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SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386, 590]

Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Think it is due to two things. Some posters seem to do this as some type of job, not sure if they get paid or are just hyper partisans. Then there are some who have been here for a while, their arguments have been debunked and now they are left with personal attacks as their sole defense. Would appreciate hearing your thoughts.

Either that, or they ignore the posts that refuted them, leave for awhile, then come back with the same tired arguments that were earlier refuted, seemingly pretending that the counter arguments were never brought up.

It gets quickly tiring. It really makes me wonder if these people are getting paid. I see no reason to come onto a forum like this with absolutely no intention of doing anything but constantly repeating the same lines over and over.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

If I may, I'm really trying to learn here. New to this forum and enjoying the variety of opinions, crazy or not. The upcoming election is critical regardless of where you stand on the issues. That's why I'm here and hopefully, more will come. Maybe all you folks don't realize it, but speaking as someone with fresh eyes on this place, your words (meaning all the posters here) really have an effect when it comes to getting a clear picture of what is important to people. Plus, the humor is great too.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Tort reform - A minor issue. In any case, this *was* offered as a bargaining chip to get Republicans on board. Obama said many times that he was willing to play ball on tort reform. No dice.
Youre kidding. No I mean really, you have to be joking with that stance.


The costs of defensive medicine
In recent studies, more than 90 percent of physicians reported practicing positive defensive medicine in the past 12 months; unnecessary imaging tests accounted for 43 percent of these actions. More than 92 percent of surgeons reported ordering unnecessary tests to protect themselves.

Another study found a direct relationship between higher malpractice awards and malpractice premiums and Medicare spending, especially with imaging services. The increased spending, however, had no measurable effects on mortality.

In a recent Gallup survey, physicians attributed 34 percent of overall healthcare costs to defensive medicine and 21 percent of their practice to be defensive in nature. Specifically, they estimated that 35 percent of diagnostic tests, 29 percent of lab tests, 19 percent of hospitalizations, 14 percent of prescriptions, and 8 percent of surgeries were performed to avoid lawsuits.

Liability reform has been estimated to result in anywhere from a 5 percent to a 34 percent reduction in medical expenditures by reducing defensive medicine practices, with estimates of savings from $54 billion to $650 billion.

http://news.vanderbilt.edu/2012/02/d...edic-medicine/
Vanderbilt University Medical Center researchers estimate that U.S. orthopaedic surgeons create approximately $2 billion per year in unnecessary health care costs associated with orthopaedic care due to the practice of defensive medicine. Defensive medicine adds billions to healthcare costs | Healthcare Finance News


Defensive medicine adds billions to healthcare costs | Healthcare Finance News
ATLANTA -- Physicians estimate the cost of defensive medicine to be between 26 and 34 percent of total annual healthcare costs, according to a recent report by Jackson Healthcare. At an estimated $2.5 trillion in annual spending, this means $650-850 billion is spent each year on medical orders intended to avoid lawsuits rather than treat patients.

UConn Advance - February 23, 2009 - Study shows defensive medicine widespread
The cost of ‘defensive’ medicine – tests, procedures, referrals, hospitalizations, or prescriptions ordered by physicians fearful of lawsuits – is huge and widespread, according to a study by the Massachusetts Medical Society and UConn Health Center researcher Robert Aseltine Jr.

The study is based on a survey – believed to be the first of its kind – that was completed by more than 900 physicians in Massachusetts. It asked about their use of seven tests and procedures: plain film X-rays, CT scans, magnetic resonance imaging, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions.

About 83 percent reported practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons.

Such practices were estimated to cost a minimum of $1.4 billion per year in Massachusetts.

Kandahar and liberals in this thread, do you really think its just insurance companies adding to the cost of health care? No one seemed to reply to this post and it seems to highlight that malpractice avoidance is contributing a hefty percentage to health care costs.
 
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FactCheck.org : Summit Extras: Medical Malpractice

As Republican Rep. Dave Camp correctly pointed out, the Congressional Budget Office estimated that limiting malpractice liability would "reduce the federal deficit by more than $50 billion." More precisely, that’s $54 billion over 10 years, according to the CBO. But CBO Director Douglas Elmendorf noted the savings would "reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009)."

I favor tort reform, but it is not going to have a huge impact.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Kandahar and liberals in this thread, do you really think its just insurance companies adding to the cost of health care?

No.

No one seemed to reply to this post

Because I don't disagree that tort reform is a worthy goal. Obama offered to work with Republicans to reform it too, and instead they gave him the finger.

and it seems to highlight that malpractice avoidance is contributing a hefty percentage to health care costs.

