Health Care Reform in the US

[Bayou Bum]

I will reiterate my expectation that proponents of health care will soon begin attempts to draft public sympathy for "the lion of the Senate" to win support for their program. "Do it for Ted!" And I fully expect any successful reform bill to be named the Kennedy Healthy America Bill or something of the sort...

And we will receive treatment under the Kennedy Healthy America Bill like Mary Jo Kopechne at Chappaquiddick.

[Slim]

Didn't want to start another thread- but thought this was the best place to pay my respects to Ted Kennedy.

No Surprise. The most liberal of liberal Senators. Known to have played the "Do you know who I am?" card even more than Al Sharpton and Jesse Jackson play the race card.

Lets reflect on the less reported parts of his illustrious history..."hiccup"...


http://www.dailymail.co.uk/debate/ar...woman-die.html

[lindajdunn]

http://www.ama-assn.org/amednews/200...9/bisb0309.htm

New legislation has been introduced that would remove the exemption from federal anti-trust laws for insurance companies.

[Inquartata]

http://www.ama-assn.org/amednews/200...9/bisb0309.htm

New legislation has been introduced that would remove the exemption from federal anti-trust laws for insurance companies.

Er---I didn't catch anything about "new legislation" in that article. Did I miss it?

I DID catch the irony of the AMA talking about market concentration and monopolies, though.

[lindajdunn]

http://www.lifeandhealthinsurancenew...er-Repeal.aspx

My apologies. I had followed a link from the source to the AMA article. The original article was from the [cough] Huffingtonpost [cough] so I probably should offer a different link to a similar article from a more reliable source. How's the primary source?

http://leahy.senate.gov/press/200909/091709a.html

[I_luv_saber]

I read an article last week or so that California is looking into making some very important reforms. I can't for the life of me find the article, but IIRC the gist of it was:

• Insurance companies could not stop service (especially due to a problem with the original application) after a claim had been filed.
  
• They must find any problems on the application in the first 30 days (or something like that), then may choose to either cancel service, raise their rates, or what have you.
  
• Insurance companies must notify people 30 days in advance (or something like that) before stopping service.
  
• Denied claims would be subject to a third-party review in some cases.
  
• Applications would become more standardized.

There were some others in there as well, but these were the highlights of the plan put forth. One issue with this plan, however, is that it only pertains to individual health plans.

EDIT: I was able to find an excerpt from the article, but still not the article itself.

CALIFORNIA: As expected, the legislature approved a measure designed to restrict an insurer's ability to rescind an individual's health insurance policy unless the insurer can demonstrate that the member intentionally misrepresented facts on the original medical questionnaire. The legislation would also require development of regulations to standardize applications and use of health questions, require extensive medical background checks and create an independent third-party review of any potential policy rescission. Governor Schwarzenegger vetoed a similar bill last year but has not indicated his stance on this year's legislation.

[dcmdale]

I read an article last week or so that California is looking into making some very important reforms. I can't for the life of me find the article, but IIRC the gist of it was:

• Insurance companies could not stop service (especially due to a problem with the original application) after a claim had been filed.
• They must find any problems on the application in the first 30 days (or something like that), then may choose to either cancel service, raise their rates, or what have you.
• Insurance companies must notify people 30 days in advance (or something like that) before stopping service.
• Denied claims would be subject to a third-party review in some cases.
• Applications would become more standardized.

That is nothing in comparison to what the Insurance Companies convinced California voters to give away in 2004, namely, the requirement of "fair dealing" with their insured.

[jeff]

dcmdate, could you elaborate on that? I imagine few of us know what that entailed. (including me) thanks!

[Inquartata]

How's the primary source?

http://leahy.senate.gov/press/200909/091709a.html

Ok. So, he wants to repeal an exemption originally instituted in 1945. Meaning that it was probably motivated by the same rationale which assigned tax benefits to employers for offering health insurance, i.e. to permit employers in wartime to retain scarce workers by raising compensation to them without running afoul of wage-fixing laws in operation at the time.

Where then is Sen. Leahy's bill to reverse THAT whole mess, then?

I sense that his reasoning is...selective.

