CNN reports that Pres. Obama and top aides have stepped up talks with Sen. Olympia Snowe (R-Maine) about a compromise health care deal that would not create a public option but would include a stand-by provision that would trigger the creation of such a government-run health insurance plan if the other elements of the bill (things like the universally-popular no-denying insurance for pre-existing conditions and some cost-containment measures) do not succeed against some formula for getting more Americans insured and lower costs.
The story says that at this point the White House sees little potential for compromise with any Republicans other than the famously moderate Snowe, although they have some hope that if they reached agreement with her she could bring along her Maine colleague, the also-famously-moderate Susan Collins.
Shifting gears slightly here, I didn’t write about it the other day, but I commend the op-ed that Bill Bradley published suggesting a bigger grand compromise: give the Republicans something that they have been demanding for years — what they call “tort reform” but is really a cap on damage awards for victims of medical malpractice — in exchange for support for the main Dem goal (universal coverage).
The idea requires a great deal of detail-filling-in, at least as to how those caps on malpractice would work (the right of patients injured by malpractice is not nothing to compromise away) and how universality would be achieved. But pursuing such a deal would help Dems answer two big criticisms: 1. that Dems haven’t really offered Repubs anything from their wish list in exchange for going along with what will basically still be a Dem plan, and 2. that the reason “tort reform” is a non-starter is that the Dem Party benefits from the considerable support of the American Trial Lawyers Association.
When I attended the Michele Bachmann town hall meeting last week, the colleague who attended to help Bachmann respond to questions about the bill, Rep. (and Dr.) Michael Burgess (Repub-Texas) did say that an offer to include “tort reform” in the bill would have been what it took to get him interested in looking for posible compromises with the overall bill.
Re: op-ed that Bill Bradley published
Bradley used a figure that stated the cost of tort related expense in health was around 8%. That is to say the least, an inaccurate figure that is many years old and has been debunked by further studies on the subject.
Actuarial consulting firm, Towers Perrin calculated in it’s 2008 report that when using 2007 data, that tort costs which include both payments from medical malpractice insurance and trial costs totaled 30.4 billion dollars.
Now out of the two trillion dollar health system its somewhere around 1.0% to 1.5%. The CBO came to the same figures in its own conclusion.
Then there is the issue of defensive medicine. It makes intuitive sense about the cost of Doctors practicing defensive medicine, lots of test etc.. It would be fair to assume this is done for fear of lawsuits. But part of it may be fee schedules. Doctors get reimbursed for expensive tests and probably the most important factor is that Doctors tend to do what other Doctors do. There is a standard of care to follow and if it says you order these tests.. then you order these tests.
Its very hard to tease out how much of these tests are due to defensive medicine. This tort reform argument certainly makes intuitive sense. But the empirical and statistical evidence does not back it up.
It is not driving the cost, it certainly is a contributing factor. At least to the point that 1.5% of health care is tort related.
http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf
Richard–
Good points.
In fact Bradley’s numbers assumed that all the costs of ‘defensive medicine’ could be attributed to liability concerns, and not to financial incentives.
I’d give the old Knick a ‘turnover’ on this one.
I’m sorry as I read your post it seems that the White House is attempting to reach a compromise with Snowe to save health care reform. That I think is the wrong reading of the situation. The White House is attempting to offer ways for the blue dogs to back down. The sound and fury of August has made the public option more likely not less. Indeed if forced through reconciliation it will be a stronger option then is currently proposed (to meet the budget requirements of the process).
This has happened for two reasons. First the Republicans have so overplayed their hand that it has made it easy to be adamantly against provisions never proposed and so can be spun as compromise. Next the public option has been paired with mandates. No public option = no mandates. Without mandates the bill will become essentially insurance regulation. Not an outcome the opponents desire.
The basic assumption was that the left was going to cave because the left always caves. But it is not the left whose seats are endangered if health care fails.
It seems to me that an 8% figure is too low. Here’s why:
>Doctors and hospital workers make mistakes. Since they are human, this is to be expected. Making the victim whole to the extent possible makes sense. But the idea that if they make a mistake the deepest pockets around must PAY, and pay BIGTIME (“I spilled my coffee on my leg — I should get to live the life of a millionaire from here on out, and my lawyer should get 1/3 PLUS legal fees!”) is an outrageous concept brought on by idiotic juries and the oversupply of trial lawyers. It has made our court system the great American lottery, and led malpractice and liability insurers to do the worst possible thing: shell out pretty big bucks in settlements just to avoid a court where just compensation has become a thing of the past.
