BF2S Forums Why Healthcare is already Socialized for the Uninsured

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

but it is company dependent, therefore a lot of people won't get that choice, especially in small businesses and for the low paid workers.

As I stated before, there are multiple options available from single providers...even for the smallest businesses.

So a government run helathcare that offered several choices of levels of care and costs would replicate (and in some cases increase) the choice seen in the current system?

Such a system neither exists nor is being offered as an alternative.

PureFodder wrote:

and is this any different in the US than anywhere else?

You tell me.

You're claiming that this is significant which can only be the case if it is different. The null hypothesis says they are the same, you have to disprove the expected result.

Your assumption is that 1) the methods of governance are the same and 2) that the systems employed are/would be the same. Neither assumption is valid, obviating your null hypothesis.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

As I've shown below, the legal differences are mainly misrepresented by bundling the effects of the tort system with several other effects that all act in the same way and then pretending that they don't exist. The legal systems in the Us and other EU countries are fairly similar.

Pretending tort reform wouldn't address much of the behavior-driven costs is just as much of a misrepresentation. I didn't bundle up the effects of overall tort--only the medical-related torts (primarily malpractice). It helps your argument to make the assumption that I did bundle up all torts, but since I didn't, all it does is show that you don't bother to actually read or understand contrary arguments to your own. You argue to argue, not to learn.

As the effects all have the same general effect of increasing unneccessary procedures, the burden of proving that tort as opposed to the other effects os what is driving this cost.

The proof has already been provided by the doctors doing the unnecessary tests and procedures.

The other effects I discussed have the same effects, causing doctors to do unnecessary tests, therefore to show that tort is the prime cause of the costs as opposed to the other effects that have the same result, there is a burden of proof, again on you.

And again the proof has already been provided. Your ignoring it does not make it go away.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

The political differences are significant I guess as the US government has a history of being more willing to prioritise the profits of big business over everything else in healtcare in comparison to other countries (see the mind shatteringly dumb move to legally prevent the US government from negotiating for lower drug prices.)

There's no doubt that that legal action was stupid. But considering the prices the government will pay under Medicare/Medicaid, I can understand the drug companies wanting no part of it...nobody willingly operates at a loss.

Or to have their profits lowered by reasonable market forces (remember that drug companies operate predominantly within the government granted monopoly markets of the patent system).

There is a difference between having one's profits lowered and operating at a loss. The former already occurs within the current system. The latter occurs when servicing government-only patients.

Profits are already governed by market forces...as they should be. And as opposed to what you would impose, which is government-determined "reasonable" profits.

All rich countries with government run healthcare have private companies that wilfilly choose to operate in the healthcare sector and do so profitably. It works everywhere else.

And we have a system of government-run healthcare as well. The proportions are just different here than in those other countries. And it works as well here as anywhere else.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

The entire US system pays too much. If almost the entire system is government run then the government will by definition be paying the correct costs. That's how it works everywhere else.

No, the entire US system doesn't pay too much. And even if it did when averaging in the underpayment by the government, that bundling misrepresents the entirety of the situation. What we have is a government-run program (similar to what is being offered up as a possible single-payer alternative) that doesn't pay anywhere close to the actual costs, much less cover even a minimal profit margin for the businesses involved. That deficit is then taken up by the private industries effectively subsidizing the government by paying reasonable charges. Again, the reason why many physicians do not accept government programs or government provided insurance--nobody wants to operate at a loss.

If the entire system is run by the government, then the entire system will cease to operate because the government doesn't pay enough to keep the system sustained. In order for that to happen, ALL medical-related industry would have to be run by the government, not just delivery of care. There is simply no way that will happen.

And yet every other country manages to keep their costs well below those seen in the US with a fairly wide range of different levels of involvement of the private sector. The private sector in those countries willfully participates in it showing that they obviously aren't getting totally screwed as there's nothing stopping them from just doing somewthing else.

Except for those who are getting screwed coming to the US for their care.

PureFodder wrote:

So their source IS exactly the report that I was talking about, maybe if you had read the JEC report you would have seen it as the fact that they base it on the Kessler and McClellan work is utterly transparent as they repeatedly state that.

So where is your sourcing that the Kessler and McClellan work is invalid? If you don't like that, I can find plenty of others. Just as you can find plenty to support your position.

You're not going to convince me. I'm clearly not going to convince you. The difference between your position and mine is that mine is not academic. It is practical. I have dealt with both systems extensively and have seen positives and negatives of both. Government-run programs have their place for a subset of the population. But for the vast majority of the US population, the current US system is as good or better than alternatives offered in other countries. Multiple polls and studies support that position. That position is not mutually exclusive of a desire for doing things better and more efficiently...but none of the alternatives offered up thus far do either of those things.

I take it that you accept that you didn't read the report properly, accept that their results were based on the Kessler and McClellan figures and that you apologise for accusing me of not reading sources when I clearly did read it properly and you didn't?

No.

And you still haven't shown how the JEC's sources are invalid.

PureFodder wrote:

If you actually look at the report properly you'll also note that they conclude the savings will not be anywhere near the $230 billion that you claim, but $39 to $71 billion per year. That would be a third to a quarter of what you claim their results to be. That represents a 1.9-3.4% saving in the US healthcare costs. Whilst these high numbers would be better than nothing that's a long, long way from making any significant impact in the healthcare costs of the USA. Clearly even this data doesn't support the idea that tort reform will have a significant impact on healthcare costs in the USA especially when you realise that healthcare costs are increasing at an annual rate of 6%.

$230B is all torts, not just healthcare-related torts. I pointed that out.

And again...you are focusing on the tort payments and legal costs alone, not the cascading costs that aren't captured in your numbers. Again, convenient to your argument but not at all representative of the true cost savings that can be realized with reasonable tort reform.

PureFodder wrote:

FEOS wrote:

Your assumption is that 1) the methods of governance are the same and 2) that the systems employed are/would be the same. Neither assumption is valid, obviating your null hypothesis.

