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Author Topic: Another Analogy
Dan_raven
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President Bush spoke about his plans to solve the health care situation in the US.

He plans to enact sweeping Torte Reform to get rid of overly expensive lawsuits.

To me that is like saying the reason gas prices are so high is because so many possible gas station employees are being kept overlong in jail. The poor gas companies, faced with a tight job market, have to pay well over minimum wage, or close shop, leaving parts of America greatly underserved in gasoline and microwaveable foods on a stick. If we limit jail sentences to, say, 10 years for all crimes, why then we allow tens of thousands of people into the job market, lowering the price gas companies, and other small businesses, have to pay for employees. This will inturn lower the cost of gasoline as those gas companies see their overhead being reduced.

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pooka
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So are you saying that people should walk instead of drive, and not eat the foods sold in gas stations? [Wink] I'm poking you because in order to read your thread, I had to read CStroman's post. And for that I cannot forgive you. Today. [Kiss]
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CStroman
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Yeah, just because doctors are human doesn't mean they should be allowed to make mistakes. They should be perfect every single time.

I agree, John Ritter's wife is right to sue because of her husband's death. It was the hospital's fault he had the health problems he did.

/sarcasm.

I would have to disagree.

You should REALLY look into OB/GYNs today. My wife has had 2 of hers have to quit because the health insurance premiums were half of their yearly wage and rising. Which makes all medical expenses higher as well.

It's a sad day in America when lawyers can control and destroy the health care system at whim.

[ October 12, 2004, 04:28 PM: Message edited by: CStroman ]

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Anna
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[Kiss] Dan
Chad : According to many international organisation, we French have one of the better health care system in the world. There's a reason why yours is bad. Money rules too much things in America. Each and every citizen should have the right to live, and by live I mean not be left dying when there is medication but you can't afford it.

[ October 12, 2004, 04:31 PM: Message edited by: Anna ]

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Dan_raven
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Thanks CStrom. I think you hit all the Republican talking points.

If there is such an increase in your doctors rates could it not be because of some lawyer, but a problem WITH THE INSURANCE COMPANIES?

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Sopwith
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Dan [Smile]

And yes, serious, major torte reform, might trim 1.5% off of medical costs.

But then Stroman couldn't sue his doctors for that surgery he had to remove the cancer that turned out to be an in-grown toenail.

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UofUlawguy
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I could be totally wrong, but didn't I read someplace that insurance companies invest heavily in the stock market, and so the premiums they charge actually have more to do with how their investments are doing than how much they are having to pay out in claims? Did I just make this up?

Didn't the biggest leaps in premiums begin to take place in the months following the major tanking of the stock market?

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Chris Bridges
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Oh, good, for a second I was afraid there would be an issue where we'd agree.

Could we also possibly lay a little accountability on insurance companies who invest unwisely and raise premiums to cover their losses? Or doctors and hospitals who refuse to police their own incompetents?

My opinion doesn't fit neatly on a bumper sticker, but I think it makes more sense. Cap medical amounts on a sliding scale, similar to what insurance companies already use to pay for injuries. Do not cap punitive damages, otherwise they're not particularly punitive.

And encourage patients to sue the hospitals, not the malpracticing doctors. The doctor can take the hit, let his insurance cover it, and keep on going. Hit the hospital for the same doctor enough times and maybe, just maybe they'll do something to get him the hell away from a scalpel.

I have no use for people who try to jerk the system just to get rich off an honest or even imaginary mistake. But do not seek to keep citizens from seeking redress for provable wrongs. That's what courts are for.

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Anna
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Chris [Kiss]
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Dan_raven
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OK. Voting for Chris and his Torte Reform plan. (I'd do the kiss smiley too, but, it really wasn't that great of a plan)
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vwiggin
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I'm not a PI or tort specialist so I can't really speculate on what effects punitive damages have on malpractice insurance premiums.

However, I have personally worked on several Hatch-Waxman patent disputes involving FDA's Abbreviated New Drug Applications. I can assure you the drug companies are doing everything in their power to unfairly extend their patent rights to protect their profits at the expense of dying patients.

I've seen drug companies hide crucial prior art information from the patent office, broker multi-billion dollar backroom deals to "pool patents" into a de facto monopoly, and stage fake patent litigation among themselves because certain patent rights are protected when the patent is in dispute.

[ October 12, 2004, 04:47 PM: Message edited by: vwiggin ]

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dread pirate romany
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Hmm, I would love to see workable solution. Maybe Chris has one, but I don't know enough to be sure.
I do think people need to have the right to have incompetence redressed, but how far is too far? I think there need to be caps.

