Think you can come up with a better healthcare system?

[I See You]

I have been looking at health insurance systems in different countries and if I could make a generalization, universal coverage systems (as proposed by Senators Obama and Clinton) will be bad for physicians. Physicians will be paid less and countries like Japan with similar system as the ones proposed by the Democrats, 50% of hospitals are in financial difficulty (for more on this check the pbs website, they did a recent piece on health care systems).
In Germany for example, a family physician is paid about $80, 000/year but cost of going to medical school is cheaper compare to the USA. My question is: is there any system out there that will cover everyone in the USA but at the same time compensates physicians well? Or do you prefer the system we have now wherein everybody is basically on their own with the help of additional government programs such as medi-care medi-caid?

 

[DrMidlife]

I think this just aired tonight on PBS Frontline: Sick around the world. It covers a bunch of countries with pros & cons. Hopefully it'll help stop the "omg in Canada you have to WAIT for an MRI so forget it!" stuff.

You have to get past the edutainment or vote-getting phase to get anybody interested in the cost of med ed or how to address lost equity for physicians/pharm/HMOs.

 

[digitlnoize]

I have been looking at health insurance systems in different countries and if I could make a generalization, universal coverage systems (as proposed by Senators Obama and Clinton) will be bad for physicians. Physicians will be paid less and countries like Japan with similar system as the ones proposed by the Democrats, 50% of hospitals are in financial difficulty (for more on this check the pbs website, they did a recent piece on health care systems).
In Germany for example, a family physician is paid about $80, 000/year but cost of going to medical school is cheaper compare to the USA. My question is: is there any system out there that will cover everyone in the USA but at the same time compensates physicians well? Or do you prefer the system we have now wherein everybody is basically on their own with the help of additional government programs such as medi-care medi-caid?

I think it's possible in theory, but no one is approaching it the right way yet.

America is unique, and we need a unique solution to this problem. We won't be able to successfully copy other countries' programs.

I would like to see coverage for all, but to maintain that coverage the patient would have to meet certain "goals": weight loss, quit smoking, no drugs, moderate/normal alcohol intake, etc. I will NOT pay for someone else's treatment for their "smoker's diseases".

If we give healthcare away for free without any mandate for personal accountability, we are shooting ourselves in the foot. We (in general) are a fat, lazy bunch...why try to control your HTN if Uncle Sam will pay for your bypass surgery to fix your clogged coronary arteries?

Physicians, particularly FP's, should be paid based on the improvement and maintainance of their patients' health.

There should be yearly (or bi-yearly) health "inspections"...much like we have for our cars. Our cars must be kept in good working order, why not our bodies? If you don't pass, due to things in YOUR control, no free coverage for you.

I would like free coverage to only apply to preventive medicine. You should still have to carry normal insurance for hospitalizations, etc. I don't see ANY way to keep specialists' salaries up through UHC...

The insurance companies should be controlled tighter though. They are WAY out of hand. They should all be forced to become non-profit...no bazillion dollar salaries for CEO #2 while Mr Smith just got denied his operation...just doesn't make sense. "We can't afford to cover your operation, but we can pay our CEO 125 million a year."

I think Universal Electronic Health Records will help TREMEDOUSLY. Do any of you have any idea how much time is spent trying to find out what meds a person is on, what conditions they have, when they were last treated, etc. Not to metion the insanity of billing...

UEHR would lower costs by a huge amount.

Also, malpractice reform. No one should be able to be awarded a malpractice settlement worth more than the value of their life insurance policy. If someone has a $50,000 life insurance policy, that's the max they should be able to be awarded in a settlement.

If they think their life is worth 50k, why pay them more than that?

This would help dramatically with malpractice, which would help physician salaries by reducing overhead, as would the universal records system.

Done.

 

[AwesomO]

My question is: is there any system out there that will cover everyone in the USA but at the same time compensates physicians well?
Or do you prefer the system we have now wherein everybody is basically on their own with the help of additional government programs such as medi-care medi-caid?

Come on now of course people would prefer a system that compensates physicians well and provides care to everyone. Only the most jaded fundamental Ayan Rand zealot would prefer the second option over a paradise that your first option is.
I'm more of a realist and because of that tend to favor a free market approach but if someone can come up with the a workable version of the fantasy health care that we saw in "Sicko" where everything is free and doctors are paid around 180K with pension and no loans I would sign up in a heart beat.

 

[AwesomO]

Just to throw out my ideal health care system. It would involve no insurance companies or govt involvement (save for the very poor, although I would contend in my system docs would be able to provide a lot of charity work). I would instead have groups of individuals be it through work, school, unions, church, etc pool their money and use that to pay doctors and hospitals retainer fees for whatever medical services they need in a given year.
For instance lets say the meat packing plant employs 600 individuals. Each of them contributes 2,000 to the annual health care fund. This results in 1.2 million a year. You then have physician groups and hospitals compete for a yearly fee.
For example
-You pay a PCP 300 dollars per patient for unlimited primary care for a year.
-You then pay a surgical group 200 dollars per patient.
-You go on and on through the various specialities paying the most specialized the least amount of retainer fees (I will explain why later).
-Finally you pay a hospital or hospital network a fee to allow our workers to stay at the hospital for a given year.
Medications can be worked out similarly.

Now as to why I propose to pay specialists smaller retainer fees. The thing about retainer fees is that you get paid whether you provide a service or not. Lets take a neurosurgeon for example. In my model I would say that a group of 600 could pay him 100 per patient for a year of coverage. That works out to be 60K for that one group. Now will many if any of these individuals need his services in a given year? Probably not which results in a free 60K for him. And because he devotes so little time to a group of 600 he can easily sign on with large number of them. At my residency city we have about 6 Neurosurgeons serving a city of 500K. Lets say half that is children or and only 300K participate in my plan. Thats 50K people per surgeon at a rate of $100 for a years coverage which comes out to 5 million a year in cash for the neurosurgeon.
Now contrast that with Peds, FM, or IM where for a group of 600 you will probably wind up seeing most in a given year and have to devote a greater amount of time to them. So they could only potentially see 1.2-2.K patients a year so you have to increase their retainer fees. Even then the PCP would be making 380K in cash for 1.2K patients.

Of course these are just very rough estimates on my part. And I'm sure there are many things I'm not considering. But it's nice to dream of such a system........Sigh now back to the real world.

 

[MossPoh]

Check out Taiwan's system. Everyone is supposedly pretty pleased with it.

They are struggling to pay it off, but it is still less than half as much as the US pays out for healthcare.

Also, one thing to note with the german family practice is that they work less hours. Sometimes significantly less work. Others are tremendously overworked. I spent a lot of time over there and found a doctor just for safety sake. The one time I needed him, he was on a month long vacation. Evidently he takes two months off per year....in addition to a 9-4 with a long hour break. He doesn't work every friday either.

Also, they don't live quite as lavish of a life over there, and even renting a large 2 or 3 bedroom apartment in Berlin runs you about 350 euro.

Is it possible? Yes, but nothing short of a complete ground up reconstruction will fix it. Thousands and thousands of administrators and middle men will need to be fired. Medical schools would need to create a more affordable education. New technology would need to be implemented into every practice...not just some. If done like Taiwan, there could theoretically be a bit of a tax reduction, but I think our significantly less dense population would make that all more difficult. The critical step is the complete rebuild rather than just putting a fresh coat of paint over the old stuff. It'd have to be a near flawless system involving some sort of national identification (us americans don't like that). It'd have to have no wait time (us americans hate lines) and it'd have to prevent large amounts of fraud (depends on the person), while also keeping physicians happy and future generations interested in pursuing medicine.

The taiwan system is really cool though. Everybody has a card. They show up at whatever doctor or specialist they need and get taken care of and then swipe their card. The information of what was done goes straight to a central location where the cash is then sent to the provider. If a patient visits a certain amount of times that was deemed excessive then an investigator is sent to their residence for a bit of a chat. I am thinking it is quite a large number of visits though.

 

[Obnoxious Dad]

I would like to make a few points concerning cost comparisons and quality.

Whenever you make comparisons between the US health care system and other nationalized or socialized systems you ought to keep in mind a number of factors that give a false impression that the US system is less efficient. The purported cost of the nationalized systems generally does not include the administrative cost, borne by the government and the taxpayers, of raising the revenue to pay for those systems. The economic distortions caused by higher tax rates in countries such as Canada and Australia are not considered. The lost wages and productivity of workers, who are sitting around for 18 months waiting for orthopedic procedures, are generally ignored. The fact that many of these countries are getting a free lunch in terms of medical research from US medical schools and through payments by American insurers to pharmaceutical companies is a fact that polite people just won’t discuss.

To address the quality issue, I am going to take the liberty of re-posting a portion of the Canadian Supreme Court’s opinion in a case that tested the constitutionality of Quebec’s prohibition on the purchase and renewal of private medical insurance. This might open your eyes about what Canada’s highest court had to say about the quality of Quebec’s single payer system. The link to the entire opinion follows immediately.


http://csc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

A. Deprivation of Life, Liberty or Security of the Person

110 The issue at this stage is whether the prohibition on insurance for private medical care deprives individuals of their life, liberty or security of the person protected by s. 7 of the Charter.

111 The appellants have established that many Quebec residents face delays in treatment that adversely affect their security of the person and that they would not sustain but for the prohibition on medical insurance. It is common ground that the effect of the prohibition on insurance is to allow only the very rich, who do not need insurance, to secure private health care in order to avoid the delays in the public system. Given the ban on insurance, most Quebeckers have no choice but to accept delays in the medical system and their adverse physical and psychological consequences.

112 Delays in the public system are widespread and have serious, sometimes grave, consequences. There was no dispute that there is a waiting list for cardiovascular surgery for life-threatening problems. Dr. Daniel Doyle, a cardiovascular surgeon who teaches and practises in Quebec City, testified that a person with coronary disease is [translation] “sitting on a bomb” and can die at any moment. He confirmed, without challenge, that patients die while on waiting lists: A.R., at p. 461. Inevitably, where patients have life-threatening conditions, some will die because of undue delay in awaiting surgery.

113 The same applies to other health problems. In a study of 200 subjects aged 65 and older with hip fractures, the relationship between pre-operative delay and post-operative complications and risk of death was examined. While the study found no relationship between pre-operative delay and post-operative complications, it concluded that the risk of death within six months after surgery increased significantly, by 5 percent, with the length of pre-operative delay: A. Laberge, P. M. Bernard and P. A. Lamarche, “Relationships between the delay before surgery for a hip fracture, postoperative complications and risk of death” (1997), 45 Rev. Epidém. et Santé Publ. 5, at p. 9.

114 Dr. Eric Lenczner, an orthopaedic surgeon, testified that the one-year delay commonly incurred by patients requiring ligament reconstruction surgery increases the risk that their injuries will become irreparable (A.R., at p. 334). Dr. Lenczner also testified that 95 percent of patients in Canada wait well over a year, and many two years, for knee replacements. While a knee replacement may seem trivial compared to the risk of death for wait-listed coronary surgery patients, which increases by 0.5 percent per month (A.R., at p. 450), the harm suffered by patients awaiting replacement knees and hips is significant. Even though death may not be an issue for them, these patients “are in pain”, “would not go a day without discomfort” and are “limited in their ability to get around”, some being confined to wheelchairs or house bound (A.R., at pp. 327-28).

115 Both the individual members of the Standing Senate Committee on Social Affairs, Science and Technology who intervened in this appeal and the Canadian Medical Association cited a Statistics Canada study demonstrating that over one in five Canadians who needed health care for themselves or a family member in 2001 encountered some form of difficulty, from getting an appointment to experiencing lengthy waiting times: C. Sanmartin et al., Access to Health Care Services in Canada, 2001 (June 2002), at p. 17. Thirty-seven percent of those patients reported pain.

116 In addition to threatening the life and the physical security of the person, waiting for critical care may have significant adverse psychological effects. Serious psychological effects may engage s. 7 protection for security of the person. These “need not rise to the level of nervous shock or psychiatric illness, but must be greater than ordinary stress or anxiety”: New Brunswick (Minister of Health and Community Services) v. G. (J.), [1999] 3 S.C.R. 46, at para. 60.

117 Studies confirm that patients with serious illnesses often experience significant anxiety and depression while on waiting lists. A 2001 study concluded that roughly 18 percent of the estimated five million people who visited specialists for a new illness or condition reported that waiting for care adversely affected their lives. The majority suffered worry, anxiety or stress as a result. This adverse psychological impact can have a serious and profound effect on a person’s psychological integrity, and is a violation of security of the person (Access to Health Care Services in Canada, 2001, at p. 20).

