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Will Vermont’s Babies Have a Better Chance?
As Peter Shumlin was officially sworn in as governor of Vermont, there was and is great hope that at least in one state we may see passage and implementation of a truly universal, single-payer healthcare system.
From Shumlin's January 6, 2011,innaugral address:
"The rising cost of healthcare for Vermont's middle class and small businesses provides an equally daunting threat to economic prosperity. Just ten years ago our little state was spending $2.5 billion a year to stay healthy. Today we spend over $5 billion. That increase represents an enormous hidden tax on families and small businesses across our state. If left untethered, the rising cost of health insurance will cripple us.
"That's why we must create a single-payer healthcare system that provides universal, affordable health insurance for all Vermonters that brings these skyrocketing costs under control. Let Vermont be the first state in the nation to treat healthcare as a right and not a privilege; removing the burden of coverage from our business community and using technology and outcomes-based medicine to contain costs. By doing so, we will save money and improve the quality of our care."
Amazing words in so many ways. Amazing that we are finally hearing them from one of our nation's governors, and perhaps equally amazing that the American people have waited so long for the human right of healthcare to be granted in even one small state.
But I have hope tonight for Vermonters. Maybe especially for baby Vermonters.
In February 2006, a young reporter working for the newspaper I edited in South Dakota was pregnant and only weeks away from delivery of her first child. I was struggling with the aftermath of my husband's third open heart surgery. On a terribly snowy night, I called that reporter to travel the mile or so to a city commission meeting so I could stay at home with my post-surgical husband.
She never complained. But the snow was so heavy that her car got stuck as she pulled out of her driveway. She was so determined to do her job, so determined not to let me down and so determined not to risk losing her insurance that she got out and pushed her car several times in the effort to dislodge it. She was not successful. Another motorist did help - it was South Dakota, after all. She covered the meeting.
But within hours, she was in labor. She emailed me. I knew it was too early for labor. I felt terribly guilty. Though others assured me it had nothing to do with it, I always believed the very serious health issues my reporter's baby faced in the days, weeks and years ahead were at least in part because her mom pushed a car during her final hours in utero. Still, no one ever complained.
Until I saw a message from her this week on the web. On a social networking site, she wrote, "We are still paying for our daughter's birth and NICU stay. Add my husband's carpal tunnel surgery (which we just recently killed ourselves to pay off), our daughter's dental surgery, her Mayo Clinic visits, recent X-rays on the infection in her thumb, and regular checkups and doctor visits (most of which occur successively until someone finally figures out what's wrong), and we're drowning in medical bills. :("
It is now 2011. Five years later, this family is still paying those bills with no end in sight.
She went on to say she had hoped to think about having another baby some day, but because most doctors now require prenatal care not covered by insurance to be paid up front and she has collectors hounding her for payment of the old medical bills, she cannot even think about another baby. It breaks her heart.
My reporter and her husband are wonderful parents. They both work. In fact, she works two jobs, sometimes more. She laments the fact that she cleans resort rooms for one of her jobs, and that sometimes it is troubling to clean rooms for wealthy folks who have never known what it is like to be sued for a medical bill while doing your best to pay it.
My reporter does not share my political leanings. She is a devout Christian. She tries to live her faith. All she hopes for, all she prays for is time to spend with her child and her husband. She has a great free streak that makes her a superb reporter during the annual Sturgis motorcycle rally - especially since she rides her own bike there every year. She is a neat young woman. I would be so glad for her if she could feel comfortable about having another child. And that child would be a lucky baby.
But unless my friend uproots - also not likely - and moves her family to someplace like Vermont or another country where healthcare is a human right, she's locked into a life of struggle and need by those who only value profit and greed.
So, Governor Shumlin, I wish you so much good fortune in pursuing transformational reform in Vermont. One of the main reasons I am so anxious for you to succeed is so that a young, pregnant reporter somewhere in Vermont can tell her editor "no, I cannot go out tonight" when a call comes in a snowstorm, and that young reporter will still know that she'll have healthcare even if staying safe and warm means she cannot keep up her duties as a reporter. I'd also hope that Vermont's babies would be given a better chance to live healthier, happier and calmer times as they became toddlers and children lovingly raised by parents not shackled by medical debt.
If we'd ever really think about the kids and the families, we'd know Governor Shumlin is right when he says:
"I call upon Vermonters to join together with the common purpose of our state once again leading where others dare not go; universal, affordable, quality healthcare that follows the individual and is not tied to employment."
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62 Comments so far
Show AllThis is authentic hope we can believe in.
Hope that, as in Canada, the courageous leadership of one small state will lead the way to genuine health care reform in the US. Once other states witness the cost savings and the better overall health stats this move will make, universal single-payer may well become unstoppable.
Thank you, Vermont for the best news in a long while!
