This is why socialist health care doesn't scare me at all

[Joan.of.the.Arch]

Under the influence while doing surgery? Yiiii! That should mean loss of license, criminal penalties, and serious rehab --Not that that would have helped your church member. I wonder if the surrounding staff were aware of the surgeon's condition and if there were not something they could have done. I guess they were sued as well. Very sorry such a horror happened.

[savingmama]

[QUOTE=mom-from-missouri;230186]I don't agree with the above posters idea of placing a $250,000 cap on malpractice suits. QUOTE]

I definitely agree that there should not be a cap of $250K for the total malpractice lawsuit, however I have heard my husband mentioning some states that have a cap of $250K for pain and suffering within the lawsuit. As a surgical resident he has mentioned that doctors prefer practicing in those states because they don't have to deal with lawyers doing ridiculously large lawsuits, which in turn means the doctor's malpractice insurance is more affordable.

To clarify, that does not mean patients can only sue for $250K in a malpractice lawsuit. It means that for pain and suffering it is capped at $250K. Then they can also sue to recoup costs of bills, lost wages, etc.

Anyone else more familiar with this, please jump in.

[savingmama]

I actually found a great article addressing specifically having a $250K cap on noneconomical damages for malpractice lawsuits.
The link is: http://www.texmed.org/Template.aspx?id=3173

Here is a great quote from it summing it up:
"Several national studies have shown that the only type of state reform that consistently showed significant results in reducing liability costs – and reducing premiums – is a cap on noneconomic damages. According to the Office of Technology Assessment, minimizing large damage awards allows insurers to better match premiums to risk.

According to the American Academy of Actuaries, the cap on noneconomic damage awards must be established at a low enough level to have a positive impact on liability insurance premiums, and has suggested that the cap on noneconomic damages be set at $250,000."

[disneysteve]

Yes, when they speak of a cap on malpractice, it is on non-economic payouts. So in mom-from-missouri's examples, the victims or their families could still have sued and won 6 or 7 figure settlements. All the bills would be paid. The kids' college could be covered. All economic loss could be compensated, but only a max of 250K could be paid out for pain and suffering.

[markusk]

...so I am perplexed by your comment , but tell me who is going to pay for classes that few if any would go to in order to eat healthier...

Who should pay for it? The Insurance companies. They should pay for it since they will reap the benefits (long term). But the vast majority don't. Not really sure why, but one of the earlier posts (l think it was Disneysteve) talked about how insurance companies, like many other companies, are only looking for short term profits. If there are classes for asthma/diabetes prevention, I think alot of reasonable people will go, especially if it has valuable content. True many won't, but many will.

More so than short sightedness, I think the real problem is no one is actually looking at the big picture of healthcare in the US. The net result is, alot of expensive healthcare is done every day, but we, as a nation, are not as healthy as most of the other industrialized countries. Let me paraphrase a good analogy I heard recently. It's like we are building a new house. But instead of having a budget and a general contractor to oversee everything/everyone, we hire individual carpenters, electricians, plumbers... AND we tell the carpenter, you will only get paid for each and every nail that you place into the house, the fancier the nail, the more you get paid per nail; to the electrician, you will only get paid for each and every light switch that is place in the house, we will pay more for fancier switches. One day we come to survey the house we find every square inch of each room is filled with nails, each room has 30+ light switches, and most of them are 3 way stiches or dimmers....and when we look at the final cost of our new home, we are shocked at how expensive it is.

In regards to malpractice caps, my understanding here in California is 250K per physician. So if you are wrongfully injured during your hospital stay, you can sue every single physician who was involved in your care for 250K each.

I am glad we are discussing healthcare in a forum like this. Actually, since healthcare currently represents about 1/6 of GDP, it makes sense. If the rate of increase continues unabated, healthcare is projected to represent 1/3 of GDP in the near future, which basically means the end of our economy as we know it.

Addendum:
Here is the actual quote that I parapharased above. It is from an excellent article titled "The Cost Conundrum" by Atul Gawande who is a physician. It appeared in a recent Newyorker Magzine.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

[cschin4]

Actual malpractice needs to be distinguished and quantified from an adverse outcome, bad reaction to appropriate treatment, etc. There are indeed risks to undergoing ANY medical treatment. You could have an allergic reaction to the medication. You could get an infection EVEN IF doctors and nurses do everything right. You could have a side effect such as a headache after a spinal or a sore throat after general anesthesia, etc.
Expected, predictable SIDE EFFECTS do NOT constitute malpractice and there are plenty of lawyers suing everyone for everything that is not medical malpractice. Everyone that dies in a hospital isn't dying due to poor medical care. Obviously, there are mistakes that are made.
But, no matter there will ALWAYS be some human error where a nurse or doctor makes a mistake no matter how hard they are trying to do their best. Do we really want to put our healthcare providers in jail for being human? Yes, gross disregard and gross negligence should be punished but who will want to go into healthcare with the threat of jail or prosecution? The vast majority of healthcare providers are in healthcare because they want to provide good care and are genuinely concerned and interested in people. The current environment of "make a mistake, get sued" doesn't necessarily help anyone and may discourage good people from being in medicine.

[PetMom]

Medicare fraud, old fashioned diagnostics (good point DisneySteve), demanding everything patients with implicit/explicit of lawsuit, ins. companies and their increasing power - all good examples.

Although some drugs give better health to many,
big pharma seems profit driven to get every man, woman, child (cholesterol pills - what an outcry that produced) and dog - on all sorts of pills.

Pills for everything now - even longer eyelashes.

Anti depressant pills for dogs.

Even timing your trips to the bathroom.

And how they have gotten their greedy hands in vet medicine which appears to have no regulation or available generics (at least people have that choice - wonderful Wal Mart helped with their $4.00 presciption cost that other stores are reluctantly trying to follow).

In the whole health socialized medicine thing all I noticed is that when finally all the healthcare big guys finally got together in Washington to discuss healthcare costs, big pharma sure got up there pretty quickly.

Of course, I realize now with all the Drs. giving their input how a lot of people may be marching in and demanding these pills (commercials on tv may be helping with that aspect) but we are an overdrugged society here.

The elderly are especially overmedicated. Many elderly go without some basic food items to afford their medications.

And some profit is at stake as the drug reps would not being literally courting drs.

To be honest though I don't know how that plays into the doctors and healtcare costs as drs. do not dispense medications - that is separate - unlike the vets who get to dispense their medications.

The govt. has tried with programs to get people/kids moving, public service announcements on healthier habits but people are still far more inundated with the million dollar budgeted pills for everything ad campaign blitz.

[disneysteve]

A study focusing on 2002-2004 hospitalizations in the U.S. revealed that about 83,000 potentially preventable deaths occurred each year. Medical errors occur in hospitals and other health care settings, such as clinics, physicians' offices, pharmacies, nursing homes, urgent care centers and patients' home.

Most people don't understand where those medical error estimates come from. The biggest study that got the most press and became the number used frequently in reports came from a very short (3 months, I think) study done at 3 hospitals. They then took the results from that study and extrapolated the numbers as if the same results are occurring at every hospital in the nation. So if each of those 3 hospitals, for example, experienced 100 errors in 3 months, they assumed that every hospital nationwide experiences 100 errors every 3 months. They just multiplied the numbers in that manner to come up with the total. Personally, I find that to be faulty logic. It was far too small a study sample over too short a term with results extrapolated over far too large a population.

[disneysteve]

numbers do not lie even if they are manipulated

Numbers certainly can lie, especially if they are manipulated.

You know that old quote (Mark Twain, I believe):

There are lies, damn lies and statistics.

I don't mean to downplay medical errors. I'm sure there are far too many and we need to find better ways to reduce them. We can't ever eliminate them because humans aren't perfect and mistakes will get made. We need to cut down on sloppy mistakes that shouldn't happen in the first place.

[disneysteve]

there should never be an excuse for the amputation of a wrong leg , even after been marked in the chart , and the leg --- while the other one is affected by gangrene to a point that a lay person can tell the difference

Absolutely! I agree 100%. Gross negligence is inexcusable. It should never happen and the involved parties should be appropriately punished when it does.

I was just trying to point out that studies can be misleading depending on how they are designed, how large the sample sizes are and how the numbers are manipulated. You can design a study to prove pretty much anything if you know what you're doing.

[markusk]