118 The jurisprudence of this Court holds that delays in obtaining medical treatment which affect patients physically and psychologically trigger the protection of s. 7 of the Charter. In R. v. Morgentaler, [1988] 1 S.C.R. 30, Dickson C.J. concluded that the delay in obtaining therapeutic abortions, which increased the risk of complications and mortality due to mandatory procedures imposed by the state, was sufficient to trigger the physical aspect of the woman’s right to security of the person: Morgentaler, at p. 59. He found that the psychological impact on women awaiting abortions constituted an infringement of security of the person. Beetz J. agreed with Dickson C.J. that “[t]he delays mean therefore that the state has intervened in such a manner as to create an additional risk to health, and consequently this intervention constitutes a violation of the woman’s security of the person”: see Morgentaler, at pp. 105-6.

119 In this appeal, delays in treatment giving rise to psychological and physical suffering engage the s. 7 protection of security of the person just as they did in Morgentaler. In Morgentaler, as in this case, the problem arises from a legislative scheme that offers health services. In Morgentaler, as in this case, the legislative scheme denies people the right to access alternative health care. (That the sanction in Morgentaler was criminal prosecution while the sanction here is administrative prohibition and penalties is irrelevant. The important point is that in both cases, care outside the legislatively provided system is effectively prohibited.) In Morgentaler the result of the monopolistic scheme was delay in treatment with attendant physical risk and psychological suffering. In Morgentaler, as here, people in urgent need of care face the same prospect: unless they fall within the wealthy few who can pay for private care, typically outside the country, they have no choice but to accept the delays imposed by the legislative scheme and the adverse physical and psychological consequences this entails. As in Morgentaler, the result is interference with security of the person under s. 7 of the Charter.

120 In Morgentaler, Dickson C.J. and Wilson J. found a deprivation of security of the person because the legislative scheme resulted in the loss of control by a woman over the termination of her pregnancy: see Morgentaler, at pp. 56 and 173.

121 The issue in Morgentaler was whether a system for obtaining approval for abortions (as an exception to a prohibition) that in practice imposed significant delays in obtaining medical treatment unjustifiably violated s. 7 of the Charter. Parliament had established a mandatory system for obtaining medical care in the termination of pregnancy. The sanction by which the mandatory public system was maintained differed: criminal in Morgentaler, “administrative” in the case at bar. Yet the consequences for the individuals in both cases are serious. In Morgentaler, as here, the system left the individual facing a lack of critical care with no choice but to travel outside the country to obtain the required medical care at her own expense. It was this constraint on s. 7 security, taken from the perspective of the woman facing the health care system, and not the criminal sanction, that drove the majority analysis in Morgentaler. We therefore conclude that the decision provides guidance in the case at bar.

122 In Rodriguez v. British Columbia (Attorney General), [1993] 3 S.C.R. 519, Sopinka J., writing for the majority, held that security of the person encompasses “a notion of personal autonomy involving, at the very least, control over one’s bodily integrity free from state interference and freedom from state-imposed psychological and emotional stress” (pp. 587-88). The prohibition against private insurance in this case results in psychological and emotional stress and a loss of control by an individual over her own health.

123 Not every difficulty rises to the level of adverse impact on security of the person under s. 7. The impact, whether psychological or physical, must be serious. However, because patients may be denied timely health care for a condition that is clinically significant to their current and future health, s. 7 protection of security of the person is engaged. Access to a waiting list is not access to health care. As we noted above, there is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care. Where lack of timely health care can result in death, s. 7 protection of life itself is engaged. The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets this threshold requirement of seriousness.

124 We conclude, based on the evidence, that prohibiting health insurance that would permit ordinary Canadians to access health care, in circumstances where the government is failing to deliver health care in a reasonable manner, thereby increasing the risk of complications and death, interferes with life and security of the person as protected by s. 7 of the Charter.

125 The remaining question is whether this inference is in accordance with the principles of fundamental justice. “f the state [interferes] with security of the person, the Charter requires such interference to conform with the principles of fundamental justice”: Morgentaler, at p. 54, per Dickson C.J.

 

[Ferrismonk]

I would instead have groups of individuals be it through work, school, unions, church, etc pool their money and use that to pay doctors and hospitals retainer fees for whatever medical services they need in a given year.

FYI, this is where HMOs originally came from. And Americans HATE HMOs (despite their ability to contain costs).

Without typing pages on the various whys (although I'd be happy to via PM or by popular demand) I am opposed to increased government involvement in healthcare. Our current system's cost is inflated because of our government's meddling, not despite it. In my ideal system, we all simply would use HSAs combined with high deductible insurance to cover health care costs. For the elderly/poor I'd simply put medicare/medicaids funds into and HSA for them. Of course this also means that healthcare providers will need to provide statistics and prices to the public so they can choose wisely between caretakers.

This system has the following benefits:
1. It contains costs by treating health insurance like insurance, not prepaid healthcare.
2. It empowers patients to get the treatment they want done, when they want it done, and by whom they want it done by.
3. Physicians/hospitals won't waste so much money on billing or fighting with insurance companies.
4. It will help keep costs low.
5. It encourages people not to "overuse" health resources for frivilous reasons.
6. If people remain healthy they will have a nice nest egg set aside for retirement.

As an aside, a GREAT book about how our healthcare system can be fixed is called "The Cure: How Capitalism Can Save American Health Care" by David Gratzer. It does a nice jobs explaining how we got into this mess and what we can do about it.

 

[I See You]

How to achieve universal coverage
1.The costs of medical school should definitely go down. At least 45% down. One way to decrease debt is to increase government subsidized loans.

2 Create a national health plan wherein all Americans will be able to buy affordable coverage. How are we going to pay for this? Employers will be mandated to contribute, government will contribute, employees will contribute (like we do now for social security). To save money, the government should eliminate medi-caid and medi-care. For those who are unemployed, government will subsidized their coverage but they will have to give back in return such as involved in community services (be a tutor, work in the local library (for no pay), e.t.c)

3. Keep private insurance so people who can afford it can buy into it.

4. keep the cost of prescription drugs down (this will be done by negotiating with drug companies).
5. Keep government spending down (how? Could be debated)

6. government and Doctor’s groups should negotiate each year the cost of major procedures, hospital stays, e.t.c.

 

[Old_Mil]

Also, malpractice reform. No one should be able to be awarded a malpractice settlement worth more than the value of their life insurance policy. If someone has a $50,000 life insurance policy, that's the max they should be able to be awarded in a settlement.

If they think their life is worth 50k, why pay them more than that?

This would help dramatically with malpractice, which would help physician salaries by reducing overhead, as would the universal records system.

Done.

This is absolutely brilliant.

 

[digitlnoize]

This is absolutely brilliant.

I try. Unfortunately, I can't take credit for it. I don't remember where I heard the idea, but I think some states have (or are trying to have) this type thing on the books...maybe Texas...I don't remember...