>If every time one sat down to one’s computer at work one was exposed to the possibility of losing one’s home and one’s livelihood, you had better believe one would be super careful to do everything necessary to avoid that fate. To accuse medical personnel of doing the same thing “in order to generate more fees” borders on the ridiculous: they would do all those unnecessary tests if they did not get an extra dime for it, as is often the actual case.
>If one were to use a fair measure of the costs of our litigious society for the medical profession, one would have to include:
-the cost of malpractice, liability and umbrella insurance, the actual costs of litigation and outrageous awards,
-the cost of preventative (from legal exposure) medicine,
-the cost of ridiculous record keeping and documentation all for the sake of “having a defensible record,”
-the cost of delaying treatment until “proof” of a real need surfaces,
-the cost of added staff to be sure witnesses are present for every procedure which put the medical person at risk,
-the cost of equipment to record the actual procedure in the OR,
-the cost of staff time to meet with hostile attorneys looking for the least slip of the tongue,
-and last, but not least, the cost of the actual out of pocket for what insurance does not pay.
>Tort reform should not just limit damages in excess of actual damages, but should provide for liability of the patient and his/her attorneys for all costs of the litigation in the case of lawsuits found to be frivolous or unsupported, even if unsupported in part. It should put the patient at risk for making stuff up. It should put the attorneys at risk for making false or inflated claims. It should limit attorneys to 20% OR actual proven costs, not both.
>If these steps were taken, I estimate the costs — and subsequent fees — for health care would be reduced by more like 20%.
>I believe that doctors and health care professionals would sleep better at night.
>A bunch of attorneys would probably have to find some other line of work — which would be a good thing for the whole economy and for the mindset of the public about the great American lottery.
>If it meant that politicians would have to spend less on media campaigns that would be frosting on the cake.
>As for the government option, I say let the Dems have it — so long as implementation is delayed until May of 2011, to allow the new congress to fix it.
Tort reform needn’t be complicated, and it needn’t cap awards for cases that merit large payouts.
In fact, real tort reform consists of just two little words:
“Loser pays”
Loser pays everything. Lawyer fees, damage awards, court costs, lost wages; the whole Monte.
What everyone keeps forgetting, including Bill Bradley, is that the public option *was* the compromise. Sheesh.
Pretty good dialogue guys. #5 so justice should only be for the rich/those who can pay. I boiled it up to seven words to help show the world that everything is not simple. Eric Black is’nt this
compromise/whatever somewhat along the lines that Bob Dole and three other past senators from both parties have suggessted? Just to remind readers that Dole/McGovern worked on the creation of food stamps. Anyways I get a little nervous about the well regualated enforcement mechanisms and if they would be used by a republican administration or be allowed to slide.
Wouldn’t government-backed health professionals have their liability covered by the government? I’m speculating…but as a public school professional, the state covers my liability while I am “on the job.” Couldn’t the public option in and of itself translate into a kind of “tort reform” for public medical employees?
@#8–
No ‘public option’ currently being considered would involve physicians being government employees (as in the VA or Great Britain).
Since most physicians would remain privately employed, they would still be personally liable.
Again, the current proposals involve greater public regulation, not direct government operation.
“Tort reform” is the right-wing mantra, but it has actually been instituted in Texas, where the effect on medical costs has been exactly nothing. It has lowered doctors’ overhead, but it has not lowered the costs charged to patients for either medical care or insurance policies.
Next.
I am surprised to hear that Olympia Snowe thinks leaving a public option out of the original reform bill is in any way contributing to reform. This is not a compromise but rather an absolute cave to the insurance industry.
The only lawmakers who have it right are the 83 members of the Progressive Democratic Caucus and Nancy Pelosi, who will vote No for any bill without (or with a weakened) public option. These no votes are our only defense against the rapacious industry that would profit even more greatly from its exclusion.
Mr. Iacono:
That must have been your opinion that you were stating regarding tort reform. Because, if you had taken a moment to follow the link that was provided to the actuarial results of the study. You would have found that it was a study based on facts and empirical data with a conclusion that in no way had any relationship to your opinion.
Quite often we find that opinion substitutes itself for fact and reality based conclusions. You might realize that the studies’ results are not related to how you feel about tort reform and your personal rationalizations and opinion of the subject matter. Opinions are always thoughtful, but they should never be confused with empirical and factual evidence. Thankfully facts do matter.
http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf