Healthcare speech last night

[Meenah]

I realize that sounds so crass, but I am so frustrated with both sides of the Healthcare "stuff". I know there is no quick answer, just a lot of frustration on my part. When I think about how much $$$$ I have paid for COBRA at various times for various kids, it makes me cringe.

[Sheherezade]

I know I'm stirring up trouble here but you know who makes the decision to see illegal immigrants? Doctors. I'm pretty sure it is unethical to turn someone away from emergency care because they are uninsured or illegal. They get seen in the ER because that's where they can go. If they aren't covered, that cost gets passed on to other patients so the hospital can cover costs. If a hospital made the decision to NOT see anyone without insurance (which I think they legally can NOT do), I'm pretty sure that the AMA and other medical organizations would see that as anti-Hippocratic oath. So, that's point number one. What do you think? Do doctors have an ethical/moral obligation to care for the sick regardless of ability to pay? Would your spouse turn a patient away with no where else for them to go if they had no ability to pay?

Which leads to point two: If healthcare legislation makes it impossible to "pass on" the costs of caring for the uninsured or illegal (and thus uninsured) by raising costs to others, how will doctors be re-imbursed for this care? Will they now do it for free? (Possible - I think charity hospitals aren't that far out of memory.) Will we start more "free clinics" through NFPs or what?

Will we set up some program to send illegal immigrants that are ill home to their own country for care? Is that logistically possible?

I'm just pondering this medical care for illegals question and the problem seems to be that physicians are obligated to treat the sick either legally or intrisically regardless of ability to pay -- but that no one wants to pay for people here illegally. Should we (as medical families) just offer this care them for free? Or change the current ethical standards? Or is this really not part of the healthcare debate at all: shouldn't this be seen as simply a part of handling illegal immigration (stopping it, patroling more,whatever)? Is this just an issue discussed in the health care debate because it stirs up emotions? Why not just say : "Yes, illegal immigration is a problem we need to deal with as well. Let's get back to talking about health care."

[Deebs]

Emergency departments are required to see patients legally (not just ethically) through the EMTALA law. Basically, if a patient comes to the ED says "I owe this hospital $1 million, am in the process of suing you, and don't intend to pay my bill for this visit" that patient will get seen and treated. The law requires they have a health screen exam and that they are stabilized and provided some kind of follow up plan. In action, it translates into the ED seeing everyone and every emergency physician writing off over $100,000 in care per year when those costs not paid for are averaged out. And no, we can't take that loss on our taxes.

I have a really good solution for seeing people who can't pay (from my perspective) - let my husband work 1 day/month in a free clinic/hospital or whatever, PAY any malpractice coverage needed, and forgive our federal student loan debt over time. It's that simple. The reality is, if my DH works in a free clinic or hospital right now as a volunteer, it will cost our family money because his malpractice policy doesn't cover that activity.

I don't know the other side of the law to know whether or not there is a way to follow through with deportation.

[Sheherezade]

Thanks Deb. I thought it was illegal to NOT see a patient. It is my understanding that most of the uninsured and illegals go through the ER. I can't imagine how they'd be setting up office visits. I know that the audit of Medicaid for illegal immigrants turned up hardly any - but did manage to throw out a percentage of U.S. citizens that couldn't produce the required paperwork. So, mostly it is ER care through hospitals.

Does none of that cost get absorbed by the hospital though? Aren't they also taking a loss - or moving the costs - when they see these patients? I can't see the law changing to allow people to be turned away from the ER.

If free clinics were set up, that would require that they be organized either privately by NFPs or by the government. We had one of those free health fairs here and they had to close access to scheduling free appointments after a week because the response was overwhelming. It was organized by docs at the hospital and a businessman brother. My DH would also work in a free clinic a few times a month if it lead to loan forgiveness. He'd work in one full time for a resident's salary straight out of training if you could pay the loans off in a few years.

Nothing like that has been proposed by anyone though, correct?

These people will still be seen though - that's my my point - and currently it comes out of the doctor's/hospital's pocket directly NOT through taxes. Of course, if the healthcare cost spiral is due to cost shifting....and that shifting gets stopped by reform....then ALL of it will come out of the doctor's pocket.

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.

Technically, yes, you're right that if full compensatories are awarded the injured patient should in theory be made whole. But what about attorneys' fees? The majority of med mal plaintiffs are going to have to hire lawyers on a contingent fee basis and turn over 1/3 of any award. It's my understanding that often times those pain and suffering awards help to pay legal fees -- so the patient gets to keep the compensatories.