[lindajdunn]

Ok. So, he wants to repeal an exemption originally instituted in 1945. Meaning that it was probably motivated by the same rationale which assigned tax benefits to employers for offering health insurance, i.e. to permit employers in wartime to retain scarce workers by raising compensation to them without running afoul of wage-fixing laws in operation at the time.

Where then is Sen. Leahy's bill to reverse THAT whole mess, then?

I sense that his reasoning is...selective.

We don't need a bill. The rising cost of insurance is resolving this problem. Many employers are reducing coverage and offeriing HSAs.

Found the information I wanted but you'll have to hold your nose because it's a secondary source and it's Huffingtonpost:

The number of private employers offering health insurance has declined steadily this decade. Back in 2000, more than 69 per cent offered their employees health insurance, according to research from the Kaiser Family Foundation and Health Research and Education Trust. By last year, that number dropped to 63 per cent.

The biggest decline came from small businesses, particularly those with fewer than 26 employees. Only 49 per cent of these small businesses offer coverage - down from 57 per cent in 2000. The National Small Business Association corroborates these findings: they found that only 38 percent of their members offer coverage; 14 years ago, 67 percent offered their employees coverage.



Read more at: http://www.huffingtonpost.com/anne-m..._b_292449.html

[dcmdale]

dcmdate, could you elaborate on that? I imagine few of us know what that entailed. (including me) thanks!

From memory so don't flame me if I get some details wrong...

The seminal case Royal Globe involved an insurance company that sold private disability insurance providing income protection in the event one became disabled. Plaintiff was a construction worker who had purchased this type of insurance from Royal Globe. Plaintiff had an accident in which he fell from a roof and was rendered quadriplegic. He filed a claim with Royal Globe and was denied because he hadn't shown evidence of disability. He sued. Eventually, the supreme court of CA found that Royal Globe had a policy of denying any claim for long term disability on the assumption that some of their insured wouldn't sue and that if the insurance company was sued, all that could happen would be that they would have to pay what they were contractually obligated to pay to that point in time, then they would deny the claim again. Eventually, since most of the money would be going to attorneys that people would eventually tire of suing. Their ability to avoid paying out on legitimate insurance claims was built into their business model.

The Supreme Court of CA determined that selling insurance without intent to actually pay claims constituted fraud and multiplied the award by 1000 as punitive damages. In California, this established a private right to sue insurance companies for bad faith dealings.

The insurance companies freaked. Rather than taking the tact that this penalized bad apples within the industry, they treated it as an attack on their business. Though changed composition on the court, they got the CA Supreme Court to largely eliminate the rule during the late 1990's; however, even after it was overturned, the insurance industry continued to blame this ruling for the high cost of insurance, particularly with respect to medical malpractice insurance.

In California, the strongest lobby in the state is the medical lobby. Since the insurance industry convinced the medical community that Royal Globe was the reason for high malpractice insurance premiums, the medical lobby got a complete constitutional repeal of Royal Globe on the California ballot and convinced enough voters to vote for it.

-------

Everybody hears about how bad huge medical malpractice judgments are. And that might be "true" if it isn't your leg chopped off or whatever. In California, at least, the doctors have written the laws regarding medical malpractice claims. They have thrown in every reasonable protection for doctors. There are still huge settlements. Why? Because "tort reform" needs to start with the medical licensing boards yanking the licenses of bad doctors. I have heard studies that claim 95% of successful malpractice awards by dollar value are against serial offenders who clearly need to have their licenses yanked. Yes, good doctors occasionally make mistakes. Yes, there are lawyers who file bad lawsuits (but what lawyer wants to put 1000 hours into a case that they are going to lose and not get paid for?). Take care of the big issue and malpractice will become much less of an issue.

Edit: I've looked for and can't find the study that I am remembering, so take this as being a unverified statement.

[lindajdunn]

Maybe we should have a separate license review board in each state wherein points are awarded in a manner somewhat similiar to points given for driving violations. Three major infractions and one could lose one's license for X amount of time.

In Indiana, one who acquires X amount of points for the first time can take a driving review course which then allows them to continue driving. No such luck on a second occurrence. One can also appeal for a hardship license, which only allows you to drive to and from work. [Given the lack of public transportation in this state, the inability to drive equals the inability to be gainfully employed.]

