basic civil right every individual ought to have, to bring a civil suit against a corporation or an individual who caused them major damage. But there you go...
Posted by: Jesurgislac | October 19, 2009 at 01:58 PM
Tort reform is a red herring because it's designed to take attention away from what the actual problem is. Republicans/conservatives like to point at expensive malpractice awards, unnecessary procedures, malpractice insurance, etc, as reasons for "tort reform", but the malpractice costs are a symptom, not the disease. And while you could make a marginal benefit by trying to adjust just for malpractice awards, you would get a lot more effect from going after the sources of the malpractice suits and awards.
And, from what I've seen, malpractice suits and awards have two major causes, neither of which is (just) greedy lawyers and/or victims. First, as with many lawsuits, often the only way to get access to the records you need is through legal discovery. If people could get better more honest explanations of what happened, and what, if anything, went wrong, from their medical records, doctors, and hospitals directly, rather than havet to fight it out in court with lawyers. Lots of the 'weak" malpractice suits probably fall into this category. (cite) When the only way for somebody to know if the doctor/hospital was negligent in their care is to sue them, lots of lawsuits will happen. Better transparency and more responsive complaint processes for doctors/hospitals, instead of instantly circling the wagons and denying any wrongdoing and sealing records would help both patient health AND cut down on "frivolous" lawsuits. Especially if the complaint processes ended up compensating people who were actually injured.
The other major reason Jes pointed out. If someone gets injured by medical mistakes, they often end up with very expensive lifetime problems, and "pre-existing conditions" that make insurance harder and/or more expensive to get. If there were a public option, national system, or if insurers couldn't discriminate based on pre-existing conditions, that part of the awards would be greatly reduced. It wouldn't eliminate things like possible loss of jobs (and thereby, loss of insurance), or pain and suffering, perhaps, but that would still reduce both the awards and the need people would feel to file the suits.
If we worked on either of these causes of malpractice suits, the number and cost of malpractice suits would drop. And patients would be happier, and quite possibly get better treatment. Conservatives' favored tactics of making it harder to sue or reducing the maximum benefits wouldn't do anything about the root causes of malpractice suits. And that's why "tort reform" is a non-starter, because the solutions it advocates does nothing to really address the causes of the problems it claims it will take care of.
Posted by: Nate | October 19, 2009 at 02:01 PM
Tort reform alternatives.
1. Meritorious lawsuits have damages capped. Result -- disincentive to practice competent medicine and plaintiffs left with uncompensated injuries. Possible, though unknown, reduction in "defensive" medicine. Note, however, that doctors who wish to get paid for doing procedures will continue to have same financial incentive to over-prescribe procedures. That incentive is not eliminated until fee-for-service is abolished.
2. Meritorious lawsuits cannot even get to court. Result -- Disincentive to be competent even stronger. Uncompensated injuries aggravated. Possible increase in ability to measure, and thereby prevent, excessive "defensive" medicine which is actually padding.
3. Only non-meritorious lawsuits barred. And just how, exactly, do we get here? What lucky soul gets to play gate-keeper, other doctors?
One could, in theory, go to a strict liability system where pain-and-suffering, future increased medical costs and lost income are paid out based on a regulatory schedule, somewhat like the theory behind workman's compensation laws. But doctors and lawyers both hate that idea. Doctors want to preserve the idea that bad results are sometimes inevitable; lawyers want to have access to the courtroom. The only ones supporting it are a small group of economists.
It's really amazing the way that the conservative supporters of "common law" suddenly want the legislature to bar the door to meritorious claims, just when they can be beneficially affected by the legislation.
Posted by: (TO) Francis | October 19, 2009 at 02:05 PM
Jesurgislac is completely right. Universal health care would be the best possible tort reform.
Posted by: Ali H. | October 19, 2009 at 02:16 PM
Re Tort reform:
First, we should acknowledge that the practice of defensive medicine is real, and is costly and to a significant degree wasteful. Still, whether it's because of the fear of malpractice lawsuits, or it's because of other societal changes is unclear - doctors are simply less willing to play god or to risk failure, and in many cases under our current cost structure neither doctors nor patients are trained to worry about the extra costs of defensive medicine, because they are insulated from those issues by the way most medical care is paid for. Indeed, under some fee structures defensive medicine is significantly more lucrative for the doctor, and because the costs aren't transparent the patient is also happier.
Second, we should acknowledge that tort reform has been tried - in, say, Texas, which is not a small place - and has not apparently affected medical costs. Now, it's possible that this is because the effects on a culture of defensive medicine would simply be too slow, and it's possible that tort reform really has the power to change a culture of defensive medicine but only if it's nationwide, rather than in a single state, even a large state. But this is not a good sign for the substantive case made by advocates of tort reform.
Third, one aspect of malpractice cases that's pretty much unique to the US is the medical and nursing costs incurred by the malpractice, as part of the compensatory damages. Because Americans are usually liable for their own medical and nursing care, malpractice awards may need to be large enough to cover the costs the malpractice has incurred, and possibly for a long time to come. In other societies, these costs are already covered. Other societies also have better terms for people rendered unable to work.
Fourth, and less topically, what I'd really like to see in "tort reform" is reconsideration of "punitive damages". I can see assessing punitive damages against the wrongdoer, because the incentives make sense. But why does the victim get them? Why does the victim's lawyer get a piece of them? Wouldn't a system in which the victim got just compensation and their lawyer bills paid make more sense, and the punitive damages could then go to a mutually agreed charity, or to the national debt, or be burned in the street for all I care? It seems to me that the incentives in "punitive damages" are weird.