The insurance industry's greatest fear is that small business owners will see how much more competitive they could be if they move to a single-payer state that every state will scramble to implement single-payer in order to keep their existing small business's from fleeing, and to attract small businesses from non single payer states.
All business, but especially small businesses find it difficult to compete with other nations that have single-payer.
Among big businesses, the U.S. and Japanese auto makers get higher profits from the cars they make in Canadian factories compared to US factories even though Canadian auto workers get a higher hourly wage but are insured by the Canadian single-payer system.
Canada does not have a single payer system. It has government-operated, universal health care. I know - I lived in Canada more than 30 years and acquired Canadian citizenship. I studied needs for reform with the Canadian system, and published book reviews about the critical issues.
For each of my two children born in Toronto,I wrote the physician a cheque for $100. That was my payment for all prenatal care, and for the physician's obstetrical service in hospital at delivery. The single payer was ME. I wrote no cheque to the hospital.
I required the services of a neurosurgeon, and secured one of the top three in Toronto by reputation. After surgery I was in hospital four days. At discharge I paid $16 for the television in my room. That was my only bill.
I have a lot to say about the THREE-LEGGED STOOL of Universal Healthcare, but my experience since 1993 is that no American listens, particularly those with power and responsibility. Vermont is creating a stool with one leg - and it will crash.
Trylon
Visiting Professor,
Thanks for asking Trylon this question. I am curious to hear about the three-legged and one-legged stools, too.
I just hope the answer does not require an examination of stool samples, though.
Leg one is the visible operations of health care. There are some half dozen models of paying for that: see "The Healing of America: The global quest for better, cheaper, and fairer health care" by T. R. Reid, 2009. This is a superb book that I encourage everyone to read. But it is only one leg.
Leg two is the social process of placing upper limits - annual CAPS - upon physician income. Physicians who regard this as socialism or even communism will leave. Cool. Load moving trucks for them and their families and wave goodbye. Into the void will come some doctor trained in another country who regards the hated CAP to be a marvelous salary. In this bailiwick hides potential for government to pay for the full costs of a medical education (a la socialist nations) and have salaried doctors, e.g. the Veterans Administration.
Leg three involves jurisprudence and the legal system with: a) caps upon jury awards for malpractice or HC system error, and b) caps upon lawyer income for services rendered in such cases. Forget Rainmakers. Forget John Edwards (who was not named in his wife's will). Lawyers have to stop believing that the value of their services for the closing of a house is One Galaxy, and for winning a malpractice suit Eighteen Galaxies. Some will leave. Help them load their moving trucks. Ideally, a special branch of jurisprudence would handle these cases - exactly the way that the cases who file for Social Security Disability Insurance are handeld.
What's the result? Go look at the cost of malpractice insurance for Canadian physicians - for every doctor from Vancouver to Newfoundland to Baffin Island. It's published, by medical specialty, on the Internet. Then look up the comparable costs in the USA. This computer research takes about 2 hours, but is worth the time to build the picture in your head.
FOUR LITERARY STEPS TO COMPREHENDING HEALTH CARE
01 =The Shelters of Stone= by Jane Auel, wrt the role of Healing and Healer among
our forebears, clear back to Cro Mangnon and Neanderthals. THE BASIC CONTRACT between Us and Them.
02 =The Social Transformation of American Medicine: the rise of a sovereign profession and the making of a vast industry=, by Paul Starr. Winner of the 1984 Pulitzer Prize for General Non-Fiction.
03 =The Solid Gold Stethoscope= by Edgar Berman, MD - chest surgeon, 1979. He operated across the table from Dr. Albert Schweitzer. He was the personal physician to Vice President Hubert Humphrey and a brilliant humanitarian.
04 =The Healing of America: The global quest for better, cheaper, and fairer health care" by T. R. Reid, 2009== as mentioned above.
My library includes dozens of books, and dozens of hours of video specials on the topic of HC reform. I made some literary submissions to Hillary when she was in charge of the Clinton attempt at HC reform, mailing them from my home in Calgary.
HC legs two and three drive most of the money changers from the Temple. Fail to do that, and all the =single payer= systems in the world will fail to meet expectations.
Trylon
Me too. Shumlin has some great ideas, not least of which, he wants more geothermal energy projects in Vermont. As to health care, I've got a great plan with BC/BS which I lose this year with my full medicare transition. Even with that BC/BS plan I refused to get colonoscopy screening because they refused to guarantee I wouldn't have to pay even though the plan brochure said is was covered.
Now with medicare, I'll have to fork over 20 to 30% of the cost for outpatient stuff. Most screening is outpatient and the costs are going up and up. I'm getting priced out of the market. I hope Shumlin can come up with some medigap coverage for all Vermonters paid by taxes like schools are but I'm not holding my breath. The CEO of BC/BS in Vermont retired a few years ago with about 8 million bucks severance package. That was robbery, plain and simple.
