Healthcare speech last night

[MarissaNicole]

So I thought I'd start a discussion - I often find your debates quite insightful because you often point out things that I hadn't thought of ....

My two cents... overall I thought it was a pretty good presentation, I liked how they had the President's speech followed by the doctor/republican speech.

I agree that we need reform but I would prefer if they would properly categorize it as "insurance reform" rather than heathcare reform. Also although I agree in the end goals I don't think that the means to get there is necessarily realistic. Things often look good on paper but are hard to pull off in real life. My biggest concern is that I don't think government is necessarily efficient in its spending so why will this program be any different? In Illinois we are following in the footsteps of California, living in the state capitol I see first hand how inefficient our state can be!

Oh and the one thing I don't necessarily agree with is the "tort reform" - I do believe in safe guards and making it more difficult to file suit but not necessarily in capping damages per se (or if they did put a cap on damages I would like to see insurance premiums for doctors drop).

So ladies and gentlemen of MSN - educate me and tell me what I am missing!

[SoonerTexan]

I'd like to hear what you all have to say, as well.

I really have no idea what they are trying to do, and how it could possibly affect your spouses as doctors

[GrayMatterWife]

Thoughts on the speech:

-Extremely partisan and, weirdly, seemed kind of crybaby--those mean old conservative talk radio people are picking on us. He called it "his" health care plan, but didn't explain which version of the House bill he was talking about.

-Claim that his plan will not run a deficit, while also offering more coverage to everyone; it defies common sense--he claims that "reducing waste" will mean make the program function in the black. Ah, yes...and the federal government has such a stellar record of being able to make things function in the black. As one commentator noted: "Why would anyone believe this is better? The federal government promises the compassion of the IRS, the efficiency of the post office, and the financial viability of social security."

-Then there was a super-weird moment where a Republican Congressman could be heard--shouting, "You lie!" to the President after he promised that his program would not insure illegal immigrants. It seemed undecorous. In response, Nancy Pelosi looked like she was going to spit fire. It was kind of funny for that--it showed how she honestly can't handle anyone violating what she believes she is entitled to--complete compliance. Then, afterward, the Dems complained later about how awful it was to insult the President during his speech. The same party that boo-ed down President Bush during one of his State of the Unions. The same party who members called Bush a "liar"--openly on the Senate floor. Whatever. Everyone should have better manners, but please--it's all a lot of the pot calling the kettle black.

-He acknowledge that tort reform would be helpful, but made no promises about actually affecting any tort reform.

-As a capper, the President invoked the name of Teddy Kennedy, to explain all of us why his version of health care reform is a moral imperative. Yes, that's right: Teddy Kennedy is now the standard of morality and righteousness.

I can't imagine that this speech persuaded anyone of anything. Maybe he feels the same way--ten hours after he spoke to us, for the nine jillionith time since he took office, he scheduled yet another last-minute speech about health care. Around 9:00 AM (Central) this morning, he trotted out some nurses who blubbered on about he was their "hope" and then he used this as evidence that he was on the moral high road.

[Pollyanna]

Oh and the one thing I don't necessarily agree with is the "tort reform" - I do believe in safe guards and making it more difficult to file suit but not necessarily in capping damages per se (or if they did put a cap on damages I would like to see insurance premiums for doctors drop).

Frivolous lawsuits for outrageous sums are what forces doctors to practice defensive medicine and causes healthcare costs to skyrocket. I highly doubt the dems would push for any type of true tort reform as trial lawyers heavily support their campaigns. Its a joke to say that the government will fund this reform without increasing the deficit. Seriously, if they can save billions from Medicare waste and fraud then let's do it FIRST. He seems to continue to ignore the CBO numbers (a non partisan group).

Did anyone notice that the number of uninsured went from 46 million to 30 million last night. I guess they decided to drop the illegals from the discussion (of course they'll still be covered but the are currently hurting the house bill so they will remove them from the debate for now).

ETA: I loved Dennis Miller's analysis.

