The uninsured..........

[UtahDan]

Originally Posted by ERCougar

There's absolutely no question in my mind that malpractice exposure increases healthcare costs.

I'm genuinely curious to know how you know this.

I think LA Ute or someone used to have a great line in their signature to the effect of "it isn't the thinks we don't know that hurt us, its the thinks we know that just ain't so."

I've gotten pretty persuaded that premium increases are tied to economic conditions and particularly the bond market. Everything I have read suggests that med-mal payouts have been static for a long time when you adjust for inflation. That is what is informing my opinion, but since I am open to having my mind changed, can you tell me what is informing yours?

PS: In rereading I realize that you said "costs." So disregarding the forgoing if it is inapplicable. I do observe that the cost of vehicles is also increased by product's liability lawsuits but this system also makes it less likely they will build something unsafe. The point being that simply saying that cost goes up because x occurs is not a trump card. Sometimes as a society we make a decision to compensate those who are hurt because it is more just to allow the defendant to spread that hit among its customers than it is to make the injured person bear the cost of his injuries alone.

[Mormon Red Death]

Originally Posted by UtahDan

I've gotten pretty persuaded that premium increases are tied to economic conditions and particularly the bond market.

Hospital bottom lines are a direct result of this. Most of the hospitals in the country make more money in the stock market (especially the catholic systems). than they do by operations. Basically, most of them have huge cash reserves.

A good operating margin for a health system is 2%. 1% is doing ok and anything over 2% is unbelievable.

Of course 1% of a billion is $10 million

[ERCougar]

Originally Posted by UtahDan

I'm genuinely curious to know how you know this.

I think LA Ute or someone used to have a great line in their signature to the effect of "it isn't the thinks we don't know that hurt us, its the thinks we know that just ain't so."

I've gotten pretty persuaded that premium increases are tied to economic conditions and particularly the bond market. Everything I have read suggests that med-mal payouts have been static for a long time when you adjust for inflation. That is what is informing my opinion, but since I am open to having my mind changed, can you tell me what is informing yours?

PS: In rereading I realize that you said "costs." So disregarding the forgoing if it is inapplicable. I do observe that the cost of vehicles is also increased by product's liability lawsuits but this system also makes it less likely they will build something unsafe. The point being that simply saying that cost goes up because x occurs is not a trump card. Sometimes as a society we make a decision to compensate those who are hurt because it is more just to allow the defendant to spread that hit among its customers than it is to make the injured person bear the cost of his injuries alone.

I think we agree here--that absent any malpractice exposure, costs would be lower. That's really all I was saying with the first point. I agree that a certain amount of liability for errors is ideal; we may (or may not) differ on what that amount is, but we both agree that there should be a system in place.

You may be right that premium increases on the whole may be more due to economic factors. However, economic factors can't account for the wide disparity in premiums between states (even neighboring ones--MI vs IN for instance). Both personal experience and numerous studies will point to a correlation between tort legislation and malpractice premiums. Common sense would confirm this as well. Like I said earlier, I don't have a problem with the malpractice climate in which I currently practice. There are serious issues in other states, however, and these are affecting access to care. Unless it incorporates tort reform, health care reform is only going to exacerbate these access issues.

[ERCougar]

Originally Posted by Cali Coug

Two quick thoughts: 1) if you are upset with my comments about solving problems in the ER, why not address them instead of just acting like you are the smartest guy in the room and an explanation doesn't need to be offered? 2) Where in the world did I say that Canada and Europe are the perfect medical models? A single link would be nice.

1) I feel like I addressed these comments pretty clearly. You responded with some convoluted argument that the fact that a hospital can buy an extra (expensive) CT scanner and thus decrease its liability risk proves that the increased liability risk really doesn't cost the hospital any money. Yeah...doesn't make much sense. You also implicitly suggested we need to be sending all dizzy old ladies in the waiting room directly to the CT scanner so we don't miss anything. Doesn't make much sense either, and reflects a remarkable lack of understanding of the medical issues involved. I don't have a problem with you not understanding the intricacies of this; I show similar ignorance when it comes to the details of the law. Just try to refrain from telling me how to do my job.

