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Author: JoshRandall Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 134949  
Subject: Doctors Choose Romney over Obama Date: 10/2/2012 1:55 PM
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http://dailycaller.com/2012/10/01/survey-doctors-choose-romn...


A new survey shows Mitt Romney with a commanding lead over President Barack Obama among doctors, with Obamacare helping to sway their votes.

If the election were held today, 55 percent of physicians reported they would vote for Romney while just 36 percent support Obama, according to a survey released by Jackson & Coker, a division of Jackson Healthcare, the third largest health care staffing company in the United States

Fifteen percent of respondents said they were switching their vote from Obama in 2008 to Romney in 2012. The top reasons cited for this change was the Affordable Care Act and the failure to address tort reform.



Apparently, docs didn't get the memo from Obama and the libs, who know more than the docs and know more what is best for their patients than the docs.
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Author: jerryab Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106599 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 12:04 PM
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the failure to address tort reform.

If tort reform was such a major issue, why do the medical liability insurance companies say tort reform has about a 1% impact on premiums? And why are the premiums so HIGH in all the states WITH tort reform (major restrictions on payouts by doctors and insurance companies) *already* in place?

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Author: wolsey1 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106616 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 1:21 PM
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the failure to address tort reform.

If tort reform was such a major issue, why do the medical liability insurance companies say tort reform has about a 1% impact on premiums?



Docs aren't voting for Obama for two reasons:

1. Taxes. Docs don't want their top marginal rate to go up 3%. They all say they're paying 50-70% in federal taxes, and they all notoriously conflate effective tax rate with top marginal rate.

2. PPACA. Docs that aren't part of a reimbursement system implementing some sort of cost containment and are stuck in a "bill more, collect more" mentality are highly resistant to the changes that are occurring.


For what it's worth the well-respected professional society for internal medicine docs, the American College of Physicians, supports PPACA as an initial step in the right direction.

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106634 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 4:17 PM
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If tort reform was such a major issue, why do the medical liability insurance companies say tort reform has about a 1% impact on premiums? And why are the premiums so HIGH in all the states WITH tort reform (major restrictions on payouts by doctors and insurance companies) *already* in place?

Seriously??? As an emergency physician, I have to deal with a totally &^%^ up legal system every &^*%^ day. When you actually have similar experience and knowledge about this issue, then your opinions might be worth listening to. You might wish to become better informed before you post again or vote. You could start by listening to people like myself who are actually informed.

The cost of medical liability is huge - estimated to be hundreds of billions of dollars every year. The cost is a combination of direct costs and defensive medicine (unecessary tests and treatments). The terrible personal toll it takes on physicians like myself who dedicate their lives to helping people who then turn around and sue them is an added cost.

The premiums are NOT higher in states with some modest tort reforms. Moreover, true tort reform (specialized medical courts, loser pays, higher standards of proof) does not exist in the US.

Obamacare is a monstrosity. The politicians who voted for it don't even have a clue what's in it or what its impact will be. It didn't include ANY proven cost-saving reforms, including tort reform. It will add huge costs to the system and will further insert the government between physician and patient - that's what we do know.

That's why physicians, the ones who have any understanding of health care policy and economics, oppose Obama.

dave

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Author: jerryab Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106635 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 5:22 PM
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When you actually have similar experience and knowledge about this issue, then your opinions might be worth listening to. You might wish to become better informed before you post again or vote. You could start by listening to people like myself who are actually informed.

You are claiming the medical liability insurance companies do not know what they are talking about. They are the ones stating--in writing, in Texas--they could not reduce premiums in Texas (for medical liability insurance for doctors) because the big payouts were so few and far between they simply did not make much of a difference to claims or premiums.

A heaping dose of your own medicine back at you.

http://www.utexas.edu/news/2005/03/10/law/

http://www.nber.org/aginghealth/fall04/w10709.html

http://www.insurance-reform.org/new-consumer-report-finds-ba...

http://www.casd.org/index.cfm?pg=InsurersAdmitCapsDontWork

http://www.williamgammon.com/Personal_Injury_Law.html

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Author: JoshRandall Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106638 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 6:25 PM
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If tort reform was such a major issue, why do the medical liability insurance companies say tort reform has about a 1% impact on premiums?

