5 ms·

I would add: 5. Some patients like to file lawsuits, hence expensive lawyers, malpractice insurance etc. Vicious cycle (involving hospitals, big pharma, lawye

I would add: 5. Some patients like to file lawsuits, hence expensive lawyers, malpractice insurance etc. Vicious cycle (involving hospitals, big pharma, lawyers, insurers) - can't just fix one aspect. However, as you said - the latest advancements in personalized treatment of cancers are very encouraging. Treatments are becoming more effective, and doctors are finally starting to treat the untreatable.

cma 14y ago
Addressing this was W Bush's solution to the healthcare cost problem. But payouts due to malpractice suits are around 1% of medical expenditures and not all of those payouts are bogus.
- gbhn 14y ago
  Directly, yes. But there's a significant effect in overtreatment that is substantially higher. Hard to tell how much higher, because of course, all this overtreatment is justified somewhere. What we know is that we're paying about $10k/family/yr more than we should. The article treats this pretty well -- noting that malpractice isn't the only solution, but admonishing democrats for being too swayed by trial lawyers who want to keep feasting at the malpractice trough.
  - cma 14y ago
    It is easy. The US pays twice as much as comparable industrialized countries for the same outcomes. Doctors in the US make twice as much, overhead is twice as much, and we pay twice as much for prescription drugs.
    - ams6110 14y ago
      The US also does most of the innovation, develops most of the drugs, equipment, devices, and treatment regimens, and/or improves on or develops feasible products and treatments based on foreign research and development elsewhere.
      - cma 14y ago
        Most of drug R&D is done as basic research in universities. Drug companies do do research, but their marketing budgets are higher than their R&D budgets. A large portion of the research is looking for baldness-cure/dick/sex pills, along with a substantial sum spent on patent work-around research which isn't setting out to create anything new, just do the same thing in a new way to work around someone else's patent. The cost of the drug R&D you are talking about (aside from publicly funded NSF/NIH research) is minuscule in comparison to the healthcare spending expenditures we are talking about. Device/procedure research is even less of a blip.
JPKab 14y ago
Tort reform would help in two ways: The obvious reduction in lawsuit costs, and also help to lower the incentive for overtreatment. However, it is pushed way too often by the conservative establishment in the U.S. as a panacea for fixing our health costs. This is completely wrong. It is a tiny chunk of the problem, and the overtreatment incentives are still there, due to profit motives of so called "non-profit" hospitals, as detailed in the long ass article.
rayiner 14y ago
The statistics show that most malpractice suits are meritorious, and malpractice suits account for 2% of the total costs of the medical industry. You can muddy the waters with "unnecessary testing" but then you have to consider both sides of the coin. If bills would come down if doctors did less tests out of fear of malpractice suits, how much would injuries from mistakes go up? The problem is: there is actually a lot of malpractice going on, and that has costs too. Tort reform is politically attractive, but it's not clear it's solving a real problem. See: http://www.press.uchicago.edu/Misc/Chicago/036480.html http://www.press.uchicago.edu/Misc/Chicago/036480.html, http://archive.sph.harvard.edu/press-releases/2006-releases/press05102006.html http://archive.sph.harvard.edu/press-releases/2006-releases/..., http://www.slate.com/articles/health_and_science/medical_examiner/2006/07/the_medical_malpractice_myth.html http://www.slate.com/articles/health_and_science/medical_exa... The basic issue is that the medical field is unusual in being self-regulated. The malpractice system is really the only way we have to hold doctors accountable, and even within that, we adopt the unique practice of letting doctors themselves adopt the standards to which they are held, rather than using objective standards.[1] We don't need to handle malpractice via the tort system. But in its absence we'd need something, say an OSHA-like agency that handled administrative complaints against doctors accused of malpractice. There isn't a free lunch here. [1] Note that e.g. automotive engineers don't get to set the standards for negligence in the context of designing cars!
- deleted 14y ago
  [deleted]
  - danielweber 14y ago
    (I meant to upvote and missed, and I can't undo. :< )
- pewpewlasergun 14y ago
  Do you have any sources on alternative systems of accountability for doctors? Or that go a bit more in depth about how they are unique in self-regulation? I haven't heard of this before, so thanks!
danielweber 14y ago
The one tort reform I want is: * the ability to set up a private NHS-like system in the US. Right now, if you do this, you will get sued into oblivion. But I'd like to put $5,000 into a pool with a bunch of other families, and have a bunch of technocrats (that I choose through the market, not one big group where I can hope I can vote for) decide how to best spend that money. Cover some things, don't cover some other things. This will necessarily mean that someone doesn't get covered for something, not because the treatment doesn't work, but because the treatment is not worth the money.
- NoPiece 14y ago
  Isn't that very close to the HMO model?
  - danielweber 14y ago
    Yes. And when they said "no" to radical chemotherapy, they were sued and forced to pay for it. (It turns out to actually reduce patient outcomes.)
    - rdl 14y ago
      Only the government would have the ability to say no, in practice, and wouldn't due to politics (saying no means you'll be actively opposed by that person's family/etc., and it will be used in campaign attack ads; saying yes is a marginal increase in cost spread out over everyone.

