[Captain Obvious]

I was wondering how long into the speech it would be until they invoked the power of a John Kennedy quote.

Wow, and a ton of cliches!!
Who'd ever guess political speeches were made up of those.

[BlackGriffen]

I tried to watch that, but Pelosi just looks to phony. I didn't even see Tom Delay say anything.

The opening was like, "Bush shouldn't be so partisan, now we will toot our partisan horn." Ouch.

I couldn't watch it.

BlackGriffen

[OldManMac]

I didn't listen to either the speech or the response, but the Demicans and the Republicrats are almost indistinguishable from each other; they're both in the pockets of big business. Dubya ran on a platform of getting the government off our backs, yet it's exploding in growth under King George's "leadership!" Homeland Security (now there's a good name for you) has 175,000 employees alone! Both parties are full of cliches and bullshit!

[kindbud]

If Republicans do it, it's stupid.

If Democrats do it - it's ok because the Republicans do it too.

[roger_ramjet]

Originally posted by BlackGriffen:
I tried to watch that, but Pelosi just looks to phony. I didn't even see Tom Delay say anything...

I couldn't watch it.

Even if you did watch it, you still wouldn't have seen Tom Delay. I think it would have been somewhat untraditional for the Republican House Majority Leader to have given the Democratic response. Tom Daschle was the one teamed with Pelosi.

[ghost_flash]

The dem's looked a bit like two high school students giving their first speeches in front of their class. Funny to watch, and listen to, yet painful and tragic as well.

[thunderous_funker]

Damn. I've given Bush a lot of flack for his sheer lack of public speaking skill, but he's got one up on either of those 2.

Sheesh. As smart and experienced as both of them are, its amazing how poorly they delivered a decent speech. It was awful to watch. Just painful.

How can so many career politicians be such total hacks at public speaking?

[davesimondotcom]

I loved it when Daschle said (paraphasing):

Tax cuts don't make health care more affordable or provide insurance.

My wife (who is not very politically active and always wants me to change the channel when something political is on) turns to me and says:

"I think if we had more money in our paychecks we could have afforded not to cut off our dental insurance. So I guess he's wrong."

[thunderous_funker]

Originally posted by davesimondotcom:
I loved it when Daschle said (paraphasing):

Tax cuts don't make health care more affordable or provide insurance.

My wife (who is not very politically active and always wants me to change the channel when something political is on) turns to me and says:

"I think if we had more money in our paychecks we could have afforded not to cut off our dental insurance. So I guess he's wrong."

Let's see....

My taxes were cut by a couple hundred bucks. My healthcare costs almost doubled. State fiscal crisis means my local taxes are way up, tuition is up and public services are totally slashed.

From what I've seen, most Americans' "tax relief" was pitiful compared to the stark loss of access to services and dramatic increases in local taxes and especially healthcare costs.

[Lerkfish]

Originally posted by davesimondotcom:
I loved it when Daschle said (paraphasing):

Tax cuts don't make health care more affordable or provide insurance.

My wife (who is not very politically active and always wants me to change the channel when something political is on) turns to me and says:

"I think if we had more money in our paychecks we could have afforded not to cut off our dental insurance. So I guess he's wrong."

Well, sorry to disagree with your wife, and I'm not going to defend Daschle, who used poor phrasing, but his essential point is correct: The problems with the high costs of health care are not soluable merely by returning money to those who need health care. The high costs themselves remain unsolved in that instance.

[davesimondotcom]

Originally posted by Lerkfish:
Well, sorry to disagree with your wife, and I'm not going to defend Daschle, who used poor phrasing, but his essential point is correct: The problems with the high costs of health care are not soluable merely by returning money to those who need health care. The high costs themselves remain unsolved in that instance.

My wife (who works in a family practice office) could tell you that one of the main reasons for the high cost of health care is the huge amount of government required paperwork involved as well as her bosses (the doc's) having outrageous malpractice insurance costs.

Neither of which Daschle would solve by getting the government more involved with more money thrown at health care.

Show me a Democrat complaining about health care costs and I'll show you one who would vote with trial attorneys agains tort reform every time.

They system isn't perfect, but the simple fact is, with tax relief, we could CHOOSE to spend that money on dental insurance. Or we could buy a new TV. But the choice is ours to make.

[Lerkfish]

Originally posted by davesimondotcom:
My wife (who works in a family practice office) could tell you that one of the main reasons for the high cost of health care is the huge amount of government required paperwork involved as well as her bosses (the doc's) having outrageous malpractice insurance costs.

Neither of which Daschle would solve by getting the government more involved with more money thrown at health care.

Show me a Democrat complaining about health care costs and I'll show you one who would vote with trial attorneys agains tort reform every time.

They system isn't perfect, but the simple fact is, with tax relief, we could CHOOSE to spend that money on dental insurance. Or we could buy a new TV. But the choice is ours to make.

Not sure you got my point, and I'm not arguing with this subsequent point.

[davesimondotcom]

Originally posted by Lerkfish:
Not sure you got my point, and I'm not arguing with this subsequent point.

I did get your point. And I offered a way to begin lowering the costs.

[thunderous_funker]

Originally posted by davesimondotcom:
I did get your point. And I offered a way to begin lowering the costs.

No you didn't. You just argued that having a little more in your paycheck would help. That isn't lowering costs.

