OBAMA/TRUMPCARE MEGATHREAD

[ptatc]

There are a couple more problems buried in there you didn't note. First of all, several states, notably Texas, have undertaken severe tort reform (since lawyers were a democratic constituency this makes sense). The end result in terms of behavior of doctors or insurance companies is pretty much the same as in other states; there may be a small difference in total costs but it's less than 1% and small enough that it's hard to definitively say the effect is distinct from zero.

 

Second...the U.S. has way too bloody much malpractice. The stats are hard to figure out but I'm convinced the best data says the U.S. does much worse on this front than most other countries. The large fraction of malpractice cases in the U.S. come from doctors who have problems more than once and are difficult to discipline thanks to protections associated with the AMA and the unwillingness of U.S. medical providers to institute reforms that significantly cut malpractice rates.

I agree. This is why the shortage of quality physicians will become a barrier to "Obamacare". There aren't enough now.

[Jenksismyhero]

If you want to talk about real waste in the medical industry, look no further than social security disability. 60 Minutes had a good piece on it last night. What a giant cluster f***. And you all want the government to take over the entire health care industry?

 

http://www.cbsnews.com/8301-18560_162-5760...disability-usa/

[Soxbadger]

I've been involved in far too many for it to be too overstated and that's just my limited experience in Illinois. I'm convinced that the laws need to change because the greatest cost in medicine is the malpractice insurance.

 

But why should the injured the the ones to suffer?

 

The insurance companies make money.

 

The doctors make money.

 

The guy who died because the doctor performed while drunk cant get a full recovery because we have a law that arbitrarily states a death is worth $200k?

 

Insurance is a great cost in any industry with great risk. There is no guarantee that if you cap malpractice that doctors will charge less. So why take the risk?

 

If Drs are willing to give free care, Im willing to give them complete indemnity from lawsuit.

 

But if they want to get rich on peoples sickness, I expect that they are not going to accidentally cut off the wrong limb. Because unless we cap all medical mal, it doesnt matter if you cap regular as opposed to gross, the insurance companies are going to charge the same, unless they have certainty that the claim will never go above X.

 

So really all medical mal caps do is hurt the people who are injured. Cause I cant imagine we are actually arguing that direct damages should be capped?

 

IE If I go into the dr for an acl repair and he cuts my spinal chord I assume we all agree that I should be able to sue for the amount of money its going to cost me to completely change my life as i cant walk again...

[Balta1701]

If you want to talk about real waste in the medical industry, look no further than social security disability. 60 Minutes had a good piece on it last night. What a giant cluster f***. And you all want the government to take over the entire health care industry?

 

http://www.cbsnews.com/8301-18560_162-5760...disability-usa/

Actually 60 minutes's piece was terrible. The majority of people applying for benefits under that program are still denied, and the appeal rate has actually fallen since the collapse rather than increased.

 

The program itself is heavily audited by the GAO because of misleading claims like the one you just made and it is constantly found to have fraud rates that are well below 1%. The people getting disability under social security meet the standards for disability. In fact, under more reasonable standards, more people probably should be able to receive that. A university of Michigan study found that out of the people who applied are turned down, nearly 80% are still not working 2 years later.

 

The main reason why disability claims have increased since the recession is an aging population. The Social Security program trustees in 1994 predicted that there would be an increase in disability claims necessitating an infusion of extra funds into the program by 2016 solely as a consequence of an aging population, putting it right on schedule for exactly what we've seen. The program itself has sent back cash to the treasury before and basically will remain close to long-term balance once what was predicted 2 decades ago happens.

 

There was also an increase in the retirement age for OASDI benefits a couple years ago from 65 to 66, leaving quite a few more people disabled who would otherwise have been covered by regular social security benefits.

[EvilMonkey]

The guy who died because the doctor performed while drunk cant get a full recovery because we have a law that arbitrarily states a death is worth $200k?

But is the person who spills hot coffee in their lap worthy of a 7 figure settlement because they are idiots?