[TulipsAndSunscreen]

Frivolous lawsuits for outrageous sums are what forces doctors to practice defensive medicine and causes healthcare costs to skyrocket. I highly doubt the dems would push for any type of true tort reform as trial lawyers heavily support their campaigns.

Completely agree. If pharma has to make concessions (they already have) and insurance has to make concessions (they WILL be forced to), then why don't tort lawyers?

I also think there should be something about personal responsibility baked in but I realize that's unpopular. In my opinion, if I am above a certain financial threshold such that I can afford to make certain lifestyle choices (like healthy food options), I think I bear some responsibility for keeping myself in reasonable physical shape (notice I don't say thin, I just mean reasonably fit). I don't believe taxpayers should take on the responsibility of people making poor lifestyle choices IF those people can afford to select better options. I feel the same way about the impact of smoking. Why should the public pay for your treatment after you poisoned yourself. In my opinion, no one under the age of 30 should be smoking. You've known your whole life it's bad for you, cut it out! But I realize that's not likely going to happen and that's it's not a popular position.

[MarissaNicole]

I also think there should be something about personal responsibility baked in but I realize that's unpopular. In my opinion, if I am above a certain financial threshold such that I can afford to make certain lifestyle choices (like healthy food options), I think I bear some responsibility for keeping myself in reasonable physical shape (notice I don't say thin, I just mean reasonably fit). I don't believe taxpayers should take on the responsibility of people making poor lifestyle choices IF those people can afford to select better options. I feel the same way about the impact of smoking. Why should the public pay for your treatment after you poisoned yourself. In my opinion, no one under the age of 30 should be smoking. You've known your whole life it's bad for you, cut it out! But I realize that's not likely going to happen and that's it's not a popular position.

It makes sense... if you are a high risk driver or if you live in a home that is at high risk for flooding they charge higher premiums.... so if you CHOOSE to smoke when you have high cholesterol and are overweight it would make sense that you have to pay more...the only problem is where do you draw the line with what things are a result of peoples choices and what are genetic factors? (ex: being overweight, is that a choice? and how do you even make the determination as to what is overweight?)

[madeintaiwan]

Oh and the one thing I don't necessarily agree with is the "tort reform" - I do believe in safe guards and making it more difficult to file suit but not necessarily in capping damages per se (or if they did put a cap on damages I would like to see insurance premiums for doctors drop).

What is the price of a life? 10k? 1 million? 40 million? I definitely think there should be caps. And I think awards should be along the lines of, if the patient can no longer work or function then monetary compensation should be along the lines of providing them the funds to maintain a STANDARD quality of life including necessary medical care as a result of the "mishap."


Off subject, I definitely believe in relief programs but it is so frustrating when you hear about subsidized housing in the form of a 4000 sqft home. True story, right down the street from my mother. I can support providing a standard of living, not LUXURIES. Awards for medical "mishaps" should be the same. Most "mishaps" are not a result of gross negligence. Preaching to the choir, but there are risks to any procedure and I don't think that entitles anyone to monetary compensation when the case happens to go the other way.

I was bleeding like crazy after my last c-section and spent the next two days drained out of my mind. It's a risk of the surgery. I'm just glad that it turned out well.

Frivolous lawsuits for outrageous sums are what forces doctors to practice defensive medicine and causes healthcare costs to skyrocket. I highly doubt the dems would push for any type of true tort reform as trial lawyers heavily support their campaigns.

I agree with this.


I'm disappointed that there wasn't more mentioned about insurance companies. I think more needs to be done to control the ridiculous practices of insurance companies. If you pay your premiums, insurance companies should pay your physician. And not two months later. I don't know what's up with the 15-20% of their funds going to push paper and to pay for panels that are set up to deny recommended and often absolutely necessary procedures. I also agree that there should be some personal responsibility in there too. If health care is a right, then there should be the responsibility to try your best to take care of your health. Hell, if health care is a privilege, there's an obligation to do right by that privilege.

The whole thing makes my head hurt.

