Why is Obama saying that our healthcare costs are way too high?

[Anonymous]

I mean, I just ordered a TON of preoperative tests for my patients today. Almost none was necessary, just needed to cover my --- against malpractice.
He said that our costs are 50% higher per-capita than the next highest country. Is that country swarming with personal injury lawyers? Those overseas doctors don't need to order the same amount of ridiculous testing.
Does Obama plan to do ANYTHING about malpractice suits????

Anyway, Mr. President, with all due respect, health care costs are about where I would expect, when we consider the cost of defensive medicine.

[Anonymous]

With all due respect, why are you directing that at Obama? Here is what the AMA JUST said about his last speech:


The American Medical Association sounded a cooperative tone after President Barack Obama addressed the group about U.S. health-care revision Monday, with its leaders saying they were particularly pleased that he acknowledged the liability worries that can lead physicians to practice "defensive medicine."

...

The AMA took Obama's remarks about liability worries as a signal that he's willing to work with doctors on malpractice revisions, even though he said he doesn't support caps on malpractice awards.

"This is the first Democratic president that's talked to us about any liability reform, so that's the good news," Nielsen said. "The other [comment about malpractice award caps] was no surprise. What we were very pleased about was that he is open to considering options that would lower the costs of defensive medicine. He acknowledged the issue" and put it in context of rising medical costs.

[Anonymous]

23:19 here. Source = WSJ

[Anonymous]

I was in the room this morning (new to this thread). We were hoping for MUCH more than he offered on this particular issue. He acknowledged the tort problem but, while striking down the option of caps, had no concrete suggestion for any other viable solution to the problem.

[Anonymous]

True, but I think he wants to see doctors and particularly the AMA get on board and start offering solutions before he commits to specifics on tort reform.

BTW caps aren't the answer to the malpractice issue. Our jury awards are comparable to those of Canada, the UK, and Australia. The only difference is that we sue more often, but caps on award size does not fix that problem. Also, there is a fairness issue that makes malpractice caps difficult for Americans to swallow. Should you be incapacitated during a medical procedure, how much do you think your family should be compensated for what happened to you and your earning potential? It seems un-American to put a modest value on what is effectively the dollar value of a life.

[Anonymous]

Yes, but even in the states where there are caps, doctors are still nervously ordering tests. It has become a culture, and a reality. We need to send the frivolous cases away fast. If an IV infiltrates and leaves a dime size scar on a person's hand, why should a plaintiff get $10,000? When he fell on his knee at age 7 and got a similar scar, who paid? It is a MESS. Heck, doctors should be able to sue patients for the annoyance of a lawsuit like that. We also need to make an online list of patients who have sued, so we can avoid them. That would make every patient think hard before suing.

[Anonymous]

Anonymous wrote:Yes, but even in the states where there are caps, doctors are still nervously ordering tests. It has become a culture, and a reality. We need to send the frivolous cases away fast. If an IV infiltrates and leaves a dime size scar on a person's hand, why should a plaintiff get $10,000? When he fell on his knee at age 7 and got a similar scar, who paid? It is a MESS. Heck, doctors should be able to sue patients for the annoyance of a lawsuit like that. We also need to make an online list of patients who have sued, so we can avoid them. That would make every patient think hard before suing.

Wow. That's evil.

[Anonymous]

Anonymous wrote:Yes, but even in the states where there are caps, doctors are still nervously ordering tests. It has become a culture, and a reality. We need to send the frivolous cases away fast. If an IV infiltrates and leaves a dime size scar on a person's hand, why should a plaintiff get $10,000? When he fell on his knee at age 7 and got a similar scar, who paid? It is a MESS. Heck, doctors should be able to sue patients for the annoyance of a lawsuit like that. We also need to make an online list of patients who have sued, so we can avoid them. That would make every patient think hard before suing.

Right. We need reform, but caps aren't the answer. I think a lot of doctors were waiting to hear about a liability cap, but it's not the answer.

As for the cost of lawsuits, it explains only a small part of the discrepancy in our health care costs. The price of tests, other procedures and medications are way higher per unit than in other countries. That is where most of the cost comes from.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, but even in the states where there are caps, doctors are still nervously ordering tests. It has become a culture, and a reality. We need to send the frivolous cases away fast. If an IV infiltrates and leaves a dime size scar on a person's hand, why should a plaintiff get $10,000? When he fell on his knee at age 7 and got a similar scar, who paid? It is a MESS. Heck, doctors should be able to sue patients for the annoyance of a lawsuit like that. We also need to make an online list of patients who have sued, so we can avoid them. That would make every patient think hard before suing.

Right. We need reform, but caps aren't the answer. I think a lot of doctors were waiting to hear about a liability cap, but it's not the answer.

As for the cost of lawsuits, it explains only a small part of the discrepancy in our health care costs. The price of tests, other procedures and medications are way higher per unit than in other countries. That is where most of the cost comes from.

Not true. That is way off. I did not vote for Kerry when he said that malpractice accounts for only 1% of the costs. Example: Radiologists charge more to read an X-ray here b/c of liability. They also double read, i.e. two doctors look at the film to reduce claims. Very few other countries do that. Plus, the darn test gets ordered to protect against a claim. Tons of equipment and services for a minor problem. BTW, just about every professional fee is higher in the US. So why should it be any different for health care? Lawyers in France don't charge as much as they do here.