Markusk === I tried to understand your post " RedThunderBird, maybe "manatory" is too strong of a word when used without context. I know we in this country have a strong aversion to anyone telling us how to live, etc.'===== the word is mandatory , as I spelled correctly and it is the context , otherwise you would not understood that " I know we in this country have a strong aversion to anyone telling us how to live, etc.' so I am perplexed by your comment , but tell me who is going to pay for classes that few if any would go to in order to eat healthier or is it going to be like in Carter years ? when the government would keep on taxing the average citizen for programs in college in which there would be two or three students [ I remember it quite well ] maximum because no else would show , since they have used the grant to paint their car as a friend of mine did , if after watching the movie / documentary " super size me " more people went to the fast food restaurants than before , do you think a class would change people's behavior when it comes to healthy diet ? ==== but wait what do you think of this ---A study focusing on 2002-2004 hospitalizations in the U.S. revealed that about 83,000 potentially preventable deaths occurred each year. Medical errors occur in hospitals and other health care settings, such as clinics, physicians' offices, pharmacies, nursing homes, urgent care centers and patients' home.==== let me tell you that if in Iraq , and Afghanistan we had any losses remotely close to a 10% of that many people=====the whole country would have been in the streets protesting === and this happen every year or this " Findings of the Institute of Medicine, 1999, show that in all U.S. hospitals the increased costs of preventable medication errors cost the economy about $2 billion each year ".According to a 2005 study of 39 million patient records, 241,280 deaths during Medicare hospitalizations were attributable to one or more common preventable medical errors. In each year from 2001 through 2003, the study found that the number of medical errors or "patient safety incidents" at America's hospitals was approximately 1.18 million, with a cost to Medicare of nearly $3 billion annually. and what is the main cause ?===Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis === I just cannot comprehend how in the world any could resolve this problem if we don't start from the top === p.s =I used Wikipedia as my main source

Sorry if you feel I quoted you out of context. If I did, I did not mean to. As you can appreciate, there is an ebb and flow in a conversation that can be misinterpreted in formats like this.

From the get go, my response to your words (in post#74) got misinterpreted by you (and thank you in advance for correcting my spelling): "RedThunderBird, maybe "mandatory" is too strong of a word when used without context. I know we in this country have a strong aversion to anyone telling us how to live, etc."

I did not mean YOUR use of the word "mandatory," but MY use of the word in post#68. What I should have said is: ReadThunderbird, maybe my use of the word mandatory is too strong when used without context. I know we in the country have strong aversion to anyone telling us how to live, etc."

Anyway, I was not thinking that you used the word out of context or without context. I realized I should have given an example of what I meant by a "mandatory" class and wanted to give an example. In retrospect maybe I should have said "prerequsite" or "strongly suggested/encouraged" classes for diabetes, etc.

[markusk]

Markusk === I tried to understand your post " RedThunderBird, maybe "manatory" is too strong of a word when used without context. I know we in this country have a strong aversion to anyone telling us how to live, etc.'===== the word is mandatory , as I spelled correctly and it is the context , otherwise you would not understood that " I know we in this country have a strong aversion to anyone telling us how to live, etc.' so I am perplexed by your comment , but tell me who is going to pay for classes that few if any would go to in order to eat healthier or is it going to be like in Carter years ? when the government would keep on taxing the average citizen for programs in college in which there would be two or three students [ I remember it quite well ] maximum because no else would show , since they have used the grant to paint their car as a friend of mine did , if after watching the movie / documentary " super size me " more people went to the fast food restaurants than before , do you think a class would change people's behavior when it comes to healthy diet ? ==== but wait what do you think of this ---A study focusing on 2002-2004 hospitalizations in the U.S. revealed that about 83,000 potentially preventable deaths occurred each year. Medical errors occur in hospitals and other health care settings, such as clinics, physicians' offices, pharmacies, nursing homes, urgent care centers and patients' home.==== let me tell you that if in Iraq , and Afghanistan we had any losses remotely close to a 10% of that many people=====the whole country would have been in the streets protesting === and this happen every year or this " Findings of the Institute of Medicine, 1999, show that in all U.S. hospitals the increased costs of preventable medication errors cost the economy about $2 billion each year ".According to a 2005 study of 39 million patient records, 241,280 deaths during Medicare hospitalizations were attributable to one or more common preventable medical errors. In each year from 2001 through 2003, the study found that the number of medical errors or "patient safety incidents" at America's hospitals was approximately 1.18 million, with a cost to Medicare of nearly $3 billion annually. and what is the main cause ?===Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis === I just cannot comprehend how in the world any could resolve this problem if we don't start from the top === p.s =I used Wikipedia as my main source

A few other thoughts.

I agree completely. We should fix the system so medication errors are as close to zero as possible. Lawsuits in these cases are appropriate. For the unfortunate patient who got the wrong leg amputated, there should be a large cash compensation, the physician involved should get his/her license revoked and the hospital admin, OR procedures, etc should be investigated by the appropriate licensing authorities.

