When we talk about tort reform, most people focus on lawsuits as a cost driver. But we also need to remember that malpractice suits are a significant motivator in changing behavior that causes malpractice. Getting away from injured patients’ability to sue tends to lead to higher incidence of medical error. There’s no way to put a price tag on that.
NOT intended to start a political debate.
I have often wondered what the fastest, smoothest path to fixing the ACA will turn out to be.
The NYTimes article linked upthread, Health Insurers List Demands if ACA is Killed, was interesting to me, mostly to read what Health Insurers like about it, no desire to return to the old days, and the need for stability.
No, the AC did nothing to address medical school tuition. The average med school student graduates with 180 to 200k in debt at 6%. On graduation they work 80 hour weeks for three to six years depending on specialty as a resident. Residency pays around 50k. Not much on an hourly basis. I know of some med school instructors still paying off their med school loans.
I don’t think further tort reform will (or should) fix rampant medical expenditures. It is already in place in many states, and I am not in favor of reforming the laws in those states any further than they’ve already been reformed. When a professional person (doctor, lawyer, engineer, accountant) commits malpractice, somebody is harmed. In some cases, grievously, expensively harmed. Is it fair to make the injured person absorb the cost of all of that harm? Somebody has to pay, and it should be the person who caused it.
Tort reform has limited the “pain and suffering” damages that injured victims can collect against physicians, and has legislated extra hoops that the injured person needs to go through to weed out the legitimate claims from the illegitimate ones. That’s all great, and I certainly support that type of reform, but tort reform should not be permitted to the extent that the injured person’s hard damages are so limited that they cannot be made whole.
Ah, the “doctors have a long and arduous training program so they deserve stratospheric compensation” argument comes out again. I’ve noticed that doctors are fond of this line. Only for themselves, though. It doesn’t seem to apply to anyone else with a graduate degree and a difficult apprenticeship.
They never say that bio, chem or physics post-docs have a long education, and spend practically all their waking hours in the lab, and therefore deserve the same compensation as doctors. You never hear that.
Nor do you hear that, say, an English Ph.D has an educational trajectory that is maybe half as arduous as a doctors’, and therefore deserves a commensurate salary, maybe half as much as a doctors’. Have you checked out what an adjunct professor of English is paid, compared to a new doctor? Hint: a lot less than half as much.
Nope. “We have a lot of education and we therefore deserve a lot of money” is said by doctors about doctors but no one else. It’s almost as if they don’t really believe it. It’s almost as if they just want the money, and are saying what they can say to get it, without regard to any actual principles.
Re: medical malpractice lawsuits
http://www.nejm.org/doi/full/10.1056/NEJMsa054479#t=article studied some malpractice claims and tried to compare actual medical errors with results. This was in 2006.
They did find that 73% of the claims with medical error resulted in payment, while 72% of the claims without medical error resulted in no payment. This means that 27% of the claims with medical error resulted in no payment, and 28% of the claims without medical error resulted in payment.
Seems like it is more likely than not that a medical malpractice claim will pay or not pay based on whether a medical error was made, but there is still a large chance that the pay versus no pay result will be “incorrect” (in both directions). It also means that both of the following can be true: (a) physicians legitimately fear being found liable even when they do not make medical error, and (b) victims of medical error have a significant chance of not being compensated.
Could we please get back to the 2017 ACA? The discussions of medical school costs, potential changes to health care legislation, etc are, in my opinion, way off topic.
Please. I started this thread hoping others would just post about their 2017 ACA experiences in terms of coverage and rates.
I did not start this thread to create a place to discuss the state of health insurance in general.
The physics, chem, and bio students don’t have to take out loans for their education.
This is a huge deal. Here is one example of a student that had a fully funded undergrad but took out $270k for med school. Total amount to be repaid with interest: $607k.
http://www.kevinmd.com/blog/2011/04/real-life-medical-school-debt.html
What he did not consider is the pre-tax income required to pay that $607k, which probably approaches $1M.
The high medical school debt that many MDs have probably distorts their career choices. For example, if you want to go into a primary care specialty, but do not feel that primary care specialties pay enough to pay off your medical school debt, you may choose a specialty based on chasing the money just to be able to pay off your medical school debt.
Now, everyone else think about why it can be hard to find a primary care physician taking new patients.
Good point about science post-docs being funded, @hebegebe, but what about English and history Ph.Ds? Does their long education mean they should get huge salaries?
A physical therapist nowadays needs a doctorate, plus practical experience. How much do physical therapists get paid compared to doctors?
I approve of this plan [-O<
Asking an English major (Ph.D or not) to fix your hernia is sure to turn out well. Or not.
Given it’s an intangible, I can’t help but agree.
