The Death of American Capitalism

[ClimbingPanther]

note: not in 'spray' forum, so while a little is OK, don't sidetrack this too much please

 

The US health care system is too expensive. I think it is an inherent weakness in capitalism, since the "demand" is often not quantifiable in dollars and the supply is severely limited. How much is your life and health worth? This is why we will always keep going to doctors, no matter what it costs us. Of course, when presented with an opportunity to make unlimited cash, a capitalist system will indeed find ways to generate that cash. Higher salaries for doctors? No prob, they're in artificially limited supply for many reasons, like licensing (which is a good thing that they're tightly controlled or we'd have bigger problems). Malpractice lawsuits and resulting malpractice insurance industry? Not going to cripple the industry b/c costs are just passed on to the customer. Where else are they going to go? This is the problem, that there is nowhere else to go, yet we must have the service offered and have no choice but to pay whatever is charged. There's no competition between doctors because there's not enough of them. Patients must compete for available doctors and often (older people esp.) must be willing to pay out of pocket since doctors have the luxury of choosing which customers can pay them the most.

[[[ personal side note: My grandma has obvious congestive heart failure, but literally no doctor would take her until someone opened a new practice recently, simply b/c she's Medicare and that doesn't pay well. When she finally got tested, she had a BNP of 2300. It's a wonder she's not dead right now. ]]]

 

Is there such thing as a healthy mix of capitalism and medicine?

What needs to change? More doctors to create enough supply to actually have such a thing as supply and demand? Many potential doctors don't practice b/c of malpractice, esp here in WA. I think malpractice lawsuits are a big problem and do not have the intended effect. Look at where the money comes from. The doctor doesn't pay a red cent, except like all doctors, he pays his premium and keeps on practicing, passing the bill for the premium on to the rest of us. So people get compensated for their injuries (not a bad thing) BUT the doctor is not put out unless he gets too many judgments against him. We are stuck with the tab, but not only for the victim's compensation... for massive lawyers fees too. This is not a good thing. It's a drain on the system. But that's just one thought I have. How bout some dissidents or alternative theories?

[jimlup]

My personal view is that fundamental care medicine and capitalism ultimately don't mix. The stakes are too high (life and death).

 

I support a base system that is universal health care. Then we allow a layer of capitalism - for profit care on top of the base layer. Clearly strong laws will be needed to enforce fair critical care for all. The expense is large but less than we are now paying privately. The malpractice issue is difficult but I think it could be solved by open minded people.

 

Right now we have a bunch of close minded elites controlling this debate. The health care industry is fighting with everything they have to avoid the single payer solution. It is ashame that they have grown so powerful since they are now standing in the way of a true solution.

[high_on_rock]

During the bush years malpractice rates have tripled, while malpractice verdicts have continued their long term steady rise of about five percent per year, so the two do not seem to be related. Seems to me that the republicans are trying to push tort reform while they have the power.

 

I fully support basic care for all, Cuba seems to manage such a system on it’s limited funding. Seems like our rich country could do as well. People put down the Canadian system because you have to wait in line for health care. We would probably have longer lines too if we let everyone get into the line rather than shove a third of the people out of line and tell them “sorry.”

 

Capitalism requires someone to suffer for the benefit of others. It requires one person skimming some of the wealth produced by someone else; the more you can skim the more wealth you create. For years we have outsourced the suffering to other countries for our riches, by allowing them to produce for low dollars what we then sell for high dollars. This does not work for health care any better than it would for education. Imagine an educational system wherein you had to pay private schools for your education, the poor would get nothing.

 

Clinton tried bringing in healthcare back in the old days and got hammered for it. I personally think the country is ready for it now, and would love to see our next round of democrats take up the cause.

 

[dmuja]

How much is your life and health worth?

 

If you contact an HMO they will tell you - they have those figured down to the cent.

 

Life is a business, it -like everything else- is a quantifiable commodity, nothing more nothing less.

 

Havent you learned this yet?

[jimlup]

While I expressed my ideals, but realistically, I don't think single payer has a snowball's chance in hell in America despite the fact that 75% of americans are in favor of such a plan. Mention the words 'single payer' and you get slammed down by the coorporate elite and health care coorporations faster than you can speak.

 

It is interesting to me how capitalism is the accepted ideal even in conversations between the so called enlightened. Capitalism basically sucks and doesn't work. This is particularly evident as the health care system moves towards a full fledged crises. The educated business classes know full well that capitalism doesn't work, they just use it as a convenient excuse when they need to oppress the masses.

 

I have a decent health plan but they just went under. Now my employer may offer a similar one but I've been starting to hear the words "health savings account" a lot more lately and I suspect that is where we are all eventually headed. Meaning that if the costs are too high - Oh Well, suffer.

 

I doubt the republicans are capable of meaningful tort reform. They always try too hard to feather the pockets of their buddies and the cooporate elite and it ends up screwing up anything they do that might marginally help.

 

Sorry, I'm rambling but the health care issue really gets me going. I went 10 years with marginal and sporatic coverage and I'm pissed about it. I don't think anyone should have to put up with that.

 

Now I can climb and not worry about health care. I had to get some things checked out this year as I get more serious about attempting some high altitude and difficult mountains in the next couple of years. I'm happy to have coverage but I certainly don't take it for granted. I go to a clinic that specializes in patients who don't have coverage, even though I don't have to, specifically to support it.

 

Anyway, thanks for your post.

[ClimbingPanther]

It is interesting to me how capitalism is the accepted ideal even in conversations between the so called enlightened. Capitalism basically sucks and doesn't work. This is particularly evident as the health care system moves towards a full fledged crises.

 

By both of our reasonings, yeah, it doesn't work for health care, but I don't think it sucks and doesn't work. I think it's beautiful when there is a normal case of supply and demand. The consumer driven market takes care of itself for the benefit of all with little oversight except for basic ground rules against improper use of the market by price fixing, monopoly, etc. The invisible hand massages the good companies and spanks the bad ones better than any government could.

[jimlup]

... I think it's beautiful when there is a normal case of supply and demand. The consumer driven market takes care of itself for the benefit of all with little oversight except for basic ground rules against improper use of the market by price fixing, monopoly, etc. The invisible hand massages the good companies and spanks the bad ones better than any government could.

 

Right, I understand your ideals. As you notice, free market capitalism is inherently unstable. But yes, I favor a form of responsibly monitored capitalism (coupled with baseline guarentees of food, shelter, healthcare and school). The problem is who does that monitoring? The people??? The elites consider them way too irresponsible.

 

As one of the people - I consider the elites (particularly those who control and manipulate the republican party) way too irresponsible!!!

 

From Adam Smith as discussed by Noam Chomsky:

 

"Beware the trappling roar of the bewildered herd!"

Edited December 23, 2006 by jimlup

[jimlup]

Further thoughts -

 

This issue is hitting the climbing community hard right now. Look at Everest. I just watched the discovery series final episode of "Everest - Beyond the Limit" and have been aware of the controversy surrounding the non-rescue of David Sharp.

 

Russell Brice is establishing an unstable monopoly of the north side of that mountain. He and Discovery channel recently got slamed by an editorial on the web:

 

http://mounteverest.net/news.php?news=15288

 

I think the editorial was unfair to Brice and that he is a "good guy" and a benovolent dictator who does the best he can on Everest. But, the problem with capitalism - and I think it is ultimately the root of what the mounteverest.net editorial was upset about - is that we can not guarantee the benovolence of the inevitable dictators who result from the instablities of capitalism.

 

Soon they will have a big Neon sign on the summit of Everest that says "Climb with Himex!"

[joblo7]

capitalism gets destroyed by unchecked greed.

 

the mass has to have some control of the elite.

 

as long as the mass knows what is going on.

 

if i was elite i would acquire all media outlets and keep them in the dark.

 

we used to have regulations to prevent this but they were changed.

 

if we go back to the constitution and follow it, we will make progress.

 

our governement can oversee, as long as we dont elect morons.

 

our democracy is eroded.we are closer to military rule than it appears.

 

 

we have to get back on course gradually, give the dems a strong majority so they can govern .watch them closely.

 

there are much better options but they are not on the table.

 

 

 

 

 

 

 

[archenemy]

note: not in 'spray' forum, so while a little is OK, don't sidetrack this too much please

 

The US health care system is too expensive. I think it is an inherent weakness in capitalism, since the "demand" is often not quantifiable in dollars and the supply is severely limited. How much is your life and health worth? This is why we will always keep going to doctors, no matter what it costs us. Of course, when presented with an opportunity to make unlimited cash, a capitalist system will indeed find ways to generate that cash. Higher salaries for doctors? No prob, they're in artificially limited supply for many reasons, like licensing (which is a good thing that they're tightly controlled or we'd have bigger problems). Malpractice lawsuits and resulting malpractice insurance industry? Not going to cripple the industry b/c costs are just passed on to the customer. Where else are they going to go? This is the problem, that there is nowhere else to go, yet we must have the service offered and have no choice but to pay whatever is charged. There's no competition between doctors because there's not enough of them. Patients must compete for available doctors and often (older people esp.) must be willing to pay out of pocket since doctors have the luxury of choosing which customers can pay them the most.

[[[ personal side note: My grandma has obvious congestive heart failure, but literally no doctor would take her until someone opened a new practice recently, simply b/c she's Medicare and that doesn't pay well. When she finally got tested, she had a BNP of 2300. It's a wonder she's not dead right now. ]]]

 

Is there such thing as a healthy mix of capitalism and medicine?

What needs to change? More doctors to create enough supply to actually have such a thing as supply and demand? Many potential doctors don't practice b/c of malpractice, esp here in WA. I think malpractice lawsuits are a big problem and do not have the intended effect. Look at where the money comes from. The doctor doesn't pay a red cent, except like all doctors, he pays his premium and keeps on practicing, passing the bill for the premium on to the rest of us. So people get compensated for their injuries (not a bad thing) BUT the doctor is not put out unless he gets too many judgments against him. We are stuck with the tab, but not only for the victim's compensation... for massive lawyers fees too. This is not a good thing. It's a drain on the system. But that's just one thought I have. How bout some dissidents or alternative theories?

 

From what I understand, there is no false doctor shortage and the threat of malpractice suits has a direct impact on those individuals chosing to practice medicine. This can most easily be seen in Obstetrics, where malprac suits are common and the awards are usually the highest (babies make people's decision making abilities go out the window). As a result, med students are avoiding that area altogether and now there is a shortage. Only when their salaries begin to raise enough to offset the threat of losing everything will there be more people willing to go back to this field of medicine will the supply start to reach the demand.

 

Furthermore, most med students graduate with a quarter of a million dollar school debt. I don't know about you, but man, I think that's mighty high. And MDs are in school forever, so they don't start paying their loans off for a long time. And they don't start out making huge dough, they have a earning curve just like everyone else. And when they do get into the big bucks, they deserve it. Fuck, I wouldn't want their job. Would you?

 

As for capitalism's shortcomings--sure they exist. But to talk about our system as if it is unfettered capitalism and to mention that we need some rules in place--well, that is just not the case. We live in a highly regulated system. And the health care system is under that right now, for better or for worse. And it sucks that folks can't all afford heart surgery. It really sucks. But in a socialist system, where healthcare is rationed, you gramma wouldn't qualify for help due to her age--regardless of what she could afford. Funny enough, she'd have to come to the US or a country like it to get care at her age.

 

I am not defending the system here--it's broken and we all know it. But let's be sure we examine the parts that are causing the problem and not dwell on things that are not really the root of the problem.

[ClimbingPanther]

I wouldn't want their job. Would you?

Ya

But let's be sure we examine the parts that are causing the problem and not dwell on things that are not really the root of the problem.

OK I got a little melodramatic esp. with the title, I just wanted to get some responses.

 

So my G-ma didn't need heart surgery or any huge thing like that...

Not a single family doctor would even give her an appointment no matter what the reason! As soon as you mention "medicare," doctors essentially hang up the phone.

 

Anyway, that was just to illustrate that the supplier is in charge of who he will supply, rather than the consumer in charge because he has a choice. An illustration that there is something very wrong and capitalism's foundation, free choice, is undermined in medicine.

 

So malpractice is one obvious problem... how to fix it? Victims of real wrongs should be compensated fairly, but their compensation should not involve limitless cash. There needs to be a reasonable cap on judgments since that money will inevitably come from you and me in the form of higher medical costs and because some fields of treatment are becoming grossly under-supplied as a direct result of this problem.

Is there any other way to stop the malpractice bleeding? Caps have already been proven to work in several states, including the great state of California. Why don't we have these laws yet?

[archenemy]

Just have time to address the medicare thing with my opinion:

 

I worked in a retirement home through college. Learned a lot of things. Also got a strong opinion on something in particular. Old people should get everything they need for free. Their healthcare should be covered. Their transportation should be covered. Counseling: free. Food: gratis. TV with 8 million channels and a remote control velcro'd to their hand of choice: Nada. These people paid into our system for over half a century. They fought the wars that defined our freedom. They wrote books and taught classes to educate us. We should show them a little fucking gratitude. Supporting them financially is the very, very, very least we are morally obligated to do. But hey, that's just me.

 

I'll give a little space here for the lawyerly types to chime in on the malpractice deal. I read a lot about it, but I think it will correct itself. We already see that beginning to change in the business world (according to Business Week; Jan 8, 2007). But again, I'll leave it to people with legal experience to add something of value here.

[tvashtarkatena]

OK, from a purely market driven system, here it comes: Single payer, government managed.

 

Why?

 

1) One nationwide system has greater buying power.

2) One data system...less loopholes, ambiguities.

3) 'Premium' service is still possible.

4) The economic friction of health insurance companies, which is responsible for the majority of high health care costs, is eliminated.

 

Let's go for it!

 

[mattp]

The argument you are looking for, Archy, goes something like this:

 

1. Insurance companies are largely behind the promotion of the idea that medical malpractice is causing a crisis in public health.

They want to reduce the cost of malpractice awards for obvious reasons (these are a big cost to them) but, where liability caps and other measures they have requested have been put in place, the insurance rates that doctors pay have not gone down.

 

2. Insurance companies are lying about the causes for systematic increases in insurance rates.

Multiple studies have indicated the real reason for higher rates that are complained about in this "malpractice crisis" is a declining return on investment. Most insurance company profit comes from investment, not from the premiums paid.

 

3. Medical malpractice lawsuits and awards are actually fairly consistent or dropping, not increasing, and costs related to malpractice are actually a tiny percent of the cost of operating a medical practice.

Statistically, there really has not been any huge spike in lawsuits and malpractice insurance is something like 3 pecent of a doctor's overhead, and 1 percent of the overall system costs.

 

4. Most malpractice is caused by a small number of doctors, and the "system" is not adequately correcting this situation.

Most people who complain about the medical malpractice crisis are the same people who generally argue that regulation and government bureaucracy is bad. However, where bad doctors are licensed to hurt their patients, we either need more regulation and government or oversite, or we have to let the "market" deal with the situation through allowing them to be held accountable for what they do.

 

 

Here's more info for you:

http://www.makethemaccountable.com/myth/RisingCostOfMedicalMalpracticeInsurance.htm

 

There are probably better sites out there, but I found this as the first or second hit when I typed "medical malpractice cost" on Google.