How convenient for a liberal to use the words of those evil insurance companies when it serves his agenda.

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Author: wolsey1 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106641 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/3/2012 7:11 PM
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Obamacare is a monstrosity. ... That's why physicians, the ones who have any understanding of health care policy and economics, oppose Obama.


I think just the opposite.

For one small example, look at the docs in charge of Healthcare Partners and Davita - they're making lots of money on the changes precisely because they understand healthcare policy, economics, and what changes are coming. And in general they're big supporters of Obama.

For another example, look at HCA's Clinical Allignment initiative to get area docs all working with each other in a collaborative way so as to increase quality and capitalize on back-end savings. Universal Health Services (UHS) has a similar effort.

The CEOs I talk to all say the same thing...increased coverage means increased opportunity.


It's true that tort reform was never part of the initial system changes, and every nonsense claim has a deep impact on the individual physicians involved that nobody but us gives a damn about. But that doesn't mean there can't/won't be changes in the future once we get past the initial stages of extreme Republican obstructionism. In doing something about rising health care costs for our society, tort reform isn't an area where a large impact can be made. That's not to say that one lawsuit isn't costly for one doc, or that marginal docs don't practice defensive medicine. They're separate issues.

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106731 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 1:38 AM
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A heaping dose of your own medicine back at you.

None of your references have any actual data on tort reform and its impact on medical liability premiums. In addition, the references have no data on how modest tort reform or actual tort reform might impact overall health care costs.

dave

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106732 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 1:47 AM
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I think just the opposite.

The numbers indicate otherwise.

For one small example, look at the docs in charge of Healthcare Partners and Davita - they're making lots of money on the changes precisely because they understand healthcare policy, economics, and what changes are coming. And in general they're big supporters of Obama.

This is a small sample and they're obviously not economically literate. They may be voting in their short term personal self interest.


For another example, look at HCA's Clinical Allignment initiative to get area docs all working with each other in a collaborative way so as to increase quality and capitalize on back-end savings. Universal Health Services (UHS) has a similar effort.

How is this relevant to Obamacare?

It's true that tort reform was never part of the initial system changes, and every nonsense claim has a deep impact on the individual physicians involved that nobody but us gives a damn about. But that doesn't mean there can't/won't be changes in the future once we get past the initial stages of extreme Republican obstructionism. In doing something about rising health care costs for our society, tort reform isn't an area where a large impact can be made. That's not to say that one lawsuit isn't costly for one doc, or that marginal docs don't practice defensive medicine. They're separate issues.

Extreme Republican obstructionism? Seriously? You betray your own extreme left-wing bias.

Your statement about tort reform lacks any factual basis. Expert analysis indicates that real tort reform (especially when combined with free market reforms) might save hundreds of billions of dollars per year. Even in an era of left-wing trillion dollar deficits, that's some serious cash.

"Marginal docs" don't practice defensive medicine? Wow, you obviously have no basic knowledge of how medicine operates. EVERY doc that sees patients practices defensive medicine - if they don't, they are sued out of practice very quickly.

dave

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Author: jerryab Big gold star, 5000 posts Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106752 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 11:09 AM
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None of your references have any actual data on tort reform and its impact on medical liability premiums.

The U Tx report looked at actual data IN TEXAS over 15 yrs (1988-2003). If that isn't "real data", then there exists no real data anywhere. If you do not want to look at the report, that is your choice. But you can't rationally claim data was not provided.

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Author: wolsey1 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106791 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 3:24 PM
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The numbers indicate otherwise. ... This is a small sample and they're obviously not economically literate. They may be voting in their short term personal self interest.

I'm not sure what numbers you're referring to.

You had mentioned that physicians who have any understanding of health care policy and economics oppose Obama and Obamacare.

