the future of medicine and doctors

In speech after speech, Bush has advocated a cap on malpractice awards that has been vigorously opposed by those who stand to lose the most money–lawyers claiming to speak on behalf of the “victims”. Whatever one may think of his other policies, on this issue I believe he has been doing the right thing. Unfortunately it’s lawyers that dominate Congress and every state legislature. For example, in Oklahoma, the trial lawyers in the legislature killed a proposed cap on malpractice. They’re going to have to get these guys voted out before they can get this passed down there.

Okie, a few responses…


Ttraub, yeah I think we can all agree that a cap on malpractice awards would be a damn good thing that Bush could do if he could get it through Congress. It doesn’t surprise me though that the lawyers who make money off the malpractice suits shot it down though. I kind of wonder though, how can that not be a conflict of interest for them to vote on that? I would have thought there’d be legislation in place to avoid bias voting such as that.


Whuds, I certainly agree that sometimes patients behave far differently when they’re sick. The point I was trying to make I guess was that the idealism of health care being this beautiful, pillowy care-free endeavor is swiftly crushed by the grim reality of some of the “horrors” of health care such as the patient who obviously is a patient because of an illness or injury. It’s kinda like how war is glorified, but after even seeing a glimpse of it, you don’t look at it in the same way.


I certainly agree that this is a good discussion though. As far as socialized healthcare goes, heh you won’t ever see me support that, regardless of any success story I read about from someone in Canada or elsewhere. I never trust the government to care about people, and with health care, that goes double.

whuds, it’s not about dogs & cats being sick vs humans. It’s about patients who are hoping to require an operation and that the physician messes up just enough. Now they are still able to function but have a “fat check” coming their way. When people are comforted prior to surgery not on any spiritual or religious reasons but because of how much they stand to make if the doctor messes up there is a problem. A dog or cat will bite but unless you’re a pitbull owner your insurance doesn’t go up.


I’m not painting all patients with a broad stroke here but there are regions of the country where you better be prepared to have a suit against you ever 3-4 years. South Florida is king to frivolous lawsuits. I have acquaintances who made quite a bit of money off of malpractice lawsuits settled out of court.


These patients don’t stop to think where this wealth is coming from because they don’t care. If you make it difficult for them to bring suit against you then the number of suits will lessen. This is why quarterly reports of bankruptcy case filings have dropped and are going to continue to drop.


The government doesn’t have to come in and demand that doctors see patients. For starters put a cap on malpractice and then take it from there. On the hill lobbyist should then be shot on sight.

Not to disagree with anything you’ve said, but I would note that the anesthesiologists have managed to reduce malpractice claims over the past 3 decades. See asahq.org for the statistics) through improvements in practice. The Wall Street Journal (6/21/05 issue) has reported on this interesting trend.


Improvements in quality control notwithstanding, there nonetheless exists an industry of litigators who seek to exploit every weakness in a physician’s practice. I suspect that a combination of caps on awards, more qualified and objective “expert witnesses”, and better education are all gonna be needed to tame this beast. WSJ also had an interesting article on doctors learning to apologize to patients for errors and a resulting decrease in lawsuits.

ttraub,


I learned from a great group of PA’s that patients don’t sue because you screwed up but because of the attitude. If the patients perceive they are being treated fairly and respectfully then they are less inclined to file a suit. Seems as though the finding matches what these PA’s told me looooooong time ago. I’m beginning to get to the stage where mentioning dates is a little embarassing.

Trust me, croooz, your “long ago” will never beat my “long ago”

  • ttraub Said:
Trust me, croooz, your "long ago" will never beat my "long ago"



LOL. I didn't say it would. Just that I am at that stage where I have to be careful who I mention years or dates to because if it's the wrong person then you get "THAT" look.

In response to various elements of this thread:

  1. Don’t move out of California to get away from lawsuits–although policy people disagree about the factors that have made California successful in reducing malpractice awards and limiting the effect of malpractice insurance on doctors’ costs, everyone agrees that it is a success. (Some say it’s a cap on awards; others say it’s reform of the insurance industry.)

  2. I think healthcare is a right.

  3. And, the idea that we don’t have government healthcare in the United States is absurd, and the idea that there are no bureaucrats rationing our healthcare even more so. Last time I read about this, a bit more than half of US healthcare expenditures–but in that range-- are now paid for either by Medicare, Medicaid, the VA or the military, all of which are government systems, and each of which work differently. As the baby boom generation ages into Medicare, and as Iraq and Afghanistan veterans return, this will only become more true. The question is not whether we will have government healthcare–we already do. It’s a question of how much.


    As for the bureaucrats, there aren’t too many healthcare options out there that don’t limit formularies, treatment options, providers, or other important choices in some way or another. If you’ve got that kind of no-limits option for healthcare, you’re either rich or extremely lucky (or, more likely, healthy enough that you haven’t yet realized the limits that already exist on your care).


    j



Hi all:


I think this is a good discussion. I am also betwixt and between at times concerning the healthcare issue. I tend to lean, though, towards Crooz’s perspective of healthcare being a privilege and not a right. I guess it’s because I don’t understand some things.


Case in point: treated a patient the other day - 39, morbidly obese, chronic retainer, because he refused, for years, to go for a sleep study - which would have easily led to his being required to wear CPAP. He’s since developed pneumonia, and a host of other issues and at one point required intubation and mechanical ventilation. He’s now on BiPAP most of the time and experiences apneic periods so often it’s a problem. He will receive great care from us (for all of his needs). But, sometimes, I wonder if all of this could have been avoided if he had heeded his wifes request. The system will now be paying for his care, which will continue for quite sometime because he is disabled.


So, in short, what responsibility will the patient have over their health. Having healthcare available as a free-for-all is questionable in my mind. How can costs be contained or kept under control for patients who have chronic illness, illnesses they could have avoided (diabetes for example). I read on a different website about someone complaining about the lack of universal healthcare because their brother, who was jailed at the time, decided to pierce himself with something and developed a pretty serious infection, couldn’t receive healthcare in jail (didn’t make sense to me…).


I’m reading a book called, “Mama Might Be Better Off Dead” and the author explores this issue, among others.


I’m just asking for opinions. I feel as if it’s very difficult to resolve (in my mind) how to deal with these issues. I know everything isn’t the patient’s fault, but what are we to do about situations like this?

Here’s an article from JAMA about healthcare financing:


http://jama.ama-assn.org/cgi/content/full/289/ 9/11…


Estimated government healthcare spending ranges from about 45-60% of total US healthcare expenditures, depending on how you figure each part of that question.


A highlight:


"These data indicate that, in addition to spending more and more on health care in absolute terms, the US government has also paid for a progressively larger share of national health expenditures during the last 35 years. Between 1965 and 1999, the government share of tax-financed health expenditures rose more than 5700%, while overall health costs increased 2900%.3 In 1965, US government tax-financed health expenditures per capita were less than most other industrialized nations. By 1999, the per capita government proportion of health expenditures in the United States exceeded total health spending per capita in every industrialized nation except Switzerland.3 Additionally, tax subsidies and public employee benefits, which, again, are usually excluded from the calculation of public health care spending, rose as a proportion of overall government-financed health expenditures between 1965 and 1999, even in the face of large increases in direct federal spending on other programs such as Medicare and Medicaid.3


“Overall, then, the US government is paying for the majority of US health expenditures while a large segment of the population remains uninsured or underinsured. Many of these funds go directly to private insurers who cover government employees. Many go to tax breaks that benefit both employers who purchase private insurance and, disproportionately, the wealthiest, best-insured families in the United States.”