D.C. Circuit guts ObamaCare

[Crackerbox]

http://medicaleconomics.modernmedic...ry/34-doctors-will-leave-profession?page=full
"If you’re thinking about getting out of the medical profession within the next decade, you’re not alone. Thirty-four percent of current physicians polled by healthcare staffing company Jackson Healthcare say they will leave the profession within 10 years.

The company surveyed more than 2,000 doctors to measure practice trends and attitudes. General practitioners most likely to give up medicine include family practitioners, general surgeons, emergency medicine physicians, and obstetricians/gynecologists.

Of the doctors surveyed, 16% said they would work part-time, retire, leave the profession, or consider getting out of medicine this year, and 55% of those who said so are younger than age 55.

Doctors saying they will leave the profession cited economic reasons (56%) and healthcare reform (51%) as the biggest culprits. Other factors included feeling burned out, making a career change, reaching retirement age, or taking early retirement.

The trend means “a real healthcare access problem” for an aging population of patients with major health problems on the horizon, says Richard L. Jackson, chairman and chief executive officer of Jackson Healthcare. “Physicians are retiring in large numbers just as baby boomers are starting to turn 65,” he adds.

Although the survey was conducted before the U.S. Supreme Court announced a ruling on the Affordable Care Act (ACA), 55% of the physicians asked said the ACA should be repealed, and 31% said the law does not do enough to address the cost and access issues Americans face although they believe that a single-payer system could. In addition, 61% said the ACA would not improve the quality of healthcare, although 54% said the new law would provide patients with better access to healthcare."

http://journals.lww.com/greenjourna...Is_Not_Falling,_But_It_Is_Severely.99177.aspx

http://www.obgmanagement.com/index.php?id=20667&tx_ttnews[tt_news]=173996

Doctors are leaving in droves from medicine. Why should they stay when they can get a teaching position, a job as a lobbyist, a job as a consultant for a medical equipment company or serve on the board, work for a pharmaceutical company in research and make more money, etc.

If you really want to blow up the profession, then keep it up.
...
Jolly Roger, explain it crystal clear so that everyone knows precisely what you're asking, i.e. a return to zero tort reform. Such a thing would result in more than 34% of docs leaving as malpractice is one of the most commonly cited concerns particularly with OB/GYNs.

 

[Farm Boy]

I think everyone can point to an individual case where the presence of a doctor saved the day...but yeah, it's intentional. In the general sense, is "beating death" a good idea? Say we beat it tomorrow...where would your kids go? Their kids? If we put a moratorium on death would we not need to put a moratorium on birth?

"Beating death" isn't going to happen. At the very least not by reducing infant mortality. Getting that to zero forever wouldn't "beat death."

I'm sorry if I get touchy around this point. People who argue for "letting nature take its course" with "flawed babies," or eugenics, or anything along those lines are arguing that people like my wife shouldn't be. People who actively argue that unplanned pregnancies should be aborted rather than borne are actively arguing that my son shouldn't be. They're actively taking up the argument that the world would be better without such marginal people. Well, dammit, my life is such marginal people. These arguments are arguing that my life has been unworthy. It's people are unworthy. It's dreams are unworthy. And all because of some arrogant principles about what is sired and born properly. Or even worse, people who are sired and born cost-effectively. The penultimate victory of capitalism over humanism in logic. It's one of the few things that actively makes me want to injure people in arguments. My failing, I know. But it's there.

 

[Crackerbox]

"Beating death" isn't going to happen. At the very least not by reducing infant mortality. Getting that to zero forever wouldn't "beat death."

I'm sorry if I get touchy around this point. People who argue for "letting nature take its course" with "flawed babies," or eugenics, or anything along those lines are arguing that people like my wife shouldn't be. People who actively argue that unplanned pregnancies should be aborted rather than borne are actively arguing that my son shouldn't be. They're actively taking up the argument that the world would be better without such marginal people. Well, dammit, my life is such marginal people. These arguments are arguing that my life has been unworthy. It's people are unworthy. It's dreams are unworthy. And all because of some arrogant principles about what is sired and born properly. Or even worse, people who are sired and born cost-effectively. The penultimate victory of capitalism over humanism in logic. It's one of the few things that actively makes me want to injure people in arguments. My failing, I know. But it's there.