It isn't democrats who are recommending "throwing money at the problem". That is what Bush and Congress are doing. Take their half a trillion dollar drug benefit debt plan. That is the quintessential example of "throwing more money at a problem" instead of doing something to address the fundamental issue of astronomical costs.

As for Tort Reform, that is a rather dubious argument mostly profered by the insurance industry seeking to limit its liability and healthcare corporations looking to improve their bottom line.

Look no further than California for an example. Here is a report showing how Tort Reform failed California, but Insurance Reform worked.

[davesimondotcom]

Originally posted by thunderous_funker:
Look no further than California for an example. Here is a report showing how Tort Reform failed California, but Insurance Reform worked.

Why not both?

After all, the existance malpractice insurance is the direct result of lawsuits, right?

[roger_ramjet]

Originally posted by thunderous_funker:
No you didn't. You just argued that having a little more in your paycheck would help. That isn't lowering costs.

It isn't democrats who are recommending "throwing money at the problem". That is what Bush and Congress are doing. Take their half a trillion dollar drug benefit debt plan. That is the quintessential example of "throwing more money at a problem" instead of doing something to address the fundamental issue of astronomical costs...

A key part of that drug bill was the establishment of health care savings accounts. Putting discretion back into the hands of consumers is the surest way to rein in health care costs. HSA's aren't about throwing money at the problem.

[thunderous_funker]

Originally posted by davesimondotcom:
Why not both?

After all, the existance malpractice insurance is the direct result of lawsuits, right?

And lawsuits are the direct result of malpractice. You know, when a doctor's incompetence or negligence results in loss of life or quality of life?

Want to lower malpractice insurance? Easy. Eliminate bad doctors. The ugly economic truth is that as long as a doctor is profitable, he'll keep his insruance. That just means as long as the insurance company's lawyers are better than the victim's lawyers, that doctor will continue to practice.

Several studies have shown that is a few bad eggs that are driving up costs for the rest of the doctors more significantly than tort claims.

[thunderous_funker]

Originally posted by roger_ramjet:
A key part of that drug bill was the establishment of health care savings accounts. Putting discretion back into the hands of consumers is the surest way to rein in health care costs. HSA's aren't about throwing money at the problem.

How exactly does that lower costs? Drug companies still enjoy a virtual monopoly and the new law prevents consumers from voting with their wallets by importing from Canada.

There is a reason that the Insurance industry and Pharma lobbied against a proposal that would let the government use its massive buying power on behalf of medicare recipients to leverage lower prices. Instead, they lobbied for (and got) the Congress to allow private providers to lure seniors out of the security of medicare with the promise that they might, somehow, perhaps offer lower prices.

It doesn't take a genius to figure out that this effectively squashes any real chance at collective bargaining by spreading consumers even thinner. Not to mention what it would do to the costs of those who remain in medicare.

[Millennium]

Originally posted by thunderous_funker:
And lawsuits are the direct result of malpractice. You know, when a doctor's incompetence or negligence results in loss of life or quality of life?

Want to lower malpractice insurance? Easy. Eliminate bad doctors.

Sounds like the same logic that spawned the No Child Left Behind Act.

[thunderous_funker]

Originally posted by Millennium:
Sounds like the same logic that spawned the No Child Left Behind Act.

That's a pathetic analogy.

Bad doctors are a known. In fact, Public Citizen publishes a list of them every year. They are the doctors who consistently seem to spawn victims. No new testing or standards need to be established.

Unfortunately, this known information is not readily available to consumers. Not only do they not know which doctors are sketchy (unless they do some research, Public Citizen's report isn't free either), but their choice of doctors is limited by the same insurance company that doesn't out dodgy doctors.

Now why wouldn't an insurance company want to out such doctors? Well, because as long as the settlements are low (and forced lower by Tort Reform) and they win cases that go to court, that doctor is still a good source of revenue for the insurance company.

And if margins get a bit tight for them, they simply raise the rates on all doctors to subsidize the bad ones.

We're talking Econ 101 here.

NCLB actually required schools to spend millions of dollars to meet new standards and conduct new testing--all of which cost more money--then slashed school funding.

[Timo]

The Funk's got a good series of points, especially when you note how difficult it is to find and discipline bad medical practioners. There's no good mechanism for it. On the hospital level they might just be dropped, but be free to show up somewhere else -- state agencies are just that (i.e., limited by the reach of the state itself), and "regulatory" groups like the AMA are better at circling the wagons than getting rid of the bad apples.

This isn't entirely surprising: doctors face massive pressure from malpractice cases as well as from insurance adjusters. No wonder policing their own is low on the priority list.

[theolein]

Originally posted by kindbud:
If Republicans do it, it's stupid.

If Democrats do it - it's ok because the Republicans do it too.

As long as they both fu©k off and leave the rest of the world alone, who cares?

[thunderous_funker]

The most exhaustive, in-dept report I've ever seen on the issue

IMO, a much read if you're serious about understanding the issue.

[BRussell]

Originally posted by thunderous_funker:
And lawsuits are the direct result of malpractice. You know, when a doctor's incompetence or negligence results in loss of life or quality of life?

Want to lower malpractice insurance? Easy. Eliminate bad doctors. The ugly economic truth is that as long as a doctor is profitable, he'll keep his insruance. That just means as long as the insurance company's lawyers are better than the victim's lawyers, that doctor will continue to practice.