It's less than 2% of our health care costs. That isn't nothing, but there are much bigger problems to worry about.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

FactCheck.org : Summit Extras: Medical Malpractice



I favor tort reform, but it is not going to have a huge impact.

No one can know for sure what the cost of defensive medicine is. I would be shocked if the figure above or $5 billion a year in a system of $2.7 trillion is accurate. Is there something that you have that breaks this into categories. For example the cost of medical insurance premiums, what percent of tests are done for defensive purposes, the cost of taking doctors out of hospitals because they have to appear in court, the cost of lawyers hired by hospitals, the amount of money paid out to settle claims. Just a list while typing so I am sure I am missing many other things.

I understand that trial lawyers are a key donor base for the democratic party, but do really believe that health care spends only $ 5 billion in this area???
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

I don't favor tort reform. Basically, what a medical malpractice suit is is just a way to determine which insurance company should cover the cost of a medical mishap- the insurance of the patient or the insurance of the doctor. The optimal answer is for the doctor's insurance to cover it if there was a preventable mistake- even if it was a very understandable one- because you want doctors to have incentives to be very careful not to make mistakes. Malpractice suits don't create costs, they just decide which insurance company pays for them. If we stopped all malpractice suits, and nobody changed their behavior in any way, the cost of malpractice insurance would go down $x and the cost of health insurance would go up the same amount, so it would be a wash. But, people would change their behavior. Doctors wouldn't have as much incentive to be careful. So, then the total costs would increase.

The legal standard for determining which insurance company should cover it is exactly what it should be. If there are precautions the doctor could have taken that would be cheaper to implement than the cost of the harm done by not taking it, then the doctor's insurance is liable. Otherwise, the patient's insurance is liable. What would be a better standard?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

It's less than 2% of our health care costs. That isn't nothing, but there are much bigger problems to worry about.

Can you cite where you found this figure or how it's determined?

How does one account for all the extra "just-in-case" screens/tests that might not be performed if doctor's didn't have to be so paranoid about liability? These are always billed with doctors asserting they are medically necessary, when many probably are not. Are these counted in this 2%?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

No one can know for sure what the cost of defensive medicine is. I would be shocked if the figure above or $5 billion a year in a system of $2.7 trillion is accurate. Is there something that you have that breaks this into categories. For example the cost of medical insurance premiums, what percent of tests are done for defensive purposes, the cost of taking doctors out of hospitals because they have to appear in court, the cost of lawyers hired by hospitals, the amount of money paid out to settle claims. Just a list while typing so I am sure I am missing many other things.

I understand that trial lawyers are a key donor base for the democratic party, but do really believe that health care spends only $ 5 billion in this area???

So if no one can know, why are you making assumptions? Why throw out the studies done on the subject then continue to act like it is a big cost saver?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

No one can know for sure what the cost of defensive medicine is. I would be shocked if the figure above or $5 billion a year in a system of $2.7 trillion is accurate. Is there something that you have that breaks this into categories. For example the cost of medical insurance premiums, what percent of tests are done for defensive purposes, the cost of taking doctors out of hospitals because they have to appear in court, the cost of lawyers hired by hospitals, the amount of money paid out to settle claims. Just a list while typing so I am sure I am missing many other things.

I understand that trial lawyers are a key donor base for the democratic party, but do really believe that health care spends only $ 5 billion in this area???

The defensive medicine angle is pretty badly exaggerated. First off, some defensive medicine is a good thing. That's the whole point of having a system for torts- to remind sub-standard doctors to be more careful. When the tort reform advocates get those statistics about defensive medicine, what they're doing is just polling doctors and asking them what percentage of tests they order would they consider "defensive medicine". That doesn't tell you how many of those tests were wasteful. It could be that all of them are defensive medicine in the sense of doctors having their behavior corrected to become more efficient by avoiding careless mistakes. But, secondly, its also just something doctors like to gripe about. Nobody likes getting sued, so they ham it up like it is a bigger deal than it is. It's kind of like asking the fans of a baseball team whether the referees are biased against their team, 90% of them say "yes", and then publishing a statistic that 90% of the referees are biased against that team. When they actually compare, for example, the spending on tests between states with extremely plaintiff-friendly malpractice laws and states with extremely defendant-friendly malpractice laws, they actually find that the spending on tests doesn't really vary at all.
 