The problem, of course, is that malpractice claims take a long time to go through the court system. This practice would require the review board to render a decision regarding the validity of the claim prior to its progression through a civil suit, which would almost certainly compromise the outcome of the civil suit.

Indiana does have a review process in which malpractice claims cannot be filed until a review board determines whether or not there is sufficient grounds to proceed. Something like this might work. [I note that eliminating frivilous suits in this manner has not reduced the malpractice premiums for Indiana doctors.]

[I_luv_saber]

I would imagine malpractice insurance is as jacked up as any other insurance is.

Also, I don't think it's just frivilous lawsuits, but the ridiculous amount of money that is sought sometimes. This is a problem not just in malpractice suits, but lawsuits in general.

[lindajdunn]

http://www.indy.com/posts/medical-ma...take-spotlight

The above article notes that malpractice insurance premiums are a very small portion of doctors' overhead. There are 38 states that, like Indiana, impose caps upon award amounts.

Outside this article:

The Indiana legislature enacted a "cap" or limit on the maximum amount of damages that may be awarded to a malpractice victim. This "cap" allows recovery up to $1,250,000.00 in damages for malpractice that occurred after June 30, 1999. I.C. 34-18-14-3 (3). The maximum recoverable award for malpractice that occurred on or before June 30, 1999 is $750,000.

Malpractice insurance costs amount to only 3.2 percent of the average physician's revenues. (Official Transcript, Medicare Payment Advisory Commission, Public Meeting, December 12, 2002.)

Premiums charged do not track losses paid, but instead rise and fall in concert with the state of the economy. When the economy is booming and investment returns are high, companies maintain premiums at modest levels; however, when the economy falters and interest rates fall, companies increase premiums in response. (J. Robert Hunter, Americans for Insurance Reform, "Medical Malpractice Insurance: Stable Losses/Unstable Rates," October 10, 2002. See also: www.insurance-reform.org/StableLosses.pdf)

The below article also has some interesting facts about malpractice insurance premiums:

http://savvyconsumer.wordpress.com/2...th-care-costs/

Among the items I found of interest:

In states that have substantially limited consumers’ ability to go to court for medical malpractice, the insurance premiums for doctors are basically the same as in other states.

[jeff]

http://www.indy.com/posts/medical-ma...take-spotlight

The above article notes that malpractice insurance premiums are a very small portion of doctors' overhead. There are 38 states that, like Indiana, impose caps upon award amounts.

I would like to see the numbers behind that. A fairly busy surgeon's practice might gross $1 million to $2 million per year, but med-mal insurance can be $100K or more. Some specialties will pay more (OB/GYN is the poster child), some less, and having a previous "claims-made" will inflate a doctor's rates.

What I think is a valid statement is that capping claims has little effect.

[jeff]

Thanks for posting that.

From memory so don't flame me if I get some details wrong...

The seminal case Royal Globe involved an insurance company that (snip) the supreme court of CA found that Royal Globe had a policy of denying any claim for long term disability on the assumption that some of their insured wouldn't sue and that if the insurance company was sued, all that could happen would be that they would have to pay what they were contractually obligated to pay to that point in time, then they would deny the claim again. Eventually, since most of the money would be going to attorneys that people would eventually tire of suing. Their ability to avoid paying out on legitimate insurance claims was built into their business model

That's hair-raising, but consistent with horror stories I've heard elsewhere.

I've claimed on this board that insurance companies have used the 'deny deny deny' tactic as part of their business model - this is a clear example of it.

(snip) There are still huge settlements. Why? Because "tort reform" needs to start with the medical licensing boards yanking the licenses of bad doctors. I have heard studies that claim 95% of successful malpractice awards by dollar value are against serial offenders who clearly need to have their licenses yanked. Yes, good doctors occasionally make mistakes. Yes, there are lawyers who file bad lawsuits (but what lawyer wants to put 1000 hours into a case that they are going to lose and not get paid for?). Take care of the big issue and malpractice will become much less of an issue.