Several studies have shown that is a few bad eggs that are driving up costs for the rest of the doctors more significantly than tort claims.

I agree with this and Timo here. I don't think lawsuits are the problem, I think they're a symptom of the underlying problem - medical errors - and if you reduce the lawsuits you're not addressing the real underlying problem.

I would frame it a little differently though. Although I'm sure there are bad doctors that need to be dealt with, I think the problem is more systemic. There aren't enough safeguards for simple things like making sure the right drug in the right dose is given. Physicians are basically infallible popes with little external accountability except for malpractice lawsuits, and that's a recipe for problems.

My view basically comes from this report.

The human cost of medical errors is high. Based on the findings of one major study, medical errors kill some 44,000 people in U.S. hospitals each year. Another study puts the number much higher, at 98,000. Even using the lower estimate, more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS.

Moreover, while errors may be more easily detected in hospitals, they afflict every health care setting: day-surgery and outpatient clinics, retail pharmacies, nursing homes, as well as home care. Deaths from medication errors that take place both in and out of hospitals – more than 7,000 annually – exceed those from workplace injuries.

"These stunningly high rates of medical errors – resulting in deaths, permanent disability, and unnecessary suffering – are simply unacceptable in a medical system that promises first to 'do no harm,'" says William Richardson, chair of the committee that wrote the report and president and chief executive officer of the W.K. Kellogg Foundation, Battle Creek, Mich. "Our recommendations are intended to encourage the health care system to take the actions necessary to improve safety. We must have a health care system that makes it easy to do things right and hard to do them wrong."

The know-how exists to prevent many of these mistakes, and so the committee sets as a minimum goal a 50 percent reduction in errors over the next five years. "We believe that with adequate leadership, attention, and resources, improvements can be made," says Richardson. "As we say in the report, 'It may be part of human nature to err, but it is also part of human nature to create solutions, find better alternatives, and meet the challenges ahead.'"

The majority of medical errors do not result from individual recklessness, the report says, but from basic flaws in the way the health system is organized. Stocking patient-care units in hospitals, for example, with certain full-strength drugs – even though they are toxic unless diluted – has resulted in deadly mistakes. And illegible writing in medical records has resulted in administration of a drug for which the patient has a known allergy. Medical knowledge and technology grow so rapidly that it is difficult for practitioners to keep up. And the health care system itself is evolving so quickly that it often lacks coordination. For example, when a patient is treated by several practitioners, they often do not have complete information about the medicines prescribed or the patient's illnesses.

To achieve a better safety record, the committee recommends a four-part plan designed to create both financial and regulatory incentives that will lead to a safer health care system. Taken together, these recommendations and findings represent a systematic way to design safety into the process of care.

[thunderous_funker]

Thanks Timo and BRussel.

Points are very well taken. Simply saying "out the bad eggs" is over-simplification. I didn't mean quite that literally, even if I do think there needs to be much greater access to information on questionable doctors/facilities for consumers. That, at least, we restore some simple market forces to the issue.

Limiting liability and the rights of victims overall to address the tiny minority of "frivolous" suits is simply counter-productive FUD distributed by those who bleed the current system from both ends.

[SimeyTheLimey]

Originally posted by BRussell:
I agree with this and Timo here. I don't think lawsuits are the problem, I think they're a symptom of the underlying problem - medical errors - and if you reduce the lawsuits you're not addressing the real underlying problem.

My impression from reading quite a large number of med mal cases and from surveying settlements is that the percentage of frivolous cases in medical malpractice is very high. The doctor doesn't have to make a medical error for there to be a suit against him. Very often, all that happens is that there are normal complications, or just a bad result. Given our litigious society and the glitter of a huge potential award or settlement, there will be suits against even very good doctors.

Even if the doctor wins the case, the defense costs still have to be paid for. Those defense costs can run into the thousands, or often into the hundreds of thousands. That's what malpractice insurance is for just as much as defense in cases where there is any actual error.

[Lerkfish]

If the AMA were truly self-policing instead of self-protecting, the amount of malpractice insurance required would diminish greatly.

[BRussell]

Originally posted by SimeyTheLimey:
My impression from reading quite a large number of med mal cases and from surveying settlements is that the percentage of frivolous cases in medical malpractice is very high. The doctor doesn't have to make a medical error for there to be a suit against him.

That's probably true, but I think that if there were more safety regulations in place it would be much harder to bring those "bad outcome" suits. Right now everything is up to the God-like physician's discretion in a "trust me, I know what I'm doing" fashion, and that invites challenges. If more regulations were in place, following those regulations appropriately would be a powerful check on any frivolous lawsuits.

[Lerkfish]

Originally posted by BRussell:
That's probably true, but I think that if there were more safety regulations in place it would be much harder to bring those "bad outcome" suits. Right now everything is up to the God-like physician's discretion in a "trust me, I know what I'm doing" fashion, and that invites challenges. If more regulations were in place, following those regulations appropriately would be a powerful check on any frivolous lawsuits.

right. I think if the general public felt that doctors were actually held accountable in some other arena besides the courts, and prevented or suitably punished for incompetence, there'd automatically be less lawsuits. They wouldn't dry up completely, but it would be a great deal harder to drum up the "lets stick it to this doctor because its the only way to effect a change" argument.

another way would be to eliminate the 33% commission for the ambulance-chasing lawyers, making it NOT so lucrative to secure outrageously large settlements.