Posted by: Warren Terra | October 19, 2009 at 02:29 PM
Jay Jerome, "tort reform" is not a health care reform (nor has it worked to lower costs where it has been passed) or even a particularly trenchant insight into issues with universal health care coverage at all. You are actually an example of the lack of conservative thought on the issue.
Conservatives and libertarians are people without a policy mind. Rather, they have a formula that goes "cut taxes" and "prevent individuals from making tort claims" which is applied to every single possible problem available.
We're not seeing the end of the Republican party. What we are seeing is the end of the movement conservatives that have been driving the party for the last 40 years. Any Republican resurgence will come with a constituency and ideas vastly different than the ones we see today, and specifically much different than the ones advocated by people like Jay Jermone, et al.
Posted by: JustMe | October 19, 2009 at 02:39 PM
Assuming we do get some form of reform through, I don't see it as a victory. Havenot the MIPC (Medical Insurance Pharma Complex) got their future profits locked in, i.e. no meaningful cost controls. We have been on a path whereby the avarice of the MIPC will lead to national economic ruin for a long time. With cost controls emasculated, we are still on the path to ruin. The policitical strength of these special interest groups is too great to resist. And yes Jerome, the trial lawyers are a part of the medical-care feeding frenzy, which have the D's on their side. But the larger issue is that the big for profit players, in insurance, medical care, and pharmaceuticals get their pound (actually tons) of flesh as well. Isn't the way forward a compromise: R's say let us do tort reform, and we will let you do other forms of cost controls. The alternative is a future trainwreck for the economy.
Posted by: Omega Centauri | October 19, 2009 at 02:47 PM
But why does the victim get them? Why does the victim's lawyer get a piece of them? Wouldn't a system in which the victim got just compensation and their lawyer bills paid make more sense, and the punitive damages could then go to a mutually agreed charity, or to the national debt, or be burned in the street for all I care?
That's been tried in a few places, and it doesn't work. First, there's no incentive to bring punitive cases against egregious wrongdoers. Second, it creates an incentive for both sides to settle the case in a way that prevents the money from going to the charity. If a case is likely to result in $100k in compensatory damages and $100k in punitives, the case will settle for $150k as both sides gain $50k.
Posted by: Ali H. | October 19, 2009 at 02:54 PM
Warren, well said. I agree that Catsy too-lightly dismisses 3% as trivial, and ignores the significant cost of 'defensive medicine.'
Punitive damages are increasingly disfavored anyway -- the Supreme Court effectively capped 'em at the same as compensatory damages in all but the most extreme cases. So I'm not sure it's a big deal. In practice, punitive damages in medical malp cases pay the lawyer's contingency fee, just as you proposed. The reason we (usually) award any additional punitive damages to the tort victim instead of to society, is that it encourages the victim to bring the case. I don't mean that people go into tort hoping for a windfall, just that the hassle and risk of a lawsuit, and the difficulty of proving 100% of your damages, discourage many meritorious cases from ever being filed. Society benefits when meritorious cases are brought, because the fear of being sued keeps people more honest in their dealings. Punitive damages are a rough and ready way to make up for entropy in the compensatory damages system.
Or they were, anyway. After the last few Supreme Court cases, I really wonder whether they are still big enough to work.
Nate, don't some HMOs have a grievance process?
Another possibility for tort reform:
If we think juries are getting it wrong, can we educate them better? A trial is not really the best way to learn about the issues. Maybe we could improve the outcome by giving them some basics before trial begins. The AMA and some consumers' organization could collaborate to create a standardized video, sort of a bigger and more approachable set of jury instructions. People waste a lot of lawyer time reinventing the wheel, e.g., "what is 'standard of care,'" and there are some important arguments defendants don't dare make too strongly, like "why I should not run a $10,000 test on everyone who walks in the door, even if it would have spotted Mr. Jones's tumor this time."
Posted by: The Crafty Trilobite | October 19, 2009 at 03:08 PM
"If anyone were making a credible argument--supported by evidence and hard facts--that tort reform would have any meaningful impact on the cost of health care, I'm sure you'd be able to get a lot of us on board."
From Uri Reinhardt -- the Ultimate Expert on health care isues:
"...part of the infrastructure reform must be a move away from resolving disputes over alleged professional malpractice through the tort system toward alternative forms of dispute resolution that separate the compensation of injured patents from the question of professional misconduct. It strikes me as absurd to view a regular American jury as a “jury of peers” capable of second-guessing a physician’s clinical decisions."
"But tort reform has nothing to do with health insurance...."
'Insurance is only part of the problem -- it's full 'infrastructure reform' that's required. If you completely eliminated for-profit insurance intermediaries from the system, it wouldn't appreciably reduce rising health care costs (my Kaiser co-pay and medicine costs are going up again in the next renewal cycle -- and they're a direct pay non-profit organization).
