Injuryboard Commentary - Reform

Why are Medical Bills so High?

Jon Lewis — Sat, 05 Dec 2009 13:49:34 GMT

Did you know that hospitals and physicians rarely ever receive the amount they charge for their services? Health insurance companies do not pay the actual bills invoiced by medical professionals. Why is that?

We had a client who was injured in a truck collision. His injuries were serious enough to warrant several nights in the hospital and a couple of surgeries. What were his medical bills? Approximately $72,000.00. What did the hospital and physicians get paid? $11,714.01, approximately 16% of the amount billed.

If you had a retail store, would you accept 16% of your prices? Why do hospitals and doctors? Are they over-charging, or are they getting paid too little?

What if you don't have health insurance? What happens then? Well, I can tell you that I handled collections for a hospital about 13 years ago, and if patients came in for emergency treatment and didn't have insurance, we sued them for the full amount, not 16%. Why do private pay individuals have to pay the full amount? I understand why health insurers receive a discount, but an eighty-four percent (84%) discount? What if Bill Gates doesn't want to get health insurance? He can pay any amount billed so why doesn't he receive the same discount as a company like BlueCross?

Is this a form of fraud or misrepresentation? In Alabama, BlueCross BlueShield has such a monopoly on health insurance that they dictate to hospitals and physicians what they can charge for their services. Many doctors speak poorly of BlueCross BlueShield as a result of their influence. Some won't even accept their rates as a result. Should the health insurance companies be setting the rates for medical treatment? Is that capitalism?

I don't have the answers to all these questions, but I think they need to be discussed, especially in light of healthcare reform. What are your thoughts?

Originally posted at InjuryBoard by Jon Lewis

AAJ Goes Underground to Debunk Rumors About Tort Reform

David Mittleman — Fri, 04 Dec 2009 10:00:00 GMT

The American Association for Justice is getting an important message across by advertising in Union Station throughout December. Blanketing the metro station’s walls, the message reads “98,000 patients may die annually from medical errors…That’s like 737s crashing every day for a whole year…Tort law won’t fix health care…Tell Congress to put patients first.” The message is meant to counter Republican attacks against healthcare reform legislation: Republicans and health insurance companies have rallied for putting limits on medical liability lawsuit awards, claiming that tort reform is the answer to the escalating costs of private health care insurance.

Union Station is one of most highly-trafficked areas for commuters travelling to our nation’s capital. The American Association for Justice specifically wants to remind Senate staffers that many people die of medical errors, and will be left with no recourse if Republicans have their way with tort reform.

As the American Association for Justice so aptly states, “health care reform is about making sure that every American has access to quality, low-cost healthcare, not about limiting the rights of innocent patients harmed by medical negligence.” Despite the opposition’s arguments, tort reform would do very little in reducing current health care costs. In fact:

· Medical malpractice is a tiny percentage of health care costs – less than one and a half percent of overall spending – according to the Government Accountability Office (GAO) and Congressional Budget Office (CBO). Restricting patients’ legal rights would have little to no effect on premiums or health care costs.

· Medical malpractice suits are less than one percent of the entire civil caseload, and have been declining for nearly a decade.

· The GAO and CBO have found no evidence of so-called “defensive medicine,” instead determining that doctors run additional tests to generate more income or help diagnose patients.

Originally posted at InjuryBoard by David Mittleman

Government Contractor's Rape Case Exposes Senators

Mike Bryant — Thu, 03 Dec 2009 09:19:00 GMT

It was nice to see recently elected and finally seated Minnesota Senator Al Franken get his first amendment passed last month. Unfortunately, it was about a very weighty topic. The amendment to the 2010 Department of Defense Appropriations Act prohibiting the government from contracting with companies who require their employees to agree to resolve certain claims, such as sexual assault, through arbitration. The amendment arises from the testimony of Jamie Leigh Jones that she was drugged and gang raped by her co-workers while working for a contractor in Iraq. When she reported the rape to her supervisor, she was locked in a metal shipping crate. She only got out of Iraq by calling her father, who got in touch with their local Congressman in Texas. When she attempted to sue her employer KBR, Inc., a subsidiary of Haliburton, she was told that she had to resolve her claim through arbitration in accordance with her employment contract. Mr. Franken's amendment was to ensure that the government does not do business with a company who would force its employees to arbitrate such a case as rape.

