I’m no expert

But that’s not going to stop me from writing about this.

Health care.  I don’t know if you guys are aware, because you have to be REALLY paying attention to have caught this, but there’s a huge debate going on in this country about the health care system.  It’s true.  If you don’t believe me, just google it and go to, say, page 10 or so and something is bound to come up.

Here’s the thing.  I don’t know the answer.  Though I think a nationalized health care program sounds more like the answer than anything else I’ve heard.  At a basic level, it seems like not only the morally right thing to do, but the option that would be best for our economy.  Having government control health care seems, to me, like it would reduce costs for American industry making it more competitive at home and overseas and give greater oversight into spiraling costs. I’m also one of those odd individuals who, despite a sometime Libertarian streak, actually thinks the government does a generally decent job in the things it runs.  For example, I think the criminal justice system is fairly decent while dealing with Charter is ridiculously bureaucratic and dumb.  In any event, the thing that truly bugs me about the whole debate is this: the popular talk that health care costs would be significantly lower if we could somehow just tame those nasty personal injury lawyers and put an end to extreme malpractice lawsuits.  This irks me for several reasons.

1.  Sometimes I think there’s some sort of feeling out there that if a doctor or nurse or hospital or anyone attached to the medical profession screws up, there should be little to no recourse for the victim.  People sometimes seem to think, “Well, it wasn’t on purpose, so let’s just move on.”  Of course it wasn’t on purpose.  People also don’t purposely run red lights or drive over the center line and cause accidents.  We have car insurance for just such non-purposeful events.  The same is true for doctors.  The same is true for lawyers or nail technicians or veterinarians or restaurant owners.  We have to have insurance to cover unexpected events — accidents.  And yes, of course it’s going to be more expensive for the medical industry since a lot more is at stake.  That’s just the nature of the job.

2.  There has already been a tremendous amount of ‘tort reform’ in that multiple states have capped the amount a jury can award a victim of medical malfeasance.  I don’t agree with these policies, but they are in place now and the insurance lobby has been very successful in obtaining them.

3.  And here’s probably the most important one for me.  The actual affect that medical malpractive litigation has on health care costs is so minimal it is almost not worth discussing.  I don’t know if Talking Heads use tort reform as a constant in their arsenal on reform because they really believe it is that important or if because, and this is the reason I actually suspect, it’s easier to use the lightning rod of lawyers than to try to affect actual change.  The thing is, every statistic I have ever seen shows that litigation costs (and malpractice insurance) account for — maybe — up to 1% of the cost of health care in the US.  Even if this is wrong, and it’s twice as much, that’s 2% of costs.  Eliminating those costs entirely would do just about nothing to change the out-of-control situation we’re in.  So I really wish people would cut it out and move on.

I know — you’re thinking, well, well, Kate, then what IS driving up costs.  Hell if I know.  I suspect it’s ridiculous profit margins, crazy expensive (and often unnecessary) tests and equipment, big salaries and little to no incentive to reduce costs.  But I don’t really know.  I know, though, that it’s not the lawyers.

Look, I know it’s popular to hate so-called ‘ambulance chasers.’  But I really urge you to think twice about this and maybe to read John Edwards (I know, I shouldn’t speak his name just yet) book, ‘Four Trials.’  I feel like people are usually apt to embrace movies like ‘A Civil Action’ and ‘The Verdict’ (both of which I like very much, as well), but when it comes to a case in the news, or when politicians use litigation costs as a platform, public opinion flips and suddenly the lawyers representing the victims are the bad guys.  And that’s something I don’t get.

Now of course the court system is vulnerable to huge abuse — by both lawyers and pro se litigants.  And by those hiring the lawyers.  But just because there are crappy claims out there doesn’t mean that there aren’t good ones and deserving people who need access to the legal system.  I venture to say that way more often than not the victim is the little guy, pitted against the megainsurance company and the odds are stacked way in you-know-whose favor.

Sorry for the rant but I’m officially bugged by this.  And I really don’t think it’s because I’m a lawyer.  But maybe I’m wrong.  Thoughts?


13 Responses to “I’m no expert”

  1. 1 gretchen November 7, 2009 at 9:29 pm

    Here are my, admittedly random, thoughts on the matter. I recently took D for his flu shot. Called to get an appt at the pediatrician and was surprised that I actually needed an appt rather than just a “stop by” to see a nurse. But hey, he’s 3, so maybe they check them out more first. She said the first available appointment was a Saturday, which worked great for me. Randy actually took him. Anyway, he comes home with a receipt indicating that insurance is being billed 200 and some dollars (they won’t get the whole amount under their contract with BC/BS — they never do). For the flu shot, an afterhours appointment (hey, I didn’t ASK for a Saturday), and an expanded focus visit (I think she looked into his mouth and ears as he was recovering from a cold). Compared to a $15-20 visit to the drug store for a flu shot for me, something just seems wrong about that picture. But I love our pediatrician, and I’m only paying the co-pay, so I didn’t ask. I can’t help thinking though that stuff like that is part of the problem.

    And I certainly don’t know the solution. I wrote a paper in law school defending the policy of providing health care to illegal immigrants — which quite frankly, is never going to happen because the idea is so politically unpopular. But my argument was that we need to provide more than just emergency care, for pure economic reasons — setting aside the moral ones. For example, we can refuse to cover prenatal care for a pregnant immigrant, but if problems arise down the road, we end up paying much, much more for a premature U.S. citizen infant. Not to mention that it would in our best interest to make sure that immigrants working in farms and the food industry received treatment for contagious diseases.

