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<Icy looks around to see if he has mistakenly wandered into a 3rd grade classroom ---- and I may have to apologize to third graders for the comparison if ya'll keep this up <smile>>

Now now ... the Sarg's tone left something to be desired, but jim there also might have a little too "self-assured" personal opinion from the extrapolation of his personal anecdotes to very broad conclusions. In fairness to jim, he did warn us readers that he had strong opinions on the matter. In fairness to the sgt, should one expect less than a strong challange when placing one's own strong opinions out there into public cyber ghettos like ours? But ya each made some wonderful points ... can't we discuss them without the other distracting personal nonsense?

jim ... What would you think is the average increase in terms of patient care costs from docs ordering tests / procedures more for avoiding litigation than for reasonable patient care issues? I know a few docs too and I know what they order and why. But beyond my own limited personal contacts and experiences (and other biases)there must have been articles and research on exactly this sort of thing .. do you know what it says? HINT - try googling - its fast, simple, informative, and I get a 10% commission if ya do <mischevious wolven grin>.

From the medical literature there appears to be more than a suggestion that fear of litigation adds significant unnecessary costs to patients (or third party payers). But from the legal professions supportive literature the amounts are lower with the interpretation being different. Both claim no significant bias <smile>. How can one reasonably balance these competing perspectives, or do one or both of you know where there are errors in such reports or misleading representations?

We seem to have somewhat related info from the Insurance/Finance industry regarding the cost of litigation on insurance rates, which I personally found both surprising and compelling ... while big dollar awards sound impressive on the news and get everyone's attention, the number of cases being settled without trial and the average settlements (relative to the total costs and fees etc.)belie the stats suggesting it is primarily responsible for (much less the sole reason for) the rate increases. Moreso, the investment portfolio behaviors of the insurance companies seem to correlate much better with rate changes than settling claims/court awards.

Might this suggest that other criteria might be critical in considering what is driving demand or ... what other factors beyond demand (regardless of its drivers) might be important in terms of medical costs etc.? Or if you're sure there are none, why is that the case here?

On another side of this rubik's cube ... how many docs bother with discovering/knowing the lowest cost reasonable alternatives for their patients, much less recommending it? Me thinks both of you "boyz" might be surprised by the answer to that question ... but then again, I am continually surprised by all sorts of things, so maybe you won't be? <shrug>

What should (and shouldn't) be covered by typical medical insurance? Beyond the psychology of patients' copay effects on their cost consciousness, what about the psychological effects on docs regarding reimbursement rates, etc.? ... There are stats published on the finances (and not from a doc's bias <g>) that show if a doc takes ONLY Medicare/caid patients they can NOT afford to practice medicine in most locales in the US today, UNLESS its without office support and they are willing to have to struggle financially themselves. So should we take into account possible reasons for why more docs seem to be leaving medicine than ever before?

Anyways, maybe I have become more accustomed to the thoughtful insightful (vs inciteful) postings in the TMF forums I regularly visit than I thought? If so, my apologies to you both ... please go on your merry ways ... but its just such an intriguing topic and it seems you both have positive things to contribute to it .. it seems a shame to me that the personal distractions may well inhibit the topic's exploration.

Take care,

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