I think the reason doctors in general, and OB/GYN's in particular, have such high premiums is because of all the iatrogenic problems they cause. What we need to do is PREVENt that kind of problem instead of just suing afterwards.

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CStroman
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Well Anna, that is Socialism, We're a democracy. Canada has socialized medicine as well, and I hear it's not in the "getting better" stages. Someone from Canada can shed some light on how great the social medicine scene is.

I'm with Chris on this.

No offense but Insurance companies have to take IN at least if not more money than they put OUT in order to survive.

I'm for reforms on both ends.

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Gwen Stefani
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Chad, did you know that *gasp* some elements of U.S. government are socialistic?
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Dagonee
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I don't think it's punitive damages that are the issue - in most states punitive damages are only available for gross negligence, recklessness, or intentional wrongdoing. I believe most malpractice still falls under negligence.

The problem claimed by the insurance industry is with non-economic damages such as pain and suffering.

Dagonee

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Anna
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Oh, RIGHT. France is NOT a democracy, as the all WORLD knows. [Roll Eyes]
At last WE have the president we actually voted for.

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Dagonee
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So do WE, Anna.
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vwiggin
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Wooo... them be fighting words. [Big Grin]
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Chris Bridges
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Exactly. Pointing at any one side of this and blaming only them is the last thing needed. Insurance companies should be willing to adjust their premiums if they can be assured that the medical community will work to remove incompetent doctors from the workforce. Doctors should be willing to do so since it makes them look better, improves the general state of medicine, and helps lower premiums. And the courts must be willing to continue weeding out the "I'm gonna get rich" lawsuits while streamlining the legitimate accusations.

One question: in the states that have enacted some sort of tort reform, have any of the insurance companies then lowered their premiums in response? Any of them?

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fugu13
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Considering that socialism is completely compatible with democracy, your remarks amuse me, Chad. Perhaps you mean communism, the system of government many associate with socialism (which is an economic system)?
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Chris Bridges
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Actually, almost exactly half of us have the president we voted for (with allowances for other candidates). Not quite the same thing.
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Anna
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Maybe I misunderstood, Dagonee, but with your indirect suffrage not all votes have the same impact, depending on the location, and that's why you had all this fuss about the other guy winning last time - they even announced it - and after that no, it was Bush ? At last here, regarding important things like, what, the president, each vote is equal to another.
EDIT to add : I'm quite p***ed off by Chad, and I didn't implicated in any way that France is better than America. Some things better, some things worse, of course. If I loathed America, I wouldn't be here on Hatrack.

[ October 12, 2004, 05:03 PM: Message edited by: Anna ]

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pooka
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I have a neighbor who had to leave labor and delivery because of the premiums, and she had never had a birth injury claim against her. Also, I've had the interesting experience of self-paying for 2 births.

P.S. Whether the number was right or not, the 200 billion we have spent on Iraq is about 1/5th the nation's healthcare bill.

[ October 12, 2004, 05:01 PM: Message edited by: pooka ]

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Dagonee
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Chris,

We have the President we voted for in accordance with our Constitutional requirements for electing the president.

By your logic, Clinton wasn't a President we voted for either.

Dagonee

[ October 12, 2004, 05:01 PM: Message edited by: Dagonee ]

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Dagonee
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quote:
Maybe I misunderstood, Dagonee, but with your indirect suffrage not all votes have the same impact, depending on the location, and that's why you had all this fuss about the other guy winning last time - they even announced it - and after that no, it was Bush ? At last here, regarding important things like, what, the president, each vote is equal to another.
We have the President voted for under current law. If enough citizens wanted to, that law could be changed. As they haven't done so, there's no other way to say it than the president WE (as in America) elected.

As for the announcement, that was done by the private press, not a government official.

Dagonee

quote:
EDIT to add : I'm quite p***ed off by Chad, and I didn't implicated in any way that France is better than America. Some things better, some things worse, of course. If I loathed America, I wouldn't be here on Hatrack.
There's lots of Americans calling him on his BS. Don't worry, he's a distinct minority.

[ October 12, 2004, 05:05 PM: Message edited by: Dagonee ]

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Anna
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Fugu : you worded that so much better than I would have done. [Smile]

[ October 12, 2004, 05:05 PM: Message edited by: Anna ]

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Dan_raven
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CSTrom, no, Insurance companies do not have to take in as much money as they put out.

They take in $100 on Tuesday.

They don't store it in a bank. They invest it.

They get a good return, 10% by Friday

They have overhead of say 5%.

On Monday yhey can now pay out the extra $5 to pay for Doctor X's $105 payment.

The insurance companies are working in numbers so large that that extra 5% is in the millions itself.

