Health Care

Paul A. Keating PKEATING at JCVAXA.JCU.EDU
Thu Sep 7 22:00:10 MDT 1995


|Date: Thu, 07 Sep 1995 20:27:20 -0400
|From: Willaim Thurber - PhD Student <thurber at FMGMT.MGMT.UTORONTO.CA>
|Subject: Re: Health Care
|
|>         Please don't say that I result to ad hominem or implying ad hominem.
|>         I do not, and did not.  In re-reading my statement above, I cannot
|>         detect the implication you say I make.
|
|Check your electronic memory, in a previous post you implied that Cdn
|docs can't make a living up here.
 
        I said that some leave because of the "grass is greener...."
        effect.  I didn't address any generalizations.
 
|>         When you only look at income without looking at expenses, then those
|>         large salaries do seem high.  Education costs and other expenses
|>         deferred until earning power reaches the $100-200K level take an
|>         unearthly bite out of income.  A global look at a doctor's economic
|>         picture is in order.
|
|You are off base here, education costs less here, and doctors do not need
|excess staff or outside agents to collect fees.  For example, my GP
|operates with one part-time staffer to make appointments, process the
|payments etc.  This is a major reason for the cost difference lack of
|administrative overhead.
 
        May be, but if we're comparing apples with apples, we'd probably
        find that your GP is an orange.  That is to say, your GP does not
        pull down between $100-200K as the others that were being discussed.
 
        Specialists making the "big bux" probably do have considerably
        increased expenses over GPs.  I would think that salary is
        negotiated, so someone is willing to pay the "big bux" to the
        doc.  Since salary figures don't just fall from the sky, I'd
        also speculate that negotiated salaries are arrived at after
        the doc makes known his "salary requirements" which would include
        paying those expenses down.
 
        I'd dare say that "big bux" and "GP working within the confines of
        a government operated/controlled health care system" doesn't quite
        mix--if it does, then there's some foolish spending going on.
 
|>         Then there are the premiums for malpractice insurance.  If we can
|>         agree that the argument to focus on is one of "cost control" and
|>         not "identification of administrator," then we should attack the
|>         litigious society we live in (in the USA) and the sharks that
|>         insure the environment remains in place--lawyers!
|
|Good point!  Perhaps a socialized system will not work because you need a
|society where litigation is not as great a threat.  But you are not
|suggesting placing limits on the freedom to sue are you?  I am not sure
|that I could support that, but I don't have a solution to that problem.
 
        One has freedom to sue, but not to bring on specious lawsuits.
        (Similar to:  one has freedom to yell in a crowded theater, but
        one is not free to yell, "Fire!" in that same theater.)  The main
        concern that is health care cost related is those premiums for
        malpractice insurance.  The force driving those premium costs up is
        not court decisions, but settlements out of court.
 
        Remember, a case has to come to trial before it can be adjudged
        specious.  Settlements milk money from threats of taking specious
        suits to trial (and since they never make it to trial, they are
        never adjudged specious).
 
        The USA is nearly alone in the world when it comes to one facet of
        life in the courts.  Legal fees are paid by the parties involved,
        period.  A doctor would have to pay for his defense regardless of
        verdict.  Those costs for legal defense and other court costs are
        extremely dear.  A malpractice suit could take months to prepare
        and present, let alone try and decide.  Those legal fees keep
        building the whole time.
 
        The scenario for abuse is:
 
        a) Lawyer, working on contingency, helps client bring whopping big
        specious malpractice suit against doctor/hospital/HMO/and anyone
        else with "deep pockets."
 
        b) Knowing that the defendents cannot afford to spend the money
        necessary for legal defense, the plaintiff's lawyer offers out
        of court settlement as a cheaper alternative to the high cost of
        litigation plus the threat of a emotionally touched jury awarding
        treble damages against defendents.
 
        c) Defendents are usually sued jointly and severally, meaning that
        each defendent is liable for the entire award of damages (e.g., if
        the doctor's insurance is the only source of money, it pays all,
        regardless of the doctor's degree of guilt.)
 