We'll see what develops.
Stay warm.
Donna, I am so ready to move to Vermont--If they pass single payer. I'll bet they have a real estate boom as hundreds of thousands cram into that state seeking refuge from the high cost high deductible nightmare Obama care is going to impose on the rest of us. As I listen to the political rhetoric on the repeal of Obamacare I find myself agreeing with points from the right, that Obamacare will be too expensive, that it will raise premiums, increase deductables, hitting us even harder, and reduce coverage. (Not everything the right says is wrong) and I see with jaundiced eye the defenders of Obamacare say it will save us money, but that too is premised largely on the assumption that as deductable and copay costs rise people will use health care less. (Not everything that the Democrats say is true.) Well, it hasn't worked out that way in Massachusetts under Obamacare's cousin Romneycare has it. Maybe, as Mass. experiences a brain drain of all those smart Harvard grads moving to Vermont for decent health care, Mass. will decide that it wants single-payer too. And then maybe we can really get the ball rolling. Stick around Donna-- you and I will see it happen.
...that Obamacare will be too expensive, that it will raise premiums, increase deductables, hitting us even harder, and reduce coverage. (Not everything the right says is wrong)
I don't particularly like "Obamacare" either, but not a single thing you asserted above is true, and indeed the right is wrong. Do you have any reality-based idea of what the helathcare bill will do and won't do? Non-employer provided insurance will be subsidized for everyone with incomes up to 4 times the poverty line. Medicaid will be expanded to cover everyone up to 133 percent of the poverty line. so I douby that anyones medical insurance will go up - at least compared to the do-nothing alternative.
And no, the health care bill does not impede states adopting as single-payer plan either. The blame for that lies in some peoples interpretation of a technicality of the the decades-old ERISA act.
I base my assertion largely on what has already happened in Massachusetts. Even with subsidies, premiums are going up even more making health care more expensive. What cost control there is is achieved by limiting coverage and/or by raising copays and deductibles, shifting costs to patients who can pay. Those who can't or those companies that will not absorb these costs are likely to drop coverage and force employees onto private plans which will have even higher premiums and less coverage for individuals and which will require still bigger subsidies that will end up costing the government even more. The CBO estimate of savings for Obamacare is at best a very rosy scenario which assumes private employers will continue to bear increased costs. The more likely result of Obamacare, in my opinion will be the "death spiral" as more and more are first forced onto private plans and then opt out of this subsidized insurance which is still too expensive by paying fines making it even more expensive for those who stay in. Too pessimistic--we shall see. Follow the outcomes in Mass. under Romneycare.
Sabo: Regarding your quote:
" Non-employer provided insurance will be subsidized for everyone with incomes up to 4 times the poverty line."
Let's be reasonable here, shall we? If states are laying off teachers, firemen, and cutting back on repairs, library hours etc. where do you suppose they will get this money? This caveat is just a ruse to gain support for a bill that will hold taxpayers hostage to insurance companies as rates continue to climb; and it remains the insurer who acts as the final arbiter as to who gets what level of care.
I'm glad the Republicans are fighting this. It should be illegal to force citizens to buy a product with no cap on pricing, and no guarantee of delivery.
The funds do not exist to satisfy this alleged subsidy! It's more bull-shit! Like the string of lies attached to everything Obama has initially stated, in contrast with each one's contrary playout. In sum: sickening!
The way things are going "the poverty line" will be where millions of us will be hoping to rise to.
It is the only moral option.
First Shumlin states that health care costs have doubled.
Then he says we must have universal, single payer, affordable health care for all that brings skyrocketing costs under control.
What is it about universal, single payer etc. that would bring costs under control?
The answer is very vague for a health care system that is incredibly complex.
"....using technology and outcomes- based medicine to contain costs."
There is a tendency to be angry and to apply blame for health care costs that are out of control but the anecdote in this article shows one reason and it is no one's fault. A premature baby that would not have made it 20 years ago, now can survive, after a million dollar stay in the NICU.
We have the technology to treat a variety of illnesses that previously we would have just given up on, but those treatments come at enormous costs.
Previously, if someone had a car accident, they would get a few plain films.
Now they get full body, very costly MRI's and CT scans for the slightest injuries.
It's a very complex issue.
These politicians who say; Free! Universal! Efficient! Affordable! are very transparent.
Real reform must come from a variety of areas including malpractice policy and addressing enormous waste and abuse.
You can't just say Universal coverage + health care is a right + government efficiencies = cost control.
"What is it about universal, single payer etc. that would bring costs under control?"
Becasue the single payer (Govt.) will pay only in accordnace with a uniform fee schedule that all providers must accept as payment. Hospitals and doctors will no longer be able to charge whatever exhorbitant amount that they feel like.
The same technologies are used in Canada yet Canada spends a little over half of what the US spends on Health care while at the same time ensuring EVERYONE has access.