 

---

 

As far as "single payor" goes, I would much rather have the government running the system than insurance companies but then again I am one of those people who thinks the Post Office or those who built the Interstate highway system do a pretty good job and the insurance companies are not looking out for my interest.

[JayB]

Hey Matt:

 

iven the fact that no one is seriously proposing to implement a universal single-payer system at the moment, but there is some political momentum behind insurance/liability reform - do you have any ideas for reforms that would help alleviate some of the problems that you cited in your post?

 

I am kind of surprised that people across the country haven't taken more notice of the hybrid plan that they've just implemented in Massachussetts. Now, just like auto-insurance, health care insurance is compulsory. Children and the elderly are covered by the state if they aren't covered, low-income people are entitled to graduated subsidies, indigents are fully covered by medicaid - but able bodied adults that exceed a given income level must be insured. I think that this kind of plan makes a lot of sense, and I think that the fact that the risk-pool will now include more people who are less likely to require costly medical care will be especially helpful.

 

[mattp]

Jay,

 

You asked if I have "solutions" for the problems cited in my post, but in fact the thesis of the argument that I presented there is that there really isn't a big problem: the medical malpractice "crisis" is mostly a political decoy being waved about for political and business purposes. To the extent that this is a "problem," the "solution" lies with bringing real information and rational analysis into popular and public discussion.

 

You may or may not believe or agree with that argument. I'm sure there are some MD's on here that will say "I had to change my practice out of fear of liability" or "I'd never go into a high risk practice like Pediatrics because it has gotten so bad," but I think there is a fairly convincing body of evidence that the arguments I presented are more correct than not. I'd be interested if someone has other information or another way to look at the question.

 

I don't know much about Massachusetts' plan, but it might be a step in the right direction. The fact that, as you point out, few politicians are willing to speak in favor of "single payor" does not in my mind make it a bad idea. And, in fact, I think I've heard that most Americans actually support the idea. Like many other issues in the social development of this nation, whether in the area of civil rights, labor reform, or even prohibition, the politicians may one day find they are driven by popular support for a new policy.

 

Matt

[JayB]

The single-payer issue is a whole separate discussion, so I'll leave that alone for now. I certainly wasn't suggesting that you can reliably asses the merits of an idea by the magnitude of the public's support for it or rejection of it, only that you need to take this into account when discussing the political feasibility of a given idea or reform.

 

As far as the insurance issue is concerned, I'd agree with the notion that there needs to be better mechanisms to weed out incompetent practitioners, and more transparency with respect to physician evaluations. Right now it's quite a bit easier for people to get objective information on plumbers than physicians. This is a more complicated issue than it seems, as doctors that agree to treat severely-ill patients who need high risk treatments could be unfairly stigmatized unless some serious thought was given to how the information would be reported. In a case like this, I think that classifying surgeons according to the risk-profile of the patient population that they agree to treat would be better than a global comparison of all surgeons who practice the same specialty.

 

One thing that I think that you've omitted from your analysis is the costs associated with doctors ordering a more comprehensive battery of tests than they think is necessary or prudent as a precaution against getting sued. Judging from all of the Dr. gossip that I've been exposed to, this happens all of the time, and I suspect that the costs are hardly inconsequential.

 

I do think that there are some other things that could be changed. Placing reasonable limits on the length of time that someone has to bring a claim against a physician would be one thing. The prospect of being liable for claims made on behalf of babies that they delivered 18 years ago means that they have to carry "Tail Coverage" 18 years into retirement. At least this is the consensus amongst the people who I know who have considered that specialty. Some kind of pro-rated claims system coupled with a larger risk-pool funded by other means might be a better system. I personally think that this risk could be securitized and sold to people who are willing to bear it, in much the same way that insurance companies securitize and sell the risk from hurricanes via high-yielding bonds that get wiped out in the event of damages that exceed a certain threshhold.

 

These things do have quite an impact on medical students when they are deciding what specialty to pursue and where to practice.

