Dialysis providers complain about losing money on Medicare reimbursement.

In the real world, physicians frequently decline to accept Medicare or Medicaid patients.

And it was a really poor move (could be ineptitude, or poor knowledge of public opinion, if they cared, which they may not have) for Team Obama to say that already-low Medicare reimbursements will be deliberately lowered as part of “paying” for the vast new ambitious health care proposal. (The providers and anyone to whom they can shift costs will be doing the paying in addition to taxpayers directly.)

Visit a few dialysis clinics sometime and ask them what they think of Medicare.

I agree with your point that Medicare has a lower overhead than private insurers and potentially that could give some savings, but if you're trying to say we can solve the health care problem by paying all physicians Medicare rates it will lead to a mass exodus from primary care.

Does anyone have ANY suggestion that can yield that kind of saving??

How about the fact that IT ISN'T TRUE? Malpractice is only 2% of health care cost, and malpractice insurance has increased while actual malpractice awards have dropped. Some states though have done what you suggest, by capping damages for malpractice. Guess what? In the states that have done so, malpractice insurance rates went UP! Savings from this strategy? Less than ZERO. That's right, negative improvement.

Next?

The problem with tort reform – the same the health reforms and every other big issue – is no one wants to meet in the middle. You have both sides pulling full force and not willing to look for any middle ground.

In the interests of intellectual honesty I think we need to tailor our statistics to what we're proposing. If we don't plan to insure all comers including illegal immigrants, we should reduce our claims of the number of uninsured commensurately. If we do plan to insure all comers, I think we need to explain how we plan to finance it.

I appreciate your response.

I agree with one of your points:

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

In fact, that is the main point of the New Yorker article from my first comment–that the financial incentives are out of whack.

As for malpractice insurance, I was responding to the previous commenter. Maybe you're right, maybe I'm looking at it the wrong way. (I'm well aware that we live in a culture where someone recently sued a dry-cleaner for a million dollars over a pair of pants.) But the idea, put forth by that previous commenter, that this is a problem caused by lawyers, seems unsupported by actual data.

If you're interested, here's another New Yorker article by the same author called “The Malpractice Mess”.

There is a saying among obstetricians – you can never be sued for deciding to do a C-section, only for deciding not to. The current malpractice climate encourages doing every possible test and intervention.

What's more is the public likes having a lot of tests. Fixing this problem will take not only a change in malpractice laws but a change in public attitude. You don't need an MRI for every back ache.

The current reimbursement system also rewards doctors for doing a lot of procedures, reimbursing them at a much higher rate than cognitive services. If you pay doctors more for doing procedures than thinking about and talking with patients what do you think happens?

This article really gets at the key to controlling health care, although as it implies it is a tough sell since Americans currently enjoy “all you can eat” medicine and resist any restrictions.

I have no hesitation in admitting that I generally turn to The Economist when I am looking for details regarding any hot world issue, or if I fail to….

But for all the worry over higher medical expenses, legal costs do not seem to be at the root of the recent increase in malpractice insurance premiums. Government and industry data show only a modest rise in malpractice claims over the last decade. And last year, the trend in payments for malpractice claims against doctors and other medical professionals turned sharply downward, falling 8.9 percent, to a nationwide total of $4.6 billion, according to data compiled by the Health and Human Services Department.

From the conclusion:

And some researchers are skeptical that caps ultimately reduce costs for doctors. Mr. Weiss of Weiss Ratings and researchers at Dartmouth College, who separately studied data on premiums and payouts for medical mistakes in the 1990's and early 2000's, said they were unable to find a meaningful link between claims payments by insurers and the prices they charged doctors.

“We didn't see it,” said Amitabh Chandra, an assistant professor of economics at Dartmouth. “Surprisingly, there appears to be a fairly weak relationship.”