The cost of malpractice insurance did not start sky-rocketing due to a large influx of new court cases or extra high Pain and Suffering claims. They started to go up as soon as the stock market fell in 2001.

Why? Because the insurance companies were loosing $ on their investments, and they had to make it up somewhere.

ps. I considered punative to = pain and suffering. That may be just me.

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Chris Bridges
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My point wasn't that Bush wasn't elected, or that his presidency is somehow illegitmate.

My point was that roughly half the people in the country wanted the other guy. Let me restate it: we didn't get the president "I" voted for.

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Chris Bridges
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The punitive part (and I'm sure Dagonee will define it better) is the part where the jury says to the company being sued, "You need to learn a lesson."

I wonder if it would cut down on frivolous suits if punitive damages didn't go to the injured? I mean, award the medical reimbursement, the pain and suffering part, to the patient. Then award the punitive damages to an agreed-upon non-profit organization or something. The errant company/doctor/whatever gets slapped and the patient gets what justice demands as due, but the possibility of getting rich from a lawsuit is gone. Anybody?

[ October 12, 2004, 05:11 PM: Message edited by: Chris Bridges ]

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IdemosthenesI
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I am a democrat who supported Gore, and it must be said, there are good and legitimate reasons for the electoral college. Were it not for the electoral college, there would be bad things happening (not that there aren't now, but still...) because of the USA's large and heterogeneous population. Our various states have such disparate interests that if voting was based entirely on population, then people living in the least populous states, like Montana, would be ignored entirely.

By the way, this is also the way our federal legislative branch works. Our representation in the lesser house is entirely decided by population, so California and New York have enormous delagations while Alaska has one guy in a Parka. However, the more stable, powerful branch, the Senate, has two people from every state. This is to keep the more populous states from completely ignoring (or worse) issues that are most important to the lesser populated states. Some examples would be Agriculture, mining, and environmental issues.

When it comes to voting for the President, the least votes any state can have is 3, even if the population is only a million (once again like Montana). This gives the lesser populated states an (albeit slight) advantage, so that the candidates cannot ignore them. The number of electoral votes for president is determined by how many congresspeople represent the state via the last census (i.e. Montana 2 senators + 1 representative = 3 electoral votes.) If this were a more homogenous nation with a smaller population, that wouldn't be neccesary, but I honestly believe there are good reasons for keeping the system around. Is it flawed? Probably. But there it is.

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Dagonee
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quote:
I considered punative to = pain and suffering. That may be just me.
From a technical perspective, they're very, very different. Pain and suffering is meant to provide compensation for an injury received. As compensation, its job is to restore the victim, to the extent possible, to the state they were in prior to the tortious behavior. Punitive damages are levied to punish tortious behavior, and are not allowed for mere negligence in most cases.

However, I've read some theories that juries sometimes award pain and suffering less to compensate the victim and more to punish the defendant. From that perspective, you're right - they are the same thing.

Dagonee

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Dagonee
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quote:
My point wasn't that Bush wasn't elected, or that his presidency is somehow illegitmate.

My point was that roughly half the people in the country wanted the other guy. Let me restate it: we didn't get the president "I" voted for.

But then Anna's statement about France having the president they elected would be meaningless, because no one ever gets 100% of the vote. Not even Saddam.

I think it's clear Anna meant "WE" to mean "the collective will of the voters, notwithstanding those who voted for a losing candidate."

Dagonee

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Sopwith
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Umm, Chris, you're in Florida, right?

Just who did you guys vote for?

(Think the world of ya Chris, just couldn't resist that easy one.)

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Chris Bridges
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Dagonne - I added to my post above, and I'm curious what you think of it.
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Dagonee
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quote:
I wonder if it would cut down on frivolous suits if punitive damages didn't go to the injured? I mean, award the medical reimbursement, the pain and suffering part, to the patient. Then award the punitive damages to an agreed-upon non-profit organization or something. The errant company/doctor/whatever gets slapped and the patient gets what justice demands as due, but the possibility of getting rich from a lawsuit is gone. Anybody
I've often thought this makes sense. You'd have to make legal fees not dependent on punitives as well, or the lawyers would still get rich from lawsuits.

Dagonee

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Chris Bridges
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Florida? Or me?

I voted for Gore (or, more accurately, against Bush). I haven't the faintest idea what the rest of Florida voted for, and I'm not sure there's an accurate way to tell anymore. I cannot begin to tell you how much I'm dreading this election on purely selfish, work-related grounds.

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Chris Bridges
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Legal fees could be dependant on the pain and suffering part.

So far, I'm liking this. Not a chance it would ever happen, of course, but it's a nice thought.

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Gwen Stefani
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quote:
Our various states have such disparate interests that if voting was based entirely on population, then people living in the least populous states, like Montana, would be ignored entirely.