I then gave some examples of docs that understand health care policy and economics far better than your or I; they're in charge of large groups and have made, and are making, lots of money on the changes that are occurring in health care. The few of these docs I know don't oppose Obama.


How is this relevant to Obamacare?

See above. The point was that physicians and hospital CEOs leading the heath care changes, in general, embrace the opportunity for lucrative at-risk health care delivery models. That's how it's relevant to the PPACA.

The docs that oppose this movement are being left behind, and many of them are angry and bitter.


Extreme Republican obstructionism? Seriously?

It's true. Senate Republicans and five Dems threatened filibuster in order to water-down any health care changes so that there could still be profiteering. And as pointed out above, it's working well for players who know health care policy and economics.


Expert analysis indicates that real tort reform (especially when combined with free market reforms) might save hundreds of billions of dollars per year

The most recent and most generous estimate I'm aware of is a savings of $54 billion over 10 years...or 0.2% of our nation's health care expenditures, and that's from Senator Orin Hatch working with CBO estimates in 2009. (I'll look for the link if you'd like).

In terms of cost containment, I'd argue that tort reform is a red herring and that the real savings is in removing incentivization for overtreatment and overbilling. Cardiologists aren't doing several nuclear tests yearly on a patient and then subjecting that patient to an unnecessary coronary angio because they're worried about a med mal claim.

In other words, not that tort reform shouldn't be pursued, but I suspect there's more savings in reducing abusive overtreatment and overbilling. Robert Wood Johnson Foundation and George Washington Univ School of Public Health are working on trying to accurately quantify abusive billing. And I've purposely left out the issue of fraud because in some instances that's more subjective.


"Marginal docs" don't practice defensive medicine?

Go back and re-read what I wrote...it's the marginal docs that anecdotally I see doing lots of defensive stuff. And in those cases I don't think it's so much as a defensive measure as it is the fact that they're marginal practitioners. Rather than having the confidence and ability to let their diagnostics or treatment be guided by the patient's history and exam, they instead order lots of studies and call three consultants.


Wow, you obviously have no basic knowledge of how medicine operates. EVERY doc that sees patients practices defensive medicine - if they don't, they are sued out of practice very quickly.

So you feel my associates and I practice defensive medicine to a degree that is significantly wasteful compared to how we would practice if we had no concern at all about med mal claims.

I don't think you could justify your comment, especially given that in our city with a population of over one million we have the lowest length of stay, lowest cost per case, lowest number of consultants per case, highest HCAHPS, and zero claims.

The point is...the docs complaining the most about 'cost of defensive medicine' I think are either reasonable docs practicing good rather than defensive medicine, or are marginal docs unable to practice with a reasonable degree of clinical precision.

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106803 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 5:21 PM
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I'm not sure what numbers you're referring to.

Physician polls show that a majority oppose Obama and oppose Obama's policies. A new physician poll by the Physician Foundation showed a huge drop from optimism to pessimism about the future of health care since passage of Obamacare:

http://www.dpmafoundation.org/physician-attitudes-on-medicin...

In the same poll, 70% of physician prescribe the opposite of Obamacare for health care reform. They state that REDUCING government would be the single best fix.

You had mentioned that physicians who have any understanding of health care policy and economics oppose Obama and Obamacare.

I then gave some examples of docs that understand health care policy and economics far better than your or I; they're in charge of large groups and have made, and are making, lots of money on the changes that are occurring in health care. The few of these docs I know don't oppose Obama.


They may understand economics better than you but not I.

They know how to make money. That doesn't mean they understand economics. Warren Buffet is a prime example of this phenomenon.


See above. The point was that physicians and hospital CEOs leading the heath care changes, in general, embrace the opportunity for lucrative at-risk health care delivery models. That's how it's relevant to the PPACA.

The docs that oppose this movement are being left behind, and many of them are angry and bitter.


They embrace their own personal short term self interest at the expense of others.

