Insurance companies are by no means lily-white. And our current system literally punishes people who take preventative care seriously with high deductibles, etc. Think what an incentive there could be to take preventative health seriously by rewarding healthy people with a small dividend if they don't reach their deductible, etc. There are lots of small areas that could be improved in this regard. I agree there are differences. But think about it this way: if there is an even greater mandate for public education than there is for public health care - think how much more likely we are to miss our targeted goals on health care than we are on education. And excuses for educational performance aside - I am aware of private schools (that do not cater to "elite" kids by any means - even offering admission to kids with special needs, etc) that do a better job educating kids for a fraction of the per capita cost in public education. Consider how fractious and politically correct the entire debate about public education is - phonics, school discipline, testing, all of the unions and personnel issues. Do we really want to embark on a project that will bring more of these types of dilemmas into play in regards to health care?
Re: Tort Reform You hear what you want to hear. Instead of trying to fix the health care system, I just hear Reeps talking about how tort reform and trial lawyers are the only ones to blame while placing no responsibility on insurance companies, hospitals or pharmaceutical companies who create the systems. Your issue here is with the right to a jury trial. What is it about the Bill of Rights that you think is so bad? Most states have caps. Fair enough. Remember, the focus of my comment is on insurance companies that settle claims and then complain about the high cost of settling claims. The only analogy of yours I can come close to would be if you paid your mechanic then lobbied your local leader to rezone his business as retribution for the cost of getting repairs. There is some basis of truth to this, but if I cited to you the low numbers of philosophy professors because of the riskiness of practicing philosophy would you not just answer that the nature of the profession is not as profitable as others so fewer people do it? This is a political stunt and a violation of their Hippocratic Oath. Actually, I think it is the reverse. More mistakes likely were made. How many still births do you think there were in the 1800s compared to today? We keep improving the odds by improving the science. This makes mistakes less acceptable, too. What I would ask is where is the statistical correlation between high Ob/Gyn premiums and malpractice awards? I don't mean to make light of the issue, as the OB/Gyn issue is a public policy issue. However, it frustrates me to talk about the demands of rural health care solely with the focus placed solely on slick city lawyers, rather than the demands of rural health care.
Re: Tort Reform Bologna. I have stated (above) that there are many other reasons for high health care costs. Republicans (though not all right-wingers) have offered lots of other ideas for combating rising medical costs - including health savings accounts that provide portability and pay-as-you-go care. A necessary check in the current environment. But democrats frequently refuse to play ball. For them it is all or nothing. Insurance companies are trying to play the game like it used to be played, without being flexible and adjusting to a different climate. But they resent having to compensate for millions of uninsured accessers of health care who simply don't pay. Medical/pharmaceutical companies are both greedy (by overcharging US customers) and philanthropic (by undercharging foreign customers) at the same time in order to fund the research and development costs and maintain the inflow of capital from their investors that is essential if they are to remain competitive. Nations like Great Britain and Canada have ceased to be movers and shakers in the area of medical research because they can no longer afford it. Left-wingers need to recognize the critical role that profit-earning USA medical and pharmaceutical companies play in contributing to increases in research and development. If it were not for Germany, Japan, USA and Australia; medical R&D would stagnate tremendously. This is not an easy dilemma to solve. These companies charge foreign customers much less for the same product in the US. But the alternative (denying to provide the product at a reasonable cost) would bring them just as much criticism. So far, the US has been able to afford an inflated price. Our market simply isn't willing to bear that extra premium any longer. I am not opposed to jury trials. But judges need to do a better job of instructing juries regarding the law and reviewing the decisions of said juries. I am also very encouraged by the increase in lawyers who specialize in pursuing legal malpractice. And that is a start. We are never going to agree on this issue. Sure insurance companies settle. You and I both know why this happens and it frequently has nothing to do with providing a just compensation for a legitimate complaint. It is also statistically verifiable and reveals the character of the average plaintiff's lawyer in our era. Besides, doctors are permitted to refuse treatment for other reasons. Okay - then do your best to factor out technological improvements and isolate physician error as best you can. I doubt there is an appreciable difference in mistakes being made now over the past. But mistakes are punished now in a way that they were never punished before. And because of an alteration in the mentality of society (and juries) doctors are being held accountable for performance that would not have been considered "mistakes" in the past. The second paragraph answers the first. There is not a compelling unanswered demand for philosophy professors. There is for OB/GYN doctors. But the demand is not being met because tangible and intangible costs are too deemed too high by those who are qualified. They are not holding out for more money - they are holding out because the system is way too likely to give them a raw deal.
1. If you've noticed how often I post during working hours, then you realize there's no "maybe" about it. 2. I thought of your point, and I tried to write my answer to acknowledge it, but apparently didn't succeed. The two things are different. Just agree with me.
Re: Tort Reform If the statistical difference is moderate, it probably reveals their access to legal advice. Oh PLEASE!!! If you had any idea how often I've been chatting up some chick, and I say, "What do you think about Kant," and then I get slapped and hear, through the ringing in my ears, "I know you're never seeing mine!"