The bill passed but it was voted against by 30 Republican Senators. The Daily show did a good job of calling the 30 out and pointing out their hypocrisy.

http://www.thedailyshow.com/watch/wed-october-14-2009/rape-nuts

After watching this, spend a little time thinking about why these 30 voted as they did. Who are they protecting and who's side are they on? This week, this same group has been leading the floor fight against the Health Care Bill. They have been calling lawyers names, they have been calling for damage caps, and they have claimed that the change isn't for the best. Ask again who's side they are on? It's never been the consumer.

Originally posted at InjuryBoard by Mike Bryant

Let's Get Real About Lawsuits and Corporate America and Organized Medicine

David Mittleman — Wed, 02 Dec 2009 10:11:39 GMT

While browsing the blogging world I discovered a post by Joanne Doroshow on the The Huffington Post with which I completely agreed. Ms. Doroshow was taking on the hypocrisy of Corporate America and Organized Medicine when it came to their positions on access to the courts.

It boils down to this. When it's injured people who want access to the courts to protect what little rights they have left after "tort reform", corporate America and organized medicine blast the anti-litigation propoganda for all to hear. We hear about frivolous lawsuits, costs of litigation, and the threats to commerce.

But... when it's corporate America and organized medicine that want access to the courts to rack up money on even the most absurd claims, the anti-court propoganda disappears. Most likely, these corporate entities are suing smaller, weaker entities to squeeze them out of money over things most of us would probably shake our head over.

So here's the truth. When you hear television ads and see online postings talking to you about frivolous lawsuits and greedy plaintiffs, remember who is sending you the message. It's probably a corporate entity that's been suing over the craziest claims, but doesn't want injured persons without million dollar bank accounts to have access to the courts.

Is that hypocrisy? If it walks like a duck, and talks like a duck....

Originally posted at InjuryBoard by David Mittleman

No Preventative Medicine: Wellness as a Crisis without a New Health Care Bill

Christy Thompson — Tue, 01 Dec 2009 17:53:27 GMT

The main dispute about health care reform is that the cost is just too much for the American taxpayers, state or federal governments to afford. Indeed, there is no arguing that the cost to implement a quality health care system in this country from the ground up will come at a sizeable cost. But everything great in US history has come at a high cost: good public transportation (where it actually exists), highways that span the nation, railroads, ideals of public education, taxpayer supported law enforcement, mail service, armed forces and arms programs. So if we can afford the price tags associated with these -- in many cases whether we agree with them or not -- why do we as taxpayers not have the right to pay for something that will keep us well?

"Crisis health care" such as ONLY seeking medical attention after a severe accident or when extremely ill leads to worsening health conditions, more death, and more costs are incurred by taxpayers. Unpaid visits to the emergency room for Americans without insurance will eventually cost exponentially more than a new health care plan.

Seeing a doctor only when disease is consuming someone's body or when a patient has a railroad spike piercing his cerebrum is a careless use of the most high tech medical machine in the world. The message of prevention is lost on the American public because they have been without it for so long that entire generations don't even really know what it means to have it and how much it could better their lives.

Supporting prevention health care rather than crisis health care is the only sure bet for the long run of a successful American health care system. Preventative medicine means doctors who take the time to inform patients and health care programs that promote healthy living and wellness as a way of being rather than letting the public depend on emergency rooms that offer only a temporary fix; it's like patching a flat tire over and over again. Eventually there will be one last blow out that just isn't fixable. This is an apt metaphor for both human beings in the current health care system and the current system itself.

Originally posted at InjuryBoard by Christy Thompson

Health Care Shouldn't Be Politics As Usual

Mike Bryant — Mon, 30 Nov 2009 16:47:00 GMT

After the vote to send the health care bill to the Senate floor, there was a round of Republican tweets that predicted that the vote would end the careers of Senators that voted for the bill. That is the way to many of the misguided Senators see this issue. It's simply a political game.