[SimeyTheLimey]

Originally posted by BRussell:
That's probably true, but I think that if there were more safety regulations in place it would be much harder to bring those "bad outcome" suits. Right now everything is up to the God-like physician's discretion in a "trust me, I know what I'm doing" fashion, and that invites challenges. If more regulations were in place, following those regulations appropriately would be a powerful check on any frivolous lawsuits.

I don't know how you do safety regulations in the case of physicians. The field is inherently one where decisions have to be made on the basis of professional judgment. There really is no way for a state regulator to stand over the shoulder of every physician and supervise. All you can really do is require stringent qualifications to enter the profession,and have review boards to take the licenses of bad physicians. Both of those mechanisms already exist in addition to the tort system.

[itai195]

Originally posted by SimeyTheLimey:
Given our litigious society and the glitter of a huge potential award or settlement, there will be suits against even very good doctors.

Even if the doctor wins the case, the defense costs still have to be paid for. Those defense costs can run into the thousands, or often into the hundreds of thousands. That's what malpractice insurance is for just as much as defense in cases where there is any actual error.

There's nothing wrong with being a litigious society necessarily, the problem is that the road to our courts is paved with dollar signs. So maybe part of an acceptable solution would be to regulate and lower the defense costs. Of course, I wouldn't seriously expect lawyers to willingly lower their own salaries, or to make their profession more accessible to the common person.

As for healthcare -- I get a sense a lot of people in the US rake in tons of unnecessary medical expenses just because they can. The costs are invisible to them because their insurance and employer pay for everything. HCSA's are an attempt to remedy that by making consumers aware of how much they're spending.

[BlackGriffen]

Originally posted by Lerkfish:

another way would be to eliminate the 33% commission for the ambulance-chasing lawyers, making it NOT so lucrative to secure outrageously large settlements.

You could probably achieve much of the same effect by changing where punitive damages go. If punitive damages, which are meant to punish the wrongdoer, not reward the victim, went somewhere besides the victim, there would be less incentive to sue.

Now, compensatory damages should still go to the victim - they're meant to compensate, not necessarily just punish.

Yeah, though, it's a complicated problem (really a set of problems) with many solutions.

BlackGriffen

P.S. So I couldn't keep the last name of a Tom I didn't even stick around to watch straight.

[SimeyTheLimey]

Originally posted by BlackGriffen:
You could probably achieve much of the same effect by changing where punitive damages go. If punitive damages, which are meant to punish the wrongdoer, not reward the victim, went somewhere besides the victim, there would be less incentive to sue.

Now, compensatory damages should still go to the victim - they're meant to compensate, not necessarily just punish.

That's more or less what some states have done. Tort reform often boils down substantially to eliminating or capping punitive damages. In other cases, there are caps on overall damages. Both are designed to limit recovery to something approaching the actual level of compensatory damages. Of course, compensatory damages can still be quite large since they include such things as pain and suffering, loss of consortium, and the really big one -- future medical expenses. There is an element of feedback here.

Lawyer's fees are also sometimes capped as part of tort reform statutes. For example, if you sue the federal government for medical malpractice, the lawyer's fees will be capped, there will be no punitive damages, and any relevant state cap on compensatory damages will also apply.

[BRussell]

Originally posted by SimeyTheLimey:
I don't know how you do safety regulations in the case of physicians. The field is inherently one where decisions have to be made on the basis of professional judgment. There really is no way for a state regulator to stand over the shoulder of every physician and supervise. All you can really do is require stringent qualifications to enter the profession,and have review boards to take the licenses of bad physicians. Both of those mechanisms already exist in addition to the tort system.

I strongly disagree with that. That's the approach to medicine that doctors have pushed (IMO, to enhance and maintain their prestige and salaries), and it's where I think the problem lies. For a different view, see the report I linked above from the Institute of Medicine. In their full report, they give very specific regulations that could be instituted, but have not.

[SimeyTheLimey]

Originally posted by itai195:
Of course, I wouldn't seriously expect lawyers to willingly lower their own salaries, or to make their profession more accessible to the common person.

There is a bit of a myth here that lawyers are all rich. Most medical malpractice suits of the type we are talking about here are handled by small law firms or solo lawyers. Those kinds of lawyers don't make huge amounts of money. Even with contingent fee arrangements (which can occasionally be lucrative) the average amount that kind of lawyer makes is (ballpark) somewhere in the $60,000 range. That's not a lot for someone with seven years required education.

The lawyers who do make large amounts of money are basically out of the league of the average medical malpractice victim. That kind of client can't afford a $600 an hour lawyer from one of the major law firms. Those kinds of lawyers generally have major corporate clients, not individual med mal clients.

[Lerkfish]

Originally posted by SimeyTheLimey:
That's more or less what some states have done. Tort reform often boils down substantially to eliminating or capping punitive damages. In other cases, there are caps on overall damages. Both are designed to limit recovery to something approaching the actual level of compensatory damages. Of course, compensatory damages can still be quite large since they include such things as pain and suffering, loss of consortium, and the really big one -- future medical expenses. There is an element of feedback here.

Lawyer's fees are also sometimes capped as part of tort reform statutes. For example, if you sue the federal government for medical malpractice, the lawyer's fees will be capped, there will be no punitive damages, and any relevant state cap on compensatory damages will also apply.

