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

[creekster]

Originally Posted by ERCougar

You're really out of your realm here. The reason they're settling is the wildly disparate risk they're facing. That said, more and more are challenging them in court. I assure you that this is the chief complaint docs have about their carriers--their unwillingness to take things to court. I have yet to hear of a case of a bad-faith lawsuit. They may exist, but they're rare. I follow this issue pretty closely as ER is one of the higher liability fields--I'm sure if they were common, I would have read of several examples by now.

Sorry buddy, you are out of your realm and you missed the point of the post. I iwll certainly give you the meidcal testing issues (within reason), becasue you obvioualy are way ahead of me there, but you dont' understand how insurers work if you think they are settling against doctors' wishes and have always done so just for the hell of it. Carriers would be happy to refuse to settle more often except it risks an adverse bad faith verdict if they do so and expose their insured to a judgement above limits. Ask all these docotr friends of yours that face the issue if they are willing to release the insurer from any bad faith claims if they fail to settle within limits. If they do, I think many carriers would be willing to roll the dice. Also, suggest that they lower their malpractice limits so that the carrier has less at risk. This would also result in more trials. Docotrs love a hard nosed carrier as long as a) the carrier is paying for the defense and b) there is no risk of erpsonal exposure to the doctor. Under these circumstances, the docotr can complain loudly about the settlment without ever having faced any risk herself.

Btw, the bad faith aspect of the law is long settled. SOme of the leading bad fatih cases in California (e.g. Isaacson and Spindle, to name just a coupld of of the top of my head) come from the 70s and 80s and involved claims by docotrs against their carriers alleging the carriers didn't ahndle the malpractice defense properly. Their lack of frequency now is preciselty becaseu the insurers were repososinve to the ealrier challenges and attempt to aovid risk to their insureds.

I also find it amusing that you rely so heavily on your fellow doctors' unhappiness abotu their insurer settling suits. It reminds me of a baseball fight. "If only you guys hadn't a held me back, I would have cleaned his clock!" What else will your buddies say? Have you EVER heard something like: "The settlment was good becasue I really screwed up" ?

[creekster]

Originally Posted by ERCougar

Are you kidding me? Overuse of CT's is one of the chief differences between us and the rest of the world. That's why this debate is raging right now in medicine. We all know we're ordering way too many CT's but until the malpractice situation is fixed, we're not stopping. Failure to CT is absolutely is one of the chief causes of lawsuits--whether it's head injury, appendicitis, bowel obstruction. I bet I order 5 needless CT's a shift; and I'm on the low end.

Yes, I think the doctor should be responsible for causing the thyroid carcinoma. Problem is, that's 30 yrs down the road--he's done practicing by then. What would you do in his place?

Need another example? You're 55. You come in with chest pain. It's sharp, lasted only a few minutes, no family history of heart disease. In Indiana, you're discharged, even knowing that there's always a small non-zero chance that you had a heart attack. In Detroit, you're either admitted to the hospital, or more likely, you're watched in the ER for 6-12 hours while serial tests are drawn. No, you don't have a choice, even though the chance this was a heart attack is next to nothing. You want to go home, you sign out against advice (and you'll cover that bill yourself). Wonder why the ER's are overcrowded?

I'm just getting started. If you think these are isolated examples, we can keep playing.

SO let's probe your examples, and putting aside the point I made about defensive non-carcinogenic tests such as blood apnels for the moment. To what do you attribnute the difference in approahces between indiana and Detroit (and apologies if this was explained somewhere else and I msised it)?

[tooblue]

Originally Posted by ERCougar

Yeah, that would be wrong. Medicaid patients in this country have far better access to advanced technology in the emergency room than in any other country. Furthermore, it's illegal for an emergency room to deny care based on inability to pay. But it DOES make a good story.

Now if you're making an argument that their lack of preventive care is causing unneeded deaths, you may have a case. But the uncontrolled diabetic who eventually has an MI and dies isn't quite so newsworthy or exciting, although this is likely a much larger contributor to mortality.

Why do they lack preventative care? Well, that's a little trickier than just lack of insurance. The poor actually have access to Medicaid, but many are amazingly unwilling to make a phone call or visit the office to fill out the paperwork. Most primary care doctors take Medicaid, and most essential medicines are paid for by Medicaid. I guess we could fill out their paperwork for them too. On second thought, social workers often already do this. Maybe we need to wipe their butt...

Healthcare reform would do more for the lower-middle class than the lower classes.

I am not concerned about the poor -as you have stated they are covered. It is the middle class that is uninsured or underinsured that is the greatest concern.