It's true for all other governmental systems that have tried it. It's the null hypothesis.

No. It's not.

http://www.themarknews.com/articles/405 … s-debunked

For you to claim that because it works elsewhere, it must work here--while clearly ignoring the key variables that enable it to work or not work elsewhere--makes your "null hypothesis" pretty easy to reject.

In fact, if one were to look at the various systems of socialized medicine in other countries, one would see that each one is different than the others. Which could just as easily lead to the null hypothesis that no single system would work universally, as there is no evidence of any systems being the same between two countries' implementations.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

The other effects I discussed have the same effects, causing doctors to do unnecessary tests, therefore to show that tort is the prime cause of the costs as opposed to the other effects that have the same result, there is a burden of proof, again on you.

And again the proof has already been provided. Your ignoring it does not make it go away.

No it hasn't

And your saying it hasn't been provided doesn't magically make it disappear, either.

Sorry to disappoint.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

All rich countries with government run healthcare have private companies that wilfilly choose to operate in the healthcare sector and do so profitably. It works everywhere else.

And we have a system of government-run healthcare as well. The proportions are just different here than in those other countries. And it works as well here as anywhere else.

At twice the cost.

Ah. So we're going to focus on a single issue rather than look at the entire problem? That sounds like an excellent plan.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

I take it that you accept that you didn't read the report properly, accept that their results were based on the Kessler and McClellan figures and that you apologise for accusing me of not reading sources when I clearly did read it properly and you didn't?

No.

And you still haven't shown how the JEC's sources are invalid.

I didn't bother as you said that you wouldn't care what the evidence said. It would be a waste of both our times. Plus I can happily show that tort reform will have little effect just using the sources that you are using which makes the entire process a whole lot simpler.

Well guess what? I bothered. And it turns out your position that the study had been debunked was debunked itself:

Look at all the other references listed in just that one JEC study--while keeping in mind that there are other JEC studies with similar numbers of references. In just the studies listed in footnote 55, there were six other references besides Kessler and McClellan’s work supporting that position. So again…READ the source. Don’t cherry-pick one of more than one hundred references, using a couple of other studies that find different results and think that suddenly the entire findings of the study using all the other sources you didn't pick is suddenly invalid.

The bottomline is that Kessler and McClellan’s study of cardiac patients showed significant cost savings associated with malpractice tort reform. Other studies showed neutral or minimal cost savings for other narrow sample sets, but looking at broader conditions. Regardless, the evidence shows savings. What’s wrong with reforming it to realize those savings? Challenging a study =/= debunking it.

And then there’s this:

That “flawed study” won at least two separate awards the following year—after peer review:

The Kessler-McClellan study won the 1997 American Economics Association’s award in health economics.

McClellan in Congressional testimony wrote:

This particular study was peer reviewed and published in The Quarterly Journal of Economics. In 1997, the International Health Economics Association, a well-known global professional association of health economists, presented us with the Kenneth J. Arrow Award for this article.

And addressing criticism of the study:

http://www.house.gov/jec/hearings/testi … -28-05.pdf

McClellan in Congressional testimony wrote:

CBO has taken issue with the estimates from the paper written by Dr. Kessler and me, contending that tort reform will not reduce defensive medicine. CBO used our work as a model, but their efforts are hampered by two critical methodological limitations. First, when CBO sought to replicate our study on a more recent sample of patients with the conditions we examined, it obtained similar results to ours. The finding of insignificant effects arose only when CBO sought to re-estimate our models on a set of patients with very broadly defined illnesses. Because hospital expenditures on patients with a broad range of illness are likely to be heterogeneous and hard to predict, the unexplained variance in hospital expenditures for these patients is likely to be large—larger than the unexplained variance in hospital expenditures for patients with clearly defined illnesses we studied. Since the standard errors of the estimates of the effects of limits on liability are proportional to the unexplained variance in expenditures, the statistical significance of estimates from models with broadly defined illnesses would be less than the significance of estimates from models with narrowly defined illnesses.

Second, we used more comprehensive data, while CBO used data from a 20 percent random sample of beneficiaries for most (1991-1996) of their study period.

Third, there was very little variation in states’ tort laws during the CBO’s entire study period (1991-1999)—according to CBO staff, only 6 states changed one or the other of the two liability system variables under analysis. In the period that we studied (1984-1994), 33 states changed one or the other of the liability system variables under analysis. These two differences—the less comprehensive data and the smaller number of “experiments” in the CBO analysis—would also lead the statistical significance of estimates reported in their brief to be lower than the significance of our estimates.

It is important to put the differences between myself and Dr. Kessler, and the CBO, in the context of what we focused on. CBO has not made estimates of savings from reductions in defensive medicine. They have, however, concluded that reduced premiums would save the Federal government billions of dollars. My own research shows the potential for billions more in savings as a result of reduce defensive medicine. What we both end up saying -- along with numerous other researchers – is that reforms will lead to billions of dollars in savings each year.

So again...how is the study not applicable? And how are the other hundreds of references in the JEC studies not applicable?

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

If you actually look at the report properly you'll also note that they conclude the savings will not be anywhere near the $230 billion that you claim, but $39 to $71 billion per year. That would be a third to a quarter of what you claim their results to be. That represents a 1.9-3.4% saving in the US healthcare costs. Whilst these high numbers would be better than nothing that's a long, long way from making any significant impact in the healthcare costs of the USA. Clearly even this data doesn't support the idea that tort reform will have a significant impact on healthcare costs in the USA especially when you realise that healthcare costs are increasing at an annual rate of 6%.

$230B is all torts, not just healthcare-related torts. I pointed that out.

And again...you are focusing on the tort payments and legal costs alone, not the cascading costs that aren't captured in your numbers. Again, convenient to your argument but not at all representative of the true cost savings that can be realized with reasonable tort reform.

You really haven't read your own source have you? The Kessler and McClelland study is specifically an attempt to quantifty the cascading effects as you would clearly know had you read and understood your own source, the JEC report specifically says it. The JEC figures are based on this study that takes the whole thing into account cascades and all.

A maximum of about a 3.4% reduction in healthcare spending is the maximum of what you could get if you include all the cascading effects. That is what the JEC study concludes.

The Kessler-McClellan study was an attempt to determine the costs of current malpractice torts on the system. They didn't determine all cascading effects. They found that there were cascading effects based on doctors' behaviors in varying tort systems.

And the amount of savings possible is far more than you suggest:

My own research concluded a reduction in defensive medicine could lower overall hospital expenditures by between five and nine percent. During FY 2004, the Medicare program spent more than $133 billion on hospital fee-for-service. That would mean potential annual savings of between $6.65 and $11.97 billion dollars, just for that program, not to mention the private sector.

Then there's reduced administrative costs associated with tort reform, as well:

A 2002 poll by Harris Interactive found that the fear of litigation impacts healthcare administrative issues. Well over three-fourths of all physicians and nurses (84% and 81%, respectively) reported that they spend more time on paper work, such as medical record documentation, because of malpractice concerns than they would based solely on the patient's clinical needs.

And there's another study from the Department of Health and Human Services:

http://aspe.hhs.gov/daltcp/reports/litrefm.pdf

Americans spend proportionately far more per person on the costs of litigation than any other country in the world. The excesses of the litigation system are an important contributor to “defensive medicine”--the costly use of medical treatments by a doctor for the purpose of avoiding litigation.

74 references. One of them is the Kessler-McClellan study from ‘96.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

No.

And you still haven't shown how the JEC's sources are invalid.

I didn't bother as you said that you wouldn't care what the evidence said. It would be a waste of both our times. Plus I can happily show that tort reform will have little effect just using the sources that you are using which makes the entire process a whole lot simpler.

Well guess what? I bothered. And it turns out your position that the study had been debunked was debunked itself:

Look at all the other references listed in just that one JEC study--while keeping in mind that there are other JEC studies with similar numbers of references. In just the studies listed in footnote 55, there were six other references besides Kessler and McClellan’s work supporting that position. So again…READ the source. Don’t cherry-pick one of more than one hundred references, using a couple of other studies that find different results and think that suddenly the entire findings of the study using all the other sources you didn't pick is suddenly invalid.

The bottomline is that Kessler and McClellan’s study of cardiac patients showed significant cost savings associated with malpractice tort reform. Other studies showed neutral or minimal cost savings for other narrow sample sets, but looking at broader conditions. Regardless, the evidence shows savings. What’s wrong with reforming it to realize those savings? Challenging a study =/= debunking it.

Actually the CBO opinion wasn't what I was basing it from so your effort to debunk the debunk has been debunked !?!

It's based on thnigs like this start at p127 if you're only interested in this particular issue.
http://www.factcheck.org/article133.html also.
The issue is that their approach is completely dependent upon the two diseases chosen being perfect averages of the healthcare system as a whole. This is at best wild speculation and other work, even by the same authors suggests that it's not representative at all. It also neglects the possitive outcomes of the tort system, that is the doctors who would have given sub-par treatment but were motivated to give the correct level by the potential threat of being sued. Of the several studies conducted this is the only one that has anywhere near those figures and is also the most restricted in terms of range of what was investigated, meaning it is prone to stumbling on diseases that have unusual effects.

As far as the large number of references goes, even a cursory glance at the report shows that almost none of the sources have anything to do with measuring the economic costs of the tort system. Again showing your failure to either read or understand the report. The research that they contend to be the most important and use the figures from is that paper, the only other source that discusses the actual issue is the CBO one, which you have decided to dismiss.

FEOS wrote:

And then there’s this:

That “flawed study” won at least two separate awards the following year—after peer review:

The Kessler-McClellan study won the 1997 American Economics Association’s award in health economics.

McClellan in Congressional testimony wrote:

This particular study was peer reviewed and published in The Quarterly Journal of Economics. In 1997, the International Health Economics Association, a well-known global professional association of health economists, presented us with the Kenneth J. Arrow Award for this article.

And addressing criticism of the study:

http://www.house.gov/jec/hearings/testi … -28-05.pdf

McClellan in Congressional testimony wrote:

CBO has taken issue with the estimates from the paper written by Dr. Kessler and me, contending that tort reform will not reduce defensive medicine. CBO used our work as a model, but their efforts are hampered by two critical methodological limitations. First, when CBO sought to replicate our study on a more recent sample of patients with the conditions we examined, it obtained similar results to ours. The finding of insignificant effects arose only when CBO sought to re-estimate our models on a set of patients with very broadly defined illnesses. Because hospital expenditures on patients with a broad range of illness are likely to be heterogeneous and hard to predict, the unexplained variance in hospital expenditures for these patients is likely to be large—larger than the unexplained variance in hospital expenditures for patients with clearly defined illnesses we studied. Since the standard errors of the estimates of the effects of limits on liability are proportional to the unexplained variance in expenditures, the statistical significance of estimates from models with broadly defined illnesses would be less than the significance of estimates from models with narrowly defined illnesses.

Second, we used more comprehensive data, while CBO used data from a 20 percent random sample of beneficiaries for most (1991-1996) of their study period.

Third, there was very little variation in states’ tort laws during the CBO’s entire study period (1991-1999)—according to CBO staff, only 6 states changed one or the other of the two liability system variables under analysis. In the period that we studied (1984-1994), 33 states changed one or the other of the liability system variables under analysis. These two differences—the less comprehensive data and the smaller number of “experiments” in the CBO analysis—would also lead the statistical significance of estimates reported in their brief to be lower than the significance of our estimates.

It is important to put the differences between myself and Dr. Kessler, and the CBO, in the context of what we focused on. CBO has not made estimates of savings from reductions in defensive medicine. They have, however, concluded that reduced premiums would save the Federal government billions of dollars. My own research shows the potential for billions more in savings as a result of reduce defensive medicine. What we both end up saying -- along with numerous other researchers – is that reforms will lead to billions of dollars in savings each year.

