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Healthcare Crisis: Step 4 Malpractice
As we consider how to change healthcare, we might want to try to do this slowly. You can find Steps 1 through 3 at this site or at my blog at http://lipspeak.blogspot.com/
Price is a function of supply and demand. This is true of healthcare and health insurance. Every participant, even the government, must make a profit or at least break even for the system to work. That means that as we increase supply and options in health insurance and work to lower demand, or slow its growth through wellness, we must reduce costs so that providers can make a profit charging lower prices.
Step 1 (Tuesday): Remove State regulation. Federal preemptive national regulations will level the playing field. Eliminate oligopolies by large insurers who can afford these regulations, allow innovative players into the market, both of which increases supply.
Step 2 (Wednesday): If groups of people can band together to purchase insurance or self insure, using professionals to negotiate and set up the plans, insurance and care will become more efficient and wellness will be encouraged, thus lowering demand.
Step 1 and Step 2 increase supply and lower demand, which will lower prices. They will also reduce costs, allowing for profits at lower prices.
Step 3, commissions and volume bonuses paid to brokers may self-correct once Steps 1 and 2 are undertaken. Larger groups will negotiate better rates using professional insurance consultants, making brokers obsolete. In the short term, commissions and especially volume bonuses create conflicts of interest and impact the rising costs of healthcare.
Step 4: President Obama received promises from health care providers that they will reduce the costs of health care by, in part, lowering the number of extra tests and procedures.
This will only happen if there are no negative ramifications for doing so. If tests are reduced and a person dies or becomes permanently disabled, the plaintiff’s attorney will argue that a simple $2000 test covered by insurance would have uncovered the illness and saved the child. When the plaintiff and the weeping mother win that case for millions, doctors and hospitals will be forced to perform that and any other possibly relevant test again. The costs of the test are far outweighed by the potential costs of litigation. The insurance companies will pay for the tests and costs will skyrocket.
I think that trial attorneys provide a valuable check on incompetence and negligence. That being said, there will have to be some very clear guidelines set that establish what tests are warranted in what circumstances. Those laws and regulations MUST protect healthcare providers against liability if they follow those guidelines. These guidelines can be adjusted over time, but not retroactively.
In a cheaper system, people die or become disabled from unusual diseases that present as normal diseases and require special expensive tests to identify. If we are not going to do these tests routinely, providers cannot be punished when that is not enough.
Governments of the people have a hard time sacrificing a few to reduce the costs of the many, even if it is so that the many can receive a basic level of care they cannot get now, without which even more children die or become disabled. This will be a tough, but necessary decision.
Unfortunately, even if passed the law will last until the first parent goes on national television holding their dead or profoundly disabled child who did not receive that $2000 test that could have saved her. The law will be changed. Healthcare providers will be forced to provide all the extra tests again. Costs will rise.
17 Responses to “Healthcare Crisis: Step 4 Malpractice”
Yeah, this would be my step #1. And I'm as pessimistic as you about implementing it in a land where a large fraction of citizens regard unlimited health care as an entitlement, the first denied test a violation of their civil rights.
“hat being said, there will have to be some very clear guidelines set that establish what tests are warranted in what circumstances.”
Every case is unique, so those guidelines would either have to be some oversimplified that they don't apply in some cases and would actually result in tests being denied which should be done. Or else they would be so complicated that doctors would just do the tests rather than bothering to understand the guidelines, to cover their butts.
In any case, I can only speak from my own experience, but I honestly don't think over testing is a problem (at least by my provider). My son suffered from severe pain for the first year of his life, and had several doctor's visits who blew it off as just “reflux”, before he was finally diagnosed with a rare disease after an endoscopy. Yes, those are expensive, but we had to jump through a lot of hoops to finally get one, and try multiple reflux medication multiple times (yes, the doctors actually told us to retry certain medicines even after they didn't work the first time). If we made the system even more averse to testing, my son might still be in severe pain (or worse) today. Maybe the cost would have been lower for everyone else, but a health care system that caters only to the “normal cases”, and to hell with everyone else, is not one I want to be a part of.