Here's an excerpt from a med-student's forum:

 

"Originally posted by kem

 

 

Good question NewGuyBob! I have no idea as to the answer but maybe the insurance company that was covering the doctor at the time of the incident would still be liable?

 

Kem

 

Umm typically not unless you have occurence based malpractice. I don't know of any insurance companies that allow this for OB/GYN although there may be a few out there. With the standard malpractice you have to buy a "tail" coverage for when you retire or change malpractice carriers (this happaens actaully quite a bit, if you move or change jobs and your new group uses a different carrier). Tail coverage covers you basically forever although some sleazy companies are now only covering you for a defined period (1-5 years, which is obviously unacceptable in OB).

 

In OB these tails are very expensive as they are in any high risk specialty. Typically these run 3 times your annual payments. I know of OB docs that had tail coverage in the 150K range. With some of the states now having premiums in the 100k range their tails must be very high.

 

This just doesn't just affect retirement. I know one OB who can't leave a group that he is miserable with and move to another state because he can't afford the tail of over 100K. HOw many docs can come up with that type of cash?

NewGuyBob

01-17-2004, 12:30 PM

Goober said:

Typically these run 3 times your annual payments. I know of OB docs that had tail coverage in the 150K range. With some of the states now having premiums in the 100k range their tails must be very high.

 

Jesus Christ, I have no idea how anyone can pay this!! :wow:

 

That is insane! Basically I'll have to live looking over my shoulder for lawsuits until the day I die?!? :scared:

NOW, I'm starting to have second thoughts about this specialty. Hey I love Ob/Gyn, but this is to much to ask.

 

Is it even possible to pay 150K a year while retired?

 

I'll start to buy lotto tickets, if I win, then maybe I'll go into this specialty. DAMN!"

 

 

[high_on_rock]

I fully agree with MattP. The information I continually receive is that the cost of lawsuits has consistently increased about 5% per year, while the insurance rates doubled and tripled in a couple years. There is a correlation, but no cause and effect. This also correlates with the republicans gaining power; cause and effect? Also correlates with the insurance companies taking a big whack on 9/11; cause and effect?

[JayB]

It'd be interesting to read through an independent analysis of what is responsible for the dynamics of malpractice insurance pricing. In the absence of collusion, it seems like it'd be hard for an insurer to arbitrarily raise rates beyond those necessary to cover their potential liabilities without sacrificing market share to competitors who run the numbers and find that they can cover their liabilities and still turn a profit with lower premiums. I would be quite surprised to learn that what's responsible for driving premiums ever-higher are the evil masterminds sitting in the CEO chair at the insurers. I suspect that there's more to it than that. Greed has been with us forever, so if the rate of premium increases is substantially higher than the historical norm, the odds are good that other forces are at play here.

 

I'll also add that while it would be rediculous for anyone to claim that there are no bad doctors, and all malpractice suits are without merit, it'd be equally rediculous to claim that there were no lawsuits brought forward in cases where the claim has no merit. It's not a medical malpractice suit per-se, but one only need look at the example of silicone breast implants to see that it's possible to win a major legal victory in a case where the central claim has no scientific merit whatsoever. I think this points to a larger problem with using a jury of people who have no scientific or medical training whatsoever to make this sort of determination, but that's another topic all-together.

[high_on_rock]

Another aspect to look at is the number of lawsuits verses the number of outragious jury verdicts. I am just making up numbers here, but if we assume that there are 100 lawsuits filed statwide per day, 50 states, 250 days per year, equals 1.25 million suits per year nationwide (again, made up numbers). What do we hear of every year, 10 jury verdicts that sound completely outragious? I am not sure the system is broken.

[mattp]

Jay,

 

You need to read a little more carefully here.

 

First you thougth I was commenting on a "problem" and then you talk about how premiums have to cover payout for an insurance company to make a profit. You seem to have missed the part where I pointed out that, in fact, insurance companies are much like banks in that their profit comes not from the premiuims paid, but from their investing the money they handle. That is why they ALWAYS delay payment of claims, through the use of a multiple redundant claims process even if they don't contest or chip away at the given claim.