They don't care about the 98,000 people that die each year due to medical errors. These are injuries that are preventable. They don't want to talk about the medical errors, or medical negligence, and the resulting medical malpractice.

Instead, they call for people to trade away their rights to get quality, affordable care. The CBO and GAO have stated time and time again that tort reform will do practically nothing to lower costs. They also found evidence that tort reform could lead to worse patient care. Less accountability will never mean better health care. Forty-six states have already passed some kind of tort reform, and costs continue to skyrocket. It clearly doesn’t work.

It all comes down to the old Bush/Rove anti lawyer mantra. The goal should be to lower costs and insure more people. But, it requires leaders that really want to fix the problem and not just use it to grandstand.

Originally posted at InjuryBoard by Mike Bryant

As Heath Care Bill Goes To The Senate Floor Focus Needs To Be On The Consumer

Mike Bryant — Mon, 30 Nov 2009 09:35:00 GMT

This week, the U S Senate will be debating the Heath care bill. It is expected that the usual Republicans will spend most of their time trying to add amendments to change the civil justice system. To cap damages and bar the courtroom door to the average American. It's the old Bush/Rove plan to attack the lawyers.

They will not want to talk about what is really going on. There is no question that America’s health care system is in crisis. Over 40 million people are without health insurance and costs are skyrocketing. Harvard researchers published a paper that concluded that illness or medical bills contributed to 62 percent of bankruptcies in 2007, up from about half in 2001. More than three-fourths of those with medical debt had health insurance.

The focus should be on how to fix the system. How to lower costs and cover the uninsured. So-called tort reform, or limiting patients’ legal rights, will not accomplish either of these goals. It will only make it harder for those injured through no fault of their own to seek recourse.

According to the Institute of Medicine, 98,000 people die every year from preventable medical errors, with countless more severely injured. Congress must put patients first, and not bargain away people’s legal rights.

Originally posted at InjuryBoard by Mike Bryant

Straight Talk on Tort Reform from Texas

Bret Hanna — Mon, 23 Nov 2009 23:20:37 GMT

Texas passed sweeping tort reform legislation in 2003 that, to a great extent, eliminated medical malpractice cases in the Lone Star State. Jennifer Bard is the Alvin R. Allison Professor of Law and director of the Health Law Program at Texas Tech University School of Law and an adjunct associate professor in the Department of Psychiatry, Texas Tech University School of Medicine, and she incorporates the Texas experience with tort reform into her analysis which concludes that such measures do not reduce health care costs. Here is her piece which appeared Saturday in the Houston Chronicle:

It's not as rare as you think for President Barack Obama and Gov. Sarah Palin to be in complete agreement on an issue of national importance.

In August, she wrote on her Facebook page that “we cannot have health care reform without litigation reform.” Speaking to the American Association of family physicians a few weeks later, President Obama said, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. ... So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.” Both of them are wrong. There is no evidence to suggest that limiting the rights of individuals to bring lawsuits will either lower the cost of health care or increase its quality. In fact, were this true, Texas would have the cheapest and best health care in the nation. The provisions of the tort reform legislation passed in 2003 have essentially eliminated medical malpractice suits. Indeed, things are so bad the lawyers for the insurance companies are complaining about the loss of business.

The only evidence we have that defensive medicine, defined as doing extra tests or surgery based on fear of litigation, drives up costs is from the least reliable source possible — the doctors themselves. Doctors' objections to law suits aren't financial — they are philosophical. Doctors are on the whole good people who devote their lives to helping others. Yet somewhere in their training they acquire the idea that this puts them beyond the constraints and hassles faced by every other professional. Lawsuits are time-consuming and embarrassing. They require explaining one's actions to a group of nondoctors, something doctors feel inappropriate. What doctors want isn't reform, it is an exemption. And that's just not how we do things in the United States.