I thought the same thing though. It's a great idea, and the perfect solution to MP reform.

It just doesn't make sense to pay someone 3 million dollars, when they would only pay their family 100k if they died in a car wreck...

 

[Concubine]

I try. Unfortunately, I can't take credit for it. I don't remember where I heard the idea, but I think some states have (or are trying to have) this type thing on the books...maybe Texas...I don't remember...

I thought the same thing though. It's a great idea, and the perfect solution to MP reform.

It just doesn't make sense to pay someone 3 million dollars, when they would only pay their family 100k if they died in a car wreck...

Not a bad idea!

 

[ATrain]

Not a bad idea!

Perhaps a good way to balance your malpractice insurance premiums would be to invest in Life Insurance companies? How long would you have to have the life policy in place before you sue for that amount...? If not regulated, you may get some unhappy patients (or patient families) boosting up their coverage an convenient times...

 

[Saregamapadanis]

In Germany for example, a family physician is paid about $80, 000/year but cost of going to medical school is cheaper compare to the USA.

I can live with a lower salary, if the government pays or reduces my debt substantially after I get out of medical school. Also, It would be great if Obama and clinton's system lowers taxes that physicians have to pay and gives other perks to physicians.

 

[digitlnoize]

How long would you have to have the life policy in place before you sue for that amount...? If not regulated, you may get some unhappy patients (or patient families) boosting up their coverage an convenient times...

The coverage would simply have to have began prior to the onset/diagnosis of the condition that led to their lawsuit.

For example:

50yo Male with a $100k life policy comes into his PCP's office in January for his annual colonoscopy.

A couple weeks later, they get the results back saying "CANCER"

They try (and somehow manage, this would likely be impossible) to get his life insurance increased to $1 million.

In March, he has surgery...something happens, the surgeon screwed up, and he lives, but now has to use a colostomy for the rest of his life, so they sue for malpractice.

They could only sue for up to $100k, because they did not have the million dollar coverage in place prior to the onset of the condition that led to the botched surgery...

Make sense?

Good luck getting a last minute increase in your life insurance before you have a dangerous procedure anyways...

 

[ATrain]

The coverage would simply have to have began prior to the onset/diagnosis of the condition that led to their lawsuit.

For example:

50yo Male with a $100k life policy comes into his PCP's office in January for his annual colonoscopy.

A couple weeks later, they get the results back saying "CANCER"

They try (and somehow manage, this would likely be impossible) to get his life insurance increased to $1 million.

In March, he has surgery...something happens, the surgeon screwed up, and he lives, but now has to use a colostomy for the rest of his life, so they sue for malpractice.

They could only sue for up to $100k, because they did not have the million dollar coverage in place prior to the onset of the condition that led to the botched surgery...

Make sense?

Good luck getting a last minute increase in your life insurance before you have a dangerous procedure anyways...

Yeah, that does make sense. Do you think this would raise the average coverage people get? If I were a life insurance salesman (ew, never) I would use that as a selling point to get greater coverage - as sick as that sounds

 

[digitlnoize]

Yeah, that does make sense. Do you think this would raise the average coverage people get? If I were a life insurance salesman (ew, never) I would use that as a selling point to get greater coverage - as sick as that sounds

Maybe a litte. I don't know if the problem lies with the people that have 100k of life insurance though...Many of the lawsuits I've seen happen (or attempt to happen) are brought to court by people who have no health insurance, no life insurance, and are looking to "get rich quick".

Ever since that McDonald's Coffee Spilling Lawsuit, winning a lawsuit has been viewed as equal to winning the lottery in the eyes of the public. Part of our new obsession with the lives of the rich and famous...

All that being said, the average joe might increase their coverage somewhat. I certainly would. But there's a point it stops being cost effective. I mean, what are the chances that you'll a) get sick b) be hurt during a medical procedure c) survive that and d) successfully bring your case to trial and win a judgement?

I think most people would elect to get the coverage they need to take care of their loved ones, or that they can afford. That should be all you need no matter what happens, be it a car accident or a medical one.

 

[spazzz]

I think this just aired tonight on PBS Frontline: Sick around the world. It covers a bunch of countries with pros & cons. Hopefully it'll help stop the "omg in Canada you have to WAIT for an MRI so forget it!" stuff.

You have to get past the edutainment or vote-getting phase to get anybody interested in the cost of med ed or how to address lost equity for physicians/pharm/HMOs.

what about the OMG i can't practice my specialty in the area I want to live because the other specialists won't allow me?

canada stinks as much as the US does

 

[Ferrismonk]

How to achieve universal coverage
1.The costs of medical school should definitely go down. At least 45% down. One way to decrease debt is to increase government subsidized loans.

2 Create a national health plan wherein all Americans will be able to buy affordable coverage. How are we going to pay for this? Employers will be mandated to contribute, government will contribute, employees will contribute (like we do now for social security). To save money, the government should eliminate medi-caid and medi-care. For those who are unemployed, government will subsidized their coverage but they will have to give back in return such as involved in community services (be a tutor, work in the local library (for no pay), e.t.c)

3. Keep private insurance so people who can afford it can buy into it.

4. keep the cost of prescription drugs down (this will be done by negotiating with drug companies).
5. Keep government spending down (how? Could be debated)

6. government and Doctor’s groups should negotiate each year the cost of major procedures, hospital stays, e.t.c.

No offense, but this entire post made me cringe (literally).

Also, It would be great if Obama and clinton's system lowers taxes

Sorry to burst your bubble, but this will NEVER happen...

This is absolutely brilliant.

I agree. The life insurance/malpractice idea is brilliant. (and life insurance isn't that expensive compared to health insurance)

 

[DOanesthesia]

canada stinks as much as the US does

Just to clarify, Canada stinks much more than the USA. It always will.

 

[DOanesthesia]

I can live with a lower salary, if the government pays or reduces my debt substantially after I get out of medical school.

I can't. My salary is going to more than make up for any financial assistance the government would offer to reduce tuition.

Also, It would be great if Obama and clinton's system lowers taxes that physicians have to pay and gives other perks to physicians.

You're kidding right? They lump physicians into the wealthy category. That means higher taxes and fewer perks for physicians.

 

[digitlnoize]

I can't. My salary is going to more than make up for any financial assistance the government would offer to reduce tuition.

I keep wondering why people complain so much about the student debt. Granted, it'd be nice if med school was cheaper, but reducing salary is FAR worse.