cma 14y ago

Addressing this was W Bush's solution to the healthcare cost problem. But payouts due to malpractice suits are around 1% of medical expenditures and not all of those payouts are bogus.

gbhn 14y ago
Directly, yes. But there's a significant effect in overtreatment that is substantially higher. Hard to tell how much higher, because of course, all this overtreatment is justified somewhere. What we know is that we're paying about $10k/family/yr more than we should. The article treats this pretty well -- noting that malpractice isn't the only solution, but admonishing democrats for being too swayed by trial lawyers who want to keep feasting at the malpractice trough.
- cma 14y ago
  It is easy. The US pays twice as much as comparable industrialized countries for the same outcomes. Doctors in the US make twice as much, overhead is twice as much, and we pay twice as much for prescription drugs.
  - ams6110 14y ago
    The US also does most of the innovation, develops most of the drugs, equipment, devices, and treatment regimens, and/or improves on or develops feasible products and treatments based on foreign research and development elsewhere.
    - cma 14y ago
      Most of drug R&D is done as basic research in universities. Drug companies do do research, but their marketing budgets are higher than their R&D budgets. A large portion of the research is looking for baldness-cure/dick/sex pills, along with a substantial sum spent on patent work-around research which isn't setting out to create anything new, just do the same thing in a new way to work around someone else's patent. The cost of the drug R&D you are talking about (aside from publicly funded NSF/NIH research) is minuscule in comparison to the healthcare spending expenditures we are talking about. Device/procedure research is even less of a blip.

JPKab 14y ago

Tort reform would help in two ways: The obvious reduction in lawsuit costs, and also help to lower the incentive for overtreatment. However, it is pushed way too often by the conservative establishment in the U.S. as a panacea for fixing our health costs. This is completely wrong. It is a tiny chunk of the problem, and the overtreatment incentives are still there, due to profit motives of so called "non-profit" hospitals, as detailed in the long ass article.

rayiner 14y ago

The statistics show that most malpractice suits are meritorious, and malpractice suits account for 2% of the total costs of the medical industry. You can muddy the waters with "unnecessary testing" but then you have to consider both sides of the coin. If bills would come down if doctors did less tests out of fear of malpractice suits, how much would injuries from mistakes go up? The problem is: there is actually a lot of malpractice going on, and that has costs too. Tort reform is politically attractive, but it's not clear it's solving a real problem. See: http://www.press.uchicago.edu/Misc/Chicago/036480.html http://www.press.uchicago.edu/Misc/Chicago/036480.html, http://archive.sph.harvard.edu/press-releases/2006-releases/press05102006.html http://archive.sph.harvard.edu/press-releases/2006-releases/..., http://www.slate.com/articles/health_and_science/medical_examiner/2006/07/the_medical_malpractice_myth.html http://www.slate.com/articles/health_and_science/medical_exa... The basic issue is that the medical field is unusual in being self-regulated. The malpractice system is really the only way we have to hold doctors accountable, and even within that, we adopt the unique practice of letting doctors themselves adopt the standards to which they are held, rather than using objective standards.[1] We don't need to handle malpractice via the tort system. But in its absence we'd need something, say an OSHA-like agency that handled administrative complaints against doctors accused of malpractice. There isn't a free lunch here. [1] Note that e.g. automotive engineers don't get to set the standards for negligence in the context of designing cars!

deleted 14y ago
[deleted]
- danielweber 14y ago
  (I meant to upvote and missed, and I can't undo. :< )
pewpewlasergun 14y ago
Do you have any sources on alternative systems of accountability for doctors? Or that go a bit more in depth about how they are unique in self-regulation? I haven't heard of this before, so thanks!

danielweber 14y ago

The one tort reform I want is: * the ability to set up a private NHS-like system in the US. Right now, if you do this, you will get sued into oblivion. But I'd like to put $5,000 into a pool with a bunch of other families, and have a bunch of technocrats (that I choose through the market, not one big group where I can hope I can vote for) decide how to best spend that money. Cover some things, don't cover some other things. This will necessarily mean that someone doesn't get covered for something, not because the treatment doesn't work, but because the treatment is not worth the money.

NoPiece 14y ago
Isn't that very close to the HMO model?
- danielweber 14y ago
  Yes. And when they said "no" to radical chemotherapy, they were sued and forced to pay for it. (It turns out to actually reduce patient outcomes.)
  - rdl 14y ago
    Only the government would have the ability to say no, in practice, and wouldn't due to politics (saying no means you'll be actively opposed by that person's family/etc., and it will be used in campaign attack ads; saying yes is a marginal increase in cost spread out over everyone.