Aren't people in Montana ignored already? (Sorry, Annie.)
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CStroman
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Wait I thought Sadaam got 100% of the vote of those who wanted to vote for him, but 0% of the vote of those too afraid to disagree.
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dkw
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I was going to suggest that punitive damages go to a non-profit rather than to the plaintiff, but Chris beat me to it.

Ooo . . . Religious conservative, agnostic moderate, and religious liberal posters all agreeing on something . . . it must be a very good idea.

Or a sign of the apocalypse.

Or just good Hatrackin'. [Smile]

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Dan_raven
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People go out of their way NOT to be ignored.

No. Its people in small states such as Rhode Island that get ignored.

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IdemosthenesI
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Well... Basically. But when there are big forest fires they get disaster relief. Besides, it's so freakin' beautiful up there, they should just be happy with the scenery! Geez I miss having Mountains on my horizon. Anyway, that's the idea behind the electoral college. I don't know if it works like a charm all the time, but it's there. I think we'd be worse off without it.

Now, when the country was first starting, before the electors were bound to vote for their state's candidate.... THEN the electoral college was a threat to democracy. It technically still could be if an elector defected, but they tendd to pick crazy radical party people, so that doesn't happen as much as you would think.

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IdemosthenesI
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Oh, and while Montana is #3 in area, it's way down the list in population. Annie, you are from Montana? Are you my aunt?? It's Nathan. You know any Taylors?
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Dagonee
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Here's an article that mentions a reason why punitives not going to the victim might not be ideal. The basic premise seems to be that punitives are designed to deter, and they only deter if someone bothers to sue, so there must be incentive to sue for punitives. But this is just an aside in the article, which is really about an economic justification for punitives:

quote:
An alternative way in which the legal system might deal with torts of varying elasticity would be to vary the amount paid by the tortfeasor but not the amount received by the victim. This would correspond to a system of ordinary damages supplemented by fines.[19] The earlier discussion of probability of conviction provides an explanation for why that is a less efficient solution. The torts for which we want high damage payments are also the torts for which we want a high probability of conviction. We get it by giving the high damage payment to the victim, thus giving him a strong incentive to sue.
Not saying I agree, but it is important to investigate unintended consequences.
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Mike
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How about some small proportion of punitives go to the lawyers / victim. Like maybe 10%? The other question is how you choose where the other 90% goes. Sounds like a nice idea, though.
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Dagonee
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The problem with the 10% plan is that the victim could settle, and the deterrent effect of punitive damages would not take place.

In fact, the victim and the tortfeasor would have incentive to settle for say 15% of the likely punitive damages. One side gets more, the other pays less. The societal benefits of punitives don't occur.

Dagonee

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Sara Sasse
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quote:
Or doctors and hospitals who refuse to police their own incompetents?
Part of the problem is that "getting threatened with a lawsuit" correlates very strongly with practicing certain subspecialties (e.g., OB/Gyn and neurosurgery) which by their nature tend to have a higher number of bad outcomes than, say, preventive medicine or general pediatrics. But "getting threatened with a lawsuit" does not correlate well with "actually practicing medicine poorly." Unfortunately, it is often cheaper for the hospital insurance to settle out of court than to take a case to trial even if the physician was clearly at fault, so it's hard to sort out who is bad and who is just, well, an OB/Gyn.

However, I am made very uneasy by the lack of transparency in medical self-policing. I understand that it is almost impossible for someone outside the profession to understand some things (really, it is), but on principle I'm a firm believer in maximizing transparency of power in such situations.

quote:
Canada has socialized medicine as well, and I hear it's not in the "getting better" stages. Someone from Canada can shed some light on how great the social medicine scene is.
Even though it is being progressively underfunded, the Canadian system tests out as a better system by all general measures one would use to compare systems internationally. Canada has lower overall morbidity and mortality rates for all major medical disorders, its citizens pay less per person to subsidize care for all than US citizens pay to subsidize care for abou 1/4 the population, and Canadian citizens overall express greater levels of satisfaction with their system than US citizens do.

Individual experiences (and the anecdotes thereof) of course will vary, but the system as a whole works better. It's been studied -- the above represents data from the WHO, relative budgetary comparison for 1999 (including for the US subsidization the VA healthcare system, Medicare, Medicaid, local public health districts, etc.), and a 5-country comparison of satisfaction scores through the Harvard School of Public Health (US, Canada, New Zealand, Australia, and Great Britain -- and the US scored lowest).

I can dig up the sites if anyone is truly interested, but I've posted them here at Hatrack many times before. Hopefully a search would work, as I'm swamped for time until the weekend.

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