After my wife was having severe stomach pain several times a week for about a year, she finally decided to go to the doctor (yes, she waits way too long for those sorts of things). The doctor said she probably just had indigestion and she should eat more fiber. When she protested, indicating the severity of the pain and could not bear it any longer, the doctor said, “well, it couldn't be that bad or you would have come in sooner.” My wife asked to see a specialist, and her request was denied because it was her first visit to the doctor. Needless to say, after a few weeks of eating more fiber, she got to see the specialist and found out that she needs to take a medication which has helped (the specialist actually said eating more fiber was exactly the wrong thing for her, but that's another story). The general practice doctor basically had a rule that you can't see a specialist after just one visit, no matter how much pain you were in. I guess that makes sense, but it makes the point that there are already plenty of precautions in place to avoid abuse of the system.
I realize these are use anecdotal. Perhaps other health care providers are ordering pregnancy tests for males as standard procedure (just kidding, of course), but I just haven't seen that.
This argument is simply absurd. The way to reduce health care costs is to eliminate the for profit insurance companies and the 20% they skim off the the top of the health care budget for marketing, dividends and outrageous CEO pay. Yes under a single payer their will be rationing but there is rationing now for the sake of profit. I had a friend and a cousin die because a private insurance company refused to approve tests until it was too late. At 63 I have no medical insurance because no for profit insurance company will touch me with a 10 foot pole. Yes. medicare is expensive but why? It is currently limited to the demographic that requires the most care, those over 65 that for profit insurance companies wouldn't cover. If everyone was on Medicare and paying the existing premiums it would easily put the insurance companies out of business. They know that and that's why they will fight it.
AD, what you're describing is not success but failure of the current system. Your son initially couldn't get a needed test, and he ultimately did get it not for any medical reason but because you were yelling and screaming. Then your wife got the wait-a-couple-weeks test when she really needed something else.
Providers are jammed between the financial pressure to do fewer tests and the lawsuit pressure to do more. So they do somewhere in between, but they have no good way to decide which to do. They probably end up doing more tests on louder people who are threatening lawsuits.
At this rate, quiet types will be weeded out of the gene pool. 100 years from now, we'll all be New Yorkers.
Ron, I disagree. Health care costs 3 trillion dollars a year, and next year it will cost 5% more. Insurance company profits amount to billions of dollars–maybe 1% of the total. CEO salaries are tens of millions–less than 1% of 1%. Your complaints are justified, but fixing them wouldn't even make a dent the real problem. Those issues are a distraction.
I definately agree that there are flaws with the current (relatively) free market system, but I also don't agree with the argument that just cutting out the profit will necessarily result in savings. If that were true, the government should take over every industry and immediately cut out all profit margins. There's a reason we don't do that.
I think Ron sums it up well. The system needs to be changed, not tweaked. I appreciate and respect the medical profession in this country, but I stopped trusting in the good faith of insurance companies long ago. Going to a single payer system may be a bumpy road at first, but it's the only long term solution to our present healthcare woes.
I didn't intend to portray my experience as a success, but neither it is a failure necessarily. Yes, in an ideal world, both my son and wife would have been successfully diagnosed in their first visit, but that would be impractical. There was no way to diagnose my son without an endoscopy, and of course I wouldn't advocate every patient who comes in with reflux-like symptoms to have an endoscopy right away. But that's my point. The system worked as intended: as less invasive and cheaper therapies did not, the doctors became more aggressive at finding the cause, and eventually did find it. It is true that if we had not been as persistent, it might have taken longer, but in general the system worked.
“Providers are jammed between the financial pressure to do fewer tests and the lawsuit pressure to do more. So they do somewhere in between, but they have no good way to decide which to do.”
And thus providers are driven to find the middle ground between doing too much and doing too little. Seems to me that's how it should be. They do have a good way to decide which to do. Do what makes sense to treat the patient. If it turns out not to be enough, because you were dealing with a specific problem you had no way of anticipating, then the court should rule in your favor.
JSpencer, sure, single payer sounds terrific. Until the poor guy starts bouncing checks, and then we're in big trouble.