I think its a hydra, really, there are more heads to kill than you realize, but I think the most directly responsible head to trim back is the lawyer's commission.
Because if the lawyer cannot get a huge proportion of the settlement, they are less likely to pursue frivolous suits. If the people wanting to sue find it harder to get a lawyer willing to handle their case, that will dwindle demand.
And, there's no reason why the lawyers HAVE to receive such a huge dividend. The only people that HAVE to receive money are the injured parties.

[SimeyTheLimey]

Originally posted by Lerkfish:
I think its a hydra, really, there are more heads to kill than you realize, but I think the most directly responsible head to trim back is the lawyer's commission.
Because if the lawyer cannot get a huge proportion of the settlement, they are less likely to pursue frivolous suits. If the people wanting to sue find it harder to get a lawyer willing to handle their case, that will dwindle demand.
And, there's no reason why the lawyers HAVE to receive such a huge dividend. The only people that HAVE to receive money are the injured parties.

As I said above, a lot of states and the federal government have taken that approach. However, you can't take it too far. The reason that lawyers use contingent fee arrangements is because if they didn't do that, their clients would never be able to afford a lawyer at all. No lawyer means no lawsuit. It can also mean that the injured person bears the cost of the injury and that the person who created the injury never compensates the victim. It's a balance of the equeties thing. As a society, we don't want people to get hurt and not be compensated. But we also don't want to make lawsuits a gold rush.

Believe me, though, most lawyers would much rather not work on a contingent fee and just charge for their time. That way they would still be paid for the cases that they lose. As it is, they only get paid if they bring cases that they win. That in itself puts a restraint on them brining too many frivolous cases. You don't want to put a lot of time into a case if you know you will lose and not be paid.

[thunderous_funker]

I guess no one read the report I posted.

Myths busted:

1) "frivolous lawsuits"

Studies have shown that only 1 in 8 (or 1 in 6 in the state of Florida) preventable medical errors resulted in a malpractice claim.

Malpractice claims are not growing, they are shrinking. Between 1995-2000 the number of claims decreased by 4%.

Roughly 54% of claims are withdrawn voluntarily by plaintiffs.

The few remaining cases that go to a tril are not frivolous. Independent analysis of claims shows that there is very wide disagreement among medical professionals about the proper course of action. If these cases were "frivolous", there wouldn't be such a range of opinion by medical reviewers of such claims.

2) "runaway juries" and the myth of the malpractice "lottery"

"the median medical malpractice payment by a physician to a patient rose 35 percent from 1997 to 2001, from $100,000 to $135,000"

96% of all malpractice cases are settled and do not go to a jury verdict

Malpractice costs patients more than it costs doctors. The Institute of Medicine estimates the annual costs to society for medical errors at $17-29 Billion. "These costs include disability and
health care costs, lost income, lost household production and the personal costs of care. They do not include medical malpractice occurring outside the hospital setting. By contrast, the
National Association of Insurance Commissioners reports that the total amount spent on medical malpractice insurance in 2000 was $6.4 billion.."

Malpractice insurance costs have risen at half the rate of medical inflation. Medical costs are up 113% since 1987 while the total amount spent on malpractice insurance has only gone up 52%.

The increase in settlements barely even covers the increase in medical costs. People aren't getting greedier, the awards are larger because the medical costs they cover are higher.

"So-called “non-economic” damages are awarded for the pain and suffering that accompany any loss of normal functions (e.g. blindness, paralysis, sexual dysfunction, lost bowel and bladder control) and inability to engage in daily activities or to pursue hobbies, such as hunting and fishing. This category also encompasses damages for disfigurement and loss of fertility. According to PIAA, the average payment between 1985 and 2001 for a “grave injury,” which encompasses paralysis, was only $454,454."

"No evidence supports the claim that jury verdicts are random “jackpots.” Studies conducted in California, Florida, North Carolina, New York, and Ohio have found that jury verdicts bear a reasonable relationship to the severity of the harm suffered. In total
the studies examined more than 3,500 medical malpractice jury erdicts and found a consistent relationship between the severity of the injury and the size of the verdict. Uniformly the authors concluded that their findings did not support the contention that jury verdicts are frequently unpredictable and irrational."

[BlackGriffen]

Originally posted by SimeyTheLimey:
That's more or less what some states have done. Tort reform often boils down substantially to eliminating or capping punitive damages. In other cases, there are caps on overall damages. Both are designed to limit recovery to something approaching the actual level of compensatory damages. Of course, compensatory damages can still be quite large since they include such things as pain and suffering, loss of consortium, and the really big one -- future medical expenses. There is an element of feedback here.

Lawyer's fees are also sometimes capped as part of tort reform statutes. For example, if you sue the federal government for medical malpractice, the lawyer's fees will be capped, there will be no punitive damages, and any relevant state cap on compensatory damages will also apply.

I never said anything about caps. I just don't think that punitive damages, damages whose purpose is to punish the guilty, should not go to reward the victim.

BG

[SimeyTheLimey]

Originally posted by thunderous_funker:
I guess no one read the report I posted.

You mean the advocacy piece. I read it. I'll deal with a couple of lines to show you how they are manipulating things to make their case:

Myths busted:

1) "frivolous lawsuits"

Studies have shown that only 1 in 8 (or 1 in 6 in the state of Florida) preventable medical errors resulted in a malpractice claim.

Probably true, but all that this means is that it is hard to sue. We already know that. It doesn't tell us anything about the cost of litigation.