It is less expensive for many reasons including..
1>Less overhead in Hospitals and Doctor's offices.
There no "billing departments" that need to be repeated thousands of times over in each and every Hospital or private Clinic. They do not have to deal with hundreds of different insurance providers or types of coverages. There is no need to deal with Health Insurance providers denying a particular claim. There is no need to hire Collection agencies to go after unpaid bills.
2>The HMO and for profit Health Insurance provider is cut out of the equation.
Thus there no need for profits to either. These entities in the USA are huge behemoths that suck wealth out of the system add costs, yet do nothing to deliver health care.
3>Universality and access for all cuts health care costs in the future.
People do not have to choose between food shelter or that checkup they have been skipping. Many people in the US put off seeing a Doctor when sick because they can not afford the copays or the deductible. They put it off and their illness grows worse.
4>With Health Care costs an expense of the Governmnet via taxes rather then a MEANS to profit as it is with the Health Care system in the "For profit model" there is an incentive for PREVENTIVE health care rather then a system where the more people that are sick, the more profits to be made.
One of the reasons the Government of Canada banned BPA and has banned Chemicals still in widespread use in the US is because they feel it a way of addressing long term health care issues which directly affect their budgets.
5>Competition does NOT decrease overall costs in Health care, it increases them.
I will use here the example of MRI's. The Fraser institute likes to point out that the US system has far more MRI machines per capita therefore they conclude it a superior system. This is rubbish. In Canada many MRI's sit idle for hours of the day simply because there no NEED to get an MRI for every ailment from a medical point of view.
In the US Medical service providers COMPETE with one another to deliver what they claim as "better health care". In order to compete each seperate enterprise purchases its own MRI and or other such diagnostic machinery. These are tremendously expensive so in order to make "Their money back on the investment" the MRI's have to be used. The more they are used the more they can bill the Insurance companies or patients.
This leads to gross inefficiencies. Services are duplicated many times over along with the staff to support them and those services overutilized to ensure profit.
I would point out that Canada has better health care outcomes in a wide swathe of medical procedures and in the MOST complex, such as transplant surgery, delivers better outcomes at as much as 1/3rd of the same procedures in the USA. This is not due to the Technology. It is due to the system.
Not so fast. In Canada MRIs sit idle AND patients have to wait months to get one unless it is an emergency. You get triage when you have a one payer system trying to save money. It is still better than dog eat dog.
I had no problem getting an MRI when one was needed. There was a wait but most of the wait was my doing as I wanted to have it done when I had returned from a vacation.
The longest WAIT i have ever had for anything was about 3 weeks. Now My health is pretty good but my elderly parents (both in their 80s) have had to see Doctors and get tests done many times in Alberta. They did not have any of these long waits.
The point about MRIS sitting idle is that the NUMBER of MRI's is not really the issue. The issue is how they are scheduled and untilized.
As example if they wanted to really address wait times for the non emergencies, there nothing wrong with the concept of extending the hours of the persons who operate these machines. The single largest reason for the waits is they tend to work 9-5 jobs.
Why not a shift that runs 2 till 10? There is nothing in the Canadian system that would prevent this outside the Political will.
Thank you, GW North. You nail all the salient points.
I would find a way to pay several hundred a month into a single payer system. If everyone did so, there'd be enough to cover everyone, minus the insurer's taking their 30% cut, and the hospitals charging extra on account of their expense in the form of billing departments.
On the other hand, I will not dole out $300 or more per month to an insurer to hear that they dug up some malady I had in l971, and that therefore disqualifies me. I've had run-ins with car insurance over things they should have paid, but didn't, and recently with property insurance, playing semantics games in order NOT to cover a problem. I am so fed up with it. 25 years ago there was SOME honor implicit or otherwise specified in any contract. Today, the big money interests know there are no remaining checks and balances and act accordingly. People who do get satisfaction remind me of lottery winners. Of course a few have to benefit, otherwise everyone would recognize the scams for what they are.
Your issues and that of the other Americans that relate to their own experiences addresses another major advantage of a single payer/universal system and that the issue of STRESS.
Stress is one of the single largest factors that lead to bad health and I can not begin to imagine the stress parents and inviduals go through in the USA in order to ensure they gave adequate coverage or combatting those HMOS and Insurance providers everytime they are ill.
Vermont here we come.
jstevens is correct. Universal health care will need a means for which to pay for it, probably with some kind of tax. But I would rather my money go for a tax for universal health care than to the money-changers in the Health Insurance Industry who are only looking out for profit and big salaries for those that run them - and they do nothing to provide health CARE for people.
As long as our health insurance cartel is a for profit industry and exempt from anti-trust laws costs will continue to skyrocket. Their first commitment is to make a profit for their shareholders. Logically their first reaction to a claim is to see how they can deny it (and save money for their shareholders). Does this sound moral in any sense?