Dr-J
WTF does this mean:
“sure, single payer sounds terrific. Until the poor guy starts bouncing checks, and then we're in big trouble.”
Please explain what the hell you are talking about!
Dr_J
Nice made up numbers. Check your facts, or better yet, check mine.
Just two days ago I sent you profits for the top four for profit orgs. Clever of you to ignore that. The distraction is the fraud perpetrated by insurance companies and their lobbying efforts to hamstring medicare.
You make it sound like these companies are the only thing holding back affordable health care. If they really are the cure-all you preach, why are 50 million uninsured, and why is the 2nd highest cause of bankruptcy medical costs?
Most of the comments stray from the point of the article, which is that one way to save money on health care is to look at tort reforms. What the article says is that some entity, most likely a task force, would set treatment protocols or algorithms. If a provider follows those algorithms he/she would then be immune from a lawsuit arising from their treatment.
The point is the algorithms may not include rare or exotic tests or treatments that actually might be appropriate for the patient. In an effort to save money though the provider would be immune from lawsuits as long as he was following the accepted protocols.
Since the Democratic Party is heavily influenced by trial lawyers I doubt this proposal will gain much support.
Hemm, if by “ignored” you mean “responded to”, you're quite right. http://themoderatevoice.com/31886/healthcare-cr….
The facts are still the same: insurance companies' profits are quite in line with those of similarly sized companies in other industries. They're a tiny slice of the health care industry pie. If you were to refund them 100% to consumers, you wouldn't make a noticeable dent in anyone's bills.
I'm not sure how to respond to your bizarre last paragraph, which has no relationship to any position I've taken. My main point is that people can't afford medical care because it *costs too much*, not because insurance companies are evil. Simply nominating a more enthusiastic payer to cover increasingly outrageous bills is a foolish reform in that it doesn't grapple seriously with the underlying costs of providing the treatments. Single payer “fixes” the system in the same sense that one “fixes” the cat, leaving it less functional that it was before.
Ned,
You’re doing a good job of identifying problems with the current healthcare model and proposing modifications to alleviate those shortcomings.
One thing that hasn’t been discussed yet is what do people want the healthcare system of the future to look and act like?
Adilinesdad laid out a scenario, but how would he want the situation to be handled differently if he had the power to remake the system? Ron Beasley can’t get insurance, so what kind of system does he see as solving that problem, and if it is single payer, what drawbacks would there be?
It’s hard to plot a course if you don’t yet understand the destination. Once people agree on where the system should end up, the details tend to fall in place much easier.
Start with an easy scenario.
You wake up sick. You’ve had flu-like symptoms for a few days, but this morning you feel worse than you ever have. You know you should seek medical help.
What do you want to happen from that point on?
Unfortunately “tort reform” as pushed by health insurance lobbyists encompasses a lot more than protection from negligence of a provider and instead gets lumped in with protections for huge soulless multinationals for large scale established policies of negligence, fraud, manipulation of test results, etc.
A true, streamlined single payer systems, with established policies and procedures to be followed will have instant and logn term savings from efficiencies that are neglected by large insurers, at least until they surpass the cost of doing business as usual. Remember Ed Norton's Fight Club insurance adjuster character's explanantion of cost? Litigation is an important component of accelerating this process to protect lives.
Insurers already ration care, as been established by other posters, there are acceptable guidelines and best practices for care that shouldn't be tied to profit margins. I think reports of 1% profit margins are a shell game with big insurers, hiding things like 25% administrative costs. Providers on the other hand can often barely stay in business due to the byzantine array of policies and billing procedures that they have to harness to deal with multiple pay sources.
Providers on the other hand can often barely stay in business due to the byzantine array of policies and billing procedures that they have to harness to deal with multiple pay sources.
Some of the most byzantine being the existing government health plans of Medicare, Medicaid and Tri-Care. This is one reason I don't have much faith in a single-payer plan saving much money – yes it will be easier having to deal with just one set of rules, but based on how the government does things now it will still a big pain in the butt (and expensive).
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