Posted by: Jay Jerome | October 19, 2009 at 03:16 PM
CT: I would imagine so. But the percentage of HMOs varies from state to state, and I'm not sure if all do. this">http://docs.google.com/gview%3Fa%3Dv%26q%3Dcache:6K8P1_G-TkcJ:www.gao.gov/cgi-bin/getrpt%253FHEHS-98-119%2BHMO%2Bcomplaint%2Bsystem%26hl%3Den%26gl%3Dus%26sig%3DAFQjCNGGg28vpNgwthd6SFs1ZXQKZivPeA&ei=bbrcSqPUKsSj8AaJtIS3BQ&sa=X&oi=gview&resnum=1&ct=other&ved=0CA4QxQEwAA&usg=AFQjCNG8lgOeexVeOcOoPXQqQdQisQgCBQ">this appears to be a report to Congress about complaint processes, but I haven't done more than skim it yet. It looks to cover more kinds of complaints than just malpractice though. Also, it's from 1998. Lots can change in a decade.
And not all doctors/hospitals work through HMOs, nor is there a guarantee with an HMO that the records will be available etc. Or that the person would still be with the HMO long enough to continue to recieve any care needed because of the accident. Which is a flaw with the employer based nature of our insurance system, not with tort reform.
Posted by: Nate | October 19, 2009 at 03:19 PM
"There is no need in the long run for legislation removing a person's right to sue: but a national health system would remove a large part of the need to sue."
I am not sure of the logic that damages could not be incurred beyond continuing medical bills, which is the only need relieved by an NHS, but it would remove all capability to sue.
Posted by: Marty | October 19, 2009 at 03:34 PM
I think you're missing the same point that JJ was, albeit from a different angle.
I am not opposed to tort reform per se. As others have articulated in the intervening comments, there are ways in which the current system can be improved. Some of those ways have counterproductive drawbacks, some do not. They're worth examining on their own merits.
What I am opposed to is JJ citing tort reform as a response to the assertion that the GOP has no plan for health care reform, as if that did anything but drive home just how few ideas they really have. Publius said:
JJ responded:
Note the context: in response to an assertion that the GOP has no ideas for health care reform, the only thing JJ managed to come up with--then or thereafter--was a time-honored conservative hobby horse that they repeatedly bring up anyway whether or not it has anything to do with the issue to be solved.
That was the context in which I was dismissive of tort reform. I even mentioned a little later that if someone makes a credible and supportable argument that tort reform will meaningfully bring down the cost of health care, I'm happy to have it brought to the table. But JJ ignored this suggestion. Just like he failed to give attention to any of the counterarguments, or anyone pointing out that his answer didn't actually refute the point. And I'm not surprised, becuase frankly he isn't even paying enough attention to correctly spell a name that's at the bottom of every single one of my comments.
So no, tort reform is not an answer to anything whatsoever having to do with insurance companies, their practices, and those who lack insurance or have their claims denied. The problem is not that it does not address all of those things. The problem is that it doesn't address any of them, and JJ is laughably presenting it as if the fact that Republicans brought up tort reform somehow refutes the assertion that they don't have any serious alternatives to the Democratic proposals other than doing nothing at all.
Context matters.
Posted by: Catsy | October 19, 2009 at 03:54 PM
catsy: "As I pause to explain to my coworkers why I'm laughing so hard--boy, you /really/ aren't paying attention. :)"
Not a Lawyer? A pickpocket? :)
Here's more data on the impact of tort reform,(unless you think the CBO isn't paying attention either).
Oct. 12, 2009
"The Congressional Budget Office said Friday that reforming some aspects of medical malpractice law would reduce the federal deficit by $54 billion over a decade.
The analysis from the Congressional Budget Office was in response to a proposal from Sen. Orrin Hatch, Utah Republican, that would cap non-economic damages on medical malpractice claims against doctors and health practitioners. 'I think that this is an important step in the right direction and these numbers show that this problem deserves more than lip service from policymakers,' Mr. Hatch said."
Posted by: Jay Jerome | October 19, 2009 at 04:08 PM
$54 billion over a decade? $5.4 billion a year--out of a multi-trillion dollar problem (if I recall your figures from above)--and that's a significant counter-proposal?.
By the way, your post above from Uri Reinhardt seems to me to suggest a better way of disciplining doctors vs. capping awards.
Posted by: Mike Lamb | October 19, 2009 at 04:12 PM
Which is $5.4 billion per year. If you take total federal spending on medicare, medicaid, and federal health employee insurance, we're talking about less than 1%, even less than some people above had predicted.
Posted by: JustMe | October 19, 2009 at 04:14 PM
he isn't even paying enough attention to correctly spell a name that's at the bottom of every single one of my comments.
Or for that matter, the name of his health economics expert.
Posted by: Hogan | October 19, 2009 at 04:15 PM
"So no, tort reform is not an answer to anything whatsoever having to do with insurance companies, their practices, and those who lack insurance or have their claims denied"
I didn't say it had anything to do with insurance companies -- you keep diverting to that red-herring.
I said it would lower health care costs. With the links I provided you, are you still claiming it wouldn't? Or don't you believe health care costs are a problem? Or don't you care?
Really, for any kind of meaningful health care bill to come out of congress, there's going to have to be some compromises made -- the Republicans want medical tort reform -- which will help lower costs/deficits -- which will mean less taxes for those of us who pay taxes -- so why don't Democrats include Tort reform in the health care legislation????
Posted by: Jay Jerome | October 19, 2009 at 04:20 PM
Once again, you yourself are serving as an example of how the "movement conservatives" are intellectually spent as a force, and that the health care reform issue proves it Republicans are simply against tort claims made by individuals, and they are applying this universal religious belief of theirs to health care reform, and it doesn't even have anything to do with health care reform at all.