So again...how is the study not applicable? And how are the other hundreds of references in the JEC studies not applicable?

a) because it is the only study of several giving such numbers, is heavily restricted in terms of scope of the investigation and scaling up to be representative of the entire system is entirely unreasonable. It is also based on the oldest numbers. b) Again for all of the references in the JEC study, there are only 2 that directly pertain to this question unless you somehow think that whether 'Prosser and Keeton on the Law of Torts' is a reasonable source on the law of torts is somehow relevant to this debate or supplies important evidence?

FEOS wrote:

PureFodder wrote:

FEOS wrote:

$230B is all torts, not just healthcare-related torts. I pointed that out.

And again...you are focusing on the tort payments and legal costs alone, not the cascading costs that aren't captured in your numbers. Again, convenient to your argument but not at all representative of the true cost savings that can be realized with reasonable tort reform.

You really haven't read your own source have you? The Kessler and McClelland study is specifically an attempt to quantifty the cascading effects as you would clearly know had you read and understood your own source, the JEC report specifically says it. The JEC figures are based on this study that takes the whole thing into account cascades and all.

A maximum of about a 3.4% reduction in healthcare spending is the maximum of what you could get if you include all the cascading effects. That is what the JEC study concludes.

The Kessler-McClellan study was an attempt to determine the costs of current malpractice torts on the system. They didn't determine all cascading effects. They found that there were cascading effects based on doctors' behaviors in varying tort systems.

And the amount of savings possible is far more than you suggest:

My own research concluded a reduction in defensive medicine could lower overall hospital expenditures by between five and nine percent. During FY 2004, the Medicare program spent more than $133 billion on hospital fee-for-service. That would mean potential annual savings of between $6.65 and $11.97 billion dollars, just for that program, not to mention the private sector.

Then there's reduced administrative costs associated with tort reform, as well:

Yet more recent studies contradict this finding.

FEOS wrote:

A 2002 poll by Harris Interactive found that the fear of litigation impacts healthcare administrative issues. Well over three-fourths of all physicians and nurses (84% and 81%, respectively) reported that they spend more time on paper work, such as medical record documentation, because of malpractice concerns than they would based solely on the patient's clinical needs.

But if their opinion of the patients needs are less than their actual needs, that's a very good thing. Rememebr that the amount of negligent injury and death is huge, implying that increased safeguards are what's needed, not less.

FEOS wrote:

And there's another study from the Department of Health and Human Services:

http://aspe.hhs.gov/daltcp/reports/litrefm.pdf

Americans spend proportionately far more per person on the costs of litigation than any other country in the world. The excesses of the litigation system are an important contributor to “defensive medicine”--the costly use of medical treatments by a doctor for the purpose of avoiding litigation.

74 references. One of them is the Kessler-McClellan study from ‘96.

The US medical system runs at double the costs of other countries. For this reason the awards for damages to cover healthcare costs incurred will be approximately twice that of other countries. Even if the exact same tort systems were being used in the US and all the other rich countries, the costs of litigation would be much higher in the US on that basis alone.

PureFodder wrote:

Actually the CBO opinion wasn't what I was basing it from so your effort to debunk the debunk has been debunked !?!

It's based on thnigs like this start at p127 if you're only interested in this particular issue.
http://www.factcheck.org/article133.html also.
The issue is that their approach is completely dependent upon the two diseases chosen being perfect averages of the healthcare system as a whole. This is at best wild speculation and other work, even by the same authors suggests that it's not representative at all. It also neglects the possitive outcomes of the tort system, that is the doctors who would have given sub-par treatment but were motivated to give the correct level by the potential threat of being sued. Of the several studies conducted this is the only one that has anywhere near those figures and is also the most restricted in terms of range of what was investigated, meaning it is prone to stumbling on diseases that have unusual effects.

As far as the large number of references goes, even a cursory glance at the report shows that almost none of the sources have anything to do with measuring the economic costs of the tort system. Again showing your failure to either read or understand the report. The research that they contend to be the most important and use the figures from is that paper, the only other source that discusses the actual issue is the CBO one, which you have decided to dismiss.

Actually, I was focusing on the rationale for the CBO's argument, not the CBO itself. Considering that McClellan did a pretty good job of explaining the difference in approach on the contradicting study(ies), his defense of his work is applicable to more than just the CBO critique.

But then again, I don't focus on a single aspect when I research something. I research to learn, not to argue trivialities.

PureFodder wrote:

FEOS wrote:

And then there’s this:

That “flawed study” won at least two separate awards the following year—after peer review:

The Kessler-McClellan study won the 1997 American Economics Association’s award in health economics.

McClellan in Congressional testimony wrote:

This particular study was peer reviewed and published in The Quarterly Journal of Economics. In 1997, the International Health Economics Association, a well-known global professional association of health economists, presented us with the Kenneth J. Arrow Award for this article.

And addressing criticism of the study:

http://www.house.gov/jec/hearings/testi … -28-05.pdf

McClellan in Congressional testimony wrote:

CBO has taken issue with the estimates from the paper written by Dr. Kessler and me, contending that tort reform will not reduce defensive medicine. CBO used our work as a model, but their efforts are hampered by two critical methodological limitations. First, when CBO sought to replicate our study on a more recent sample of patients with the conditions we examined, it obtained similar results to ours. The finding of insignificant effects arose only when CBO sought to re-estimate our models on a set of patients with very broadly defined illnesses. Because hospital expenditures on patients with a broad range of illness are likely to be heterogeneous and hard to predict, the unexplained variance in hospital expenditures for these patients is likely to be large—larger than the unexplained variance in hospital expenditures for patients with clearly defined illnesses we studied. Since the standard errors of the estimates of the effects of limits on liability are proportional to the unexplained variance in expenditures, the statistical significance of estimates from models with broadly defined illnesses would be less than the significance of estimates from models with narrowly defined illnesses.