I hear you.

It's freakin' pro-abortion people and death panels. You know, if people hate those who are not perfect like themselves (what a sham), then they can abort their own babies and leave the rest of us out out it.

Kill off your own relatives when you think they're too old, too physically challenged, or whatever. Leave the rest of alone from your macabre blood lust to kill anything deemed deformed.

 

[JollyRoger]

Jolly Roger, explain it crystal clear so that everyone knows precisely what you're asking

To the playing field be made level again in litigation so that every defendant gets the same treatment. No more special rules for certain classes of defendants.

 

[Crackerbox]

To the playing field be made level again in litigation so that every defendant gets the same treatment. No more special rules for certain classes of defendants.

That's just a return to zero tort reform. In that system, then malpractice paid out enormous sums, often settling out of court, regardless of the guilt of physicians.

Did the patients GET the money? Nope. They split the money with the attorney so it's in the attorney's interest to file as many cases as possible, spurious or otherwise, to clog the system.

When we return to a time in which the physician has an adequate amount of time with the patient, as once happened in American history, then and only then would something like that work. This is impossible today under managed care, where a physician is told to see X number of patients and actually paid to not treat patients.

When some insurance person who doesn't know the patient from Adam can then by long distance limit the physician-patient time and treatment protocols, then how could the physician be solely responsible for errors? Their hands are tied behind their back.

Huge numbers of physicians leaving, inadequate numbers of new medical students (not to mention the attrition of completing med school), and you want to make it worse? OK then.

At one time, it was not unusual for the OB doc to allow a videocamera within the OR where a patient was delivering. Not anymore. It's too litigeous now where the slightest thing can cast suspiscion that the doctor neglected some miniscule thing and this is then tenuously tied to some issue with the child up to 18. That's the effect of malpractice in action.

 

[Farm Boy]

Kill off your own relatives when you think they're too old, too physically challenged, or whatever.

Please, no.

 

[Timsup2nothin]

"Beating death" isn't going to happen. At the very least not by reducing infant mortality. Getting that to zero forever wouldn't "beat death."

I'm sorry if I get touchy around this point. People who argue for "letting nature take its course" with "flawed babies," or eugenics, or anything along those lines are arguing that people like my wife shouldn't be. People who actively argue that unplanned pregnancies should be aborted rather than borne are actively arguing that my son shouldn't be. They're actively taking up the argument that the world would be better without such marginal people. Well, dammit, my life is such marginal people. These arguments are arguing that my life has been unworthy. It's people are unworthy. It's dreams are unworthy. And all because of some arrogant principles about what is sired and born properly. Or even worse, people who are sired and born cost-effectively. The penultimate victory of capitalism over humanism in logic. It's one of the few things that actively makes me want to injure people in arguments. My failing, I know. But it's there.

Easy there killer...I'm not evil personified, and I do respect your position. I also have two kids who are the product of a difficult pregnancy that I would sorely regret not having had...if it is possible to regret an unknown outcome. But in a general sense we are beating death. Lower mortality rates, not just among infants but in every age group. If it weren't for the fact that we as a species horrifically make up for this by creating a monstrous mortality rate among the unborn we would be staring Malthus in the eye.

The medical profession is like the developers of the atomic bomb. They have a single minded and appropriate focus on 'prevent death'. But the rest of us have to measure the application of their knowledge.

My generation is not going to do it. We were rushed off to the doctor for stubbed toes and sniffles as children, treated to easy childbirth and even easier avoidance of childbirth and then took our kids to the doctor to give us peace of mind for even less than stubbed toes and sniffles, had our minor aches and pains treated as if they were disabling, and when our bodies started easing up the hormones so we could start thinking we went to the doctor so we could act like teenagers. Predominantly we are going to go out with a doctor, or more likely a crew of doctors, standing over us fighting for every minute and second.