Posted by: JustMe | October 19, 2009 at 04:24 PM
The first question about tort reform is what is getting reformed? Why don't we remind ourselves that the major reason for malpractice insurance is malpractice. Doctors who don't have malpractice claims tend to have relatively low insurance rates. If doctors were to show some humility and check the standards of 'best practices' the amount of harm done by doctors would drop substantially, as would their insurance bill.
What we cannot do is allow doctors to get away with carelessness and incompetence and make their victims bear the cost. That, however, seems to be roughly what is proposed.
As for the 'cost of defensive medicine', let's look at the doctors who practice it the most and see how much they personally benefit from ordering too many tests or otherwise overtreating in the name of 'defensive medicine'. As long as doctors are allowed to own laboratories that they can send work to or engage in cross-referrals, I will not trust a word they say about how their costs are being driven up.
Posted by: Free Lunch | October 19, 2009 at 04:26 PM
If after this many exchanges you still can't grasp why I keep bringing up insurance companies and why that's germane to the statement of yours to which I originally responded, you are either being willfully obtuse or are sincerely unable to wrap your head around the subject we're discussing.
In neither case am I willing to waste any more time on you until you demonstrate an ability to read for comprehension instead of skim for targets.
Posted by: Catsy | October 19, 2009 at 04:34 PM
Catsy, I'm no fan of "tort reform," at least not in the sense of damages caps and higher pleading standards. I also agree it's a shibboleth, and that the primary goal of the tort reform movement is to protect liability insurers, not consumers. But it is relevant.
The goals of health care reform include better quality care, more people covered, and lower costs. If litigation alone creates 3% of health care costs, then when you add the cost of high malpractice premiums and 'defensive medicine' overtesting and so forth, tort reform could theoretically lower the costs of providing health care significantly. That in turn could lower the price of health insurance. Less expensive insurance means a few more small businesses could buy it for their employees, so a few more people would be insured. Also, less 'defensive' medicine would mean higher quality care -- for instance, if doctors performed fewer unnecessary caesareans, we would have better outcomes for those mothers and newborns.
I very much doubt that tort reform lowers health care costs significantly in the real world, so I think that whole chain of consequences is fantasy, but I can't prove it. If Jay J could prove otherwise, tort reform would be a useful part of health care reform.
Posted by: The Crafty Trilobite | October 19, 2009 at 04:34 PM
Posted by: Warren Terra | October 19, 2009 at 04:35 PM
JustMe:"Which is $5.4 billion per year. If you take total federal spending on medicare, medicaid, and federal health employee insurance, we're talking about less than 1%, even less than some people above had predicted."
Coincidences abound: If you're dismissive of 1% tort savings, health insurance company profits make up approximately 1% of total health expenditures too, so I guess you're dismissive of those too.
Again, there's money to be saved with Tort Reform, but you people are too partisan to pursue it... In other words, you're just as detrimental to the reform process as the conservatives... two peas in the same pod.
Hogan: "Or for that matter, the name of his health economics expert."
Apologies for any misspelled names, not intentional, but as previously posted, I'm slightly dyslexic, and it's difficult for me to pick up misspelled names on the spell checker.
Posted by: Jay Jerome | October 19, 2009 at 04:47 PM
JJ: Consider it withdrawn. It won't happen again.
Posted by: Hogan | October 19, 2009 at 04:51 PM
Sure, and as for the latter I said as much in one of my responses. I have no dog in the hunt personally on tort reform, no ideological leaning either way. I don't care which way it shakes out, only that it does so to the maximum collective benefit to society.
I just find it a laughable rebuttal to the assertion that the GOP has no serious ideas or alternatives for health care reform. Set alongside the Democratic proposals on the table now, it may or may not be a useful piece to help reduce health care costs. But by itself? If the sole response of substance from the GOP to the problem of health care reform in this country is "tort reform", then yes, they are truly intellectually bankrupt as a movement.
Posted by: Catsy | October 19, 2009 at 04:51 PM
The biggest problem, to me, with the conservative fondness for "tort reform" is most of what they claim to want, which is less "frivolous lawsuits" that cost doctors/hospitals lots of money would be best provided by other reforms mentioned several times above, by different people, that would ALSO provide other benefits. Rather than just arbitrarily capping damages or making it harder for people to sue when they're injured.
Posted by: Nate | October 19, 2009 at 04:51 PM
"If after this many exchanges you still can't grasp why I keep bringing up insurance companies and why that's germane to the statement of yours to which I originally responded, you are either being willfully obtuse or are sincerely unable to wrap your head around the subject we're discussing."
This guy's insulting my intelligence (boy, am I devastated)- an impolite personal attack - so where's the new regime posting rules enforcer?!!?
Just kidding Catsy, you can be as abrasive and obnoxious as you like... it's the contentious American idiom in action... as intrinsic to our cultural expression as the 'dozens' or trash-talk on the basketball court. I'd respond in kind, but with the double-standard mind-set in place here, I'd probably get banned.
Posted by: Jay Jerome | October 19, 2009 at 05:11 PM
But what percentage of total health expenditures go to marketing of health insurance? How much goes to the overhead within the insurers, such as the executives and all those low-level employees who keep the insurance companies' "medical losses" down by denying claims and practicing recission? I'm pretty sure that I've seen someplace that a double-digit percentage of our medical expenses are consumed by private insurers and not transmitted to care providers - and not all of that is profits.