Second, we used more comprehensive data, while CBO used data from a 20 percent random sample of beneficiaries for most (1991-1996) of their study period.

Third, there was very little variation in states’ tort laws during the CBO’s entire study period (1991-1999)—according to CBO staff, only 6 states changed one or the other of the two liability system variables under analysis. In the period that we studied (1984-1994), 33 states changed one or the other of the liability system variables under analysis. These two differences—the less comprehensive data and the smaller number of “experiments” in the CBO analysis—would also lead the statistical significance of estimates reported in their brief to be lower than the significance of our estimates.

It is important to put the differences between myself and Dr. Kessler, and the CBO, in the context of what we focused on. CBO has not made estimates of savings from reductions in defensive medicine. They have, however, concluded that reduced premiums would save the Federal government billions of dollars. My own research shows the potential for billions more in savings as a result of reduce defensive medicine. What we both end up saying -- along with numerous other researchers – is that reforms will lead to billions of dollars in savings each year.

So again...how is the study not applicable? And how are the other hundreds of references in the JEC studies not applicable?

a) because it is the only study of several giving such numbers, is heavily restricted in terms of scope of the investigation and scaling up to be representative of the entire system is entirely unreasonable. It is also based on the oldest numbers. b) Again for all of the references in the JEC study, there are only 2 that directly pertain to this question unless you somehow think that whether 'Prosser and Keeton on the Law of Torts' is a reasonable source on the law of torts is somehow relevant to this debate or supplies important evidence?

Did you miss the part where two prominent economists, one of whom is an MD as well, had their work peer-reviewed and published, winning two separate economic awards for their work?

Are you really arrogant enough to think that your limited review of summaries of their work makes you more qualified than the PhD economists with decades of experience that reviewed their entire effort and then awarded them for it?

Really?

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

You really haven't read your own source have you? The Kessler and McClelland study is specifically an attempt to quantifty the cascading effects as you would clearly know had you read and understood your own source, the JEC report specifically says it. The JEC figures are based on this study that takes the whole thing into account cascades and all.

A maximum of about a 3.4% reduction in healthcare spending is the maximum of what you could get if you include all the cascading effects. That is what the JEC study concludes.

The Kessler-McClellan study was an attempt to determine the costs of current malpractice torts on the system. They didn't determine all cascading effects. They found that there were cascading effects based on doctors' behaviors in varying tort systems.

And the amount of savings possible is far more than you suggest:

My own research concluded a reduction in defensive medicine could lower overall hospital expenditures by between five and nine percent. During FY 2004, the Medicare program spent more than $133 billion on hospital fee-for-service. That would mean potential annual savings of between $6.65 and $11.97 billion dollars, just for that program, not to mention the private sector.

Then there's reduced administrative costs associated with tort reform, as well:

Yet more recent studies contradict this finding.

And again, you focus on one of over a hundred sources in the JEC study. Of course there are studies that contradict this study, just as there are other studies that contradict those studies. That's what happens when you're dealing with theoretical topics. The fact that people don't agree with others' theories does not make those theories invalid.

PureFodder wrote:

FEOS wrote:

A 2002 poll by Harris Interactive found that the fear of litigation impacts healthcare administrative issues. Well over three-fourths of all physicians and nurses (84% and 81%, respectively) reported that they spend more time on paper work, such as medical record documentation, because of malpractice concerns than they would based solely on the patient's clinical needs.

But if their opinion of the patients needs are less than their actual needs, that's a very good thing. Rememebr that the amount of negligent injury and death is huge, implying that increased safeguards are what's needed, not less.

Nobody said anything about decreased safeguards.

And the "patients' needs" was referring to the amount of paperwork, not treatment.

PureFodder wrote:

FEOS wrote:

And there's another study from the Department of Health and Human Services:

http://aspe.hhs.gov/daltcp/reports/litrefm.pdf

Americans spend proportionately far more per person on the costs of litigation than any other country in the world. The excesses of the litigation system are an important contributor to “defensive medicine”--the costly use of medical treatments by a doctor for the purpose of avoiding litigation.

74 references. One of them is the Kessler-McClellan study from ‘96.

The US medical system runs at double the costs of other countries. For this reason the awards for damages to cover healthcare costs incurred will be approximately twice that of other countries. Even if the exact same tort systems were being used in the US and all the other rich countries, the costs of litigation would be much higher in the US on that basis alone.

That connection has no basis, as our tort awards are not linked to the cost of healthcare provision.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

FEOS wrote:

Your assumption is that 1) the methods of governance are the same and 2) that the systems employed are/would be the same. Neither assumption is valid, obviating your null hypothesis.

It's true for all other governmental systems that have tried it. It's the null hypothesis.

No. It's not.

http://www.themarknews.com/articles/405 … s-debunked

For you to claim that because it works elsewhere, it must work here--while clearly ignoring the key variables that enable it to work or not work elsewhere--makes your "null hypothesis" pretty easy to reject.

In fact, if one were to look at the various systems of socialized medicine in other countries, one would see that each one is different than the others. Which could just as easily lead to the null hypothesis that no single system would work universally, as there is no evidence of any systems being the same between two countries' implementations.

There's a wide range of different political systems within the rich western countries. They've all managed to successfully run a government based healthcare system. The notion that the US is the single exception to the rule demands an explaination.

Your 'source' is an opinon piece that gets thoroughly hacked appart by the coments below it.

Many of your "sources" are opinion pieces as well. That get hacked apart by scientific studies.

There are a range of opinions and studies, you've grabbed the most extreme one that fits your argument and declared it to be the truth.

FEOS wrote:

Your point? An opinion getting rebutted by other opinions does not make original opinion invalid.

There's a range of opinions. You've just selected the one that happens to agree with your pre-concieved idea and used it as evidence that government run healthcare doesn't work.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

And your saying it hasn't been provided doesn't magically make it disappear, either.

Sorry to disappoint.


Ah. So we're going to focus on a single issue rather than look at the entire problem? That sounds like an excellent plan.