I guess that begs the question whether attorneys should be entitled to that big a cut. However, what looks like a windfall may not be when you consider that the attorney may have litigated several cases with Zero pay out for every case in which they acutally get a share of an award. There are of course a few Johnny Edwardses out there, but most of the plaintiffs' lawyers I know are not unfairly compensated in my opinion.

[MarissaNicole]

Technically, yes, you're right that if full compensatories are awarded the injured patient should in theory be made whole. But what about attorneys' fees? The majority of med mal plaintiffs are going to have to hire lawyers on a contingent fee basis and turn over 1/3 of any award. It's my understanding that often times those pain and suffering awards help to pay legal fees -- so the patient gets to keep the compensatories.

I guess that begs the question whether attorneys should be entitled to that big a cut. However, what looks like a windfall may not be when you consider that the attorney may have litigated several cases with Zero pay out for every case in which they acutally get a share of an award. There are of course a few Johnny Edwardses out there, but most of the plaintiffs' lawyers I know are not unfairly compensated in my opinion.

A lot of the damages awards depend on where you live - in some places your lucky to get ANY damages from a jury - in other places you'll get a rediculous amount that is in no way logical.

Like selu said non-economic damages are often where the attorney's fees come from. I was fortunate to work for what I believe were really good PI attorneys and if they felt they didn't earn the whole third (which was a lot of the time) they didn't take the full third even though that is what they contracted for. Although 1/3 seems like a large amount it is to compensate attorneys for taking the risk. They risk winning big or winning nothing - it therefore should (in theory) discourage attorneys from taking bad/frivolous cases. Also the point of the 1/3 fee is that very few people would ever pursue personal injury cases if they had to pay the attorney hourly... people cannot afford it and it is not worth the risk of paying all that money for the risk. (Depending on where you are from - the statistics are - or should be in favor of defendants).

My problem with capping non-economic damages is that not only is it a source of money to help plaintiffs pay their attorney's fees without tapping into the funds they need to pay the medical bills but it also levels the playing field for the poor - here is how. Lets say Johnny makes minimum wage. Johnny either gets in a car accident or is injured/killed by medical error. Johnny (or his son) were counting on Johnny's income to pay for his son's college. Because Johnny only made minimum wage, his economic damages are significantly less because they are based on Johnny's income and income potential. But if Johnny had been an investment broker, his income potential was higher and his lost wages are higher.... therefore if you cap economic damages you are putting a price on someones life and saying that certain people are worth less....

ETA: Therefore if there are caps they should be caps on OVERALL damages (all damages combined) not on non-economic damages because you kind of need the non-economic damages to even things out.

Don't get me wrong I am not totally against tort reform - I just don't like the blanket statement because it can be overly broad and not necessarily productive.

I am all about requiring affidavits by a doctor in that specialty saying that the doctor breached the standard of care in order to even file a lawsuit.

[GrayMatterWife]

But what about attorneys' fees? The majority of med mal plaintiffs are going to have to hire lawyers on a contingent fee basis and turn over 1/3 of any award. It's my understanding that often times those pain and suffering awards help to pay legal fees -- so the patient gets to keep the compensatories.

If it goes to trial, the attorney takes about 40% of the recovery. If you're lucky. And that's before costs and expense reimbursements.

Punitives are different that attorney's costs and fees. The attorneys, of course, love punitives, because they get a percentage of punitives, too. You could create a statutory cap on attorneys' recovery for such fees.

Now, if you starting charging attorneys--PERSONALLY, not the clients--who file frivolous med-mal claims the defense attorney's costs and fees, that might help.

[GrayMatterWife]

Withdrawn. Never mind. I've had a long day and I so don't want to deal with the result hate-posts/hate-PMs on this.

[GrayMatterWife]

I am all about requiring affidavits by a doctor in that specialty saying that the doctor breached the standard of care in order to even file a lawsuit.

Me, too. A preemptive Rule 11, sort of.

[MarissaNicole]

I was talking to my aunt and she told me that* 2010 is when the babyboomers start turning 60 and qualifying for medicare....my aunt was telling me that begining January 1st, every day for the next 15 years there will be roughly 8,000 people turning 60 and qualifying for medicare....

Another problem that will effec the shortage of primary care providers....

*I am not claiming any accuracy to this statement as I have not had time to research the accuracy of it.....but either way there are a lot of babyboomers and it is something that we will have to deal with!