People always look to costs and say how we will root out waste abuse and corruption.
My wife is a psychiatrist, and a journal article recently showed how "defensive medicine", ie docs being afraid of being sued, was responsible for up to $ 850 BILLION a year. The total of all of the docs' premiums for malpractice insurance is about $20 billion. Not a good return on investment.
Out of the 20 billion, the docs' lawyers are paid, as well as the patients claims. If a patient wins a suit, their lawyer gets a contingency fee of 30-40% plus expenses. So the patients get only 10-15 billion and extra tests and hospitalizations and end of life care costs 850 billion.
How to save: In England, a patient CAN'T sue, because the docs are "given" to help patients, by national health, and are therefore protected by sovereign immunity. The most egregious cases get NO compensation. This would not fly in the US, so I would propose a health court, no fault, workers comp system, let the trial lawyers participate and get their fee, because negligence would still have to be proven, get the experts hired by the court, so it's more like science rather than debate and exaggeration, and costs could go down.
#2, JP Morgan, Berkshire Hathaway, and Amazon want to do no profit health self insurance. The administration in the white house have used the concept of "associations".
Now, the ACA, has "limited" ins co overhead and profit to no more than 20%.
Sounds great! right?
BUT, 20% OF A 500 PREMIUM WAS 1000, JUST TO PUSH PAPER AROUND AND PAY BILLS. nOW PREMIUMS ARE UP TO 20,000, AND 20% IS 4000 JUST TO PUsh paper around. Their incentives are to increase costs and premiums because they get 20 %,
Setting up non profit self insurance associations or coops or mutual cos would save a lot of the overhead.
Doing Both of these things would save 40-50%.
These thing are doable in the states, and are doable, rather than a federal 1 payer system.

TexasTowelie

(116,496 posts)

5. Welcome to DU.

Reply to ppsurgn (Reply #4)

Wed Feb 21, 2018, 01:46 PM

Feb 2018

A few comments about your reply.

If you are interested in setting up no-fault medical professional liability insurance then there would be no need to prove negligence--that is what makes it "no fault". The only thing that needs to be proved is coverage verification.

Although the U.S. system is litigious it does have some benefits to it in that it purges medical professionals who have lost the ability and skills to perform in a medical setting. In fact, an excessive amount of claims within the civil justice system can ultimately result in criminal prosecutions. A system such as the NIH has the perverse incentive of keeping marginal personnel practicing because the pressure to remove those practitioners comes from the state rather than from the individuals.

No profit self insurance also has a multitude of problems ranging from patient privacy issues to what happens to the patient in a cost-basis analysis. At what point does the medical costs exceed the value of what the employee may ever contribute to the employer's bottom line? If the medical costs do exceed the tipping point, then what prevents the employer from terminating the employee and leaving that person uninsured? What happens when an employer has taken a life insurance policy on "critical employees" which is becoming commonplace in American business. Should an employer be able to terminate an employee that has become obese?

Just as it doesn't make sense for an individual to get auto insurance through their employer, it doesn't make sense to get health insurance through their employer either. Too many situations occur that may result in the patient not receiving the best medical care available and creating other conflicting interests.

Yes, there is a significant cost because of defensive medicine, but there are some benefits that many Americans would not be willing to sacrifice in order to lower those costs.

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