Thank you for your brave work on this issue, you are a true patriot.
"It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds." -- Samuel Adams, Founding Father
A major driver of U.S. costs that isn't discussed in the article is our parasite lawyer class, who drive up the cost of insurance for doctors and lead to widespread over-testing or "defensive medicine". Few Americans are proud of our litigious society.
Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.
Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there.
The cost to avoid lawsuits adds up with a lot of tests that are not needed. Doctors end up doing whole batteries of tests on everyone to avoid the 1:1000 or higher chance that the person in their office with a headache really had an aneurysm and get the doctor sued for negligence when he sends them home.
Another side effect of all these tests is that many are extremely dangerous. CT scans in particular are ordered way too often and can does people with levels of radiation that lead to problems later in life.
I have anecdotal evidence to back up these claims: my mother is in internal medicine and my father is a surgeon. both have practiced defensive medicine and my father has complained about how common an occurrence it is on a regular basis.
Many tests, drugs and treatments have been applied in the name of defensive medicine.
The followup question is, how much defensive medicine is necessary? If there's a 5% drop in that practice then do the costs from lawsuits go up to compensate? Are we at an equilibrium point, or are doctors doing defensive medicine because the myth of the power of a lawsuit is so strong?
I am a physician, and I teach in a medical school. Although they are 2% of total costs, they drive up the cost in unnecessary procedures that patients demand without medical indication. Those $1080 MRIs are often ordered to avoid a lawsuit. That adds up to a lot more than 2%.
I'm a doc based in the UK. I know that we order fewer useless investigations than you do in the US. Thankfully we don't have a litigation heavy medical culture yet. Although, I think it's slowly heading that way.
My dad is a surgeon, so that's my appeal to authority and anecdote. In my country litigation isn't a problem, but unnecessary treatment is. People go doctor shopping to find one that gives them the treatment they want. Same problem, different cause.
As I understand it now, doctors have largely invested in testing companies. When they (not all doctors obviously) - I probably thinking primary doctors - order tests the test is a money maker for the doctor.
Wouldn't a calculation of the effect of litigation include the scenario you mentioned? Otherwise it would seem to be a bad calculation. Do you have any studies that show how often a test is ordered simply to avoid a lawsuit?
The second link hardly endorses your view. It says
Although our estimates delineate a wide range of potential savings, systemwide savings from aggressive malpractice reform could approach $41 billion over five years.
According to one source [1] the U.S. spent $2.6 trillion in health care in 2010. An $8 - $9 billion dollar savings per year from eliminating defensive medicine hardly adds up to "a lot more than 2%".
I agree that the second link is saying more about the effects from malpractice reform. I have seen the Kaiser study, and what I think they are not taking into account is the culture of defensive medicine that may physicians don't even think about. For example, an MRI is more likely in a US Emergency Room than in a UK Emergency Room. UK practice is (in general) evidence based, and they won't order it unless it makes sense to do so. May US physicians would not identify this as "defensive" because the practice is so widespread, although the root reason for ordering it stems from that cause. I am not aware of an analysis that takes this into account.
I only read the abstracts, so correct me if I'm wrong, but both of those links fail to compare the US with other countries. I.e they don't show that costs in America are higher than other countries due to defensive medicine. It could be that all countries have higher costs due to defensive medicine, we wouldn't know from these studies.
Yeah but 2% of a very high cost is higher than it would be if the cost is lower (obviously). Of course you won't cut the costs much by targeting those 2% at first, but if you ever get to reasonable prices those 2% would transform in 7% and 7% is starting to be notable.
Regarding the so-called "parasite lawyer class", you might be interested in reading "Blocking the Courthouse Door: How the Republican Party and Its Corporate Allies Are Taking Away Your Right to Sue"[1]
From a Booklist review of the book:
By demonizing trial attorneys and exaggerating high-profile litigation
awards -- the famous McDonald's hot-coffee case -- campaigns for limiting
damage awards threaten to jeopardize the American right to civil jury
trials guaranteed by the Bill of Rights. Investigative reporter Mencimer
examines the Republican campaigns for tort reform that would protect
large corporations from "frivolous lawsuits." The campaigns carry the
dual benefit of supporting the interests of corporations that are major
Republican campaign contributors and hurting trial lawyers, who are part
of the contribution base of Democrats. Mencimer criticizes the media for
their lack of understanding about civil litigation, willingness to
swallow reports of litigation abuses, and failure to understand that
Republican tort reform will also limit the ability of news organizations
to sue for information. Drawing on national data and scrutiny of
individual cases, Mencimer defends the civil justice system and its
reliance on jurors, average citizens who are the same people who vote.