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So if no one can know, why are you making assumptions? Why throw out the studies done on the subject then continue to act like it is a big cost saver?

I don't know something called common sense. Some things do not need a lot of studies to understand if a number is directionally correct.

Rather than deflect, do you really think that the items mentioned above cost only $5 billion a year. Why stand by something we are know is nonsense and hide behind some study.

Answers such as the above is what makes people hate politics. It seems to have to divorce yourself of common sense when making these arguments.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

I think you are missing the point. Defensive medicine to avoid suit is driving a good percentage of health care costs. If tort reform were enacted that would allow insurance costs to drop by placing ceilings on lawsuits, they will curb costs by requiring fewer tests.

There are hidden costs, not just lawsuit savings that will take some cost out of the system. Tort reform is a common sense solution to curb costs. But, we unfortunately have more than a few lawyers in Congress that are lobbied pretty heavily. Tort reform as a legislative goal will be a long haul.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

I think you are missing the point. Defensive medicine to avoid suit is driving a good percentage of health care costs. If tort reform were enacted that would allow insurance costs to drop by placing ceilings on lawsuits, they will curb costs by requiring fewer tests.

There are hidden costs, not just lawsuit savings that will take some cost out of the system. Tort reform is a common sense solution to curb costs. But, we unfortunately have more than a few lawyers in Congress that are lobbied pretty heavily. Tort reform as a legislative goal will be a long haul.

Most states already have some sort of tort reform.


Tort Reform Since 1986 - By State


It's benefited Doctors and insurance companies, has done nothing for the consumer.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Can you please provide specific and detailed sources to back up your claim that "Republicans Hate Health Care"?

Thank you

A pretty good sign is their attack on the insurance mandate which they themselves created as an alternative to UHC, wouldn't you say?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

A pretty good sign is their attack on the insurance mandate which they themselves created as an alternative to UHC, wouldn't you say?

On a state by state basis. The fed has no business enacting such a thing. A mandate would be completely legal as a state function. It makes sense too, as state legislatures are more accountable than the fed overall. The other idea is that if 50 states are all enacting programs it will be a lot easier to see whats working and what is not. With the fed administering this we can expect to have less accountability, less cost reduction, more red tape, and more overhead from layers of people sticking their nose into healthcare that should not.

What the AHCA is going to do is separate people into 2 categories, those that are subsidized and those that are taxed for their healthcare. Its already happening, people with good healthcare have their premiums going up like crazy---there is talk that middle managers in places like California and New York will soon be taxed for their healthcare at whatever the rate is (40%? seems high but I think I remember reading that). More people in the lower end of the middle class are losing their healthcare and they will be on the subsidized end. Expect the amount of people paying their own way and not being taxed on health care to shrink in the next 2 years. It looks like that was the goal all along anyway.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

Most states already have some sort of tort reform.


Tort Reform Since 1986 - By State


It's benefited Doctors and insurance companies, has done nothing for the consumer.

You act like that chart is meaningful. If you dont go in and break down what they did its pretty well worthless. Insurance companies demand certain tests be done to curb the possibility of lawsuit. Even in cases where the doctor is sure of the prognosis. So both have their hands tied. Lower the spurious lawsuits and you lower the tests required.

Im curious as to how much tort reform has occurred in the last 10 years, since costs have been going up faster, rather than the last 25.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

The reconciliation process could probably be used to get rid of the mandate, yes. But it would not be sufficient to repeal the entire law.

It was sufficient to pass it but not repeal it?

:roll:
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386]

Most states already have some sort of tort reform.


Tort Reform Since 1986 - By State


It's benefited Doctors and insurance companies, has done nothing for the consumer.

Funny that you supply a link that has nothing to do with your ASSERTION that tort reform benefits doctors and insurance companies, yet those "savings" are not passed on to the consumer. I believe that a HUGE part of the tort reform needed would be to make the LOSER pay the legal costs of the winner, that alone would do wonders for the added costs of "malpractice" insurance. Perhaps you could show a link (or two) RELATED to your assertion.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

I don't care how you want to dress this pig up, it's a TAX.

I guess Pelosi's "We're gonna have to read it to know what's in it" was true. Guess what we have found out? It's a TAX. Obama never, ever, once told the general public this HC bill was a TAX. And, I might add, not just on the "rich". Every person that pays taxes will pay for this HC bill.

Obama lied - pure and simple. For all the Dems out there a question . . . . . . who said: "Read my lips, NO NEW TAXES!" How many times was GB the elder bashed with that comment?