[EvilMonkey]

The reason the cost is going up is that the taxpayers are no longer paying for education. The saying is that we used to be a state school, then we were a state supported school and now we are a state associated school. When I started working at the school the state supported 80% of our budget. Now it is down to under 20%. The state is giving almost as much support to private institutions that it does to "state" schools now. The schools have been forced to find other ways to get money. They can't raise tuition much each year because the state put a cap on that. So they raise "mandatory fees" and enroll many out of state students because the tuition limits don't apply to them.

There is simply n o reason that it should cost $40,000+ a year for a person to go to college, where they see an actual person for maybe 4 hours a day, 4 or 5 days a week. 2-3 students per year should be able to cover a teacher's costs. What do the other 30-50 students cover? Time for higher educational facilities to cut the fat.

[Soxbadger]

But is the person who spills hot coffee in their lap worthy of a 7 figure settlement because they are idiots?

 

Read the case and why they ruled that way and then get back to me.

 

McDonalds knew that the coffee they served was hotter than industry standards. They were hit with punitive damages (punishment) and the award was the amount of money McDonalds made selling 1 day of coffee (I believe). So it was because McDonalds knew they were serving a dangerous product. Not sure whether its right or wrong, but its more than just the lady was dumb. The coffee was so hot it basically melted her clothes.

 

The case that really should make you sick is the Dr who sued BMW because they repainted his brand new car. I think they were originally hit with millions of dollars of damages.

 

Amazing I can remember that case still:

 

http://en.wikipedia.org/wiki/BMW_of_North_...a,_Inc._v._Gore

 

And to be fair, I dislike most lawyers. I dont let my clients pull s*** like this. Which makes me a good or bad attorney depending on what you believe attorneys should be doing.

 

 

[Texsox]

But is the person who spills hot coffee in their lap worthy of a 7 figure settlement because they are idiots?

 

When McDonalds had already settled many, many lawsuits over their too hot coffee while continuing to serve coffee many degrees hotter than anyone else? Yes. Their rational was their customers did not drink the coffee in the car, but waited until they were at work. Further causing the McD trouble was their employees initially refused the woman napkins while laughing at her.

 

Read up on it. It really is a fascinating case and miles different than was portrayed in pop culture.

[ptatc]

But why should the injured the the ones to suffer?

 

The insurance companies make money.

 

The doctors make money.

 

The guy who died because the doctor performed while drunk cant get a full recovery because we have a law that arbitrarily states a death is worth $200k?

 

Insurance is a great cost in any industry with great risk. There is no guarantee that if you cap malpractice that doctors will charge less. So why take the risk?

 

If Drs are willing to give free care, Im willing to give them complete indemnity from lawsuit.

 

But if they want to get rich on peoples sickness, I expect that they are not going to accidentally cut off the wrong limb. Because unless we cap all medical mal, it doesnt matter if you cap regular as opposed to gross, the insurance companies are going to charge the same, unless they have certainty that the claim will never go above X.

 

So really all medical mal caps do is hurt the people who are injured. Cause I cant imagine we are actually arguing that direct damages should be capped?

 

IE If I go into the dr for an acl repair and he cuts my spinal chord I assume we all agree that I should be able to sue for the amount of money its going to cost me to completely change my life as i cant walk again...

Im only referencing the ones where its far exaggerated. Million dollar compensations for things that dont deserve it. There are many probably most who deserve it. Its like medicare fraud. Most deserve it and I dont havea problem with it. However it needs more oversite. Im not a lawyer and im sure the judgements are legal. However, many of the ones ive been involved with get many more times what its worth for rehab and getting back to function.

[ptatc]

There is simply n o reason that it should cost $40,000+ a year for a person to go to college, where they see an actual person for maybe 4 hours a day, 4 or 5 days a week. 2-3 students per year should be able to cover a teacher's costs. What do the other 30-50 students cover? Time for higher educational facilities to cut the fat.