As in all other cases involving a professional, every medical malpractice case depends on another physician's testimony that the offending doctor caused the patient's harm by acting below the standard of a reasonable physician in similar circumstances. To say that a jury isn't qualified to choose the testimony of one expert witness over another in a medical malpractice case is to say they shouldn't be allowed to do so in cases involving exploding tires because they are not automobile engineers. Unless Obama and Palin are interested in trading in our legal system for one with less citizen input — say one more like China's — then not only isn't litigation reform a necessary part of health care reform, it is no part of health care reform.

But don't throw out the baby with the bath water. Perhaps doctors are practicing defensive medicine, but that doesn't mean litigation reform will change their habits. First, it is hard to attribute overtesting to fear of litigation when the current payment system financially rewards doctors and hospitals for the number of tests they order and procedures they run, rather than on the time they spend talking to the patient to find out what's wrong. Second, it is entirely possible that those interested in selling them malpractice insurance have greatly inflated the risk. After all, given the relative rareness with which medical malpractice suits are brought, fear of litigation should no more be motivating a doctor's decisions than fear of alien abduction.

No one has ever suggested that civil litigation can directly reduce medical error. Reducing infection rates by adopting uniform protocols for hand-washing and instrument sterilization is not the same as pressuring a company to withdraw a defective product from the market. But our system of civil justice, as outlined in the United States Constitution, is not to blame for health costs or medical malpractice. Health reform can take place without litigation reform — both systems may be broken but they are not dependent on each other.

So perhaps if Obama and Palin really want to lower the cost of health care and improve its quality, they should be listening to economists and safety experts rather than either doctors or lawyers.

This analysis is spot on and from someone who does not appear to have "skin the game." Yes she is a lawyer, but not one that makes her living representing those injured by medical malpractice or working for the insurance companies that hire lawyers to defend doctors when claims are pursued against them for malpractice. We should consider her analysis in the objective light in which it is presented.

Originally posted at InjuryBoard by Bret Hanna

U S Senate Debate: Still No Talk About The 98,000 That Die Each Year

Mike Bryant — Sat, 21 Nov 2009 18:30:00 GMT

It's been interesting to watch the U S Senate debate today. There is more to go, so I'm sure they might just touch on just about everything. About 30 minutes ago, Senator McCain started the fraudulent claims that medical malpractice reform would make a significant difference. Sure, half of one percent savings by eliminating all claims would be a great difference. To your Insurance contributers Senator McCain.

Let's talk about the 98,000 people that die each year due to medical errors. Let's go after those numbers and reduce them. You do that and you will bring down malpractice claims. You will get rid of the few doctors that do a majority of the malpractice. You will save lives.

We will see how the rest of the night goes. Hopefully, it will get around to what is best for the American consumer.

Originally posted at InjuryBoard by Mike Bryant

Defensive Medicine: There Is Someone On The Defense All Right

Mike Bryant — Sat, 21 Nov 2009 17:07:00 GMT

The conservative blogs are loaded with talk of tort reform. We here at the Injuryboard continue to write about it. Guess the claim that no one is talking about it, is not only false, but intentionally misleading. It's interesting, how many of these posts get a comment with a link to the town hall site, which is claimed to have all of the answers. I spent some time looking at the link and it really does defy logic.

There is a section on defensive medicine and the very next section is entitled: "There Is No Proof That Threats of Litigation Deters Injuries" . What?????????????????? The reality is that while they use some facts, they stretch those facts and push frivolous arguments to come to a conclusion that fits for them. Even their damages charts distort the numbers to include extra fees that I would guess is the defensive medicine that actually the plaintiff was injured from. I would expect the executive compensation or medical charges costs includes even less for the injured consumer.

If you still have questions spend a little time with the American Association for Justices paper on the issue of the defensive medicine claim.

Ask the tough questions:

What tests are doctors doing that are actually not needed?

Have they ever found cancer or other medical life threatening issues with those tests?

Who got the money for those tests?

Why are so many people still dying in American hospitals?

Would more tests actually reduce the number of claims and keep more consumers alive?

My guess is that anyone claiming the existence of these tests really won't want to answer these questions. Mainly, because it simply doesn't happen and if it does they are involved in FRAUD. But, let's keep talking about it.

Originally posted at InjuryBoard by Mike Bryant