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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