Docs that oppose this movement - the vast majority - are angry and bitter since it interferes with their ability to practice medicine efficiently and ethically. They are angry since it cripples their ability to take care of their patients. They are angry since the health care system is going bankrupt and Obamacare just pushes us closer to eventual bankruptcy. They are angry since ALL proven cost-saving reforms were ignored by the authors of Obamacare. They are angry because patients and physicians are losing more of their freedoms and basic rights due to Obamacare.

It's true. Senate Republicans and five Dems threatened filibuster in order to water-down any health care changes so that there could still be profiteering. And as pointed out above, it's working well for players who know health care policy and economics.

They came to the table and presented proven ideas for reform and they were completely ignored. Completely.

So... ultimate bankruptcy of the health care system is working well???

The most recent and most generous estimate I'm aware of is a savings of $54 billion over 10 years...or 0.2% of our nation's health care expenditures, and that's from Senator Orin Hatch working with CBO estimates in 2009. (I'll look for the link if you'd like).

In terms of cost containment, I'd argue that tort reform is a red herring and that the real savings is in removing incentivization for overtreatment and overbilling. Cardiologists aren't doing several nuclear tests yearly on a patient and then subjecting that patient to an unnecessary coronary angio because they're worried about a med mal claim.

In other words, not that tort reform shouldn't be pursued, but I suspect there's more savings in reducing abusive overtreatment and overbilling. Robert Wood Johnson Foundation and George Washington Univ School of Public Health are working on trying to accurately quantify abusive billing. And I've purposely left out the issue of fraud because in some instances that's more subjective.


You can "suspect" whatever you want and throw out bogus numbers all you want. But it doesn't change reality or supercede the views of experts.

Nobody knows how much defensive medicine costs and no study will provide an accurate estimate. Physicians (who might know better than anybody else since they are the ones practicing defensive medicine) estimate that defensive medicine accounts for 26-34% of total annual healthcare costs. That's right. 26-34%!!!! With $2.5 trillion in annual healthcare spending, that comes to a total of.... $650-850 billion dollars!!!!

http://www.healthcarefinancenews.com/news/defensive-medicine...

So, who do we believe??? The experts - those who actually deal with medical liability costs and incur defensive medicine costs??? Or somebody less informed????

Frankly, I don't know which estimate is correct. I do know two things. First of all, tort reform will save billions and billions of dollars - even the uninformed naysayers admit that - possibly hundreds of billions of dollars. And leaving tort reform out of "health care reform" is absolutely criminal and political malpractice.

Go back and re-read what I wrote...it's the marginal docs that anecdotally I see doing lots of defensive stuff. And in those cases I don't think it's so much as a defensive measure as it is the fact that they're marginal practitioners. Rather than having the confidence and ability to let their diagnostics or treatment be guided by the patient's history and exam, they instead order lots of studies and call three consultants.

Seriously??? ALLLLLL doctors practice defensive medicine EVERY day.

If you don't order a certain test (relying on the history and exam) and there is a bad outcome (and there will be since mortality is 100%), you're screwed. You may be screwed anyway but perhaps a little less screwed.

I practice medicine. I've practiced medicine for almost two decades. Among all my colleagues, I practice less defensive medicine than average. So far, I have been fortunate to face fewer lawsuits than average. But I have learned to practice more defensive medicine in order to avoid medicolegal risk. That's based on personal experience and education regarding the medicolegal climate. So, please quit spouting slurs about "marginal" doctors. It's beyond offensive.

So you feel my associates and I practice defensive medicine to a degree that is significantly wasteful compared to how we would practice if we had no concern at all about med mal claims.

I don't think you could justify your comment, especially given that in our city with a population of over one million we have the lowest length of stay, lowest cost per case, lowest number of consultants per case, highest HCAHPS, and zero claims.

The point is...the docs complaining the most about 'cost of defensive medicine' I think are either reasonable docs practicing good rather than defensive medicine, or are marginal docs unable to practice with a reasonable degree of clinical precision.


So you are a physician?

Yes, I feel that way. According to the surveys, the average doctor feels that way (see the above numbers about estimated costs of defensive medicine).