[Anonymous]

Obama is not going to do anything about tort reform-he is just not. What Obama does is speak one thing and do another. He knows this healthcare initiative of his isnt' popular so is trying to nuetralize some of the doctors in hopes they will play along. Do not do it.

[Anonymous]

I will not play along. I will quit. I like my kids more than any career.

[Anonymous]

Anonymous wrote:Obama is not going to do anything about tort reform-he is just not. What Obama does is speak one thing and do another. He knows this healthcare initiative of his isnt' popular so is trying to nuetralize some of the doctors in hopes they will play along. Do not do it.

The medical community is not stupid. There HAS to be tort reform as part of any health care reform package. He will not neutralize the doctors unless it is.

Obama is not stupid either - he will realize this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes, but even in the states where there are caps, doctors are still nervously ordering tests. It has become a culture, and a reality. We need to send the frivolous cases away fast. If an IV infiltrates and leaves a dime size scar on a person's hand, why should a plaintiff get $10,000? When he fell on his knee at age 7 and got a similar scar, who paid? It is a MESS. Heck, doctors should be able to sue patients for the annoyance of a lawsuit like that. We also need to make an online list of patients who have sued, so we can avoid them. That would make every patient think hard before suing.

Right. We need reform, but caps aren't the answer. I think a lot of doctors were waiting to hear about a liability cap, but it's not the answer.

As for the cost of lawsuits, it explains only a small part of the discrepancy in our health care costs. The price of tests, other procedures and medications are way higher per unit than in other countries. That is where most of the cost comes from.

Not true. That is way off. I did not vote for Kerry when he said that malpractice accounts for only 1% of the costs. Example: Radiologists charge more to read an X-ray here b/c of liability. They also double read, i.e. two doctors look at the film to reduce claims. Very few other countries do that. Plus, the darn test gets ordered to protect against a claim. Tons of equipment and services for a minor problem. BTW, just about every professional fee is higher in the US. So why should it be any different for health care? Lawyers in France don't charge as much as they do here.

It is true. The biggest number anyone has come up with for the cost of malpractice including defensive medicine is 9% of our spending. We need to account for much more than that to get health care costs in line with other countries that have comparable outcomes. We are 50% higher than Switzerland and 140% higher than the OECD median. See Gerard Anderson, Johns Hopkins, or work by Uwe/Hussey, Reinhardt.

I think 1% is low, but do you realize how far we have to go to match other countries - and not just average countries, but countries with the same outcomes? We have the third largest government healthcare budget in the world - and yet that budget only covers 1/4 of our population, when most comparable countries cover their entire population.

As for the cost, I don't know. I'm not sure who is underpaid and who is overpaid. I have a feeling that some specialties are getting underpaid. But I know that there is price pressure, and eventually one of those double reads is going to go offshore because it can be sent offshore.

I get that you see a lot of waste due to defensive medicine. But even that is a drop in the bucket compared to the huge gap between the US and other nations. And what do we get in return? We don't live longer, we don't get better outcomes for our procedures.

[Anonymous]

Medical malpractice claims (or defense of such claims) might only account for 1% of US healthcare costs but defensive medicine practices account for probably 25% of all testing/interventions in the US. Ask any doctor and they'll agree that a huge chunk of what they do, they do because they have to cross every last T and dot every last I in the event that they will be accounting for their actions later and not because the interventions lead to better health outcomes.

Frankly, I don't see "defensive medicine" ever ending in this country because what have become the "standards of care" in medicine are such based on years of practicing defensively. This is not going to change overnight or ever regardless even if we ever get tort reform. Case in point. I have a long history of migraines. Last month I had a horrible migraine that was not helped by my prescription migraine medicine. It was obvious that my headace was a migraine (had the classic aura, etc). I was 100% convinced of this. Went to the ER for pain control. ER doctor insisted that he needed to get an MRI of my head which he said he 100% expected to be normal but he felt obligated to order. Of course it was benign. In my excruciating pain I didn't protest. Did I need a $4K scan to tell the doctor what he and I both already knew? No, but standard of care for head-ache work-up in the hospital these days is a head scan because God forbid one not be done and the hospital be held liable for something they missed while I was under their care. Would this MRI have been done 15 years ago? probably not. Will it ever not be done in the future even if we had all sorts of liability caps? No, because it has become standard of care and changing this at every ER and in every practice setting across the country won't happen.

[Anonymous]

Anonymous wrote:...ER doctor insisted that he needed to get an MRI of my head which he said he 100% expected to be normal but he felt obligated to order. Of course it was benign. In my excruciating pain I didn't protest. Did I need a $4K scan to tell the doctor what he and I both already knew? No, but standard of care for head-ache work-up in the hospital these days is a head scan because God forbid one not be done and the hospital be held liable for something they missed while I was under their care...

I don't know whether it's one in a hundred, one in a thousand, or whatever, but if you happened to be one of the unlucky few with a brain tumors, wouldn't you consider it worth the expense? I am not claiming it is a clear call, only that the practice has some benefits.