And, because we have all these self-interested private insurers, how much of our medical expenditures goes to the many hospital employees who work on bargaining with all the different insurers, and on managing all the different paperwork from all the different insurers (a growing industry), and how much money is spent arguing with the insurers over all those denied claims? How much money is consumed by the hospitals' collections departments, because we don't have single-payer?
Posted by: Warren Terra | October 19, 2009 at 05:16 PM
Rewinding, we have this exhange:
Catsy: But on this most important of issues, the GOP literally -- literally -- had nothing of substance to say.
Jay Jerome: Does the term "Tort Reform" ring a bell?
The Facts: The CBO estimates that Senator Orrin Hatch's tort reform proposal would reduce spending on health care by 0.5%. That's one half of one percent.
That's not a very large savings. JJ's claim does nothing to counter Catsy's claim that the GOP has no substantial alternative.
Posted by: elm | October 19, 2009 at 05:17 PM
Addressing other points:
Claiming a 1% savings due to tort reform overstates its effectiveness by a significant margin. The estimate is 0.5%.
Additionally, insurer profit is immaterial. Focusing on profit ignores advertising costs, executive salaries, bonuses, etc... That's another red herring.
Posted by: elm | October 19, 2009 at 05:30 PM
And as we increasingly gain perspective on these debates, the GOP's actions are going to look worse and worse.
I'm not sure this is so, but I hope it is.
The health care debate may be an inflection point in how Americans think about their relationship to government, and more broadly about their relationship to each other.
There's a deep tradition in the US of people wanting, basically, to be left alone to do as they wish. That works OK when you have a population of 10 million and a continent's worth of open land. When public services are nonexistent, absolute self-reliance isn't a virtue, it's a necessity.
It doesn't work so well with a national population of 300 million and a global population of 6 billion.
Like it or not, there are a lot of us here now. We're running out of cheap or free resources to exploit. Everything anyone of us does is that much more likely to affect somebody else.
What does this have to do with health care?
15% of the population has no health insurance at all. 60% of all personal bankruptcies are due to medical bills. We're on our way to medical care soaking up 20% of GDP.
If the debate at that juncture is about tort reform, or what the health insurance or big pharma profit margins are, or whether people get too many MRIs, we're asking the wrong freaking questions.
The questions we should be asking are:
What kind of a thing is health care?
Is it a market commodity like cars, or shoes, or televisions?
Or is it more like water, or clean air, or schools, or highways?
Another question we should be asking is:
What responsibility do we bear toward each other?
As far as I can tell, the whole debate about health care assumes that it's just another helpful service, like getting your lawn mowed.
I'm saying it's not just another helpful service like getting your lawn mowed. It's a necessity of reasonable, civil, common life, like water, or highways.
Actually, I'd say that making sure everyone can go to the freaking doctor when they're sick is an absolute moral imperative, and the fact that there's even a debate about it reveals a deep corruption in our national soul, but we'll probably have an easier time talking about it if we stick to the nice, neutral vocabulary of public policy.
I'm also saying that we bear enormous responsibility for each other, because we no longer live in a world where you can take an axe, a rifle, some matches, and your favorite dog and go live on a mountaintop somewhere. Everything that any of us does touches everyone else.
If we don't recognize and act on that, a lot of people are going to die, whatever scrap of common social fabric we still have left is going to fall apart at the seams, and we're all going to go broke.
The reason I hope the GOP is utterly discredited by the health care debate is because they are always, always, always on the side of "leave me the hell alone".
And that just ain't going to work anymore.
If we can get that and act on it, maybe we'll be OK.
If we can't, we're done. Europe, India, and China are going to eat our lunch. Hell, Brazil will probably start kicking our @ss.
There's nothing whatsoever that says the US can't become a second or third rate nation. It wouldn't be hard at all for this country to become just another cheesy, corrupt banana republic. There are a number of ways in which we're damned close to that now.
That's my take on the whole debate.
Posted by: russell | October 19, 2009 at 05:58 PM
Marty: I am not sure of the logic that damages could not be incurred beyond continuing medical bills, which is the only need relieved by an NHS
As others noted, another reason for bringing suit is the discovery process - if the doctor and the hospital are closing ranks and refusing to show the evidence, a lawsuit forces them to do so.
but it would remove all capability to sue.
Are people not allowed to sue Medicare and VA doctors for malpractice in the US? Seriously?
Posted by: Jesurgislac | October 19, 2009 at 06:04 PM
Are people not allowed to sue Medicare and VA doctors for malpractice in the US? Seriously?
I've never heard that claim before. This article suggests the opposite -- you can indeed sue a doctor for malpractice arising from a Medicare-covered procedure. Also, Medicare requires the provider to absorb the cost of treating certain preventable mistakes.
This law firm offers to represent veterans in malpractice suits against VA providers. That would seem like a terrible business strategy if you couldn't sue them.
Posted by: elm | October 19, 2009 at 06:14 PM
Somewhat off topic, but not really...
[Edward G. Robinson, wearing 'biblical' clothes, in a mobster voice] 'Where's yer messiah now?? Huh? Yeah! Where is he?'
Posted by: jonnybutter | October 19, 2009 at 06:17 PM
elm, then in that case I have no idea why Marty would think that extending Medicare to the whole population would take away their capability to sue.