If you're an Gas making 300k/year it will take 1-2 years salary to pay off your student debt completely. After that you're making 300k a year for the next, say, 18 years...for a total career length of 20 years...kinda short, really, but just for kicks...

So, full salary for 18 years: 300k * 18 = 5.4 million.

Compared with a 150k/year for the full 20 year career (because the government covered ALL of your schooling costs.)

150k * 20 = 3 million.

That's 2.4 million dollars you just lost! No thanks.

I think I'll pay for my own schooling, thanks.

That being said, I do think the government should start covering schooling costs for PCP's...otherwise we'll be in serious trouble soon...

 

[danzman]

This is a topic of great interest to me. After thinking about this for a while I tend to think that there is nothing fundamentally wrong with the system that we have, rather, you can cut the fat a little to save enough money to fund the whole system. This is how I imagine healthcare will change in the future as socialized medicine will never, ever work in this country (no one will be willing to pay taxes that high.) America has a great system for caring for large scale medical problems (i.e. little wait time for CT, surgery, etc’), but we screw things up by paying to much money for end of life care and for small scale problems (i.e. a trip to the er for a cold is 1500 bucks.) If I had my way, these are the things I think I would add.

Note, most of these are not original ideas, but just some good ones I’ve found along the way.

1. A universal electronic database (Id even be for the implantable chips) that would store medical records. Now every time you go to the ER they can see your entire history in seconds. This helps shore up the fractured care of today’s medicine, and keeps drug seekers out of the ER (“Oh I see you have been to three ER’s in the past week for your low back pain and requested Demerol…)
2. Set up tax based incentives for people who can maintain a healthy BMI. I can’t see it possible to take money from fat people, but maybe rewarding thin people would work better.
3. You want to be on Medicaid, you can’t smoke, period. If you want to have your medical expenses paid for by the government, you should be willing to give up it up. Family physicians must administer Cotinine drug tests every three months along with routine physicals for each Medicaid member over 18.
4. Twenty dollar upfront for every ER visit w/o insurance. If they can’t pay, they will be seen, but they must pay before they can come back. Every American can pay twenty dollars to see a doctor. And again, if they can’t, they just get billed.
5. Extra patient information about DNR’s to Medicare patients. I think more people would have them if they had the chance to get one and knew more about it. Would cut down on futile care.
6. Physicians have right to terminate end of life care and cannot be sued. This would help stop the “We want everything done to keep grandma alive” from the families of Medicaid/Medicare patients.
7. Open more urgent care clinics. Many areas do not have these and must rely on ER visits for late night vomiting and poison ivy etc’.
8. A huge revamp of the Medicaid system must be made in order to continue funding. This has to include some sort of way to curb unwanted childbirth for poor/high-risk teens as they are a huge burden to the system. Any ideas I have are pretty controversial so I’m open to suggestion.
9. The above cap on malpractice rewards based on life insurance is brilliant.

If you notice, most of these involve more patient interaction with a primary care doctor. This would help to increase FP salary and perhaps influence more new physicians to enter the field. Medicine in America is expensive, it always has been, and it always will be. And you would have to take a realistic approach to fixing it (not fairy tales like universal care with lower taxes) But, I think things like these and others can act to trim up some of the ludicrous spending and allow for more practical and efficient medicine. What do you think?

 

[I See You]

No offense, but this entire post made me cringe (literally).

how is that???

 

[BackupPlan]

Limiting recovery for malpractice to the amount of the injured person's life insurance is a dumb idea, because it misses the point of life insurance. People buy life insurance based upon the future needs of their dependents. That is, a college kid with no dependents needs no life insurance. Why? Because they don't have anyone who is depending on their future income. A married guy with two kids and a stay at home wife needs hundreds of thousands of $ of insurance to replace his income until the kids are grown up. A neurosurgeon with no kids and a $600K income needs no life insurance because there is nobody who depends on his income.

So if malpractice was limited to life insurance costs, a bad doctor could kill the college kid and the neuro and would have no liability. After all, the lack of life insurance means that the two dead people didn't value their lives, right?

Clearly it's a dumb idea.

And don't get me started on what happens to the guy who, at age 20, is wheelchair-bound after a doctor screwup and needs lifetime care 24/7. He'll need at least a few million to pay for that. But he has no life insurance, so he gets nothing.

While I agree that tort reform is necessary, it's the punitive damages that need to be limited, not the damages that are awarded for future costs. I also think that pain and suffering awards could be limited. But a blanket cap on malpractice liability is the worst idea. At least until doctors never make mistakes.

 

[digitlnoize]

Limiting recovery for malpractice to the amount of the injured person's life insurance is a dumb idea, because it misses the point of life insurance. People buy life insurance based upon the future needs of their dependents. That is, a college kid with no dependents needs no life insurance. Why? Because they don't have anyone who is depending on their future income. A married guy with two kids and a stay at home wife needs hundreds of thousands of $ of insurance to replace his income until the kids are grown up. A neurosurgeon with no kids and a $600K income needs no life insurance because there is nobody who depends on his income.

The point of life insurance is not simply to pay for the future needs of their dependents. There are many other valid uses for that money.

Let's take your college kid, for example: Just because he isn't married with kids doesn't make his death free. His parents will still have funeral costs, plus the mental health costs associated with losing a child. He should have life insurance to cover these costs. I had a $50k life insurance policy from birth onward...my mom would be a basketcase if I died and would need alot of psych care...The college kid should still have life insurance.

The same goes for the neurosurgeon. If I was making that much money a year I would at least spend some of it on a life insurance policy...dependents or no. #1: A guy making 500k won't be single... #2: If he his a big enough dork to still be single after making that much, he should get a policy and donate the money...say for a new wing of the hospital...If no one cares about this guy, who is going to sue for malpractice?

So if malpractice was limited to life insurance costs, a bad doctor could kill the college kid and the neuro and would have no liability. After all, the lack of life insurance means that the two dead people didn't value their lives, right?

Right. Good job. If they (or their loved ones) valued their lives, they would pay for life insurance...Family and friends will need taking care of...funeral costs and debts should be paid off...The lonely neurosurgeon with no friends or family should set up a scholarship, or start a clinic...or something...

And don't get me started on what happens to the guy who, at age 20, is wheelchair-bound after a doctor screwup and needs lifetime care 24/7. He'll need at least a few million to pay for that. But he has no life insurance, so he gets nothing.

This is what disability insurance is for. If he doesn't have that, then that's his problem.

While I agree that tort reform is necessary, it's the punitive damages that need to be limited, not the damages that are awarded for future costs. I also think that pain and suffering awards could be limited. But a blanket cap on malpractice liability is the worst idea. At least until doctors never make mistakes.