This is an eye-opening look at an important issue for readers concerned
with the civil justice system.
also, "The Lawyer Myth: A Defense of the American Legal Profession"[2]
From the Booklist review:
However disliked lawyers have become, they have played an essential role
in the development of the American democracy, assert legal scholars
Strickland and Read. Taking aim at media critics -- left and right -- who
blame lawyers for a host of social ills, Strickland and Read debunk
several popular myths about lawyers. They begin with the notion that
there are too many lawyers and lawsuits, citing statistics to put things
into perspective, and they point to the benefits that have come from
lawsuits, including increased consumer protection from faulty products.
But they concede the need for reform in a chapter that calls for major
research into alternative legal mechanisms. Finally, Strickland and Read
look toward the next generation of lawyers and outline the
characteristics most essential for the practice of law: competency,
responsiveness, and integrity. They emphasize that it’s not what lawyers
bring to the law but what they give that makes a difference. This book
is not likely to stop lawyer jokes, but it is an insightful look at a
much-maligned profession.
I believe there to be a more concrete cause of US healthcare costs: collusion between insurance companies and healthcare providers. "Insurance" includes both health insurance and malpractice insurance, as well as "providers" being hospitals/doctors and manufacturers of equipment and drugs.
Tesla are crony capitalists building a car that is worse for the environment (toxic battery, power waste across the grid, majority power from coal powerplants) than traditional combustion engine machines.
Classic Chris Dodd. Obvious outcomes -- like the 2008 financial crisis, which occurred on his watch as Chairman of the Senate Finance Committee-- are "watershed" and heretofore "never seen before." This way, he can escape responsibility for the role his own actions played in creating the mess.
In fact, the public rejection (if final) of SOPA/PIPA are not watershed events, but evidence of Dodd's absolute failure to execute the job he was hired for.
Traditionally, Hollywood (run by angry liberals) and the Republican Party are hostile, so this shift is more of politics reverting to the mean. The main reason GOP members were on SOPA was the support of Nashville and the NFL.
This shift is a very positive development, it means the bill is becoming impossible to pass in a Republican House (and where GOP Rep. Lamar Smith has discredited himself by leading fellow Republicans into the SOPA morass).
There's no real hostility between Hollywood the industry and the Republicans, just Hollywood the media spectacle. High-profile actors tend to be more liberal, but the Hollywood executives (the ones who actually "run" it) are typically moderate business-conservative type people, the same as most other places in big business. In fact they literally are the same people due to CEO churn, and definitely from the same social circles; e.g. NBC Universal's CEO was formerly Comcast's CEO, and is a personal friend of JPMorgan Chase's CEO.
The RIAA types are even more welcome in the Republican Party traditionally, due in part to Nashville as you mentioned, and in part due to the significant influence of first Sonny Bono and now his widow Mary in Congress.
If this is a regression to the mean, when was the mean ever in effect? In the 1980s, Ronald Reagan maintained strong ties with Hollywood (even with people like Lew Wasserman who were active in the Democratic Party) and promoted their interests; in the 1990s, the GOP led the charge for the DMCA and Sonny Bono Copyright Extension Act. Arguably there was strong hostility in the 1950s-70s, when Joseph McCarthy thought Hollywood was full of Communists, and Nixon complained about it being controlled by Jewish Democrats, but that was a while ago, and for reasons (paranoia about Jews and Communists) that hopefully aren't going to recur.
Everything we need is already in the Constitution, in the First and Fourth Amendments of the Bill of Rights. We just have to defend our freedoms...through protest and through votes.
"Those who expect to reap the blessings of freedom must, like men, undergo the fatigue of supporting it."
--Thomas Paine: The American Crisis, No. 4,1777
One day is, honestly a too small price to pay. I know they would not go as far as this, but a blackout until the SOPA is dead and buried (i.e. not only one day) would be a better way of protest. Think of it as the equivalent of a hunger strike. That's only when you get lots of people worried/annoyed that they will be prompt to act. One day is not going to cut it.
"It does not require a majority to prevail, but rather an irate, tireless minority keen to set brush fires in people's minds." -- Samuel Adams, Founding Father