I've got nothing to add here. I just want to bump your post because it's so friggin brilliant. BWAHAHAHAHAHA!
Here in Australia we have a split system. There is a national health system which is paid for from a tax levy (1.5% of everyones income tax goes to it). Everyone gets free treatment in a private hospital (but not a private room or choice of doctor) , free optical etc, and subsidised GP fees (some GP's just charge the "scheduled fee", meaning its free to the patient, others charge overs, so the patient needs to pay extra). All life threatening illnesses etc are treated very quickly - elective surgery (eg. knee reconstructions) have waiting lists. Also, there is a private health insurance, private hospitals etc. These get you elective surgery quickly, or you can go to a public hospital as a private patient - own room, own doctor etc. If you earn over $50,000 and don't have private insurance, you get slugged extra tax. Also, the older you are when you take out private insurance, the more it costs (ie. a 60 year old who has had private insurance all their life pays a lot less than a 60 year old taking it out for the first time). We had our first child in a private hospital, second in a public hospital as a private patient. I had my appendix out privately, and my daughter had her tonsils out privately. All cost basically nothing - a few bucks for anaethetists fees.
The health care system in this country is clearly broken. The only issue is wether universal health care is the solution. I tend to think it isnt, that you can keep it in private insurance and increase the coverage tremendously, covering the bottom with government aid. But those types of issues need to be seriously addressed, and special interests politics prevent that. Bottom line is I think the system is going to have to completely break down before we get any movement on things. Its close, but not there yet.
Re: Tort Reform Either you have adopted Republican political tactics, or you just are unable to discuss both sides of an issue. HSAs have a very real potential for creating adverse selection. In fact, they are designed to do just that-- attract young, healthy workers and older, richer workers out of conventional health plans. If you want to tout HSAs as being part of the solution, then you have to acknowledge that if they are successful, the second part of the solution is figuring out a way to shore up "traditional" health plans when you separate out the healthy from the actuarial pool. I'm sure you must not have looked at John Kerry's proposals for health care reform, nor John Edwards in the primaries, as they are VERY far from all or nothing. In fact, Edwards' plan was as moderate as you could get with very little structural change. Kerry's plan does exactly what I discussed above, seeking to shore up traditional health plans by providing a government safety net that ensures the sickest people are always covered, while more conventional medical expenses remain the domain of private insurance. Do you know which lobby was most strongly behind the HSA portion of the Medicare drug bill? Insurers constantly try to set up the system, whether through change or resisting change, to favor their profits. That's their duty under securities laws, but it should not be the guiding principle for public policy. I encourage you to review the 10-K filings of any pharmaceutical company and compare the amount of money spent on "R&D" to the amount of money spent on marketing. It is out of proportion. Not to mention that some expenses classified as R&D are really just thinly-veiled marketing schemes to doctors. By example, the editor of the New England Journal of Medicine is publishing a book in which she documents that many "research studies" submitted to the Journal were thinly-veiled attempts to tout a new spinoff drug. R&D is a great thing, but again, let's look at both sides of the issue instead of pretending that Big Pharma is a white knight. I don't know the answer to this question: What do you think is the proportion of foreign sales to U.S. domestic sales for most drugs? It seems the basis of this argument is that the only place pharmas earn a profit is from US prescription sales. I doubt that is true, it is just that here they make a LARGER profit. Meaning there's room for compromise. Importing drugs would bring market pressure on the companies to lower their prices here. I would LOOOOOOOOOOOOOVE to hear your theories on jury instructions and the standard of review for JNOV motions. Why do you think our current system is suddenly incapable of doing what it has done for the past 200 years? . . . Refusing to treat plaintiffs lawyers and their families is a cynical political ploy. It violates the doctor's Hippocratic Oath. I'm not sure that anything other than common sense answers this question. Certainly you don't need a study to accept that fewer babies and mothers die in childbirth than did in the 1800's? You also don't need much to realize that the "standard of care" changes with technological improvements. If you went to a physician who decided to bleed you with leeches would you accept that and blame the medical malpractice system for holding that doctor accountable for his/her performance? The fact is if a condition is preventable, it is now less acceptable for a doctor not to prevent it than it was in the past when it was not preventable. Fetal Heart Monitors make it inexcusable for a physician not to recognize an infant in distress. Yes, that means that when a physician makes an error the punishment is more severe than 40 years ago before FHMs existed, but then again, the error is also more inexcusable. It is never going to be possible to discuss a matter when you ascribe only noble purposes to one interest group and only evil purposes to another interest group. If OB/Gyn practices paid more than oncology/neurology/etc., etc., there'd be no shortage. If the only thing missing from top-notch health care in rural areas was Ob/Gyns, the issue would be addressable. There's a lot more to that issue.
Yet Canadians would rather go to the US and spend money for the treatment they need rather than wait months in a Canadian Health Care system. There is already a case before the Canadian Supreme Court in which a man is using the Charter of Rights to gain access to private care in Canada.