I don't believe that doctors should pay money for their medical mistakes. Doctors are human, and as such, they make mistakes. Criminal charges should be brought in cases that are malicious or true negligence. Civil suits should be capped.

This seems harsh, but part of the problem here is the idea that all lives are of equal "value". Are they? We shouldn't give someone 5 million dollars simply because they lost their legs. Were they a productive member of society prior to their loss? If so, there are ways of measuring their productivity, and compensating them in proportion to their contribution to the world.

How else does one value their own life besides through their contributions to the betterment of the world?

Answer: Life insurance.

 

[MaximusD]

I think it's possible in theory, but no one is approaching it the right way yet.

America is unique, and we need a unique solution to this problem. We won't be able to successfully copy other countries' programs.

I would like to see coverage for all, but to maintain that coverage the patient would have to meet certain "goals": weight loss, quit smoking, no drugs, moderate/normal alcohol intake, etc. I will NOT pay for someone else's treatment for their "smoker's diseases".

If we give healthcare away for free without any mandate for personal accountability, we are shooting ourselves in the foot. We (in general) are a fat, lazy bunch...why try to control your HTN if Uncle Sam will pay for your bypass surgery to fix your clogged coronary arteries?

Physicians, particularly FP's, should be paid based on the improvement and maintainance of their patients' health.

There should be yearly (or bi-yearly) health "inspections"...much like we have for our cars. Our cars must be kept in good working order, why not our bodies? If you don't pass, due to things in YOUR control, no free coverage for you.

I would like free coverage to only apply to preventive medicine. You should still have to carry normal insurance for hospitalizations, etc. I don't see ANY way to keep specialists' salaries up through UHC...

The insurance companies should be controlled tighter though. They are WAY out of hand. They should all be forced to become non-profit...no bazillion dollar salaries for CEO #2 while Mr Smith just got denied his operation...just doesn't make sense. "We can't afford to cover your operation, but we can pay our CEO 125 million a year."

I think Universal Electronic Health Records will help TREMEDOUSLY. Do any of you have any idea how much time is spent trying to find out what meds a person is on, what conditions they have, when they were last treated, etc. Not to metion the insanity of billing...

UEHR would lower costs by a huge amount.

Also, malpractice reform. No one should be able to be awarded a malpractice settlement worth more than the value of their life insurance policy. If someone has a $50,000 life insurance policy, that's the max they should be able to be awarded in a settlement.

If they think their life is worth 50k, why pay them more than that?

This would help dramatically with malpractice, which would help physician salaries by reducing overhead, as would the universal records system.

Done.

This is simply ridiculous. I will explain later.

 

[BackupPlan]

Answer: Life insurance.

Wow. There are so many issues with your plan, digitlnoize, that I simply don't have the time to address them individually.

Your bottom line is that nobody should care if doctors screw up because they're only human, and that if a person cares enough about their own medical care, they should essentially buy their own medical malpractice insurance in the form of life insurance?

I don't think you have any comprehension of the economic or personal implications of a medical "mistake". I don't think you have any comprehension of the costs of medical care following such mistakes. I don't think you have any comprehension of the devasating nature of many medical mistakes, deliberate or not. And I don't think you have any comprehension of the everyday struggle it is for most people to pay for health insurance, let alone topping it up with enough life insurance or disability insurance to cover a haphazard doctor.

We're not talking about a fender bender. We're talking about life-altering/ending occurrences that are the ultimate responsibility of the doctor, regardless of whether it was a deliberate mistake or just a "my bad!"

Sorry, but the best party to insure against those mistakes are the doctors themselves. Placing the burden of insuring against the mistakes of others onto anyone but the responsible party is one heck of a bad policy decision.

(Or perhaps you're not going to be a good doctor and you're preemptively trying to save yourself from the myriad of valid malpractice claims that you'll be subjected to..? Or are you a sleazy life insurance salesman?)

 

[digitlnoize]

Wow. There are so many issues with your plan, digitlnoize, that I simply don't have the time to address them individually.

Your bottom line is that nobody should care if doctors screw up because they're only human, and that if a person cares enough about their own medical care, they should essentially buy their own medical malpractice insurance in the form of life insurance?

I don't think you have any comprehension of the economic or personal implications of a medical "mistake". I don't think you have any comprehension of the costs of medical care following such mistakes. I don't think you have any comprehension of the devasating nature of many medical mistakes, deliberate or not. And I don't think you have any comprehension of the everyday struggle it is for most people to pay for health insurance, let alone topping it up with enough life insurance or disability insurance to cover a haphazard doctor.

We're not talking about a fender bender. We're talking about life-altering/ending occurrences that are the ultimate responsibility of the doctor, regardless of whether it was a deliberate mistake or just a "my bad!"

Sorry, but the best party to insure against those mistakes are the doctors themselves. Placing the burden of insuring against the mistakes of others onto anyone but the responsible party is one heck of a bad policy decision.

(Or perhaps you're not going to be a good doctor and you're preemptively trying to save yourself from the myriad of valid malpractice claims that you'll be subjected to..? Or are you a sleazy life insurance salesman?)

And maybe you're a sleazy tort lawyer...

We've gotten to the place we are in BECAUSE we are placing the burden on the doctors. This has lead to distrust between doctors and patients and skyrocketing medical costs. Seems like a great plan to me.

I am well aware of the devastating effect that a botched operation can have on someone's quality of life. However, the public fails to realize that things can go wrong in medicine for a multitude of reasons. Doctors should still be held to standards of care, but people need to stop looking at malpractice suits as a lottery ticket, and until that happens our health care system is stuck in a downward spiral.

Doctors and patients must regain one another's trust and that trust is being undermined by the current tort system.

People DO need to take responsibility for their lives and the consequences of their decisions. They need to purchase life, disability, and medical insurance instead of that new iPhone.

Regardless...I never said that this was the "be all end all" solution to the health care system. It's just some ideas from one person.

I'd like to hear other suggestions...good luck

 

[BackupPlan]

And maybe you're a sleazy tort lawyer...

Touche.

Doctors should still be held to standards of care, but people need to stop looking at malpractice suits as a lottery ticket.

I agree, although I don't think the vast majority of malpractice suits are without basis whatsoever. I think the AMA pushes its overbroad "the bad lawyers are to blame" position just as hard as the ABA pushes its overbroad "the bad doctors are to blame" position.