[Rapunzel]

Thoughts on the speech:

-Extremely partisan and, weirdly, seemed kind of crybaby--those mean old conservative talk radio people are picking on us. He called it "his" health care plan, but didn't explain which version of the House bill he was talking about.

-Claim that his plan will not run a deficit, while also offering more coverage to everyone; it defies common sense--he claims that "reducing waste" will mean make the program function in the black. Ah, yes...and the federal government has such a stellar record of being able to make things function in the black. As one commentator noted: "Why would anyone believe this is better? The federal government promises the compassion of the IRS, the efficiency of the post office, and the financial viability of social security."

-Then there was a super-weird moment where a Republican Congressman could be heard--shouting, "You lie!" to the President after he promised that his program would not insure illegal immigrants. It seemed undecorous. In response, Nancy Pelosi looked like she was going to spit fire. It was kind of funny for that--it showed how she honestly can't handle anyone violating what she believes she is entitled to--complete compliance. Then, afterward, the Dems complained later about how awful it was to insult the President during his speech. The same party that boo-ed down President Bush during one of his State of the Unions. The same party who members called Bush a "liar"--openly on the Senate floor. Whatever. Everyone should have better manners, but please--it's all a lot of the pot calling the kettle black.

-He acknowledge that tort reform would be helpful, but made no promises about actually affecting any tort reform.

-As a capper, the President invoked the name of Teddy Kennedy, to explain all of us why his version of health care reform is a moral imperative. Yes, that's right: Teddy Kennedy is now the standard of morality and righteousness.

I can't imagine that this speech persuaded anyone of anything. Maybe he feels the same way--ten hours after he spoke to us, for the nine jillionith time since he took office, he scheduled yet another last-minute speech about health care. Around 9:00 AM (Central) this morning, he trotted out some nurses who blubbered on about he was their "hope" and then he used this as evidence that he was on the moral high road.

I didn't watch it. But, I enjoyed your analysis. I'll have to track it down now because the mental images your post gave me were pretty entertaining....

[Rapunzel]

Something interesting that dh mentioned to me today:

Tort reform is financially harmful to ONE specialty: radiology.

It's necessary to bring down costs (tort reform, that is) - but we (radiologists' families) will be the ones taking that bullet for everyone in the nation (because our incomes will substantially drop with many less "cover-my-butt" studies being done).

Just an interesting little fact that I hadn't thought of....

[Deebs]

I think it's funny that it's even been brought up that illegals won't be covered. I assure they already are and will continue to be - if they don't have coverage and can't pay, their primary provider is the emergency department. As long as EMTALA exists, that will be the case.

For anyone who has not lived in an incredibly hostile med-mal environment, I will tell you some of the reason that tort reform is necessary. While it hasn't been shown to decrease malpractice insurance rates in the states that have it, it has allowed some providers to remain. Illinois has tort reform, which I would not model another reform after, but it has worked to an extent.

When DH was in medical school in IL (and I was working in health care administration), we literally saw the "brain drain" occur. Trauma surgeons, neurosurgeons, EPs, OBs, and anesthesiologists didn't just see their insurance rates soar, they saw themselves dropped by their carriers over and over again. Many docs left the state for neighboring states to practice in (many Chicago docs moved practices to Kenosha, WI), others had to move to locums work. I was in a hospital in northern IL where we had a helicopter, and were flying trauma patients in from over two hours away, by car, because we had the ONE trauma surgeon left in the area. It was crazy, scary, and left the population with a huge threat to their health. Twice, I came in to work on a Monday to find that we had docs who pulled their own privileges effective immediately because they had been dropped by their carriers literally overnight.

If tort reform hadn't happened in IL (and we're still waiting for it to be overturned, as it has been in the past here), DH and i would not be here. We have older physician friends who are in practice and have been for years who are upset that DH would come back to the state because they think that well-trained docs should stay out to prove a point that you can't just resume to business as usual once you pass a reform. We left OH, though because the reform there is no longer stopping as many lawsuits as it once was, and DH was tired of how defensively he felt he had to practice.