2) Do you not feel that the Canadian and European systems are superior to ours? Sorry, I'm not going to take the time to research your posts, but that sure doesn't seem like a far stretch.

[exUte]

Originally Posted by Mormon Red Death

Hospital bottom lines are a direct result of this. Most of the hospitals in the country make more money in the stock market (especially the catholic systems). than they do by operations. Basically, most of them have huge cash reserves.

A good operating margin for a health system is 2%. 1% is doing ok and anything over 2% is unbelievable.

Of course 1% of a billion is $10 million

have a negative Operating Income. the non-patient revenue gets them over the hump to about a 2-3% net income.

BTW........the LAX area in the last 24 months closed 4 hospitals that accounted for 2,000 hospital beds due to the losses incurred by the illegal immigrant financial strain. And my hospitals have closed their ER departments because of the financial strains.

[MikeWaters]

Originally Posted by exUte

have a negative Operating Income. the non-patient revenue gets them over the hump to about a 2-3% net income.

BTW........the LAX area in the last 24 months closed 4 hospitals that accounted for 2,000 hospital beds due to the losses incurred by the illegal immigrant financial strain. And my hospitals have closed their ER departments because of the financial strains.

I don't believe this is true. Many hospitals rake it in, and have had huge expansions as a result.

[exUte]

Originally Posted by UtahDan

I'm genuinely curious to know how you know this.

I think LA Ute or someone used to have a great line in their signature to the effect of "it isn't the thinks we don't know that hurt us, its the thinks we know that just ain't so."

I've gotten pretty persuaded that premium increases are tied to economic conditions and particularly the bond market. Everything I have read suggests that med-mal payouts have been static for a long time when you adjust for inflation. That is what is informing my opinion, but since I am open to having my mind changed, can you tell me what is informing yours?

PS: In rereading I realize that you said "costs." So disregarding the forgoing if it is inapplicable. I do observe that the cost of vehicles is also increased by product's liability lawsuits but this system also makes it less likely they will build something unsafe. The point being that simply saying that cost goes up because x occurs is not a trump card. Sometimes as a society we make a decision to compensate those who are hurt because it is more just to allow the defendant to spread that hit among its customers than it is to make the injured person bear the cost of his injuries alone.

Here are some financial facts: let's assume I determine that I want $1M out of a malpractice settlement. Enter attorneys. I have to now sue for $2M because they will take 50% of the $2M settlement. They is an entire industry making money off the misery of patients. What a country!

[exUte]

Originally Posted by MikeWaters

I don't believe this is true. Many hospitals rake it in, and have had huge expansions as a result.

and I will post their Income Statement and then you decide.

[MikeWaters]

Originally Posted by exUte

and I will post their Income Statement and then you decide.

http://www.texaschildrens.org/Default.aspx

[exUte]

Originally Posted by MikeWaters

http://www.texaschildrens.org/Default.aspx

Income Statement
Data are annualized for periods other than twelve months.

Period ending date 9/30/2006
Number of months in period 12 Cost report status Amended Settled Without Audit Settled With Audit Settled Without Audit Settled Without Audit

Inpatient Revenue $1,030,018,674
Outpatient Revenue $373,153,906
Total Patient Revenue $1,403,172,580
Contractual Allowance (Discounts) $764,048,121
Net Patient Revenues $639,124,459
Total Operating Expense1 $666,464,278
Operating Income $-27,339,819
Other Income (Contributions, Bequests, etc.) $2,355,806
Income from Investments $41,879,306
Governmental Appropriations $0
Miscellaneous Non-Patient Revenue $94,135,169
Total Non-Patient Revenue $138,370,281
Total Other Expenses $14,065,817
Net Income or (Loss) $96,964,645

children's hospitals are a bit different. lot of outreach activity. but notice their operating income was -$27M and they discounted their services roughly 50%.