This could not be further from the truth. Believe me with the way the state is not paying the institutions the excess has been cut from most state institu.tions. there are always exceptions but there are few state schools that are running up those tabs. The exceptions are the big research institutions. The privates are a whole different game.

[StrangeSox]

There is simply n o reason that it should cost $40,000+ a year for a person to go to college, where they see an actual person for maybe 4 hours a day, 4 or 5 days a week. 2-3 students per year should be able to cover a teacher's costs. What do the other 30-50 students cover? Time for higher educational facilities to cut the fat.

Administrative and facilities bloat, slashed state funding.

 

Definitely not professorship positions, which are being increasingly replaced with non-tenure adjunct lecturer positions.

[StrangeSox]

Actually 60 minutes's piece was terrible. The majority of people applying for benefits under that program are still denied, and the appeal rate has actually fallen since the collapse rather than increased.

 

The program itself is heavily audited by the GAO because of misleading claims like the one you just made and it is constantly found to have fraud rates that are well below 1%. The people getting disability under social security meet the standards for disability. In fact, under more reasonable standards, more people probably should be able to receive that. A university of Michigan study found that out of the people who applied are turned down, nearly 80% are still not working 2 years later.

 

The main reason why disability claims have increased since the recession is an aging population. The Social Security program trustees in 1994 predicted that there would be an increase in disability claims necessitating an infusion of extra funds into the program by 2016 solely as a consequence of an aging population, putting it right on schedule for exactly what we've seen. The program itself has sent back cash to the treasury before and basically will remain close to long-term balance once what was predicted 2 decades ago happens.

 

There was also an increase in the retirement age for OASDI benefits a couple years ago from 65 to 66, leaving quite a few more people disabled who would otherwise have been covered by regular social security benefits.

Npr had a similarly terrible piece earlier this year.

[StrangeSox]

I've been involved in far too many for it to be too overstated and that's just my limited experience in Illinois. I'm convinced that the laws need to change because the greatest cost in medicine is the malpractice insurance.

You may be convinced of that, but there is really no empirical support for that position. At all.

[StrangeSox]

When McDonalds had already settled many, many lawsuits over their too hot coffee while continuing to serve coffee many degrees hotter than anyone else? Yes. Their rational was their customers did not drink the coffee in the car, but waited until they were at work. Further causing the McD trouble was their employees initially refused the woman napkins while laughing at her.

 

Read up on it. It really is a fascinating case and miles different than was portrayed in pop culture.

Let's not forget that she suffered third degree burns. It wasn't some mildly hot coffee that was uncomfortable.

[Soxbadger]

Im only referencing the ones where its far exaggerated. Million dollar compensations for things that dont deserve it. There are many probably most who deserve it. Its like medicare fraud. Most deserve it and I dont havea problem with it. However it needs more oversite. Im not a lawyer and im sure the judgements are legal. However, many of the ones ive been involved with get many more times what its worth for rehab and getting back to function.

 

This is greed. I may be eternally optimistic but unfortunately I just do not think you can convince people not to be greedy. So there will always be a client, lawyer, business, dr, person who is willing to try and game the system to make profit.

 

And that is really why I think that everyone should get health care, because money and all that is just a game. Insurance risks really wont change, because the risk of people who dont have health insurance is already covered in a different form of insurance. It also is better for insurance because if you insure from birth you just want the largest amount of insureds. Unless you are going to exclude due to preconditioning, which then gets at a more fundamental question of do we as a society have a duty to try and ensure that everyone has an equally healthy life if science allows it, even if the cost is may be extremely high for some as compared to others.

 

[ptatc]

You may be convinced of that, but there is really no empirical support for that position. At all.

The evidence is that the greatest cost of practicing medicine is the malpractice insurance. This is why many physicians are getting into group practice to share expenses and cut costs. The cost needs to come down and the cost of medicine will come down. Experience does count for something. It may be lower on evidence based theory but it does count.

[ptatc]

Administrative and facilities bloat, slashed state funding.

 

Definitely not professorship positions, which are being increasingly replaced with non-tenure adjunct lecturer positions.