Roughly 54% of claims are withdrawn voluntarily by plaintiffs.

This is misleading. Most lawsuits are withdrawn voluntarily after settlement. That's how settlement works. You negotiate money in exchange for voluntarily withdrawing the suit. The real question would be what the cost to the defendants was up to that point. The answer is quite a lot.

The few remaining cases that go to a tril are not frivolous.

This is where they really manipulate things. "The few remaining cases that go to trial." It is true that few cases of any type go to trial. Most are bounced out on some form of summary judgement pre-trial, or result in settlement. Either way, the defendant incurs substantial expenses defending himself. That's where the bulk of litigation expenses are paid -- in the pre-trial stages. You have to do motions, discovery (hugely time consuming), depositions, expert witnesses, tests, and so on. Those expenses have to be paid for by someone and they don't go away just because you settle the case. Doctors will pass their expenses on to their malpractice carriers, who will turn them around as premiums. The doctors will turn that premium around as charge the patient. Ar Heinlein used to say, TANSAAFL: There Ain't No Such Thing As A Free Lunch.

I don't say this lightly, T_F, but that piece was written by a clever lawyer to manipulate people who don't know how the legal system operates. Everything it said was true. It's what it didn't say that was the lie.

[thunderous_funker]

Ah, so because there are costs associated with settlements that I failed to quote, you're dismissing the entire report???

Neat.

The fact is, the number of claims is low. That number is decreasing, not increasing. There is no "crisis" of malpractice claims.

Settlements are actually rather small. The modest increase in the size of settlements reflects the rise in medical costs those awards are meant to cover. There is no "crisis" of irrational or runaway juries.

The costs of malpractice are relatively minor, contrary to the constant FUD of some kind of "crisis" in premiums. In fact, the sudden rise in premiums is a result of artificially low premiums that insurers used to capture market share. It was never a sustainable model. Higher premiums reflect more realistic market forces. Its not the result of crazy judges, frivolous lawsuits or some kind of victim's "lottery".

In fact, premiums are rising at a lower rate than medical costs overall. They still represent less than 5% of doctor's revenue and the rise and fall of premiums today has more to do with the bottom line of insurers than any bogus "crisis" of malpractice lawsuits. That is, they are more indicative of the ebb and flow of the overall economy than anything else.

[SimeyTheLimey]

Originally posted by thunderous_funker:
Ah, so because there are costs associated with settlements that I failed to quote, you're dismissing the entire report???

Neat.

The fact is, the number of claims is low. That number is decreasing, not increasing. There is no "crisis" of malpractice claims.

Settlements are actually rather small. The modest increase in the size of settlements reflects the rise in medical costs those awards are meant to cover. There is no "crisis" of irrational or runaway juries.

The costs of malpractice are relatively minor, contrary to the constant FUD of some kind of "crisis" in premiums. In fact, the sudden rise in premiums is a result of artificially low premiums that insurers used to capture market share. It was never a sustainable model. Higher premiums reflect more realistic market forces. Its not the result of crazy judges, frivolous lawsuits or some kind of victim's "lottery".

In fact, premiums are rising at a lower rate than medical costs overall. They still represent less than 5% of doctor's revenue and the rise and fall of premiums today has more to do with the bottom line of insurers than any bogus "crisis" of malpractice lawsuits. That is, they are more indicative of the ebb and flow of the overall economy than anything else.

I'm dismissing it because it wasn't only not objectively written, it is grossly misleading. It omits the bulk of the expenses caused by litigation in a disingenuous way. That makes it not something to be taken seriously. For example, so what if the number of malpractice claims isn't going up (assuming that is true). The "crisis" isn't the number of claims, its the increase in the cost of those claims either in litigation expenses, or settlement value. It's not a question of volume, it's a question of cost.

I'm not sure on what you are basing your assertion that settlements are actually quite small. One of the things I do in my job is value settlements. The figures I see are far from small. In fact, you value a settlement according to your judgment of what the likely jury verdict would be, discounted by your feeling about the risks of going to trial. So the settlement value is connected to the size of jury verdicts, as well as other costs such as the cost of defending yourself even in a winning case.

Whether you are correct or not about premiums isn't really the point. You can't say that litigation and the expenses associated with it has nothing to do with the cost of premiums. That makes no economic sense since the premiums are to pay the cost of litigation expenses. The two are directly tied.

[Lerkfish]

Originally posted by SimeyTheLimey:
As I said above, a lot of states and the federal government have taken that approach. However, you can't take it too far. The reason that lawyers use contingent fee arrangements is because if they didn't do that, their clients would never be able to afford a lawyer at all. No lawyer means no lawsuit. It can also mean that the injured person bears the cost of the injury and that the person who created the injury never compensates the victim. It's a balance of the equeties thing. As a society, we don't want people to get hurt and not be compensated. But we also don't want to make lawsuits a gold rush.

Believe me, though, most lawyers would much rather not work on a contingent fee and just charge for their time. That way they would still be paid for the cases that they lose. As it is, they only get paid if they bring cases that they win. That in itself puts a restraint on them brining too many frivolous cases. You don't want to put a lot of time into a case if you know you will lose and not be paid.

ahhh...you make a good point.
I think I go back to hydra analogy because I'm not sure just dealing with one head will kill the beast.