        d) Defendents opt for settlement--the cut losses and run technique,
        regardless of guilt or innocence, and pay out amount less than what
        was asked for in the suit, but still a large amount.  Remember, this
        settlement amount is still large, but smaller than the cost of
        proving innocence in court.
 
        e) Plaintiff's lawyer gets 30-40% off the top, then uses the rest to
        pay plaintiff's court costs and any other related costs, then gives
        balance to plaintiff.
 
        f) Plaintiff feels happy--he/she just screwed the "well-to-do."  The
        defendents feel relieved that they could end the matter with less
        money.  Since the lawsuit never made it to trial, it was never
        adjudged "specious" and given the legal "heave-ho"!
 
        g) Coercion, legal style!
 
        Now, if the USA joined the rest of the civilized world and incorporated
        a statute that required plaintiffs to pay the defendent's legal fees,
        court costs, and other expenses incurred when the court finds for the
        defense, more innocent defendents would opt for court and not the
        settlement option.  As the loosing plaintiff would pay costs, and
        not the malpractice insurance, the doc's premiums wouldn't go up,
        and he wouldn't have any expense to pass to consumers.
 
|>         GAO computations show that adopting a government-run health care
|>         system similar to Canada's is not sustainable on revenues raised
|>         from present payroll taxes.  Your premise of paying the same
|>         health tax, therefore, is flawed.
|
|Given current costs I concur, but we agreed that this involves cost
|control.  It is difficult to isolate the portion of the tax bill from all
|the other government services, but we can still compare the systems from
|a standpoint of the marginal difference.  ie If you/I did not have
|medicaid/OHIP we would see our tax burden fall by about the same amount.
 
        Still, the amount of tax that I would end up paying is still going to
        be much more than you do.  What I pay now only supports those eligible
        for benefits.  Add the rest of the USA's population, and like it or
        not, taxes needed to pay even for minimal health care will be excessive.
 
        As for isolating taxes, those that I pay into Medicare are isolated
        from my personal income tax.  They are collected by my employer and
        sent to Uncle Sam separately.
 
|>         Your cradle-to-grave care is born on the backs of those who are
|>         healthy enough to never use the system.  Seems like incentive to
|>         smoke, drink, and grow fat!  "Not to worry, the government will
|>         take care of me."
|>
|>         Require hospitalization after driving into a tree after a six-pack?
|>         No problem!  Government to the rescue.
|
|If smoking and or drinking and getting fat and or driving into a tree
|were comfortable or fashionable alternative then we would have a
|problem.
 
        Hospitals are already full of those who suffer maladies caused
        by their own excesses.  Luckily, many are paying for their care.
        To them, those alternatives were comfortable and/or fashionable.
        Fashionable smokers with lung cancer, comfortable couch potatoes
        suffering from heart ailments and other cancers, &c.--all there,
        being treated now.
 
|> |Guilty as charged.  A by-product of my enthusiasm for this system, if it
|> |were perfect "why would I want to" is valid.  I apologize for a) precluding
|> |a better system and b) incorrectly assuming our system was perfect.
|>
|>         Validity's still not the question.  Admitting to one strawman by
|>         offering another one!  I'd rather see mention of straying from
|>         the argument of "freedom that we have that you don't" than the
|>         two-headed strawman apology!
|
|Settle down!  Go sing Hakuta Matata with your kids 5 times.  If you don't
|have any you can borrow mine.  :)  You are just about the first guy I've
|met who gets angry when during the course of a reasoned argument his
|opponent acknowledges a fallacy and apologizes.
 
        No anger at all.  I just calls 'em like I sees 'em.  I guess my
        point was missed:  The apology was for "precluding a better system"
        and "incorrectly assuming our system was perfect."  Neither of
        these comprised the strawman to which you acknowledged "Guilty
        as charged."
 
        I couldn't understand why one would apologize for "X" and "Y" after
        admitting commission of "Z"!  Sort of like admitting guilt to burglary,
        then apologizing for an assault and for a parking ticket.  The apology
        doesn't jive with the admission.
 
        If I was smitten with any emotion, it was being dumfounded. ;-D



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