By the way 241,280 deaths divided by 39 million patient records = 0.00618 or 0.6%. I am not trying to minimize the deaths (one preventable death is outrageous!) but trying to look at the big picture. The real question is, how many of the 39 million hospitalizations were REALLY necessary? At every point during a hospitalization there is the possibility of human error. Most people will be very surprised by even the complexity of just reconciling a persons medication list during admission and discharge. I always tell patients: you don't want to be admitted to a hospital unless you really need to, because you can really get sick in hospitals.

Furthermore many of these errors are occurring in our present "for profit" healthcare system. This has nothing to do with "Socialized Medicine."

"Preventable Medical errors" is a broad term. But in general they do NOT mean "Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis." It includes from the not so serious, like getting Tylenol when Motrin was ordered for headache; or very serious, like a premature baby getting the wrong dose (adult dose) of heparin (a blood thinner) so the baby dies due to excessive bleeding.

"Deaths during hospitalizations from common preventable medical errors," include things like bed sores that lead to sepsis (a dangerous blood infection) because an immobile patient did not get their body turned every few hours, or an elderly patient (with known walking problems) falling and breaking the hip while trying to get to the bathroom because no one was there to assist.

All hospitals now have their own internal investigational procedures even for simple, "no harm done errors." There are are also mandatory reporting of certain events, like falls resulting in deaths, broken bones, etc. It is referred to as a "Sentinel event" and triggers, at least here in CA, an investigation by the state. Basically the hospital gets a colonoscopy of all its nursing/pharmacy/OR procedures , and have to show that there is some system in place to prevent it from happening again.

[markusk]

Here are some numbers that you may find quite interesting==== 2,594,000 U.S armed forces during the war in Vietnam------- 58,228 deaths which equals 2.24 % of the total armed forces , during a ten year period ======== from what you have stated only .6% percent and I quote "By the way 241,280 deaths divided by 39 million patient records = 0.00618 or 0.6%. I am not trying to minimize the deaths (one preventable death is outrageous!) but trying to look at the big picture. The real question is, how many of the 39 million hospitalizations were REALLY necessary?" and the study was a two year period from 2002 to 2004 ---- if the study continued for a period of ten years , what would the percentage be ? without extrapolating or multiplying , as the amount of patients increases 0.6 percent would become a criminal act ----- during these two years over 83,000 people died due to negligence , and yes to misdiagnosis ---Cancer: In a Harvard study of malpractice claims in the U.S., cancer was far and away the most misdiagnosed illness, primarily breast and colorectal. Study authors attributed this to doctors failing to stick to cancer screening guidelines.or Medical errors are associated with inexperienced physicians, new procedures, extremes of age, complex care and urgent care=====One study found that being awake for over 24 hours caused medical interns to double or triple the number of preventable medical errors, including those which resulted in injury or death. this a major problem , and with health care for all [ socialize medicine ] would become a bigger one , as more people would enter the system === as we have not dealt with the problems from the past , logic dictates that they will become even greater ones . empower the patients with the truth , for I do not know what the percentage is , but I know that the majority of the people would rather have a live loved one , that millions of dollars for a death one . I am of those , and in the words of the great president Abraham Lincoln You may fool all the people some of the time, you can even fool some of the people all of the time, but you cannot fool all of the people all of the time . this is a very important , actually is a vital issue . The big picture is that no one should die from a preventable mistake by a doctor , that is the big picture .

Agreed.

But I should clarify that the valid points you make are NOT due to "socialized" medicine.

1) "In a Harvard study of malpractice claims in the U.S., cancer was far and away the most misdiagnosed illness, primarily breast and colorectal. Study authors attributed this to doctors failing to stick to cancer screening guidelines."

In our present "fee for service" incentive payment structure, primary care physicians get paid very little for routine follow up visits including cancer screening. You can get 10 to 20 times more money for doing simple 10 minute botox injections for cosmetic purposes, than a 20 minute interview where the primary care doctor listens to you, talks to you, examines you and then discuss a treatment plan (including cancer screening). A healthcare provider can make more money doing 8 botox injections per day vs a physician doing preventive medicine seeing seeing 30 patients per day. The current structure is not really set up for preventive medicine, since physicians, nurses, pharmacies, hospitals only get paid when you get sick.

2) "One study found that being awake for over 24 hours caused medical interns to double or triple the number of preventable medical errors, including those which resulted in injury or death. this a major problem , and with health care for all [ socialize medicine ] would become a bigger one , as more people would enter the system"

In the past, interns would routinely work 100 hours per week; certain surgical specialties are closer to 120 hours per week. Airline pilots and truck drivers had sleep deprivation rules for safety reasons, but not healthcare providers. By the time I was an intern, there was a mandate by the government that required a limit of 80 hours per week; certain surgical specialties are allowed 90 hours (I think). Even with the limited hours, I can't believe during training I went work at 6AM, spent the night "on call" and up all night, and getting home next day by about 2PM, and doing this every 4 days. The 80 hour work week was not done on a volunteer basis. Hospitals resisted. Why? Because interns and residents are CHEAP. Average salary is about 40K. If you are running a 24 hour "for profit" healthcare system, there is going to be a desire to use the cheapest labor possible.