The Repubs have every right to bash President Obama and the rest of the Dems with this lie IMO.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

A pretty good sign is their attack on the insurance mandate which they themselves created as an alternative to UHC, wouldn't you say?

What? If I oppose the gov't demanding that we all buy puppies, I therefore must hate puppies? LOL
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

It was sufficient to pass it but not repeal it?

:roll:

See below. Very little of the law was passed using reconciliation...just a few minor tweaks. PPACA, which has the meat of the law, passed with 60 votes in the Senate.

The sequence of events was like this:

December 24, 2009 - The Senate passes the Patient Protection and Affordable Care Act (PPACA) on a vote of 60-39. PPACA contains all of the major provisions we now associate with "Obamacare" (e.g. individual mandate, Medicaid expansion, ban on preexisting conditions, end of lifetime maximums, health insurance exchanges, subsidies and taxes, Independent Payment Advisory Board, ban on rescission, restrictions on price discrimination).

January 19, 2010 - Scott Brown is elected to the Senate.
February 4, 2010 - Scott Brown takes office, reducing the number of Democratic senators to 59.

March 21, 2010 - PPACA passes the House of Representatives, as-is, on a vote of 219-212, and heads to the White House to be signed into law.
March 21, 2010 - The Health Care and Education Reconciliation Act of 2010 (HCERA) passes the House of Representatives on a vote of 220-211. This bill made some tweaks to the dollar amounts and timetables in PPACA.

March 23, 2010 - President Obama signs PPACA into law.

March 25, 2010 - A slightly modified version of HCERA passes the Senate under budget reconciliation rules, by a vote of 56-43.
March 25, 2010 - The modified version of HCERA passes the House, by a vote of 220-207.

March 30, 2010 - President Obama signs HCERA into law.
 
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With all of the talk of the wonders of PPACA law(s) and how ACCESS will be improved (i.e. 30 million will be added to the rolls of the "insured") nobody has explained HOW that could possibly reduce costs, the stated GOAL of the law. Everyone seems to agree that medical care insurance is simply a FOR PROFIT third party in the "system" that gives no care at all, yet does add costs (the ACCEPTABLE limits on these costs are stated in PPACA as 20%). All discussion seems to be about "fairness", "compassion" and "insurance", while NO talk of the REAL cost of U.S. medical care (1/6 of our economy) is EVER mentioned. Hmm....
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Obama lied - pure and simple. For all the Dems out there a question . . . . . . who said: "Read my lips, NO NEW TAXES!" How many times was GB the elder bashed with that comment?

He was mostly bashed by other Republicans. Democrats aren't as enamored with Grover Norquist and the no-new-taxes mantra in the first place, so we are more inclined to not care that much about it anyway.

The Repubs have every right to bash President Obama and the rest of the Dems with this lie IMO.

Go for it, bash him all you like. Get it out of your system. Feel better now? :2wave:
 
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With all of the talk of the wonders of PPACA law(s) and how ACCESS will be improved (i.e. 30 million will be added to the rolls of the "insured") nobody has explained HOW that could possibly reduce costs, the stated GOAL of the law. Everyone seems to agree that medical care insurance is simply a FOR PROFIT third party in the "system" that gives no care at all, yet does add costs (the ACCEPTABLE limits on these costs are stated in PPACA as 20%). All discussion seems to be about "fairness", "compassion" and "insurance", while NO talk of the REAL cost of U.S. medical care (1/6 of our economy) is EVER mentioned. Hmm....

We have an Independent Payment Advisory Board to study which medical procedures are cost-effective and which are useless; this data will then be used to encourage greater use of the effective procedures and lesser use of the ineffective ones. Furthermore, we will have health insurance exchanges where insurance companies can compete with one another on an easily-digestible number of variables, which will allow fair comparisons among potential customers and bend the cost curve down through simple supply and demand.

Furthermore, I would suggest that if people are covered with health insurance, they'll be more likely to go to the doctor BEFORE they have a major expense, which will save money in the long run.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

See below. Very little of the law was passed using reconciliation...just a few minor tweaks. PPACA, which has the meat of the law, passed with 60 votes in the Senate.

So, if that vote were held TODAY it would not pass. We all agree that it squeaked by "just in time" and is still being written. Is it not VERY curious why the law needed to be passed URGENTLY in 2009, when it takes effect MOSTLY from 2014 to 2018? Much of this law is simply about federal insurance PRICE control (mainly about "sharing" those costs), and very little about any REAL changes to medical care.
 
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