You say yourself that it works as well as anywhere else, but costs twice as much. when chosing between two options with similar outcomes chosing the one with double the costs sounds like an excellent plan.
(more later when I have time.)

Works as well meaning in delivery of service. Where it breaks down is payment timeliness and sufficiency. Our government-run system fails on both criteria. Regardless, you fail to address my point. But I guess you will later, eh?

Your point is that the US is a unique case amongst the rich nations therefore there even though it works everywhere else in the wide range of conditions that they encompase but so far haven't backed up that statement with anything.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

Actually, I was focusing on the rationale for the CBO's argument, not the CBO itself. Considering that McClellan did a pretty good job of explaining the difference in approach on the contradicting study(ies), his defense of his work is applicable to more than just the CBO critique.

But then again, I don't focus on a single aspect when I research something. I research to learn, not to argue trivialities.

No you research to try and prove preconcieved notions.

As I said and you failed to understand, the problem with the Kessler and McClellend figures are that they rely entirely on the two issues that they looked at being representative of the entire system. They chose them specifically for their unique properties that helped them complete the bulk of the aims of the research (which were not to estimate the economic impact of tort on the whole system btw). This fact alone singles them out as being non-representative. If you actually wanted to find out the effects of tort on the system as a whole you'd have to look at a large range of diseases/treatments, a wide range of non-hospital related issues that sit well outside the type of investigation that they conducted and ensure that you were selecting the treatments/issues in a random manner. That would be how you do it. The reason that they didn't do that is because it was not the aim of their research. The aim of their research was to determine the tort effects upon those specific issues, not the wider system, which is why it should not be viewed as a reasonable value for the system as a whole.

They simply don't address that issue.

Why don't you lower the condescension a notch or three?

I fully understand what you said. What you've failed to understand is that, for the specific instances they studied, they showed--conclusively--that tort reform makes a positive difference. Other studies with varying degrees of specificity have shown positive difference or neutral difference. None have shown that it makes costs higher. Thus, all the evidence shows that tort reform would at a minimum make things no worse and likely make them better. And that reform involves both sides of the issue (see other tort reform sources provided). The current malpractice torts do not achieve the goal of punishing doctors for their mistakes. If malpractice torts were reformed for no other reason, I would think that you would want them reformed to fix that--punishing far more innocent doctors than guilty ones.

Just one of the many areas that can--and should--be reformed before determining whether or not to ditch the current system in its entirety.

You started with the condedcending, not me.

They showed that tort reform made a differecne in the cases they were studying. Studies have come out with a range of different economic results and patient safety results. Nobody has done a sensible study into the effects on the whole system that would allow you to make the pronouncements that tort reform is always beneficial. This becomes especially clear when you realise the wide range of different ways that you can enact tort reform, all of which are expected to have differing results. For example, we already know that only something like 1-2% of negligent injuries end up being compansated by the current system in the US. One method of tort reform is to reduce the barriers to patients seeking compensation. Whilst definately good, as it can get more financial help to those who deserve it and punishing healthcare doctors/workers/companies that cause these injuries, it's obviously going to increase costs, not reduce them.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

Did you miss the part where two prominent economists, one of whom is an MD as well, had their work peer-reviewed and published, winning two separate economic awards for their work?

Are you really arrogant enough to think that your limited review of summaries of their work makes you more qualified than the PhD economists with decades of experience that reviewed their entire effort and then awarded them for it?

Really?

Their work is exemplary, and a very good method for looking into the effects of tort on certain aspects of the medical system. It should be used as a method by which the study of the entire system is conducted by (incidentally it has, and people looking at different very differing results, almost all of them lower than the Kessler results, some are even showing an increase in costs with tort reform using their methods applied to different diseases/issues). This is what the research was about and what they rightfully won awards for. The problem is simply that once they had the figures from their research on two diseases they decided to try going one step further and use them to calculate the effects on the entire system, the important assumption here being that these two illnesses are representative of everything that occurs in the medical system, which they are not, even according to their own work.

You've just contradicted yourself. You say they attempt to apply it to the entire system, then say they said themselves their findings aren't necessarily representative of the entire system. Make up your mind.

The key to their research is showing that tort reform makes a positive impact in cost of medicine beyond the courtroom. Far more studies have supported that finding (to varying levels) than have not. Yet you say it shouldn't be pursued. Truly mind-boggling.

Actually I didn't contradict myself, even your accusation clearly shows that it is non-contradictory. The findings are only representative of the issues that they directly looked at. They then take the values they got from this research and apply them to the whole system based on the guess that they happened to study two diseases that gave average results for the entire healthcare system. This would be like studying the impact of the recent recession on Ferrari and taking those results , assuming they are the everage for the entire system, and applying them to the transportation industry as a whole (ie. all car/bike/train/boat/aircraft manufacturers). While the Ferrari study may be groundbreaking and highly accurate, it is not reasonable to expand those findings as applicable to the entire system. If you want to do that you'd have to look at all the different types of transportation and take randomised samples of a range of manufactures in each.

As the studies have not been properly conducted, we really can't tell whether specific tort reforms will save money or increase injuries. For example from the book I linked to earlier, a study by Klick and Stratmann (p 150) gave evidence that one particular type of tort reform may cause an increse in infant mortality. The problem with enacting sweeping tort refom before anyone has a reasonable idea of the likely consequences is that there is serious possibility for causing a lot of problems. there are also issues with the way that tort reforms have been carried out. For example the non-economic damages cap. Firstly an almost all cases has the weird property of being non-inflations adjusted (the $250,000 cap set in California in the 70s would be about $1million today if inflation were included). Secondly by capping non-economic damages you end up with the elderly, women and children being greatly diasadventaged by the system as they often have little if any direct economic losses. For example malpractice leading to women no longer being able to have children has no economic value, a kid being crippled before he starts work is different from crippling a kid after he starts work. The same arguments for defensive medicine being caused by the prospect of being sued a huge amount would be expected to lead to doctors estimating how rich the patient is and giving different levels of care based on that. It is logical that if a poor kid and a rich businessman walk into your practice you'll spend more time and effort on the rich person because they can sue you for a hell of a lot more than the poor kid can, likely leading to waste on the rich guy and too little on the poor kid. As far as I'm aware nobody has even approached looking at this issue. This is just a couple of examples of how tort reform is a far more complex issue that you seem to believe, with the potential for a wide range of possitive and negative outcomes. Trying to do it the current poor understanding is just asking for a disaster.