You go Vermont! Show us the way.
P.S. NASA did a damned good job of showing us the way to the moon, Mars and beyond. I have no doubt this same kind of effort can exceed the private sector in finding new and innovative answers in medicine.
Go Vermont! Show the rest of the nation how it can be done!
Somehow all the other advanced affluent democracies have some form or version of universal health care at half the cost of the US and with better outcomes. Nobody goes bankrupt in those countries and everyone is covered. But in the USA, universal health care is an impossibility because it's socialism or wealth redistribution, as the right wingers scream 24/7. Jstevens echoes some of the right wing talking points to bash single payer or universal health care. He raises the phoney baloney malpractice policy canard. He sounds like Rush Limbaugh, malpractice is really just a small fraction of overall medical costs. We have universal health care for those 65 and older and we have socialized medicine for veterans. We also have a high bankruptcy rate due to medical expenses. I wish Vermont good luck.
The other countries to which you refer do not have our malpractice policies. I can make this blanket statement because no one has our malpractice policy.
Over 80% of diagnostic exams performed on patients are normal.
I know this because I ask physicians. This is not a statistic I can find anywhere. I also have seen it myself from working at hospitals.
That means that 80% of tests result in someone getting a big dose of radiation for nothing--no benefit--just to protect physicians from lawsuits, and who can blame them?
It's easy to say that I have raised a Right Wing talking point, but the talking point has some merit.
The Medicare to which you refer pays out way more than it takes in--something like a 3:1 ratio. So you can say that we should have free health care for everyone, but don't imagine that costs aren't going to balloon, and that the government isn't going to deny services and that we aren't all going to have to pay for it somehow.
The government doesn't bring efficiency to anything ever.
This is so obvious I hate to have to justify it.
Many US states have capped the amount of damages that can be levied with no measurable impact on overall health care costs.
The reason your doctors provide uneeded tests is to ensure they maximize profits. Every test generates more profits. If that fancy diagnostic machine sat unused then the Company that INVESTED in it would be losing money. They LOSE money when they do not USE the equipment.
It is not about "malpractice". It is about generating profits. No physician is going to tell anyone that the reason they order so many tests is so they can make more money. Malpractice suits are a convenient scapegoat.
On a total overall basis the US has 50 percent more medical malpractice claims then Britain (just as example) and 350 percent more in total then Canada. Yet over 2/3rds of all US claims in the USA were dropped.
On average the Canadian Payout for malpractice was 15 percent higher then in the USA.
In both Canada and the USA the costs to the system due to medical malpractice as measured against GDP are less then .5 percent. The number the same in Britan and Australia.
When one factors in the sum total of all costs , this including malpractice insurance, payouts in cases lost by the physcians, costs for defense attorneys and the like an additinal .46 of GDP is added to US costs resulting in still less then 1 percent overall and all those other countries have those costs as well.
A few holes in your argument:
1. Patients with no insurance have just as many unnecessary tests as those with good insurance.
2. Take an Emergency Room setting for example--The ER doctor orders a barrage of tests on a patient. The ER doctor does not profit. The doctor who interprets the exams does. Look at what actually happens in hospitals and you will see that malpractice drives the behavior.
I have provided the total costs.
Contrary to your claims malpractice suits happen in other Countries. As I have already stated payouts on Average are higher in Canada then in the USA.
US Total costs for malpractice claims, legal costs and "preventive medicine" are only marginally higher in the USA then in other countries.
What makes you think Doctors are not sued in Canada? What makes you think they are not sued in Britain or France or Switzerland? What makes you think doctors in those Countries do not have to buy malpractice insurance?
"Malpractice suits" is the convenient bogeyman that is used to cover up for a grossly inefficient and costly system. The US spends close to 17 percent of GDP in total on its Medical system and less then one percent of this attributed to "Preventive medicine to prevent lawsuits, malpractice claims and legal costs" Take away that one percent and the US system is still a much more costly system.
"1. Patients with no insurance have just as many unnecessary tests as those with good insurance."
Is this a joke, ha, ha, not amusing. People with no insurance get NO tests, no nothing, they go without medical care until it becomes an absolute emergency. You hate government programs so I assume you are against Medicaid, too. But millions are not poor enough to qualify for Medicaid or any other state aid (which you are against) and they don't make enough to afford private insurance. If they go to the ER for an emergency, that is the most expensive care and it's not free. The hospital will go after the patient for payment. If the patient has any assets, they will be taken away to pay the hospital bills and they will go into bankruptcy and insurance rates and hospital costs will continue to soar to cover the costs of the poor folks who have to go to the ER for care.
Malpractice keeps doctors on their toes, that's a positive.
You can't go to the ER for regular check ups, for a PSA test, for eye care or palliative care.