The data that you cite about your own practice is anecdotal and lacking specifics. I would need to know the size of your practice, how long the practice has existed, the nature of your patient population, etc. And even with that data, your practice is a tiny slice of the overall picture and not necessarily reflective of the greater reality.

dave

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Author: wolsey1 Big gold star, 5000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106817 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/4/2012 7:28 PM
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Physician polls show that a majority oppose Obama and oppose Obama's policies. ... In the same poll, 70% of physician prescribe the opposite of Obamacare for health care reform. They state that REDUCING government would be the single best fix.

Yes, most docs oppose Obama and the PPACA - that point was never in contention in this thread. I think they're wrong and full of hyperbole. As an aside, a link to fax-based poll results where we can't see how the questions were worded and only 4% of docs responded...give me a break.

And government is not to blame for insurance company downcoding, preauthorizations that get denied after the fact, or the cherry-picking of relatively healthier patients.


They may understand economics better than you but not I. They know how to make money. That doesn't mean they understand economics. Warren Buffet is a prime example of this phenomenon.

The economics of a changing healthcare environment striving for getting more lives covered and with better outcomes, is what I was referring to.

Buffet carefully selects out value, and hoards cash to await distressed value, precisely what we wouldn't want in health care for our society.


They came to the table and presented proven ideas for reform and they were completely ignored.

The PPACA is precisely a proven conservative, market-based alternative to a public system created by the Heritage Foundation in the early '90s and, for example, implemented by Romney in Massachusetts.


You can "suspect" whatever you want and throw out bogus numbers all you want. But it doesn't change reality or supercede the views of experts.

So CBO and Republican Senator Orin Hatch are proffering bogus numbers. Got it.


And leaving tort reform out of "health care reform" is absolutely criminal and political malpractice.

There are reasonable studies showing that defensive medicine is not a large driver of rising health care costs, so it's not unreasonable for tort reform to not have been an initial area for a political fight.

This is the start of health care reform, not the end. The initial goals were more covered lives and reducing the federal debt, both of which are accomplished.


Seriously??? ALLLLLL doctors practice defensive medicine EVERY day.

Nope. I don't, never have, nor my associates, nor the docs on the MEC at two hospitals where we've discussed this very issue.

I'll admit I give wide latitude to ED docs because they often don't know the medical history of the patient and they work in an environment where the patient's condition can rapidly change before a better understanding of the underlying process can be made. But having said that, I think the good ones are doing what the situation calls for, and not necessarily defensive medicine.


If you don't order a certain test (relying on the history and exam) and there is a bad outcome (and there will be since mortality is 100%), you're screwed. You may be screwed anyway but perhaps a little less screwed.

I think that's hyperbole, and I don't feel that way. I've heard med mal defense attorneys uniformly say a clinically detailed, well-reasoned note far outweighs the lack of some follow-up test or scan. Indeed, the well-reasoned note addresses what you're not ordering and why.


I practice medicine. I've practiced medicine for almost two decades. Among all my colleagues, I practice less defensive medicine than average. So far, I have been fortunate to face fewer lawsuits than average. But I have learned to practice more defensive medicine in order to avoid medicolegal risk.

Yep, 19 years, no lawsuits. A few nonsense claims, but they went away quickly after discovery.


So, please quit spouting slurs about "marginal" doctors. It's beyond offensive.

I'm surprised at the incredulity. You should sit on Credentials Committees, Peer Review, or Performance Improvement Committees as I do and then see if there are or aren't marginal docs.

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Author: erikinthered100 Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: 106871 of 134949
Subject: Re: Doctors Choose Romney over Obama Date: 10/5/2012 12:27 PM
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The PPACA is precisely a proven conservative, market-based alternative to a public system created by the Heritage Foundation in the early '90s and, for example, implemented by Romney in Massachusetts.

No matter how you spin it, the PPACA is not "conservative, market-based" reform. It increases the role of government in medicine and marginalizes private health care insurance. It fails to include one of many proven pro-free market reforms offered by the opposition party. In fact, it doubles down on failed policies which have caused health care costs to soar. It fails to include reform of a completely dysfunctional tort system which raises health care costs and victimizes health care providers.