I'd like to hear other suggestions...good luck

Simple. Cap pain and suffering and cap punitive damages. Actual damages for actual losses (e.g. health care costs, future health care costs) that can be measured accurately and proven conclusively should be paid. If the doctor caused this harm (even by accident), then his or her malpractice carrier should pay. That's what insurance is for.

The "lottery" aspect to these suits comes in two forms - punitive damages that are there to punish the doctor (which are dumb, since the doctor rarely makes mistakes on purpose), and the good old pain and suffering uncapped damages where we read about pathetic money-grabbers and gold-diggers faking their injuries and pain. These should be capped at a reasonable figure.

This will have three positive effects. First, it will make sure that the doctors are held responsible for their errors, and it doesn't shift the burden to the blameless patient. Second, it will stop stupid sob-story awards for massive amounts of pain and suffering and punitive damages that don't benefit anyone except trial lawyers and greedy losers who play the system. And third, it will ensure that legitimate mistakes are properly compensated for (i.e. the injured party is placed in the as close to the same position as they were prior to the injury, not in a better or worse position.)

That's all that needs to be done.

Half the trouble is that the AMA is full of doctors who have been brainwashed into thinking that their profession makes them minor deities that can do no wrong and they should be exempt from all lesser-mortal things like accountability. The other half of the trouble is that the ABA is full of sleazy lawyers who aren't interested in making the system better - they're interested only in making the awards remain high so they can take their 33%.

As long as lawyers can take medical malpractice on a no-win no-fee basis, every idiot with a fake claim has nothing to lose by rolling the dice in court. And as long as lawyers can take their lucrative third of the winnings, they have no reason to change the rules. And as long as doctors remain unwilling to accept that sometimes they screw up and actually harm people and might have to actually give a damn about their patients, the AMA will have no incentive to meet the ABA in the middle and sort this whole mess out.

The one thing that I think is not a great solution is to require the regular joe on the street to have to bear the cost of the legal system and the medical malpractice system simply because the doctors and lawyers can't get their acts together.

 

[cofcemt]

2. Set up tax based incentives for people who can maintain a healthy BMI. I can’t see it possible to take money from fat people, but maybe rewarding thin people would work better.

Just have one thing to say about BMIs, they are an awful and often misused medical tool (if you can call it that) to guess at someone's life health. It misses almost everything important to gauge about a person; exercise regiment, what they eat, health history, muscle mass,...I work with many athletes that are considered "obese" or "severely obese" by the BMI, but have body fat percentages between 5 and 10%.

Also, your idea that a low BMI would then reward thin people,...oh goodness...just because you are thin doesn't mean you weight is healthy. You could have a very low BMI, but have a high body fat percentage because you never exercise and let your body waste away.

Sorry to go off, but generalizations like these are why people don't truly understand what constitutes a healthy human being.

Now, if you amended your statement to say that persons in a certain "healthy" body fat percentage range with inclusion of persons that do not smoke and have low personal risk factors (alcohol, body image, ...) then I might agree. Also, extensive personal histories should be taken and blood tests (ie. cholesterol, triglycerides, ....) should also be considered.

 

[Xoynx]

I think it's possible in theory, but no one is approaching it the right way yet.

America is unique, and we need a unique solution to this problem. We won't be able to successfully copy other countries' programs.

I would like to see coverage for all, but to maintain that coverage the patient would have to meet certain "goals": weight loss, quit smoking, no drugs, moderate/normal alcohol intake, etc. I will NOT pay for someone else's treatment for their "smoker's diseases".

If we give healthcare away for free without any mandate for personal accountability, we are shooting ourselves in the foot. We (in general) are a fat, lazy bunch...why try to control your HTN if Uncle Sam will pay for your bypass surgery to fix your clogged coronary arteries?

Physicians, particularly FP's, should be paid based on the improvement and maintainance of their patients' health.

There should be yearly (or bi-yearly) health "inspections"...much like we have for our cars. Our cars must be kept in good working order, why not our bodies? If you don't pass, due to things in YOUR control, no free coverage for you.

I would like free coverage to only apply to preventive medicine. You should still have to carry normal insurance for hospitalizations, etc. I don't see ANY way to keep specialists' salaries up through UHC...

The insurance companies should be controlled tighter though. They are WAY out of hand. They should all be forced to become non-profit...no bazillion dollar salaries for CEO #2 while Mr Smith just got denied his operation...just doesn't make sense. "We can't afford to cover your operation, but we can pay our CEO 125 million a year."

I think Universal Electronic Health Records will help TREMEDOUSLY. Do any of you have any idea how much time is spent trying to find out what meds a person is on, what conditions they have, when they were last treated, etc. Not to metion the insanity of billing...

UEHR would lower costs by a huge amount.

Also, malpractice reform. No one should be able to be awarded a malpractice settlement worth more than the value of their life insurance policy. If someone has a $50,000 life insurance policy, that's the max they should be able to be awarded in a settlement.

If they think their life is worth 50k, why pay them more than that?

This would help dramatically with malpractice, which would help physician salaries by reducing overhead, as would the universal records system.

Done.

Most intelligent suggestions I've ever heard for improving health care. Bravo! Refinements:
- Make UEH records optional, thus protecting the privacy rights of the paranoid. But make sure to bill them a surcharge for the time required for taking a hx.
- Brilliant to equate malpractice awards at life-insurance peaks. Trouble is, most people I know don't have any life insurance because they either can't afford it or are too young to think about it. Some standard values are required for the uninsured, but these should be no more than 5 figures.
- Insurance companies are responsible for the ridiculous costs of healthcare. If health insurance were banned, very few could afford the current rates. The market would force down prices until the majority could afford them--just as health care worked throughout history until the last century.
- Establish a medical equivalent to public defenders.

 

[BackupPlan]

Seriously, capping malpractice awards at the harmed or dead person's life insurance coverage is ridiculous.

1. Old and sick people cannot buy life insurance. It is too expensive. Old and sick people are also the most likely to need medical care. Docs would have a free 'screw up' pass for the elderly and sick.

2. This plan turns life insurance into malpractice insurance for all intents and purposes, except the people who are faultless pay for it. Doctors are the winners in that situation. Patients are the losers.

3. Like the poster above says, the idea is brilliant except that most people carry no life insurance. Translation - it works but for the fatal flaw. (i.e. it doesn't work).

Some doctor-carried malpractice insurance cannot fairly be taken out of the equation. It just doesn't work for anyone except the doctors.

 

[Ferrismonk]

Touche.

I agree, although I don't think the vast majority of malpractice suits are without basis whatsoever. I think the AMA pushes its overbroad "the bad lawyers are to blame" position just as hard as the ABA pushes its overbroad "the bad doctors are to blame" position.