FEOS wrote:

PureFodder wrote:

Also the guy explaining why they are wrong is a Professor with decades of experience, it's him that is supposedly arrogant, not me. You need to learn how to disconnect what I'm saying from what experts say about the topic.

You've been bashing the study, not some professor. You may be using some of his findings, but it's been you who's been bashing it. Don't scapegoat the professor simply because your position is less tenable.

So your saying that I am arrogant because I find the arguments of one professor more convincing that that of another, where as you finding the other academic more convincing is not arrogant? The logic behind the criticism of the Kessler and McClelland claim (ie. that their work doesn't represent a system wide average) is perfectly sensible as anyone who has designed a complex experiment will tell you.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

And again, you focus on one of over a hundred sources in the JEC study. Of course there are studies that contradict this study, just as there are other studies that contradict those studies. That's what happens when you're dealing with theoretical topics. The fact that people don't agree with others' theories does not make those theories invalid.

Again, look at those hundreds of sources, clearly the only two involved with answer the question of the wider effects of tort on the healthcare economics are that one and the CBO one. You agree that there are multiple competing results out there. What you have also done (as many do) is find the one with the highest number and declare that to be the best, as it fits your preconcieved notion the best.

pot-kettle, tbh.

The sources used apply to broader discussions regarding medical tort reform. You focusing on a single aspect of the problem set does not mean everyone else has to.

PureFodder wrote:

FEOS wrote:

Nobody said anything about decreased safeguards.

And the "patients' needs" was referring to the amount of paperwork, not treatment.

I'm not talking about treatment I'm talking about administration caused negligent injuries caused by fuck-ups in paper-work and admin that lead to treatments being correctly decided upon but not being carried out/carried out incorrectly due to admin mistakes/carried out on the wrong person etc. This is one of the leading causes of negligent injuries.

That's not what the documentation burden was referring to. The documentation burden being referred to is closer to the issue of paperwork associated with billing.

It specifically says medical record documentation which is a base from which doctors will tackle future medical problems the patient faces. Fuck-ups here lead to future fuck-ups, which will be the fault of the doctor messing up the medical records.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

That connection has no basis, as our tort awards are not linked to the cost of healthcare provision.

The economic damages are though, this leads to the payout being generally larger and therefore more money and effort being put towards trying to get/avoid this cost. This will increase litigation costs as the overall healthcare expendature per capita increases.

And you've (again) missed the issue. The problem with tort reform is not in real damages--associated with income loss, etc. It is with punitive damages, which result in outlandish amounts to "teach them a lesson". Nobody is arguing that people who have been harmed shouldn't be compensated appropriately. It is not the real damages that destroys people--it is the punitive damages. And it is the punitive damage caps that make the most difference in both insurance rates and fear factor for medical providers.

And again: damage awards are not related to healthcare costs incurred, they are related to income loss and punitive damages, by and large. No relation at all to healthcare costs associated with the case.

No, a large part of the costs relate to the actual medical costs associated with negligent injuries. As this does exist, and the average costs of the US healthcare system are higher, there wil be a predictable increase in the legal costs on that basis alone. I'm not disagreeing that the non-ecomic damages exist and have a significant effect, just that the costs in the US legal system will be higher as a result of this increased health costs. The difference between the US litigation costs and that of other rich countries cannot therefore be put antirely at the feet of the non-economic damages.

FEOS wrote:

PureFodder wrote:

They showed that tort reform made a differecne in the cases they were studying. Studies have come out with a range of different economic results and patient safety results. Nobody has done a sensible study into the effects on the whole system that would allow you to make the pronouncements that tort reform is always beneficial. This becomes especially clear when you realise the wide range of different ways that you can enact tort reform, all of which are expected to have differing results. For example, we already know that only something like 1-2% of negligent injuries end up being compansated by the current system in the US. One method of tort reform is to reduce the barriers to patients seeking compensation. Whilst definately good, as it can get more financial help to those who deserve it and punishing healthcare doctors/workers/companies that cause these injuries, it's obviously going to increase costs, not reduce them.

Point to a study that shows tort reform created a negative cost impact. All studies I have seen (and sourced, btw) show either positive or neutral cost impact...while concurrent studies also show that the current system doesn't perform the function for which malpractice law was enacted.

Thus, reform is needed on multiple levels and for multiple reasons...one of which is positive cost impact in healthcare.

All the studies are concerned with specific types of tort reform, there are a million ways in which you can reform the tort system, many of which will increase costs but may be benficial in other ways such as reducing the barriers for people to sue doctors/companies as we all know that the vast majority of negligent injuries do not result in any compensation to the victim. You seem fixed on only looking at certain types of tort refom.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

You've just contradicted yourself. You say they attempt to apply it to the entire system, then say they said themselves their findings aren't necessarily representative of the entire system. Make up your mind.

The key to their research is showing that tort reform makes a positive impact in cost of medicine beyond the courtroom. Far more studies have supported that finding (to varying levels) than have not. Yet you say it shouldn't be pursued. Truly mind-boggling.

Actually I didn't contradict myself, even your accusation clearly shows that it is non-contradictory. The findings are only representative of the issues that they directly looked at. They then take the values they got from this research and apply them to the whole system based on the guess that they happened to study two diseases that gave average results for the entire healthcare system. This would be like studying the impact of the recent recession on Ferrari and taking those results , assuming they are the everage for the entire system, and applying them to the transportation industry as a whole (ie. all car/bike/train/boat/aircraft manufacturers). While the Ferrari study may be groundbreaking and highly accurate, it is not reasonable to expand those findings as applicable to the entire system. If you want to do that you'd have to look at all the different types of transportation and take randomised samples of a range of manufactures in each.

