Saturday, December 18

More on health care

President Bush said yesterday he is "passionate" about protecting the business community from "frivolous lawsuits" (source).

*cheap shot*: I wish he were passionate about protecting patients from malpractice and a potential loss of physicians.*end cheap shot*

I'm sure he thinks this is the way to fix it, but it's not that simple.

Christine reminded me of a conversation we had with my physician brother and his physician wife where the main point was: you can weather one (rightful or wrongful) guilty malpractice ruling, but after that you're in big trouble in the next one or the one after that. That's important to know in this debate. It softens my position (a little) on the money physicians make.

They also pointed out that Obstetricians and Neurosurgeons are the most susceptible to malpractice (which I knew once, but had forgotten), so this is where we're seeing shortages in certain areas.

Then, I got some good input from Paul. He's a lawyer, and a friend, and more conservative than me. I always value his opinion. First, I'm reprinting his comment from below:

When I was in law school, there was a Friday afternoon social event each week called "Wine Mess". Mainly there was beer. Not only did law students attend, but other graduate students, including medical students. As I was conversing with a new medical student at one of these events, I asked him why he chose to go to medical school. "The money", he said. Maybe he was exceptional or maybe he was baiting me.

I think the problem is not only the greed of some people in the medical profession (I'm simly astonished that they are no better than the rest of us!), but also the way we pay for them. Or the way we don't pay for them. The insurance companies pay for them. While we climb all over the latest iPod clones to find the best value, we spend a lot less time choosing a doctor, and I would say that we do so because we are not paying for the doctor. If his fees were coming directly out of our pockets, I think we would do a better job of applying discipline to the medical arts by making choices based on the price/value equation.

On the other hand, even with the system we have, we do really well in this country, provided we have the means to pay the premiums and oft-times when we don't. I have had wonderful doctors all of my life. I really don't mind the nice cars they drive, particularly if they can heal my wife, my children, and me. And they have.

I think its a fortunate thing that we have plaintiff's malpractice lawyers. Otherwise, the medical services delivery system would be completely unaccountable to the consumer. I don't think the malpractice lawyers are the problem. But I'm prejudiced, of course. I guess we shall see, now that the ability of the lawyer's to get paid in malpractice cases is being severely restricted in state after state.

I'm not doing very well in anwering your question. Its not an easy one. I don't think Canada has the answer, as we have discussed before.

Also, if we had to pay for the services ourselves, I think we would take better care of ourselves. I like the HSA [Health Savings Account] idea, as you probably infer.

Thanks for asking my opinion.

Interesting point about the market effects of how we pay for health care (that's one reason why Paul's opinion is so valuable). In addition, Paul is a cancer survivor, so he knows intimately about receiving care.

If Paul says we need plantiff malpractice lawyers, since he's an above-board lawyer-type, then I'm sure he's right. Besides, that capitalism, too, right?

Then Paul posts a story that illustrates one of the problems with socialized medicine.

So, where does that leave us?

Paul's tack (I think) would be to re-marketize the whole thing:
1. Pay less for insurance, and then mostly for catastrophic-type stuff
2. Save more for health care (eg, in HSAs) and pay for health care out of pocket.
3. Reduce the role of the middle-man, ie insurance agents, companies, and HMOs. Put the market to work on these guys.
4. Let juries of peers regulate as needed.
5. Physicians need to police themselves better. I think Paul would agree with this.

I another solution would be to regulate more - go more socialist.

Then there's the Bush/AMA solution: legislate against patients and lawyers interfering with business. Back to the 1890s. *end snark*

Calling John Hardy: I'd be interested in your input from an Australian perspective. What's health care like down there? How does it work?
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