After all, a swift google would tell him that people can and do sue the NHS, when they have cause.
What the provision of universal healthcare would do, fairly obviously, would be take away the financial need to sue in order to save your life (and/or your finances).
Posted by: Jesurgislac | October 19, 2009 at 06:33 PM
Jesurgislac, I think that brings us full-circle to publius's original posting. Opponents of reform have demonstrated no substantive counterproposal and have relied more on hyperbole and rhetoric than facts, policy, or analysis.
Posted by: elm | October 19, 2009 at 06:45 PM
Really, for any kind of meaningful health care bill to come out of congress, there's going to have to be some compromises made
Not with Republicans -- the Finance Committee showed how useless that is. The Dems need 60 votes to vote for cloture, then they only need 51. That's how the Repubs ran the Senate when they were the minority -- let's see how they like it when it gets pulled on them.
Posted by: Jeff | October 19, 2009 at 08:29 PM
"a swift google would tell him that people can and do sue the NHS, when they have cause."
Except we are not in the UK and our government is not very fond of being sued.
Posted by: Marty | October 19, 2009 at 08:34 PM
Come to think on it, I think it's far more likely that those in FAVOR of "tort reform" are lawyers -- they're just the ones working for the large corporations. Think how much easier their job is if Joe Average can't sue their clients. There's motive, right there.
Posted by: Jeff | October 19, 2009 at 08:37 PM
Several commentators here have missed the fact that the estimated 3% cost of malpractice litigation includes the cost of defensive medicine. The direct cost of malpractice litigation is less that 0.5% of all healthcare costs.
Source: http://www.nytimes.com/2009/09/23/business/economy/23leonhardt.html
Posted by: Kenneth Almquist | October 19, 2009 at 08:44 PM
Marty: Except we are not in the UK and our government is not very fond of being sued
elm already answered your assertion that people are not allowed to sue their Medicare doctor or their VA doctor in the US on October 19, 2009 at 06:14 PM. Looks like you're still wrong.
Posted by: Jesurgislac | October 19, 2009 at 08:51 PM
Kenneth Almquist: The cost of "defensive medicine" is unlikely to be affected by damage caps or by making it harder to sue. But if people don't need to sue for discovery or to avoid being permanently bankrupt and uninsurable, then there won't be as much need for "defensive medicine". And if people find out when doctors make mistakes, rather than having to sue to find out, chances are things like basic checklists are going to be less resisted. Which...seems to be the point of that article, actually.
And I, for one, really, REALLY don't get the part where they talk about doctors not liking effectiveness research. I mean, I get that some doctors oppose it, but what I don't get is WHY. Doctors are scientists, I don't get why they'd oppose evidence-based medicine, unless it's just inertia and familiarity, or associations that don't like anything that hasn't been used for 20 years, like in engineering (though given the adoption of new drugs in medicine, I don't know how likely that is).
That article's whole point seems to be almost exactly what I and others have been arguing.
Marty: Huh. Looking over the stuff on the Federal Tort Claims Act, and how it's been even more neutered by the Supreme Court, that's pretty disgusting. Not something I unfortunately see either party doing anything to fix, though.
Posted by: Nate | October 19, 2009 at 09:02 PM
Kenneth Almquist: "The direct cost of malpractice litigation is less that 0.5% of all healthcare costs."
Guess how much of it comprises the total National premiums we pay for health care:
From CBO Letter to Hatch:
National implementation of a package of proposals similar to the preceding list would reduce total national premiums for medical liability insurance by about 10 percent.
(My Bolds...)
So, don't you think it would be a large step toward accomplishing passage of health care if Americans who are scared shitless that Obama's plan will screw them, to be told their health premiums would be REDUCED 10% if the tort reform described in the letter was implemented as part of the health care package?
I mean, don't Democrats want to save Americans money, or do they just want to raise the costs we're going to have to pay to finance the extended coverage?
I said: "there's going to have to be some compromises made"
Jeff said: "Not with Republicans -- the Finance Committee showed how useless that is."
Really? That must mean Olympia Snow changed party affiliations during the hearings.
Posted by: Jay Jerome | October 19, 2009 at 09:56 PM
That's Olympia Snowe
Posted by: Jay Jerome | October 19, 2009 at 09:58 PM
Olympia Snowe is now synonymous with "Republicans", plural? Getting her on board means "Republicans" support it?
That'll go over well at Redstate.
Posted by: Catsy | October 19, 2009 at 10:12 PM
Jay: And what, if anything, do you have to say about the fact that other reforms could address the fundamental causes of malpractice suits, and provide other benefits, without arbitrary damage caps or denying people the right to sue?
Posted by: Nate | October 19, 2009 at 10:23 PM
Yes, defensive medicine is a problem. Yes, doctors today are too reliant on excessive, expensive tests (my grandfather, now sadly departed, was a neighborhood family physician and an instructor for nearly seventy years, and in his later years the declining diagnostic abilities of his students was a constant refrain).
But, while the "defensive medicine" label for this phenomenon is very evocative, what evidence is there that it's actually a response to malpractice suits? Certainly if you look at the US states that have instituted tort reform, the costs haven't gone down, nor has "defensive medicine" ceased.
The fact is that, the way we pay for medical care, the doctor often has a financial interest in doing more tests. Not only might they get paid by the procedure, they may also own a piece of the testing firm. Remember June's famous Atul Gawande article?