Simple. Cap pain and suffering and cap punitive damages. Actual damages for actual losses (e.g. health care costs, future health care costs) that can be measured accurately and proven conclusively should be paid. If the doctor caused this harm (even by accident), then his or her malpractice carrier should pay. That's what insurance is for.

The "lottery" aspect to these suits comes in two forms - punitive damages that are there to punish the doctor (which are dumb, since the doctor rarely makes mistakes on purpose), and the good old pain and suffering uncapped damages where we read about pathetic money-grabbers and gold-diggers faking their injuries and pain. These should be capped at a reasonable figure.

This will have three positive effects. First, it will make sure that the doctors are held responsible for their errors, and it doesn't shift the burden to the blameless patient. Second, it will stop stupid sob-story awards for massive amounts of pain and suffering and punitive damages that don't benefit anyone except trial lawyers and greedy losers who play the system. And third, it will ensure that legitimate mistakes are properly compensated for (i.e. the injured party is placed in the as close to the same position as they were prior to the injury, not in a better or worse position.)

That's all that needs to be done.

Half the trouble is that the AMA is full of doctors who have been brainwashed into thinking that their profession makes them minor deities that can do no wrong and they should be exempt from all lesser-mortal things like accountability. The other half of the trouble is that the ABA is full of sleazy lawyers who aren't interested in making the system better - they're interested only in making the awards remain high so they can take their 33%.

As long as lawyers can take medical malpractice on a no-win no-fee basis, every idiot with a fake claim has nothing to lose by rolling the dice in court. And as long as lawyers can take their lucrative third of the winnings, they have no reason to change the rules. And as long as doctors remain unwilling to accept that sometimes they screw up and actually harm people and might have to actually give a damn about their patients, the AMA will have no incentive to meet the ABA in the middle and sort this whole mess out.

The one thing that I think is not a great solution is to require the regular joe on the street to have to bear the cost of the legal system and the medical malpractice system simply because the doctors and lawyers can't get their acts together.

I agree with most of this post, well said. I am a licensed life insurance producer (albeit not a practicing agent) and have a couple things to say in agreement with digitlnoize. Term life insurance is designed for the young (while you have little/no assets) and goes away when you are older (when you should have saved up some assets). Whole life insurance is just stupid and basically nobody should have it unless they bought it when they were young and are now no longer insurable. Life insurance should also only be bought to meet four needs:

1. Funeral expenses ($6-10K)
2. Pay off your debt so your decendants don't have to
3. Provide a replacement for your income so your family's life doesn't need to change after your gone (go back to work, etc)
4. Provide money to meet retirement/educational goals for your loved ones

Although tying malpractice payouts to life insurance seems like a nice idea (I've even said so earlier before I thought much about it), it really doesn't make a whole lot of sense when you understand why life insurance exists. Capping the amount of money awarded for "pain and suffering" makes more sense since that is where the huge payouts are and what ruins Doctor's lives, even though pain and suffering experienced is a very subjective topic.

I think another part of the problem is that normal laypeople are the ones who decide on the guilt/payout necessary for a malpractice suit. Does a normal layperson understand when a CT is warranted and when it is not? It would be nice if the jury actually understood what happened in the case. It'd be hard to do that without having all doctors on the jury though...

 

[scpod]

....The "lottery" aspect to these suits comes in two forms - punitive damages that are there to punish the doctor (which are dumb, since the doctor rarely makes mistakes on purpose), and the good old pain and suffering uncapped damages where we read about pathetic money-grabbers and gold-diggers faking their injuries and pain. These should be capped at a reasonable figure.

This will have three positive effects. First, it will make sure that the doctors are held responsible for their errors, and it doesn't shift the burden to the blameless patient. Second, it will stop stupid sob-story awards for massive amounts of pain and suffering and punitive damages that don't benefit anyone except trial lawyers and greedy losers who play the system. And third, it will ensure that legitimate mistakes are properly compensated for (i.e. the injured party is placed in the as close to the same position as they were prior to the injury, not in a better or worse position.)

That's all that needs to be done....

Your logic is somewhat flawed and here's why:

The only cases that lawyers have the incentive to file are the ones likely to make them a lot of money. The cases that have a lot of merit, where there really was true malpractice, don't get filed if they aren't worth a lot a money. There are plenty of suits filed where the doctors really didn't make mistekes, yet the insurance company will settle the suit instead of fighting it because it costs them less money. A trial costs a fortune. And, the doctor has no choice in the matter....the insurance company decides whether to fight it or not. So, the doctor can make no mistake, have a blemish put on his record, and have his rates raised all at the same time.

When lawyers decide to file a suit they will file against every single doctor who made a note in the chart-- even if they just consulted once. It costs the average doctor something like 40 to 50 grand to have his name removed from a lawsuit even if he had nothing to do with it. If you let your malpractice provider do it then you're sure to have those rates raised again-- and you still didn't do anything wrong.

The only way to make it fair is to scrap the whole thing and start again.

There should be a totally new system where people can file a suit on their own, for little cost, and medical experts can determine if it has merit. If it's determined to be frivolous, then it's droppped. If not, then a trial should procede. Let the court appoint lawyers and medical experts, who are paid at a fair market value for their services, and let the only people who make real money on this be victims who are truly wronged. Make it like jury duty for the doctors and lawyers-- if they get picked they have to serve for the betterment of the community. Payouts would be limited to actual damages and a small sum for pain and suffering. There would be no real financial incentives for anyone but the plaintiff and every mistake that has merit would be assured to go to court as long as the patient decided to file it. Seems fair to me.

 

[BackupPlan]

The idea of an expert review panel prior to allowing a lawsuit is excellent, scpod. By far the best solution posted here.

A board of three docs, three lawyers and three lay people would work really well. Nobody could say that the docs were looking after their own, the lawyers were looking after their own, or that the patients weren't given their day in court.

Is there any reason why this system couldn't be implemented? (Apart from the fact that lawyers might oppose it? But then again, it might bring a scrap of repute to their profession.)

Part of me knows that the insurance companies will find another way to charge high premiums still.

 

[scpod]

....Is there any reason why this system couldn't be implemented? (Apart from the fact that lawyers might oppose it? But then again, it might bring a scrap of repute to their profession.)...

I think it's unlikely simply due to the large number of legislators who are lawyers. It would take away their livelihood. Why would they vote for a system that would take money out of their own pockets? The problem with the cuurrent system, though, is exactly that. It's a system based on how much money the lawyers can make.