And, since no country with single-payer has a tort system anywhere close to as punitive or capricious as ours is, one has to suspect the US must be keeping the lid down on medical errors for everyone else. That’s while paying more of full price for drugs, and… throwing in a defensive subsidy for most while we’re at it.
Intangible as the benefits of federal tort reform, along with an attempt at making pharmaceuticals priced here somewhere even close to what Canada pays might be, you have to wonder why the ACA didn’t attempt to address either.
And that explains why hernia-fixers deserve $400,000 a year rather than $300,000 a year, how, again?
I mean, I wouldn’t ask my cardiologist to fix my hernia either…
Part of the reason for the high costs of the tort system is the fact that we don’t have nationalized health care - or some other government system of guaranteed care.
Tort lawyers take cases on contingency, and they value the case by the level of damages that are provable in court. The biggest component of those monetary damages is the expected future costs of medical care for patient incurred by virtue of the malpractice. Other expenses, like lost wage, are also factored in – but the first question a lawyer is asking is how much have the medical bills been so far, and what are they likely to be in the future.
I’d note that public agencies like Medicaid and insurance companies will file liens against an anticipated recovery in these cases, so part of the result of the lawsuits is that the insurance companies get reimbursed. In essence, it shifts a small fraction of the cost of health care from the health insurance companies over to the malpractice insurance companies.
Ignoring the question as to whether you ever did, it’s a fact that eventually you reach the age you don’t need an English major any longer. You’ve come to grips with the fact your sentence structure will never improve, no matter the correction. And no matter the examples to go by. You still need a doctor, though, more than ever as the years go by.
The salary differential is likely due to the amount of privation suffered to arrive at either degree. Fewer are willing (or able) to make it through the Chem, Math, internship, etc. That and the incidental expenses when they finally get to where they wanted to go.
Don’t think an English Ph.D pays anywhere near what the hernia guy/gal does to practice their profession. After hearing nothing but crickets and murmurings of trigger warnings after asking about malpractice in the US vs all the other first world countries, I googled the subject.
I either didn’t notice or don’t recall what the hernia specialist paid in malpractice insurance but I did see an average cost, along with what I believe was the high - obstetrician, at 140,000 a year. Does make you wonder how many people would settle for that fine arts degree if they were facing an occupational insurance tab on that scale.
Because this is a political process. It was a very heavy lift to get even this imperfect law, given the massive resistance from the other side and their sponsoring lobbies. The President wasn’t going to waste his time on something which would have such a negligible effect as tort reform.
Drugs are another matter. It would have been a real coup if there had been structural changes to pharma, as there have been to insurers and providers. (Just as it would have been an incredible coup to get the public option in the law.) But it couldn’t be done because, as the old quote says, “Politics is the art of the possible.” ACA barely passed as it was; it wasn’t possible to get everything, so the President took what he could get. He hoped that he’d have the necessary cooperation to make the law better for the American people as time went by, and of course, that hasn’t happened.
Can’t say I recall it exactly as you’ve described, LasMa but… we’re looking to the future now and here’s a concrete suggestion to the question of: what do you propose to replace/modify/improve it?
Something that the tort industry squeals at and pharma doesn’t pull their pocketbook out to spend ad dollars on. See if all those first world countries we wish we were like are on to something, what with the little, inconsequential differences.
Of course not.There is a properly functioning free market as to what those PhDs earn, so those salaries are set fairly. I would hope those people are going in with the full realization of what the job prospects are and are doing it because they love the field. And if some of our best and brightest decide not to enter those fields because of the compensation, it is unfortunate, but it is not life and death.
However, medicine can be a matter of life and death, and while we don’t want people to enter medicine solely to make lots of money, you certainly don’t want to discourage our best and brightest away from medicine because it pays poorly relative to the time and money invested. Remember that these people are 30+ when they first make enough money to start paying off their loans, at which point they may also need to slow down for families.
My D is considering pre-med, and I sat her down and explained the economics. We will fund four years of education for her, and if she chooses an undergrad program where she has received merit, she has the possibility of graduating from med school debt free. But do we really want a world where all the doctors either come from full pay families or face devastating loans? I do not.
cata, perhaps this will refresh your memory:
https://morningconsult.com/2016/03/24/why-prescription-drugs-arent-part-of-obamacare/
Prescription drugs weren’t the crisis back then that they are now. It would have been really nice if there had been a willingness to work together over the last 6 years to address the crisis as it emerged. Instead, there have been 60+ votes to repeal the law in its entirety – with no replacement, and nary a whisper about the developing pharma crisis.
My proposed solution is something we can’t talk about here. I will note that the fixes being discussed by the incoming powers that be are mostly centered around keeping the major provisions of ACA, which they’ve suddenly discovered are extremely popular.