Leaving aside those insinuations of grasping motives, the doctors have no reason not to practice so-called "defensive medicine", because the doctors aren't supposed to consider the costs. And many patients also have no reason not to seek unnecessary tests or procedures, because of the way our health insurance works, and because the employer-provided insurance system means that many patients don't even see how their insurance is paid for in a transparent fashion. Why not pester the doctor for more tests, under the circumstances?
There was a good essay on NPR last week, in which an emergency room doc talked about treating a kid who'd had a bad fall, but who the doctor was 99.99% certain just needed bed rest and some observation by his parents. The kid's dad wanted a CT, to eliminated that last 1-in-10,000 chance. Because it was his kid. And so he pressured and pressured the doc. And the doc knew it'd be less hassle to approve the CT, and its unnecessary expense and radiation exposure, and that the dad wouldn't see the cost, and the doc would actually get a little bit more money.
Now, I don't know of a systematic way to address the phenomenon called "defensive medicine" without inserting some bureaucracy that would be at best paternalistic and at worst horribly destructive. But I think that blaming this whole thing on malpractice suits is extremely naive.
Posted by: Warren Terra | October 19, 2009 at 10:23 PM
So, don't you think it would be a large step toward accomplishing passage of health care if Americans who are scared shitless that Obama's plan will screw them, to be told their health premiums would be REDUCED 10%
You could tell them that, but it would be a lie. The report discusses the potential reduction in medical malpractice liability insurance premiums that doctors pay to liability insurance companies, not health insurance premiums paid by consumers to health insurance companies.
Posted by: Tyro | October 19, 2009 at 10:46 PM
Not to forget that the illusory 10% reduction would disappear within a very short time given the rate hikes the insurance industry announces now even if there is no HCR at all. Is 'this will postpone your bankruptcy by 3 years, if you are lucky (and we can't get away with our planned extra fees)' so reassuring?
[sarcasm]Given the national attention span, maybe[/sarcasm]
GOP proposal in case of Kathrina II: Get a plumber to fix your dripping taps, so the water rises a bit more slowly.
Posted by: Hartmut | October 20, 2009 at 06:26 AM
When the government runs free market insurance companies out of business, and then leaves government run insurance entities in charge of whatever form of 'insurance' exists at that moment; wouldn't then therfore mere citizens be unable to sue the government (insurance thingies), especially when a significant portion of these insurance czar structures expenses will be tied up with the committee to re-elect their assigned Democrat??
Posted by: blogbudsman | October 20, 2009 at 09:34 AM
Re: Russell's comment at 5:50 on October 19th. As usual spot on. John Donne would be proud.
On eother quick comment. Reading this thread and the types of arguments put forth by those who question the need or direction HCR is taking right now, I am more and more convinced that what we really need is single payer, but that reform without a public option is a waste of time.
Posted by: John Miller | October 20, 2009 at 09:45 AM
shorter blogbudsman: "But if monkeys *DO* fly out of my butt, won't they eat my face? Right before they kill all the apple pie & make us eat porridge?"
Waxing hysterical over made-up unlikelihoods, & presenting the unholy mash-up as proof that we need to be *more* hysterical, is not a basis for argument, nor is it a "point", nor is it a contribution to a sane conversation among adults.
Wanna try again? Hint: figure out what point you're trying to make, then construct a logical train of thought that goes from the ground (ie, a solid foundation) all the way up to your point.
Posted by: chmood | October 20, 2009 at 09:58 AM
Note to self: reactivate pie filter for ObWi; a couple of the old regular trolls are back doing their best to fling poo.
Posted by: Catsy | October 20, 2009 at 10:18 AM
Blogbudsman: When the government runs free market insurance companies out of business
*looks around* In the UK, the NHS has been operating successfully and effectively for 60+ years.
As a direct result, from all reports, private health insurance companies in the UK provide a far better service to their customers than their opposite numbers in the US: I have never heard of a Brit who had BUPA insurance (for example) having to spend hours and hours nagging them to get them to pay up on agreed-on bills. BUPA know they have to compete effectively with the NHS, and they can't afford to dish out the kind of timewasting crap to their customers that private health insurance companies in the US get away with.
If you support the free market, blogbuds, why? Is it just out of a sense of religious faith, or do you believe that free competition delivers a better service to the customer? If so, how do you explain that in the UK both the NHS and the private health insurance companies deliver a better service than you get in the US?
I'd say it's fairly obvious why: if BUPA promise they'll pay and then make their customers go through endless fights over every bill, their customers will simply leave them - they always have an alternative. In the US, your "free market" system leaves customers with no choice but to die or take the deal.
Posted by: Jesurgislac | October 20, 2009 at 10:27 AM
Jay Jerome: "their health premiums would be REDUCED 10% if the tort reform described in the letter was implemented as part of the health care package"
That's simply untrue. The CBO letter said that malpractice insurance premiums would be reduced 10% on average. You even quoted that passage directly but misinterpreted or misrepresented it.
The affect on medical costs is much smaller, a reduction of 0.5%. Any reduction in medical insurance premiums would be similar to this.
Posted by: elm | October 20, 2009 at 10:42 AM
Once again, Jesurgislac is right.