And just be clear, as I have stated in the past, I do not believe the US should adopt the Canadian health care system, but rather learn from in the development of it's own system.

[Jeff Lebowski]

Originally Posted by ERCougar

I would argue that healthcare reform is a political/economic issue rather than a moral one. If we were letting people die in the streets, that's a moral issue. Despite what some would have you believe, this isn't happening--or at least, we're doing our best to prevent it. Medicaid is the best emergency care insurance in the world.

I posted the links. There have been studies that analyze the mortality rates of insured vs. uninsured. Based on these rates (and eliminating other factors), at least 18,000 Americans die each year due to lack of health insurance.

http://cougarguard.com/forum/showpos...2&postcount=36

http://cougarguard.com/forum/showpos...3&postcount=37

[il Padrino Ute]

Originally Posted by Indy Coug

Everson Walls and....

Palmer?

I think they sang a cool song about some guy who was lucky.

[Indy Coug]

Originally Posted by Jeff Lebowski

I posted the links. There have been studies that analyze the mortality rates of insured vs. uninsured. Based on these rates (and eliminating other factors), at least 18,000 Americans die each year due to lack of health insurance.

http://cougarguard.com/forum/showpos...2&postcount=36

http://cougarguard.com/forum/showpos...3&postcount=37

They only stratified the study by age? No freaking wonder they got higher mortality rates for the uninsured. Mortality goes up as income goes down. You could try to fool yourself by thinking it's primarily due to lack of access to health insurance, but it's more closely tied to thing such as (not ordered by importance)

1. Higher homicide rate
2. Higher substance abuse (alcohol, drugs, smoking, etc.)
3. Poorer nutrition, exercise

http://cougarguard.com/forum/showpos...2&postcount=36

http://www.urban.org/UploadedPDF/411...ured_dying.pdf

Since a higher percentage of uninsured are poor, unless you stratify your sample by household income, you are going to get some seriously skewed results.

[Jeff Lebowski]

Originally Posted by Indy Coug

They only stratified the study by age? No freaking wonder they got higher mortality rates for the uninsured. Mortality goes up as income goes down. You could try to fool yourself by thinking it's primarily due to lack of access to health insurance, but it's more closely tied to thing such as (not ordered by importance)

1. Higher homicide rate
2. Higher substance abuse (alcohol, drugs, smoking, etc.)
3. Poorer nutrition, exercise

http://cougarguard.com/forum/showpos...2&postcount=36

http://www.urban.org/UploadedPDF/411...ured_dying.pdf

Since a higher percentage of uninsured are poor, unless you stratify your sample by household income, you are going to get some seriously skewed results.

Good point.

From the article:

Another study using Health and Retirement Survey data for adults age 55–64 found that, after controlling for socioeconomic status and other factors, uninsurance increased such older adults’ risk of dying over an eight-year period from 7.5 percent to 10.5 percent. The study thus estimated that, among such near-elderly adults alone, more than 13,000 people die every year due to uninsurance, “plac[ing] uninsurance third on a list of leading causes of death for this age group, below only heart disease and cancer” (McWilliams et al. 2004).

[UtahDan]

Originally Posted by creekster

SO let's probe your examples, and putting aside the point I made about defensive non-carcinogenic tests such as blood apnels for the moment. To what do you attribnute the difference in approahces between indiana and Detroit (and apologies if this was explained somewhere else and I msised it)?

I applaud the insurance lobby for having framed this issue so well that we are arguing about which needless procedures are making premiums go up. The truth is that med-mal payouts have been more or less static for years and yet the premiums continue to rise. The reason for this is that insurance carriers make most of their money from investment income and this is cycle.

Dr's premiums over the last 30 years have risen and fallen along with the economy, not in relationship to payouts. But again, bravo to the insurance lobby for successfully blaming the plaintiffs bar. You would think we could defend ourselves a little better.

[Indy Coug]

That's referencing a different study, not summarizing the results of their own study. I'm limiting my comments to the methodology of the study you cited which concluded there were 18,000 additional deaths.

[Jeff Lebowski]

Originally Posted by Indy Coug

That's referencing a different study, not summarizing the results of their own study. I'm limiting my comments to the methodology of the study you cited which concluded there were 18,000 additional deaths.

Yes, I understand. But the last page of the report argues that they have under-estimated the deaths. To support this argument, they cite several other studies that have shown higher numbers, including this study that did in fact account for socio-economic factors. The 13,000 deaths number was just for one age group.