The figures on the cost of medical malpractice don't take into account how physician behavior changes as a result of the fear of lawsuits. It only takes into account the actual cost of the insurance.
From The WSJ:
Canadian law firms, unlike U.S. firms, often require plaintiffs to pay for an initial investigation to determine whether the claim has merit. That cost discourages many people from pursuing a lawsuit.
Another deterrent, plaintiffs' attorneys say, is that the Canadian Medical Protective Association is aggressive in defending its members because it is in the unique position of insuring virtually all of the country's 76,000 or so doctors.
"It's different from the U.S., where you have a great number of private insurers, each with a different corporate mentality to litigation,'' says Richard Halpern, a Toronto attorney.
"Here, we don't see nuisance payments to settle cases, we see where the CMPA is prepared to throw all the money at it to defend it no matter what it's worth. Litigation in Canada is therefore very, very expensive, and there are very few plaintiff's lawyers with the wherewithal to carry through with these cases.''
The association's legal fees have risen, but its track record is strong: Of the cases tried in 2007, judgments went in the patient's favor 25 times and the doctor's 70 times. The median amount of damages was about $91,000.
Although Canada allows jury trials, the few cases that go to court are usually tried in front of a judge.
"Some of my cases are too complex for a jury, and it does prolong the trial and use up a lot of resources,'' Halpern says. "On the other hand, I do believe we don't make enough use of juries. Juries may be more sympathetic, particularly when you do obstetric cases. There's the sympathy factor.''
Halpern is awaiting a judge's ruling in a case in which a baby was born with cerebral palsy because a nurse failed to realize the baby had been starved of oxygen in the womb. Halpern would be surprised if the judge awarded punitive damages.
"We generally don't pursue that here in Canada because most medical cases involve negligence,'' not intentional wrongdoing, Halpern says. "I've never seen a punitive damage award in a medical malpractice case.''
• • •
Florida's largest malpractice verdict came in 2006 when jurors awarded $217 million in punitive and other damages to Allan Navarro, a Tampa man who became a paraplegic after suffering a stroke misdiagnosed as sinusitis.
On appeal, Navarro settled for less but the case fueled the debate over tort reform and the litigiousness of American society. Canadian lawyers can advertise, though it is rare to see billboards or TV ads like those in Florida.
"This country has a system in which mass advertising of services encouraging individuals to file lawsuits, meritorious or non-meritorious, is a mentality that just isn't present in countries like England and Canada,'' says Dr. Robert Yelverton, chief medical officer for Women's Care Florida.
The company, with 107 doctors in Central Florida, requires patients to waive their right to a jury trial.
Despite the push for tort reform, the facts don't warrant what Public Citizen, a nonpartisan research group, calls the "politically charged hysteria surrounding medical malpractice litigation.''
Florida has limited attorney fees and imposed a cap, generally $500,000, on noneconomic damages. Partly as a result, malpractice insurance rates have dropped, though they are still far higher than those in Canada.
For orthopedists who do risky spinal surgery, the annual base rate for $1 million in coverage is $72,000 in the Tampa Bay area and $140,000 in Miami. The most any Canadian orthopedist pays is about $12,000.
"I do know that most of my orthopedic colleagues have no malpractice insurance and can't afford it,'' says Dr. Michael Wasylik, a Tampa surgeon and past president of the Hillsborough County Medical Association. "That's one way not to get sued: don't have insurance.''
The downside of that strategy: Florida doctors who "go bare'' on insurance can have their license suspended if they are unable to pay a judgment of up to $250,000. (Wasylik is insured.)
While malpractice litigation accounts for only about 0.6 percent of U.S. health care costs, the fear of being sued causes U.S. doctors to order more tests than their Canadian counterparts. So-called defensive medicine increases health care costs by up to 9 percent, Medicare's administrator told Congress in 2005.
"How much money is spent in this country to assure that every test known to man is done to avoid a lawsuit?" asks Yelverton of Women's Care Florida. "Defensive medicine is not talked about nearly enough, although the costs are huge."
Note how it mentions Canadian Doctors pay into a COMMON pool to lower insurance costs?
That is the single largest factor.
Australia has a system much closer to the USA yet they still have lower health care costs per capita. Again you overstate the case. You are not basing your reports on independent assessments. You are basing them on groups that have a vested interested in seeing lawsuits GO AWAY.
Preventive medicine happens in every country. 140k a year for insurance for litiagtion is high not because payouts are high , it is because your doctors will not buy insurance in a pool. Preventive medicine is driven, not by the amount of insurance paid it is driven by the fact that if a Doctor commits malpractice, there can be a lawsuit.
I get life insurance through my company for about 1/10th the cost I would privately for the same amount because our company is a POOL.
Thats how insurance works. Any Doctor who buys INVIDUAL insurance will pay exponentialy more then a Doctor who buys it as part of a pool.