    Whatever they end up with as far as a health care plan, it will be a compromise, and full of political undertones rather than practical ones. I just hope they come up with something that more or less works . . . and I’m just glad that I’m not the one who has to come up with the plan!

  2. 2 gracieandkate November 7, 2009 at 11:45 pm

    G, I haven’t been able to read your whole post yet, but I want to thank you immediately for posting. It makes me so happy. And for the opportunity to remind me of a couple of things I wanted to say: (1) you and me both — so happy not to be the one who has to fix all this; (2) I love my friend Dr. Heather and hope no one would ever read my post to be saying that I’m somehow anti-doc. Very grateful for doctors. Wouldn’t be able to breathe without them.

  3. 3 gracieandkate November 8, 2009 at 12:08 am

    And what I really meant was “immediately thank you.” Better.

  4. 4 gracieandkate November 8, 2009 at 10:11 am

    Ok, now fully read. Excellent points, IMO. The situation with Little Boy is really interesting — and probably, like you say, not uncommon and contributing to exorbitant (and unnecessary) costs.

    As for the immigration paper — that does seem to make good, economic sense. I think we too often have a visceral reaction to things that may involve our pocketbooks and that can cut short any reasoned discourse on the matter. It’s a shame.

    I really hope I’m not alienating anyone here, particularly not my friend The Doctor, whom I adore. And think she alone may be able to solve all our problems — health care and all else.

  5. 5 gretchen November 8, 2009 at 10:37 am

    Of course, I was rather off topic from tort reform. 🙂 I’m not anti-doc either — nor do I mean to be critical of my doc or her office — who knows what they need to manipulate to get paid and “work the system.” Just think the system seems a little off . . .

  6. 6 gracieandkate November 8, 2009 at 4:56 pm

    Agree completely.

  7. 7 Sara H November 9, 2009 at 10:28 am

    I’m not opposed to reasonable tort reform, but this seems like something that should be done at the state level and not part of some omnibus bill. I wish I knew more about how much this really costs – I’m always hearing stories about how people decide not to go into certain specialties, such as ob/gyn, because of the potential liabilities. I think it’s a tricky question that is about more than money, it’s about value of life and limb. Who can answer those questions? What jury wants to err on the side of being stingy or cruel? And without specialists, it seems like you’re just entering a bad circle – no specialists = docs who know less about, say, rare cancers = more mistakes = more liability. What are the right incentives/disincentives?

    I agree, would someone please give immigrants some sort of ability to get a work certificate and get on employers’ health care at the very least? Just aside from the moral argument, why we can have a community of people who are, in effect, vital to our economy but not provide other things and remove this “illegal” label and all that goes with it is beyond me.

    Certainly the current system is broken, but I think gov’t is partially contributing, which is why I’m not sure a public option is the answer. Medicare reimbursement rates (way to be anticompetitive, Feds), skyrocketing taxpayer costs, prohibitions on competition, etc. I just wish a more surgical approach was on the table. I’m not opposed to the co-op idea, I guess, as long as it remains limited.

  8. 8 gracieandkate November 9, 2009 at 11:34 am

    Oh, yeah, that’s another thing — why is health care exempt from antitrust regulation? What? So, throw old-fashioned competition out the window there.

    And the thing is — I hear those things, too — about peeps steering away from certain specialties because of insurance costs (I think this is more of a problem in rural, single-private-practice areas), but I need more information. Because I think this is an insurance problem, rather than an actual lawyer/tort problem. I think insurance companies just refuse to cover (or essentially do in that they charge so much) certain practices. But I think that’s because they really don’t have to to make money, so why would they. I don’t know that it’s based in actual risk, but what do I know? Nothing. But, like I said, that doesn’t stop me from writing!

  9. 9 Kristin November 9, 2009 at 12:28 pm

    I think I’ve posted this article here before, but I’ve read it a couple of times now, and I think it’s become a bit viral as I often meet people who have also read it. It’s an eye-opening look at costs and how we (as a country) absolutely have to think out of the box to get them down, and how doing that can even result in better care.

    The visual of medical offices as mini-malls is especially chilling to me. Although these did start popping up in Staten Island, where I grew up, in the late 80s early 90s, I don’t think I ever really thought about them too much until I read this article.


  10. 10 Kristin November 9, 2009 at 12:30 pm

    Oops! That is a link to where you can get the H1N1 vaccine in NYC, not the article I was talking about. I had just sent it to my pregnant friend Carla. Sorry! Sort of on topic. Here is the article.


  11. 11 gracieandkate November 9, 2009 at 12:39 pm

    Yes, I think you have posted that before, but I’m glad you did again because I think it is SUPER interesting and I should reread it. Mucho thanks.

    Now then, totally off topic, but we have our windows open at home. It’s November. You heard that right folks — windows open + Wisconsin = November. Well, not all days in November but today and this weekend. Hooray!

    Ok, back to health care.

    And Carla. How’s she feeling?

  12. 12 Kristin November 9, 2009 at 1:45 pm

    It’s GORGEOUS here! Yesterday too. I didn’t even wear a jacket today. Hurrah.

  13. 13 Mark Baird November 12, 2009 at 1:20 am

    People need to be careful what they wish for or the Chamber of Commerce will take all of our rights away as mine have.

    I have spent hundreds of hours researching this issue. It is a complicated issue but I believe the issue is over blown.

    The one thing I do not get is that they say 85% of the people want some kind of tort reform. If that is the case then why do these people not control themselves when they are on juries.

    I now have to fight two fronts for my son, political and big business with large pockets. In the state of Minnesota their are caps so if this 10 billion company decides to drag this out for years forcing my lawyer to lose money then so be it. They have the deep pockets and I have a middle class income.


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November 2009

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