Without the administrative support the professors production will decrease dramatically. I hate taking a great deal of time entering data into spreadsheets.

[StrangeSox]

Without the administrative support the professors production will decrease dramatically. I hate taking a great deal of time entering data into spreadsheets.

I meant at a higher level, New directors of this or that made-up position, outsized compensation packages, etc., not administrative assistants. I can dig up the data on this tomorrow if you're interested.

[ptatc]

This is greed. I may be eternally optimistic but unfortunately I just do not think you can convince people not to be greedy. So there will always be a client, lawyer, business, dr, person who is willing to try and game the system to make profit.

 

And that is really why I think that everyone should get health care, because money and all that is just a game. Insurance risks really wont change, because the risk of people who dont have health insurance is already covered in a different form of insurance. It also is better for insurance because if you insure from birth you just want the largest amount of insureds. Unless you are going to exclude due to preconditioning, which then gets at a more fundamental question of do we as a society have a duty to try and ensure that everyone has an equally healthy life if science allows it, even if the cost is may be extremely high for some as compared to others.

I'm not disagreeing that it's greed or that there shouldn't be universal healthcare. I just don't think this version of a new system will work effectively. I think cost control is the first step and policing the greed more effectively will be better than just offering this type of program.

[ptatc]

I meant at a higher level, New directors of this or that made-up position, outsized compensation packages, etc., not administrative assistants. I can dig up the data on this tomorrow if you're interested.

If you meant administration then I completely agree. I took it as the academic administrative assistant. I think it's true in most situations (including the government) where there is too much "supervision" and not enough doing. Again, my whole life is based on data and research, but I don't need to see this data I live it daily.

[Jake]

The trend towards part-time and untenured professorships is bad for everyone. Will just lead to only a select few schools having the select few qualified researchers while the schools trying to cut corners will be delivering a crap experience with underprepared and underpaid teachers

[EvilMonkey]

This could not be further from the truth. Believe me with the way the state is not paying the institutions the excess has been cut from most state institu.tions. there are always exceptions but there are few state schools that are running up those tabs. The exceptions are the big research institutions. The privates are a whole different game.

So 3 students ponying up $120k between them doesn't cover the cost of one professor? Then he is over paid. Read what I wrote there a little bit more. As mentioned a few posts ago by someone it is more the admin bloat I am referring to.

 

http://www.ibhe.org/PA96266/search.aspx

 

Just check out the many admin positions. Assist. provost to this, assistant to that, all 6 figure jobs. And this doesn't count THEIR support staff, because you know they each have an assistant, a secretary, a few peons and so on.

Edited October 8, 2013 by Alpha Dog

[StrangeSox]

$120k from three students wouldn't come close to covering the cost of a single professor, given how many ways that $120k would be split before it went to a professor's salary.

[ptatc]

So 3 students ponying up $120k between them doesn't cover the cost of one professor? Then he is over paid. Read what I wrote there a little bit more. As mentioned a few posts ago by someone it is more the admin bloat I am referring to.

 

http://www.ibhe.org/PA96266/search.aspx

 

Just check out the many admin positions. Assist. provost to this, assistant to that, all 6 figure jobs. And this doesn't count THEIR support staff, because you know they each have an assistant, a secretary, a few peons and so on.

It's not just salary. There is the massive research costs. Salary is less than 25% of the cost for a professor's work at a research institution.

Unless you don't want much of the advancement in medicine that we currently see (again just my field) the money needs to be there.

 

I completely agree with the administration cost.

[ptatc]

The trend towards part-time and untenured professorships is bad for everyone. Will just lead to only a select few schools having the select few qualified researchers while the schools trying to cut corners will be delivering a crap experience with underprepared and underpaid teachers

Completely true. In physical therapy it's already very difficult to find qualified people because very few return to school to get an academic doctorate, most stay in the clinic. The current climate in the state is making it worse. Again, part of the reason that the change in healthcare will lead to inferior care for the masses.