DH won't practice in Cook County (Chicago's county) because that's where many big lawsuits have been filed and won and we know docs who will never practice the same as they did because of it. He's literally afraid to practice there (and we have three friends there who were named in suits in the last month, so that doesn't help).

While many believe that you can't be sued for more than what your insurance will pay out, I worked with docs who were. These people had to sell homes, cars, and other personal possessions to pay what was beyond their coverage limits.

I'm guessing that the reason that Obama even brought up the possibility of looking at malpractice protections is that the AMA has started pulling support for the reform plans after they had a HUGE loss in membership once they endorsed it. Or, maybe it will make it look more bipartisan.

Okay, I think my pregnant mind is rambling, so if I don't make sense, ignore it, but I don't know how you can completely ignore some kind of med-mal protection or reform if you are going to call this plan health care reform.

I thought the speech showed great leadership. I sincerely hope our congressmen can come to some consensus and pass a bill that will at least begin to address some of the very serious problems with our system.

Tort reform: My problem with caps is not that they are bad for trial lawyers and radiologists but rather that they are bad for the most severely harmed patients. Sometimes mistakes do happen, and if that mistake causes injury to a patient that will necessitate ongoing medical treatment for the remainder of that patient's life, should the patient bear the cost after the cap amount? 250, 500, 700K doesn't go very far for the most severely injured.

[GrayMatterWife]

What is the price of a life? 10k? 1 million? 40 million? I definitely think there should be caps. And I think awards should be along the lines of, if the patient can no longer work or function then monetary compensation should be along the lines of providing them the funds to maintain a STANDARD quality of life including necessary medical care as a result of the "mishap."

You make a great point. In the speech, there was no distinction between compensatory damages awards (awards based on actual losses, including loss of future income, etc.) and punitive damages awards (awards that have nothing to do with any calculable losses, but are imposed to punish the physician).

All politicians talk in these silly, superficial, easy terms when it comes to "tort reform"--they want to "cap jackpot litigation" or somesuch. No one really wants to cap genuine compensatories based on REAL findings of GENUINE malpractice. What most people want is reform for windfall awards based on overly emoted arguments. For example, the ridiculous recoveries that John "Who's the Daddy" Edwards used to win for his clients. Baby was born with cerebral palsy. Injured babies=huge sympathy, big recoveries, regardless of actual fault. Juries want to blame someone, so when the attorney argues "The baby is speaking to me, asking me to ask you to help..." juries often cave. That crap needs to stop.

But it won't. Regardless of what Obama wants, there is NO WAY there will be significant tort reform. The very powerful personal injury lobby OWNS the Democrats. Seriously. Will never ever happen.

[GrayMatterWife]

Tort reform: My problem with caps is not that they are bad for trial lawyers and radiologists but rather that they are bad for the most severely harmed patients. Sometimes mistakes do happen, and if that mistake causes injury to a patient that will necessitate ongoing medical treatment for the remainder of that patient's life, should the patient bear the cost after the cap amount? 250, 500, 700K doesn't go very far for the most severely injured.

Very valid concern. This goes to the difference between compensatories and punitives. If there is a severe injury, then the compensatories will be high for long-term care, if you can prove fault. I really don't think anyone is talking about capping properly established compensatories. At least, I hope not. That's not right. But there must be reform to make clear the standard for establishing liability, and to limit punitives.

[Vishenka69]

Since we don't have cable, I didn't watch the speech last night but read the text today. My thoughts - the man can talk. As with most of his speeches, he talks in grandiose terms and uses tearjerkers to drive his points home. I just don't buy that federal gov't can become all efficient overnight (or even over a couple of years) just because he said so. I can't imagine where he's going to get the money to fund all those options. If he's planning on just printing money and devaluating the dollar, in the end we will all lose, health covered or not. My main concern is not DH's salary but the fact that I haven't seen any proof that this particular plan, the way it was presented last night, will truly make us a better and healthier country. There are still tons of issues that haven't been addressed and I doubt will be.

[Meenah]

Why was covering illegal immigrants even being discussed? If they are illegal and asking for benefits, why aren't they being deported? It isn't as if they can't be located.