 

It is not evil masterminds that sit in the insurance company CEO chair. They are bean counters. And thy have a PR arm and a political lobby that serves their bottom line just like any other large business. There's nothing wrong with that, but you have to take their press releases and op-ed pieces with a grain of salt. And it is not necessary for there to be active "collusion" for the industry to embark on a campaign that is in their interest, but which is not necessarily truthful.

 

As to the other part of your post - that about frivolous claims - I can only say that from my own experience it is far more common for valid claims to be defeated or "compromised" than it is for frivolous claims to bring large awards. I agree that there are problems with using juries of people lacking scientific or medical training, but in fact I bet the deficiency of the training in these "factfinders" weighs in favor of lower liability more than it does in favor of greater. Take a quick poll on any street corner and see how many people will say "most lawsuits are frivolous" as compared to how many will say "Most lawsuits have merit."

 

You are constantly calling me "paranoid" or expressing your disdain for the latte sipping metrosexual. Today, at least, I think you could benefit from sipping another latte and being paranoid enough to at least read and respond to the posts that you are arguing with.

[mattp]

Another aspect to look at is the number of lawsuits verses the number of outragious jury verdicts. I am just making up numbers here, but if we assume that there are 100 lawsuits filed statwide per day, 50 states, 250 days per year, equals 1.25 million suits per year nationwide (again, made up numbers). What do we hear of every year, 10 jury verdicts that sound completely outragious? I am not sure the system is broken.

 

I think you are on to something here, Mr. High. We have been hearing misinformation for years about the outrageous McDonalds hot coffee verdict because there really are not that many outrageous verdicts to complain about. Read the actual story behind the McDonalds coffee case, and you may or may not conclude the verdict was out of line, but the fact that we are still hearing about it ten years later speaks volumes.

 

I'm not arguing that our legal system is perfect, or that there are no outrageous or unfair results, but I do think it is the best system that we have and those who argue for tort reform have never presented a better alternative.

[JayB]

This is a sidebar, but under a single-payer system, I assume that the government also assumes responsibility for all of the costs associated with medical liability. I am not sure how it could be otherwise, but maybe someone can enlighten me here. Even if the premiums come out of the physicians' salaries, it's not terribly hard to see where the money to pay the premiums is ultimately going to have to come from.

 

One of the grander ironies of a single-payer system is that I suspect that few lobbies would fight more rabidly against its implementation than the trial lawyers. If the government actually assumed liability for medical malpractice under this system, suddenly the light would go on and there'd be a broad recognition that "Hey - the people who bear the costs associated with medical liability are...us." I suspect that shortly after this epiphany, you'd see an almost immediate imposition of caps on liability claims, and there'd be precious little opposition to their implementation. Bye-bye spectacular settlements, or any settlements beyond those specified in the spread-sheet, for that matter. Same costs, borne by the same people - anyone who pays for medical care - but now made more concrete by the absence of any intermediaries.

 

I suspect this is the primary reason why these caps on payouts are a frequently found in conjunction with single-payer systems. This might also give people who think that attorneys that earn their living in the realm of medical practice actually play an important and constructive role in insuring that patients actually get quality care something to think about with regards to a single payer system. If you get hosed by a doctor in a single payer system, what recourse do you have?

[JayB]

BTW - I know where insurance companies make most of their profits, so the problem must have been with my writing rather than my reading.

[mattp]

I'll have to think about that one, Jay, but you may raise a signficant point about the relationship between a single payor system and the personal responsibility of individual providers. However, I'm not sure that there is no responsibility for or a lack of accountability for imprudent or substandard performance if we look at the government directed interstate highway system, public utilities, or other similar institutions of our "socialist" society.

 

If the trial lawyers took it in the shorts due to the adoption of a single payor system, I bet most attorneys and most Amercian citizens could handle that result.