Health Insurance

[Eagle92]

Gern,

You wouldn't believe some of the crap I've heard in reference to lawsuits. Patients suing docs despite ignoring the doc, docs being sued trying to provide some help at the scene of an accident, docs being sued b/c the have the same name as a dead physician, ad nauseum.

 

Then you got billing and that bureaucracy. Today every procedure has a code, and if you put the wrong code, you may not get paid. Now that may sound like an easily fixable problem, BUT the government will not allow you go go back and fix the code after they pay ya. AND if your code disagrees with the hospital's, NEITHER one gets paid, and if you were already paid, you need to pay it back with penalties and interest.

 

Example if the doc's office uses code 518.83 chronic respiratory failure, but the hospital uses code 518.84 acute and chronic respiratory failure, guess what, both the doc and hospital don't get paid or both are fined.

 

Also if Medicare/medicaid disagree with a doc's diagnosis, unless there is a second medical opinion supporting the original doc, guess what, Medicare/aid won't pay. AND even if there is a 2nd opinion, they do sometimes deny it, causing the hospital and doctor's office $ to appeal the decision.

 

Guess who has to pay the costs of the 2nd doctor's opinion, appeals process, and beuracracy needed to keep track of all this stuff. The Patients do!

 

 

[GernBlansten]

So to fix the problem of a few bad lawsuits, you'd prefer we take away our liberty and freedom? I just don't think that's a good trade.

[Eagle92]

One very simple tort reform would be for the loser to pay all court costs and legal fees, in addition to any fines, penalties, and awards. That way the plantiff who decided to go ahead and sue the wrong physician I mentioned int eh MS court case would have had to pay for the defendant's legal fees, instead of having the physician paying for his own defense.

[vol_scouter]

Gern,

 

First, remove some of the legal shackles that prevent medical staffs from removing 'hacks'. Second, damages should be limited to something commensurate with the damages. So if lifetime care is required, a reward of a few million dollars when properly invested and spent should provide the lifetime. Third, if no gross negligence then no award. Fourth, set up panels to review the claims. If the panel says that there is not adequate evidence for a suit and the plaintiff chooses to sue anyway, then the loser pays all costs. This would decrease the likelihood of being frivolously sued without removing the right to sue. Fifth, a suit should be able to financially damage a physician no more than a business owner, i.e. the business can be bankrupted and sold but the businessman will not be held personally liable and so will not lose their possessions. Similarly, physicians could lose their business but their personal holdings are not on the table. [Note: In some cases that does not hold for businessmen and likewise could be done with physicians, e.g. homicide disguised as a medical act]. Those are my off the cuff thoughts.

[GernBlansten]

The problem with loser pay, is that the little guy is at a huge disadvantage. The well funded defendant can stall, continue, delay and drain the resources from the little guy. Thus forcing the verdict by default.

 

Take a family of modest means who have a child who is given a bad diagnosis and treatment that leaves the child disabled. The defendant is a Catholic hospital with the resources of the Vatican behind it. Who do you think will prevail? Will the family faced with a loser pays even try? Probably not. Is that freedom and liberty?

[GernBlansten]

Vol,

Damages are currently limited to what the plaintiff can convince the jury to award. What you are asking for is some external limit that not only limits the award, but freedom and liberty.

If I think I've been damaged $15 dollars, I should be able to go before my peers and ask them to award me $15. If they think my damages are only $10, so be it. If they think its $20, well who am I to complain. But I should not have the freedom and liberty to ask for the $15 limited by some external force. Like the federal government.

[Eagle92]

Gern,

You would be surprised at the number of lawyers who do pro bono work or contingency work.

 

Also you talk about the family of modest means. What about the physician I mentioned who had to hire an attorney and deal with all the legal aspects of goign to court, etc, and HE WASN'T EVEN THE PHYSICIAN WHO TREATED THE PLANTIFF (caps for emphasis, not shouting.).

 

By having the loser pay all costs, will make people think do they have a legitimate case to pursue?

 

 

Then again after the jury that awarded millions to the lady who spilled coffee on herself, I don't know.

 

[GernBlansten]

Ok, riddle me this.

The plaintiff has no money but has a claim against someone. If he has no means to pay if he loses, is his case heard? Or is justice just for the rich?

[evmori]

Well, Gern, if the plantiff loses, how does he make amends if he has no money?

 

Justice isn't for the rich but insane lawsuits do nothing more than tie up the courts and create a bunch of stupid laws because some people have no sense! I'm all for not legislating personal safety!

[Eagle92]

Gern,

 

If memory serves, some state bar associations require that lawyers do a specific amount of pro bono, or "for the good of the public" work, i.e. free lawyering. So there are ways for those who cannot pay to get help.