The Highest estimate I have seen in the US for the costs of "defensive medicine" is 9 percent of TOTAL heath care spending. This does not mean it 9 percent higher then all those other countries as all those countries have to worry about lawsuits and all practice "preventive medicine" to varying degrees.
If one assumes it 3 times higher in the US then in Canada and this is being VERY Generous to the "it the defensive medicine crowd" then this would explain away 6 percent of extra costs.
The US spents 17 percent GDP on its health care in total. 6 percent of that is about .6 percent.
Thus using numbers extremely biased in your arguments favor this would lower costs from 17 percent of GDP to 16.4.
Which is still higher then any other country in the World.
Canada is also the BEST example to use in your favor as all of the other developed countries have a model of malpractice that comes closer to the US system.
Now in 1971 the US still had its malpractice suits. Indeed the number of suits were higher then then today per capita.
In 1971 the USA spent 7.6 percent of GDP in total on health care. Canada spent 7.1 percent of GDP in total on health care. This was when Canada introduced its nation wide system.
Since that time the US has many states putting caps on damages and the like. There is no way in the world the math supports your arguement that Costs growing from 7.6 percent of GDP total to 17.2 percent total in a 40 year period is due to "Malpractice suits" to any great degree .
Nor can Canadas growth from 7.1 percent of GDP to 10.1 percent of GDP in that same period be attributed to "Lower malpractice claims" in Canada.
BTW I would point out that the US system makes far more "Medical Mistakes" then most any country in the developed world. This includes things like prescribing the wrong medications, removing a limb from the wrong person or having a person contract illness from being exposed to an unsanitary enviroment.
Perhaps if you had better trained doctors there would be less lawsuits?
"The government doesn't bring efficiency to anything ever."
Wow, another right wing/LIBERTARIAN/AYN RAND talking point. I get it, government is evil and always wrong, so just give up and continue to do what we have been doing, which has been nothing until Obamacare. If we did nothing, health care costs would continue to sky rocket, more people would become uninsured, insurance CEOs would continue to suck up multi-millions every year. Social Security is a 75 year old success story and hasn't missed a payment in all those years. Medicare gives millions of seniors a shot at affordable health care otherwise they would just die in the gutter. Universal health care works in other countries while the mish mash crazy quilt mess we have in America leaves tens of MILLIONS without any health insurance, without health care.
Malpractice reform or tort reform usually means a cap on malpractice claims. How fair is that if some poor soul is butchered by a hospital, doctor or medical appliance, is crippled for life and will have lifetime expenses thereafter? Malpractice reform is great for the doctors but bad for the patients. Though I will grant that doctors need some relief from the high insurance costs, that's the fault of the GREEDY insurance companies not the doctors. If we had universal health care then patients would not have to sue doctors for needed care or corrective surgery unless there was a horrible case of botched surgery.
I am a doctor in a single payer system and I believe you are wrong. I have a lot to criticize of the system I work in but it is way better than the US. It is cheaper and has better outcomes. How else do you want to measure efficiency? In my system the perinatal death rate is 5 per 1000 births, Cuba comes in at 5.7 and the US at 6.3. Us gets beat by Cuba and my system beats yours by that measure. Of course, if you took the death rate of rich US babies you would get a different picture.
JERZY: Very astute analysis. There always seems to be at least one right wing plant pushing the business-friendly meme in these threads. I'm glad someone else outed today's candidate. Jake must have a date tonight. Someone else is on duty.
I couldn't be any LESS business friendly.
Right Wing plant?
I think both Wings have glaring flaws which can usually be explained by corporate control of both parties.
I feel compelled to point out things which I know to be false--like the bogus claim that the only reason doctors order unnecessary tests is to make more money.
The Left Wing fails enormously by thinking that single payer universal coverage health care is the answer.
It solves the problem of people not having coverage, but it doesn't address the cost.
Malpractice reform would address one part of the problem of escalating costs but that isn't the whole answer either.
Look at how we deal with breast cancer for example, a disease that is really on the rise.
The main thrust of the very well funded breast cancer awareness campaign is to go in and get your mammogram every year. (Which, by the way, delivers a dose of cancer causing radiation each time)
The focus should be on the environmental causes of the increase in breast cancer--hormones in food, toxins in the water, unhealthy diets, etc.
There is a very destructive trend in the US to pit the left against the right.
The left's answer to everything is the redistribution of wealth. Don't focus on the wars' effect on the budget, focus on getting somebody else to pay more taxes.
Don't focus on the reason health care costs are out of control, just demand universal coverage.
Health care is bankrupting people. That is a huge problem. Corporations are doing every thing they can to avoid providing benefits. That is also a huge problem. These problems require much more creative and extensive solutions than to make it "free" and single payer.
I have never uttered any defense of the insurance industry.
They are part of the problem.
However, you can't expect the government to reform the corporations that it bows to.
