Healthcare Reform Thread II

[Arrian]

Explain to me why this is laughable.

It's laughable to me b/c I don't buy that "defensive medicine" will vanish with tort reform. I think the alleged benifits to it are overblown. I do think there would be some cost benifit, mind you.

I see tort reform as mainly (not solely, but mainly) about people hating on lawyers. Hey, it's easy to do. I get worked up sometimes too, but I just don't see it as a serious solution.

I will, however, read your link and see if it changes my mind.

-Arrian

[Arrian]

From the report you linked:

The study found that 83 percent of physicians reported practicing defensive medicine, and that an average of 18 to 28 percent of tests, procedures, referrals and consultations and 13 percent of hospitalizations were ordered for defensive reasons.

Ok, but being the skeptic that I am, I have to question the self-reporting going on here. Tort reform would obviously be benificial to doctors. Being smart folks, don't you think they have an incentive to exaggerate their defensive efforts? I do.

I don't doubt that it happens. I wonder, however, if those unnecessary, extra tests and whatnot would really go away under a fee-for-service system.

-Arrian

[Ramo]

You mean a fee per patient or fee per visit scheme?

[KrazyHorse]

The lack of universality is ALSO associated with a set of costs. The net cost associated with universality is the difference. The (admittedly speculative) argument I was making is that the net costs would decrease past the interval that the CBO scored.

WTF is up with this semantic horse****?

This isn't semantic horse****. This is an example of you throwing around terms which don't make any sense in the context you use them. That makes you extraordinarily difficult to follow.

The MedPac reform.

I could try to quantify that, but I don't have time right now.

So the only thing you've listed which might control costs is precisely what you don't have time to explain?

Uniformly increasing rates sounds crazier than increasing the rates nonuniformly (which might be justified due to a scarcity of certain specialists, depending on the circumstances).

Why would anybody think that anything Stevens did re Alaska was anything more than a money grab?

I suppose that's true. The marginal price may stay constant, but what about net expenditures? One of the hypotheses posited by the Dartmouth guys is that the variation in expenditures is largely set by the social norm. If the doctor is accustomed to treating a large number of patients who wouldn't be able to afford a certain set of procedures due to insurance constraints, the doctor would tend to use more affordable alternatives for all patients.

Which again gets us to the issue that Medicare does NOT currently effectively restrict health care on a cost-effectiveness basis, and never has.

Your entire argument seems to boil down to the idea that we'll try and move as many people into medicare/private insurers which follow medicare's remuneration practices and then we'll fix medicare so it works really well.

???

[Jon Miller]

I don't see what is wrong with some defensive medicine. I am sure that sometimes it catches something, often doctors only are good with what they have seen before, and if you have something they don't have experience with, they might misdiagnose you.

Defensive medicine I think would help fix that inclination.

JM

[KrazyHorse]

Also, given that the US Medicare & Medicaid administrators haven't been able to garner the political will to effectively mandate cost-effectiveness EVEN THOUGH ONLY A MINORITY OF AMERICANS WOULD BE AFFECTED, what makes you think that they would be able to do so in the face of the broader-based opposition which would arise when more people would be affected?

[Ramo]

So the only thing you've listed which might control costs is precisely what you don't have time to explain?

Because quantifying the effect would take some effort. Digging around google scholar. Not something I want to do right now.

[KrazyHorse]

There's actually good reason to believe that medical malpractice lawsuits lead to better patient outcomes.

[Ramo]

Also, given that the US Medicare & Medicaid administrators haven't been able to garner the political will to effectively mandate cost-effectiveness

They are. Their decisions are just consistently vetoed by Congress. Creating a political space act to independently of the 2-6 year time scale isn't exactly an impossible feat. We did that with the Fed, starting with Volcker. And that is even bigger.

[KrazyHorse]

Just give me the quick and dirty proposal, and how you think it will differ from the current medicare administration (in terms of the imposition of cost-effectiveness requirements)

[Ramo]

The entity responsible makes a set of recommendations to change Medicare. The plan has to either decrease costs or increase quality, and not increase aggregate spending. The plan is presented to Congress for an up or down vote, without amendment. The idea is that you're trying to change the default choice.

[KrazyHorse]

They are. Their decisions are just consistently vetoed by Congress.

I have no idea what you're talking about. Can you provide an example of Medicare decision to cease reimbursement for a given treatment based on cost-effectiveness concerns which was vetoed by Congress?

[Ramo]

This is not the specific kind of example you're talking about, but it's part of the theme. There's a rule to keep Medicare spending growth at GDP growth. Starting in 2002, it has been too high. Every year payments to doctors are scheduled to be cut. Every year, starting in 2003, Congress passes legislation reversing it. Last year, they were to be cut by 10.6%, but instead was raised by 1.1%.

http://www.msnbc.msn.com/id/31495588/ns/politics-capitol_hill/

[Ogie Oglethorpe]

I see tort reform as mainly (not solely, but mainly) about people hating on lawyers. Hey, it's easy to do. I get worked up sometimes too, but I just don't see it as a serious solution.

I will, however, read your link and see if it changes my mind.

-Arrian

Why not. I'm all for Universal Government Supplied Legal Care. Has the benefit of actually being referenceable in the constitution as a right of the citizens to due process and all.


I think lawyers legal fees should be strictly enforced.

[Guynemer]

Jon, regarding the stats you posted re: number of physicians...

It doesn't list neurologists, cardiologists, gastroenterologists, endocrinologists, nephrologists, dermatologists, pulmonologists, rheumatologists, geneticists, intensivists, infectious disease specialists, cardiothoracic surgeons, neurosurgeons, orthopedic surgeons, plastic surgeons, or several other types of specialists, nor the various and sundry pediatric flavors of the aforementioned.

Just to start with.