 

Also most law schools provide some type of free legal help via their students, so that they can gain expereince. EDITED: Those students do a lot of the grunt work, and then bring in lawyers, sometimes profs and sometimes alums, to deal with those issues only a lawyer can deal with.

 

Also a lot of lawyers will work on contingency, they don't get paid unless you win the case.

 

 

Now my question is this: what about the doctor who was sued, and the plantiff was never a patient of his, why should he have to pay to defend himself when he was never involved?(This message has been edited by Eagle92)

[GernBlansten]

Pro bono work does nothing to help the destitute plaintiff in your loser pays scenario. The loser of the suit pays all legal fees. His own, and the defendants. So, unless the plaintiff can post a bond to cover the expected legal expenses of the defense, how can the suit even be filed?

[Beavah]

Yah, Gern, da thing of it is that the plaintiff is suing for the doc improperly performing a service that the plaintiff didn't pay for in the first place.

 

That's a different thing then when someone runs a red light and hits your car, eh? Tort law is designed for those cases where another citizen has damaged you and therefore should make you whole.

 

In medicine, yeh have something that's being paid for by the state or by an insurer/employer that is a contracted service with no guarantees. Leastways, I've never had a doc or hospital guarantee a risk-free outcome. If yeh choose to engage the service under those terms then yeh assume that risk. If yeh weren't even paying for da service then what exactly is your claim? It should be Medicare or da insurer that is suing for a refund. Or, in a single payer system, it should be da insurer who decides to stop authorizing services from a provider who doesn't have good outcomes.

 

What you're proposing instead is that the person has a right of compensation from his neighbor if his surgery doesn't work out. Because that's what happens, eh? The man sues the hospital, whose liability insurance goes up, whose charges for services in turn go up to cover, resulting in more expenses for health insurers, who in turn increase premiums, who pass da charges along to employers, who take more out of da neighbor's paycheck. And along da way, a lot of lawyers and administrators get paid a lot of overhead .

 

That's just enormously economically inefficient, eh? And I'm not even sure it's just. But it's an absurd public policy.

 

B

[GernBlansten]

So, in order to stop frivolous lawsuits, we have to kill my freedom and liberty. I'm happy to inform you Mrs. Blansten, the operation was a complete success but the patient died.

[Eagle92]

I hate to say it, but things can and do happen in surgery. Maybe our current health care system is so good, that people ignore the possibility of death when procedures are done.

 

Give you an example, I knew someone who died while having an endoscopy being done. Everything was done by the book to the letter, but they died nonetheless.

 

A friend of the family died in heart surgery. Everything went well, they were about to sew him up, even told the family to go get a bite to eat. Within minutes of the family going to get food, something happened and he died.

 

If it sounds as if I am callous, I am not. but I think the perception is that surgery is going to work 100% of the time, and that is not the case. And some people want to blame someone.

 

And sometimes folks do look at a paycheck when things don't go their way. I was in the emergency room, and the person next to me started a conversation. We chatted, and she wasn't satisfied with the treatment her physician was giving her. So she decides to go to the emergency room to get a second opinion, and said that she was thinking about suing her physician, if there was a different diagnosis.

 

#1 that ED visit is more expensive that her going to another doctor for a second opinion, thus raising medical costs.

 

#2 She was looking for a payout.

[The Blancmange]

I'm not sure why Beavah brings up the red herring of who paid for the care. Unless he is suggesting that malpractice jurisprudence has regressed to the days of Hawkins v. McGee (know affectionately to law students as the "hairy hand case), he is interjecting a contract principle into a tort case. Certainly he knows better.

 

Imagine the practical ramifications if this were the case. Those who could afford to pay out of their own pocket would be entitled to proper care (or at least have recourse in the case of a medical error), while those who rely on Medicare/Medicaid, or have no means to pay would be stuck with second-rate care the corresponding errors.

 

"What you're proposing instead is that the person has a right of compensation from his neighbor if his

surgery doesn't work out."

 

I've re-read the entire thread and no one has suggested anything like this. What is being argued is that the government should not restrict the right of someone injured by a medical error, by care which falls below the recognized standard of care, to be made whole in the only manner the law can provide, with monetary damages.

 

Lest we forget that these cases do involve real people, here are some recent examples of significant medical malpractice verdicts for people whose lives have been drastically altered, or ended. Keep in mind that these are cases that went to trial and probably involved some issue that was fairly debatable. Most of the worst examples of malpractice do not go to trial because they are settled before that point.

 

http://www.chicagotribune.com/news/local/ct-met-edward-hospital-lawsuit-verdic20101026-9,0,1426846.story

http://www.timesunion.com/local/article/Jury-awards-family-154-000-for-Glens-Falls-787394.php

http://www2.highlandstoday.com/content/2010/oct/18/191533/jury-finds-for-patient-in-medical-malpractice-case/