[thunderous_funker]

Originally posted by SimeyTheLimey:
I'm dismissing it because it wasn't only not objectively written, it is grossly misleading. It omits the bulk of the expenses caused by litigation in a disingenuous way. That makes it not something to be taken seriously. For example, so what if the number of malpractice claims isn't going up (assuming that is true). The "crisis" isn't the number of claims, its the increase in the cost of those claims either in litigation expenses, or settlement value. It's not a question of volume, it's a question of cost.

I'm not sure on what you are basing your assertion that settlements are actually quite small. One of the things I do in my job is value settlements. The figures I see are far from small. In fact, you value a settlement according to your judgment of what the likely jury verdict would be, discounted by your feeling about the risks of going to trial. So the settlement value is connected to the size of jury verdicts, as well as other costs such as the cost of defending yourself even in a winning case.

Whether you are correct or not about premiums isn't really the point. You can't say that litigation and the expenses associated with it has nothing to do with the cost of premiums. That makes no economic sense since the premiums are to pay the cost of litigation expenses. The two are directly tied.

I'm sorry to hear that you don't consider statistics from the insurance industry, medical associations or state regulatory agencies to be objective enough for you. I wouldn't want facts to interfere with your ideology.

The National Practitoner's Data Bank says the median award is $135,000. That includes both verdicts and settlements. A private firm called Jury Verdict Research reports that the median verdict award is $1 million. 96% of all cases are settled. There is no massive increase in payouts to "frivolous" lawsuits. Period.

As for the cost of premiums, you're changing the goalposts. The topic is the cost of healthcare. The argument put forward by BushCo is that the increase in healthcare costs is in large part due to "frivolous" lawsuits and the increase in malpractice premiums and that Tort Reform will lower healthcare costs.

The facts would indicate otherwise. Healthcare costs have increased at double the rate of malpractice costs. Awards are increasing at an even lower rate. The rise in malpractice premiums has almost nothing to do with payouts to victims.

So while litigation certainly has bearing on the costs of malpractice, the costs of malpractice seem to have a very limited impact on overall medical costs.

Not to mention that many states (like California) enacted Tort Reform long ago only to see their heathcare costs AND malpractice premiums go way up.

And 5.1% of doctors are responsible for 54% of malpractice according to the NPDB. Yep, that is the number of doctors that have paid 2 or more awards. Of that number, only 6% have been disciplined by state boards of medicine. And of the doctors that have paid 5 or more awards, only 17% have been disciplined.

[SimeyTheLimey]

Originally posted by thunderous_funker:
The National Practitoner's Data Bank says the median award is $135,000. That includes both verdicts and settlements. A private firm called Jury Verdict Research reports that the median verdict award is $1 million. 96% of all cases are settled. There is no massive increase in payouts to "frivolous" lawsuits. Period.

Somewhere between $100,000 and $1 million sounds about right to me. It depends on the nature of the injury and the victim, but that's a reasonable range. Those also aren't trivial figures. Nor are they the total cost. You can easily add a hundred thousand or more in defense costs to every case whether lost at trial, settled, won on a pre-trial motion, or won at trial. This is because of the "American rule" that litigants bear their own legal costs.

As for the cost of premiums, you're changing the goalposts. The topic is the cost of healthcare. The argument put forward by BushCo is that the increase in healthcare costs is in large part due to "frivolous" lawsuits and the increase in malpractice premiums and that Tort Reform will lower healthcare costs.

I don't believe that anyone is arguing that the only reason for the increase in medical expenses is litigation. That's a strawman. Nevertheless, medical malpractice is indisputably a cost of medical care that is passed on to the consumer.

By the way, Ralph Nader really can't lecture anyone about frivolous lawsuits. He's the master. He even sued the airlines in the early 1970s because he got mad when an airline bumped him. Of course, he lost, but only after a year or more of useless litigation (although it did create a case that is used in Administrative Law textbooks, which is where I saw it).

In any case, Public Citizen is not some neutral, disinterested observer. It has a strong, pro-litigation bias.

[zigzag]

Originally posted by Lerkfish:
ahhh...you make a good point.
I think I go back to hydra analogy because I'm not sure just dealing with one head will kill the beast.

Yes, it's a multi-faceted thing. Everyone here is partly right, and there are no magic bullets. Frivolous suits and runaway verdicts are part of the problem, but only a part - you could eliminate them altogether and it would probably only make a dent in the overall scheme of things. Similarly, doctors could regulate themselves much more effectively and implement safer procedures, but that alone wouldn't solve the problem - they'd still run the risk of getting sued if they didn't order one or another test. And as itai noted, as long as people expect every broken fingernail to be covered by insurance, you'll have a cost problem. It has to be addressed one angle at a time.

[thunderous_funker]

Originally posted by SimeyTheLimey:
Somewhere between $100,000 and $1 million sounds about right to me. It depends on the nature of the injury and the victim, but that's a reasonable range. Those also aren't trivial figures. Nor are they the total cost. You can easily add a hundred thousand or more in defense costs to every case whether lost at trial, settled, won on a pre-trial motion, or won at trial. This is because of the "American rule" that litigants bear their own legal costs. [/B]

I never said they were trivial costs. The average award is $135,000. That includes both settlments and jury awards. I see no indication that court costs are not included in that number. If you've got stats that say otherwise, I'd very much like to see that. That would be critical to the issue.