It would be if Ferrari were the leading brand of car sold in the country in which the study was performed...as heart disease was (at the time) one of the leading causes of death and one of the leading causes of treatment in the US.

It doesn't represent the bulk of the costs of the system and isn't applicable to the rest of the system, therefore it isn't a representative value for the entire system.

FEOS wrote:

PureFodder wrote:

As the studies have not been properly conducted, we really can't tell whether specific tort reforms will save money or increase injuries. For example from the book I linked to earlier, a study by Klick and Stratmann (p 150) gave evidence that one particular type of tort reform may cause an increse in infant mortality. The problem with enacting sweeping tort refom before anyone has a reasonable idea of the likely consequences is that there is serious possibility for causing a lot of problems.

That can't possibly be the case. You've already said that taking one instance and reflecting the results across the entire population is an invalid study...therefore, the infant mortality study must be invalid, making the findings invalid and unable to be used to argue your position.

I said there was evidence that it may cause problems Notice that I didn't pronounce it to be the entire truth, but a study with results that, while not being representative of the entire system, show there is a variety of possible outcomes.

If we use your flawed logic, there was one study, therfore it is exactly what will happen throughout the entire system. So either your argument for the Kessler data representing the entire system is wrong, or you must conclude that this is representative.

FEOS wrote:

PureFodder wrote:

there are also issues with the way that tort reforms have been carried out. For example the non-economic damages cap. Firstly an almost all cases has the weird property of being non-inflations adjusted (the $250,000 cap set in California in the 70s would be about $1million today if inflation were included).

Source, please.

So, if inflationary indices were taken into account, you would be fine with a cap on non-economic (punitive) damages?

http://books.google.co.uk/books?id=NrOE … ;resnum=1#
And no, even with inflation it's a bas idea see below.

FEOS wrote:

PureFodder wrote:

Secondly by capping non-economic damages you end up with the elderly, women and children being greatly diasadventaged by the system as they often have little if any direct economic losses. For example malpractice leading to women no longer being able to have children has no economic value, a kid being crippled before he starts work is different from crippling a kid after he starts work.

Not true. In the US "potential" income for those affected before being able to work is taken into account for economic damages.

Your argument about women being unable to have children is interesting...to say there shouldn't be a cap implies there should be a dollar value associated with the situation, but the cap is lower than the dollar value you would associate with it. Which further implies there is an acceptable cap to the award(s) in those situations.

There's a wide range of potential problems out there with wierd and horrible injuries being negligently inflicted upon people. The cap just prevents those getting the worst of it from being compensated. One way around the issue is the British rule of thumb guide for what injury is worth what value, ie. loose a thumb and you get $X for it. If X is too high, defense lawyers will choose to fight rather than settle. Too low and the defendent will take it to court rather than settle. When everyone settles it's way cheaper all round. This reduces the costs without any legal obligations or capping so when the feak cases come around it can still rewards as much or as little as is sensible.

here's an article on some of the problems with caps.

FEOS wrote:

PureFodder wrote:

The same arguments for defensive medicine being caused by the prospect of being sued a huge amount would be expected to lead to doctors estimating how rich the patient is and giving different levels of care based on that.

Not at all. That's why there is a thing called "standard of care" that is irrespective of wealth level. The defensive medicine part comes in when unnecessary treatment/testing is performed in excess of the standard of care due to concerns over litigation.

If a doctor does less than the established standard of care--for whatever reason, they are liable.

But there are still something like 100,000 negligent injuries each year in the US medical system most of which result in no legal action, so clearly a lot of what doctors consider to be a standard degree of care is actually too low. There are likely to be many doctors who are pushed into giving the correct level of care by the threat of being sued. Now given limited time and a choice between splitting that time between a rich pations who can sue the crap out of you and a poor one who is unlikely to be able to sue and can't win as much, there is likely to be preferetial treatment.

FEOS wrote:

PureFodder wrote:

It is logical that if a poor kid and a rich businessman walk into your practice you'll spend more time and effort on the rich person because they can sue you for a hell of a lot more than the poor kid can, likely leading to waste on the rich guy and too little on the poor kid. As far as I'm aware nobody has even approached looking at this issue. This is just a couple of examples of how tort reform is a far more complex issue that you seem to believe, with the potential for a wide range of possitive and negative outcomes. Trying to do it the current poor understanding is just asking for a disaster.

Nobody needs to approach looking at that issue for the reason stated above. There is clearly poor understanding of the situation here in the US...at least by those who aren't from the US who argue against it based on something they've read vice experienced.

Fear of being sued is what is supposedly causing the defensive medicine, the same argument would therefore apply to choosing which of your patients to put the most time and effort into looking after.

FEOS wrote:

PureFodder wrote:

So your saying that I am arrogant because I find the arguments of one professor more convincing that that of another, where as you finding the other academic more convincing is not arrogant? The logic behind the criticism of the Kessler and McClelland claim (ie. that their work doesn't represent a system wide average) is perfectly sensible as anyone who has designed a complex experiment will tell you.

I'm pretty sure I haven't said your professor's arguments were invalid simply because he disagreed with my position. That would be the difference between our positions.

I've designed plenty of complex experiments. You don't dismiss results found simply because they don't match your presupposed outcomes.

So have I, but you also know before you begin what the reasonable limits of the work are and  what you can reasonably conclude from the results are. If the results said that the tort reforms were terrible and caused huge problems it would also not be applicable to the entire system. Hence why I didn't say the issues with infant mortality are representative of the entire system, because they aren't. That conclusion is far beyond the limits of the study. It's simply not reasonable to study one or two diseases and apply the results to the entire system. That's beyond the scope of the studies that have so far been carried out.

I'l get back to the rest tomorrow