Absolutely. I've also seen citations that 'most claims are against serial screwups'. Unfortunately, in our system it's very bad to get a doctor unlicensed. and even when that happens, somebody who is leaving a trail of bodies behind him can go to another state and start over. There are some who say (cough!) that we should get rid of licensing altogether, but that would just give open access to incompetents.

Edit: I've looked for and can't find the study that I am remembering, so take this as being a unverified statement.

Fair enough.

[dcmdale]

I've claimed on this board that insurance companies have used the 'deny deny deny' tactic as part of their business model - this is a clear example of it.

One of several reasons that I am skeptical of any health care solution built around insurance. Insurance is a huge part of the problem, not the solution.

If the only two options were mandatory insurance and socialized medicine, I would opt for socialized medicine as the lesser of two evils.

Absolutely. I've also seen citations that 'most claims are against serial screwups'. Unfortunately, in our system it's very bad to get a doctor unlicensed. and even when that happens, somebody who is leaving a trail of bodies behind him can go to another state and start over. There are some who say (cough!) that we should get rid of licensing altogether, but that would just give open access to incompetents.

I do support licensing for that reason and also suspect that disciplinary boards will continue to need to be dominated by doctors. If a doctor is giving an explanation for a particular situation or course of action, it *is* important that the people judging have an understanding for what is going on and what alternatives there were.

I suspect that medical disciplinary board have much the same problem with discipline that the Catholics have in disciplining pedophile priests. Both professions want to deny the existence of the problem, in part because they are appalled that anyone in their profession would have a problem. Second, faced with evidence, as a caring profession there is a natural sympathy for the person in front of them that doesn't take into account past and future victims.

[jeff]

I agree with your points, and will also add that there's structural problems for "turning in" dangerous doctors: if somebody's in private practice and does office procedures, there's not a lot of oversight as to what's going on. If he goes to a hospita, the most doctors can do there is revoke privileges, as they are not representatives of state licensing. Even that's a big step, and the doctor in question can sue! Protecting "one of our own" also has to be a factor, just as seen with police and other professions.

Getting rid of truly incompetent doctors would be very helpful, just as with bad lawyers, cops and politicians, but the processes for doing so are not up to the ask. (Removing all those processes by eliminating licensure would be far, far worse)

[dcmdale]

I agree with your points, and will also add that there's structural problems for "turning in" dangerous doctors: if somebody's in private practice and does office procedures, there's not a lot of oversight as to what's going on. If he goes to a hospita, the most doctors can do there is revoke privileges, as they are not representatives of state licensing. Even that's a big step, and the doctor in question can sue! Protecting "one of our own" also has to be a factor, just as seen with police and other professions.

Getting rid of truly incompetent doctors would be very helpful, just as with bad lawyers, cops and politicians, but the processes for doing so are not up to the ask. (Removing all those processes by eliminating licensure would be far, far worse)

I think lawyers are for the most part a more ornery lot: they are quite a bit more likely to turn each other in. On the other hand, a bad lawyer on the other side of the room often means more in your pocket. Might be a wash.

My mother was a nurse and several times during her career the word came down from hospital administration that, "Anything ordered by Dr. XXX had to be countersigned by another Doctor." Usually this was shortly before Dr. XXX was invited not to come back anymore. The worst period in her career was when the hospital that she worked at was bought by a group of doctors who had been booted from all the other hospitals in the area. It took about 3 years before the state hospital credentialing board forced them to sell and one of the doctors was "encouraged" to retire, but the others were permitted to continue practice.

[Inquartata]

We don't need a bill. The rising cost of insurance is resolving this problem.

To which other social problems shall we apply this odd logic?

There's no reason to have CAFE standards any more, because the rising cost of cars is resolving the problem.

Brilliant, no?

All "rising costs" are doing is reducing quantity demanded. It is not addressing the root problem of tax benefits being located with the wrong parties, eg employers. This is what skewed markets in the first place, but hey, why cure the disease when we can treat the symptoms incessantly instead?

In California, the strongest lobby in the state is the medical lobby.

This claim is advanced for many groups. I have heard it made for the state prisonworkers' union and the teachers' union at a minimum. I cannot find any figures to back any of them being strongest. Is there a list somewhere?