Originally posted by SimeyTheLimey:
I don't believe that anyone is arguing that the only reason for the increase in medical expenses is litigation. That's a strawman. Nevertheless, medical malpractice is indisputably a cost of medical care that is passed on to the consumer.[/B]

And yet Tort Reform is the oft repeated solution to the problem. I fail to see how it will have any significant impact. The number of suits is decreasing. The awards aren't even keeping pace with medical inflation. Tort Reform is a gross rubber stamp solution that sacrifices victim's rights and rewards a system that is already far too lax on accountability.

Originally posted by SimeyTheLimey:
By the way, Ralph Nader really can't lecture anyone about frivolous lawsuits. He's the master. He even sued the airlines in the early 1970s because he got mad when an airline bumped him. Of course, he lost. [/B]

Nice ad hominem argument. I'll add to your long list of them.

In case you didn't notice, Ralph Nader didn't write the report. He founded Public Citizen, he doesn't run it.

[thunderous_funker]

In the interest of putting forth something positive, let me say that it is quite clear to me that the problem isn't litigation and it's questionable effects on medical costs.

The problem is the staggering number of preventable medical errors and accidents!

In the face of such huge numbers of errors and accidents and their associated costs and problems (including but not limited to litigation), Tort Reform is just the proverbial deck chair on the Titanic.

Accidents lead to lawsuits and the solution is to limit lawsuits?? Retarded.

Public Citizen's report concludes with these recommendations for decreasing the incidents that eventually might lead to litigation:

Solutions to Reduce Medical Errors and Long-term Insurance Rates:[list=*][*] Implement patient safety measures proposed by the Institute of Medicine. The
“systems approach” to patient safety advocated by the Institute of Medicine shows promise.
Some three years after the release of its report little has been done to establish mandatory
nationwide error reporting systems, identify unsafe practices, or raise performance standards.
Although experts using the systems approach have identified a number of promising
strategies to reduce malpractice, few have been implemented.
[*]Open the National Practitioner Data Bank. Information about doctor discipline,
including state sanctions, hospital disciplinary actions and medical malpractice awards is
now contained in the National Practitioner Data Bank. HMOs, hospitals and medical boards
can look at the National Practitioner Data Bank but consumers cannot, because the names of
Public Citizen’s Congress Watch 5 “Medical Misdiagnosis”
physicians in the database are kept secret from the public. Congress should lift the veil of
secrecy and allow the people who have the most to lose from questionable doctors to get the
information they need to protect themselves and their families.
[*]Improve oversight of physicians. Less than one-half of one percent of the nation’s
doctors face any serious state sanctions each year. 2,708 total serious disciplinary actions a
year, the number state medical boards took in 2001, are a pittance given estimates that
between 44,000 and 98,000 deaths of hospitalized patients are caused by medical errors
annually. State medical boards should be strengthened and more doctors should be
disciplined for incompetence.
[*]Limit physicians’ workweek to reduce hazards created by fatigue. American
medical residents work among the highest—if not the highest—number of hours in the
professional world. They work up to 120 hours a week, including 36-hour shifts for several
weeks at a time. After 24 hours of wakefulness, cognitive function deteriorates to a level
equivalent to having a 0.10% blood alcohol level. In other words, doctors who would be
considered too unsafe to drive may still treat patients for 12 more hours. Residents should be
limited to an 80-hour workweek.[/list=*]

Simple. Practicle. Fairly inexpensive to implement. It doesn't infringe on the rights of victims nor shelter the incompetent.

I have to believe that lowering the number of errors and accidents will do infinitely more to address the skyrocketing costs of healthcare than Tort Reform ever could hope to.

[SimeyTheLimey]

Originally posted by zigzag:
Yes, it's a multi-faceted thing. Everyone here is partly right, and there are no magic bullets. Frivolous suits and runaway verdicts are part of the problem, but only a part - you could eliminate them altogether and it would probably only make a dent in the overall scheme of things. Similarly, doctors could regulate themselves much more effectively and implement safer procedures, but that alone wouldn't solve the problem - they'd still run the risk of getting sued if they didn't order one or another test. And as itai noted, as long as people expect every broken fingernail to be covered by insurance, you'll have a cost problem. It has to be addressed one angle at a time.

I agree with this. Tort reform isn't a magic bullet but it has some effect so it is a question of balancing the interests. Tort suits perform a valuable societal function. But tort suits are also big business and just like any other business, regulation can be required. Unsurprisingly, trial lawyers are quite organized in opposing this.

However, even with tort reform, there is still room for looking at the other issues in health care.

[SimeyTheLimey]

Originally posted by thunderous_funker:
Nice ad hominem argument. I'll add to your long list of them.

Pointing out that Ralph Nader's group has a well-known position on litigation, and that therefore his group's "report" is not objective is not an ad hominem attack. However, saying that Ralph Nader is a left wing wacko might be.

Just out of curiosity, suppose we were discussing the Second Amendement and a conservative came along and touted a report by the NRA. Would you look at it a bit askance? I bet you would. Nader has no credibility on this issue. You only find it to be the "best report" because you happen to agree with the conclusion. That doesn't mean that the rest of us shouldn't look at the proponant of the report and notice that they have a track record that makes them dubious.

By the way, since you seem to like partisan sources, you might like to take a look at this It's hard to take Public Interest seriously on this if they are funded even a little bit by the American Trial Lawyer's Association. It's an obvious conflict of interests.