Posted by: I Hate Chavs | October 20, 2009 at 10:52 AM
Once again, though, if Jay Jerome had any clue about health care, he'd have something interesting to say. As it is, since he comes from the intellectually stunted and lobotomized Republican party, all he can do is repeat "tort reform... tort reform... tort reform" like a mindless automaton. He and the Republicans have no clue or interest in health care policy whatsoever and are just reading off a script of pre-written ideas that they apply to everything, like trained monkeys. His solution to food safety? Tort Reform and Tax Cuts. Transportation infrastructure? Tort reform and tax cuts. Financial meltdowns? Tort reform and tax cuts.
Posted by: JustMe | October 20, 2009 at 11:14 AM
JustMe, I'm under no delusions about either the quality or intent of Jay Jerome's posts. They serve as nothing but a (too-often-successful) distraction to the topic at hand.
I can only hope that a short, sourced, direct refutation of his claims will discourage others from taking the bait (I wait in hope).
Back to the topic at hand: russell's 5:58 post makes a very strong case: "[Health care is] a necessity of reasonable, civil, common life, like water, or highways." The debate on health care should focus on this aspect. Those who disagree with that assessment should stand by that belief and argue their case.
I also strongly agree with John Miller's assessment that reform without a public option -- that is, reform that leaves us at the mercy of private insurers -- is worthless.
Posted by: elm | October 20, 2009 at 12:08 PM
I thought Jay Jerome was actually a Hillary Clinton supporter who is mad that Obama won? Am I mistaken?
Posted by: Sebastian | October 20, 2009 at 12:10 PM
Sebastian: Some posters here have interpreted his behavior as Pro-Hillary concern trolling rather than genuine support for Hillary Clinton.
In this thread in particular, I would point out that he hasn't advocated for Hillary Clinton's health care proposals from the primary.
Posted by: elm | October 20, 2009 at 12:28 PM
I cannot recall seeing JJ advocate for HRC's positions. I do recall him spending an inordinate amount of time trying to tear down Obama, as well as a track record of doom-and-gloom predictions about Obama's candidacy that reached Weekly Standard-esque levels of wrong. The whole thing did not leave me encouraged to have him manage my portfolio.
But that has no bearing on the arguments he's presented in this thread, which read like someone who just got a Logical Fallacy Advent Calendar and is in a hurry to open all the doors. A few of his responses in particular were so nonsensical that I had a hard time responding with anything other than abject mockery. The words were in recognizable English, but had all the meaningful semantic content of "plums deify".
To put it bluntly, it's impossible to have a discussion with someone who skims for targets to respond to rather than reads for comprehension of the material.
Posted by: Catsy | October 20, 2009 at 06:36 PM
Catsy wins!!!
Posted by: chmood | October 20, 2009 at 10:50 PM
Well, extensive debate has shown conservatives have a single idea that could potentially reduce medical costs by .5%, and could be solved in other ways than the one proposed by conservatives.
Jay Jerome has certainly proved how Serious conservative are. Thank you, good sir.
Posted by: yoyo | October 21, 2009 at 03:08 AM
yoyo: Well, extensive debate has shown conservatives have a single idea that could potentially reduce medical costs by .5%
...but probably not.
Where people sue to cover their lifetime medical costs, a cap on torts payments will simply mean they do not have enough money to cover their lifetime medical costs.
But their healthcare will still need to be paid for.
What the conservative idea of a cap on torts means is not that medical costs will be cut, but that the taxpayers will have to shell out for healthcare costs required by victims of medical malpractice and health insurance denial.
In short, conservatives are arguing that the costs should be transferred from the insurance companies to the taxpayers, and calling this a "saving".
Posted by: Jesurgislac | October 21, 2009 at 05:08 AM
Where people sue to cover their lifetime medical costs, a cap on torts payments will simply mean they do not have enough money to cover their lifetime medical costs.
But their healthcare will still need to be paid for.
I've seen lots of back and forth in this thread on various aspects of tort reform. Most of them attempt to quantify the effect of litigation on medical costs.
I may have simply missed it, but I haven't seen anyone address the basic, crucial point that Jes raises.
Litigation is the remedy that our system provides if you are harmed by medical care. It is, to my eye, an amazingly inefficient remedy, and also quite an unfair one, because the guy with the best lawyer will get the best result.
But, for good or ill, it is the remedy that our system affords.
Remove it, or limit it, and what do folks do if they are harmed through medical malpractice? Or even just accident?
Jes has pointed out, quite clearly, ways in which publicly provided insurance addresses this. The only flaw I find in her reasoning is in her assumption that, under a cap on torts, costs would shift to the taxpayer. IMO, in lots of cases costs wouldn't shift anywhere. Victims of malpractice or medical accident would just be SOL.
If you are not in favor of publicly provided health insurance, and you're in favor of limiting litigation, what's your solution for folks who are harmed through receiving medical care?
Posted by: russell | October 21, 2009 at 10:30 AM
To be fair, russell, I think it's not nearly as easy to litigate VA malpractice as it is to litigate other kinds.
My only evidence is anecdotal, so I won't bother you with it. Consider this a statement that's put together of pure opinion, if that helps.
If true, though, modeling public health care after the VA would not be a good idea.
Posted by: Slartibartfast | October 21, 2009 at 10:43 AM
In short, conservatives are arguing that the costs should be transferred from the insurance companies to the taxpayers, and calling this a "saving".
Ding. Ding. Ding. Exactly, but how does this differ from any "conservative" proposal?
Posted by: I Hate Chavs | October 21, 2009 at 10:52 AM