There are reasonable studies showing that defensive medicine is not a large driver of rising health care costs, so it's not unreasonable for tort reform to not have been an initial area for a political fight.

It is unreasonable. Failing to include reform of an unjust and costly tort system in health care reform is reprehensible, not reasonable. I believe we have different standards for reasonable.

And all studies, "reasonable or unreasonable," are unable to accurately assess the costs of defensive medicine. But all suggest that the costs are significant - again I believe billions of dollars to be significant while you apparently do not.

This is the start of health care reform, not the end. The initial goals were more covered lives and reducing the federal debt, both of which are accomplished.

Wow, this is a bizarre comment. What exactly is a "covered" life anyway? Does being "covered" help you if you don't get timely care while you're on a waiting list? Does being "covered" help you if you are denied care? Does being "covered" help you if the supply of your needed medicine just ran out? If the government just mandates something, then it becomes reality?

As for reducing the federal debt, again wow. Recent estimates project extra costs of $890 billion for Obamacare over the next ten years - about $120 billion annually in the latter part of the decade. Based on past experience, these estimates are likely to be low. In addition, these estimates do not include the added costs of mandated care and increased insurance premiums. They also do not include the added costs of compliance (paperwork and documentation). The projected increased revenues are about $1 trillion over ten years. This leaves a mere $110 billion difference over ten years or $11 billion dollars per year - about 1% of the current budget deficit. This difference is unlikely to hold up. The costs, as I pointed out, are likely to be greater than projected. Also, revenues are typically lower than CBO projections since they use static models which don't account for how tax policy will influence behavior. So, we've added about $1 trillion dollars in new taxes and failed to make any meaningful dent in a $1 trillion dollar deficit. In fact, history indicates that Obamacare's costs would exceed projected increased revenues and it will ADD to the deficit. At the same time, we've seriously crippled our ability to raise further revenues and climb out of our massive debt hole. It is obscenely irresponsible to add these huge uncertain costs to a system already $16 trillion in debt and adding more than $1 trillion in red ink every year.

Nope. I don't, never have, nor my associates, nor the docs on the MEC at two hospitals where we've discussed this very issue.

I'll admit I give wide latitude to ED docs because they often don't know the medical history of the patient and they work in an environment where the patient's condition can rapidly change before a better understanding of the underlying process can be made. But having said that, I think the good ones are doing what the situation calls for, and not necessarily defensive medicine.


Our experiences are obviously different. I would humbly suggest that your perspective (and that of other MEC members) is more than a bit naive. I would put greater weight on the cumulative opinion and experience of physicians which suggests that defensive medicine is routine and possibly hundreds of billions of dollars per year.

Yep, 19 years, no lawsuits. A few nonsense claims, but they went away quickly after discovery.

In my world, a "claim" is a lawsuit. While your personal experience is impressive, it is anecdotal. It could be pure chance. It could be a number of other factors I previously mentioned - the local medicolegal climate, the patient population, the type of practice, etc. I don't think it's helpful to discuss a matter which is anecdotal and possibly pure chance.

I'm surprised at the incredulity. You should sit on Credentials Committees, Peer Review, or Performance Improvement Committees as I do and then see if there are or aren't marginal docs.

I'm not arguing that there aren't "marginal" docs. Doctors are human. But I believe it is exceedingly arrogant to suggest that the practice of defensive medicine makes somebody a "marginal" doc. If that's the case, every single one of the doctors (hundreds) I've worked with in my career are "marginal." So, you're way off base.

I think we can agree to disagree. You seem to have a distorted view of what Obamacare does and doesn't do. You also seem overly confident of this view and overly dismissive of any alternative view. We seem to have a different view of what is "conservative" or "reasonable." You seem to have an unwavering religious belief or faith in government. History emphatically shows that this belief or faith is misguided and disastrous. So I do not share this belief or faith.


dave

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