3) "as we have not dealt with the problems from the past , logic dictates that they will become even greater ones . empower the patients with the truth , for I do not know what the percentage is , but I know that the majority of the people would rather have a live loved one , that millions of dollars for a death one"

I will quote a thought provoking article by Peter Singer, "Why we must ration healthcare" that recently appeared on the NYtimes. It's really a good read.

When a Washington Post journalist asked Daniel Zemel, a Washington rabbi, what he thought about federal agencies putting a dollar value on human life, the rabbi cited a Jewish teaching explaining that if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally. Perhaps that is how those who resist health care rationing think. But we already put a dollar value on human life. If the Department of Transportation, for example, followed rabbinical teachings it would exhaust its entire budget on road safety. Fortunately the department sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million. Other government agencies do the same. Last year the Consumer Product Safety Commission considered a proposal to make mattresses less likely to catch fire. Information from the industry suggested that the new standard would cost $343 million to implement, but the Consumer Product Safety Commission calculated that it would save 270 lives a year — and since it valued a human life at around $5 million, that made the new standard a good value. If we are going to have consumer-safety regulation at all, we need some idea of how much safety is worth buying. Like health care bureaucrats, consumer-safety bureaucrats sometimes decide that saving a human life is not worth the expense. Twenty years ago, the National Research Council, an arm of the National Academy of Sciences, examined a proposal for installing seat belts in all school buses. It estimated that doing so would save, on average, one life per year, at a cost of $40 million. After that, support for the proposal faded away. So why is it that those who accept that we put a price on life when it comes to consumer safety refuse to accept it when it comes to health care?

Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.

The theory sounds good, but in practice it has problems. We are not good at taking account of differences between very small risks, so if we are asked how much we would pay to reduce a risk of dying from 1 in 1,000,000 to 1 in 10,000,000, we may give the same answer as we would if asked how much we would pay to reduce the risk from 1 in 500,000 to 1 in 10,000,000. Hence multiplying what we would pay to reduce the risk of death by the reduction in risk lends an apparent mathematical precision to the outcome of the calculation — the supposed value of a human life — that our intuitive responses to the questions cannot support. Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.

[disneysteve]

The current structure is not really set up for preventive medicine, since physicians, nurses, pharmacies, hospitals only get paid when you get sick.

I understand your point, but this statement isn't really true.

I'm a family practice doctor. I get paid for an office visit whether you come to me for a general check-up or a sick visit. Since there are a variety of tests and procedures involved in preventative care, the lab, x-ray facility, hospital and surgi-center all make money in the process. If I send a woman for a mammogram, radiology makes money. If I send a patient for a colonoscopy, the facility, the physician, the anesthesiologist and the nurse all make money. If I order a panel of lab work, the phlebotomist and laboratory make money. So there is plenty to be made by doing preventative care.

[markusk]

I understand your point, but this statement isn't really true.

I'm a family practice doctor. I get paid for an office visit whether you come to me for a general check-up or a sick visit. Since there are a variety of tests and procedures involved in preventative care, the lab, x-ray facility, hospital and surgi-center all make money in the process. If I send a woman for a mammogram, radiology makes money. If I send a patient for a colonoscopy, the facility, the physician, the anesthesiologist and the nurse all make money. If I order a panel of lab work, the phlebotomist and laboratory make money. So there is plenty to be made by doing preventative care.

Yes, of course. I was only trying to point out that a patient usually goes to their primary care provider because there is a problem or a chief complaint. I believe few patients go to their primary care physician for preventive care (as the main reason).

From the perspective of a primary care physician, he/she must deal with the patient's problem(s) first, then if there is time and the physician remembers or there is some system in place to automatically "red flag" the encounter as "mammogram/colonoscopy past due," then the primary physician can order the mammogram/colonoscopy/labs. If the primary care doc does not, then no one gets paid down the line.

I guess I am imagining an incentive/pay structure so that the primary care doc can initiate the preventive care encounter via email, phone call or office visit, order the tests AND get paid well for that phone call/email/office visit. Of course this can't happen in most places right now because there is a shortage of primary care docs and all are overworked (and underpaid) just seeing sick patients.