So what did we get when Obama decided to allow more government encroachment into the US health care system?
Price controls for the pharmaceutical industry?
Off the table.
Much needed malpractice reform?
Off the table.
Meaningful insurance reform?
Of course not.
The more the government is involved, the more you can expect out of control costs followed by limiting services.
What is really needed is the address of waste and abuse.
Predictably, Obama emulated the worst parts of European systems without the good parts like price control and ma;practice policy.
HOw is that supposed to work Professor?
"C.D. has a number of people who pretend to care about progressive issues;"
That's fallacious thinking.
"but what they're here to do is subvert them, hamper the discourse, throw aspersions at key thinkers, and subliminally reinforce the right wing memes. "
Progressives can differ on issues. Let's not build up the wrong theories. Nobody's perfect and forums are here to help. If everyone were pure progressives, we wouldn't be having CD.
VP, thanks. Doesn't single payer automatically reduce medical malpractice? I heard it does.
Yes, corporate control of the government is the problem with almost everything that is wrong with the country.
And yes, Obama teamed up with the insurance companies and the pharmaceuticals to make sure that "reform" meant business as usual for them.
He also had a gift for attorneys-no malpractice reform.
The government is close to 100% corrupt, inefficient, bloated and controlled by corporate interests.
So, let's turn health care over to them.
That's your logic in a nutshell.
Then you declare my arguments right wing as if that precludes logic.
I guess there's no need to reflect on anything if it was ever uttered by Reagan.
Health care costs in America are soaring out of control and our quality of care is slipping.
With those terms, it would be reasonable to look at the inherent waste in our system of delivery.
Obama looked at European and Canadian models of health care and declared everything that makes those systems work better than ours "off the table."
And I am tired of your ad hominem attacks and pompous assertions.
Keep believing that anyone who doesn't agree with you on health care tortures animals.
You may have your little cheering section here on CD, but your arguments won't carry much weight elsewhere.
Good luck to all of you optimists. The lack of health care is in such crisis in Vermont that a clinic has been set up. It only operates a few hours per week. State Law will NOT allow doctors from other States to cross the border and render humanitarian care in Vermont. (Read my article titled SIZE MATTTERS.)
Please check to see how much the CEO of Vermont Blue Cro$$/Blue Shield makes. Please check to see how Single Payer was defeated by Gov Dean when he was in office.
I have lived in Vermont for more than a quarter of a century. Have you read the report of the murder in a Bennington Nursing Home a few weeks ago? It will NOT be prosecuted.
We don't need insurance. We need health care.
Dennab...The 'love it or leave it arguement' is a bit out of place here.
You ask what I have done ... I have advocated for SINGLE PAYER for MANY years now. Many of my articles on the topic have been published on the Internet but banned in Vermont. I have attended health care meetings sponsored by the VT Workers organization locally and in Montpelier and was told by the group that the use of the words "single payer" should not be used because they would offend some.
I have been a candidate for VT AG in the past 3 elections and have used the exposure to advocate for justice and single payer health care for all.
In addition, for years I have been talking with Bernie and his staff in an attempt to at least get a FQ health care clinic down at this end of the State. I could go on and on and on but you seem a little hostile.
Fine words by the governor, but it's now up to the Vermont legislature to craft the legislation to make his proposal live. Questions for the Vermonters on this thread: Has the governor named someone to coordinate legislation? Who in the legislature has echoed the governor's words? Who in the legislature has vowed to oppose such legislation?
Dennab, thanks for your reply and the info it contains, but there are no answers to the questions I posed. I think it will take many folks like yourself literally standing over their shoulders to ensure the VT legislature crafts a people-friendly bill. People Power *must* be mustered to counter the weight of corporate influence.
I live about 15 minutes from the Vermont border. Hmmm, just might pack up and become a 'monter', as we jokingly call them.
It is good to know that somewhere, somebodies, as some real smarts.
In relative terms, and I know this might be difficult , what are the political leanings of the States that border Vermont?
New Hampshire is geographically and politically to the right. They are dealing with some free state project crazies over there with a libertarian mindset. New york is also more to the right politically.
Vermonters are quite independent but they do lean left on public services. I don't think, however, that Vermont can not be considered socialist by any stretch of the imagination.
South of us you have taxachussets which seems to be able to lean left and right simultaneously.
Prevention/information is the key to successful healthcare.
When you eat at fastfood joints, eating a couple GMO/chemical laced egg/bacon/bread things/ verses an organic broccoli/kale/banana/apple/coconut/greens smoothie.....you see why healthcare is so expensive.
Folks in the US don't need a doctor, they need a nutritionist!!!
Traditionally, Congress has not integrated public health issues into Farm Bill programs, despite strong scientific evidence that food production and consumption patterns are linked to rising health costs and associated diseases.
Excellent point organicfmr!