But there is a hope that our kids, from watching this happen, will opt for a different relationship with medicine and death.

 

[Farm Boy]

Sure, there is death with dignity. There is effective reduction of birth rates. The latter comes with increased wealth, generally, and increased wisdom in sexual relationships and contraceptives. But you can kid yourself about it being about killing our way out of it while shaking the scary curse totem stick of Malthus if you want. I'm sick of people quoting Mathus at me in arguments. It happens when I talk about the cheap availability of food, but nobody volunteers their spouse or child to starve. They want to volunteer somebody else. Rot.

 

[Timsup2nothin]

Sure, there is death with dignity. There is effective reduction of birth rates. The latter comes with increased wealth, generally, and increased wisdom in sexual relationships and contraceptives. But you can kid yourself about it being about killing our way out of it while shaking the scary curse totem stick of Malthus if you want. I'm sick of people quoting Mathus at me in arguments. It happens when I talk about the cheap availability of food, but nobody volunteers their spouse or child to starve. They want to volunteer somebody else. Rot.

I'm not volunteering anyone. A doctor would say that I'm volunteering myself maybe, because I live hard and seek no medical care so I personally will almost certainly be leaving the station on time. I just counter the prevalent marketing push that we need to individually and collectively mortgage all other objectives in the name of more doctoring. How people respond to that marketing, or my counter marketing, is entirely up to them.

 

[Farm Boy]

I'm pretty opposed to how we use elderjails nursing homes in general, if that helps. They have a subsection of the population that they are perfect for, especially in the States where kids and families tend to cast off their elders as inconvenient as hell, or people whose families simply cannot care for them at all, but in the big picture for how many years they seem to get used? Ew.

 

[Crackerbox]

I'm pretty opposed to how we use elderjails nursing homes in general, if that helps. They have a subsection of the population that they are perfect for, especially in the States where kids and families tend to cast off their elders as inconvenient as hell, or people whose families simply cannot care for them at all, but in the big picture for how many years they seem to get used? Ew.

Based upon one long term study, the average length of stay in a nursing home was five months. You have to ask yourself, if Mom and Dad are that sick, then wouldn't you wish for them to stay within your home and die in peace, rather than in a place of death, stinking of urine and moaning?

Not everyone can do this, but if unemployed or it's possible, then it is great kindness. Many elderly give up all hope, become confused due to unfamiliar surroundings, and so become doomed.

http://www.geripal.org/2010/08/length-of-stay-in-nursing-homes-at-end.html

Spoiler :

The length of stay data were striking:


the median length of stay in a nursing home before death was 5 months
the average length of stay was longer at 14 months due to a small number of study participants who had very long lengths of stay
65% died within 1 year of nursing home admission
53% died within 6 months of nursing home admission

 

[Timsup2nothin]

I'm pretty opposed to how we use elderjails nursing homes in general, if that helps. They have a subsection of the population that they are perfect for, especially in the States where kids and families tend to cast off their elders as inconvenient as hell, or people whose families simply cannot care for them at all, but in the big picture for how many years they seem to get used? Ew.

I prefer the term 'warehouses' myself, and I'm opposed.

However, after years of demanding her 'independence', which required a rotating cast of family members living with her (an odd definition of independence, clearly) I finally got my mom out of her house. She lives in a house with a live in caretaker couple who bring in day staff when they need to be in too many places plus up to five clients. The old folks live in a clean house with prepared meals, monitored meds, round the clock assistance available, and each other for company...and it costs less than maintaining her in her house did without requiring a rotation of family members to give up their lives for periods of time. She is way happier and collectively our only regret is that we didn't do this five years sooner.

It is not the warehouse that the convalescent home is, by any stretch.

 

[JollyRoger]

That's just a return to zero tort reform.

No, that is curing tort deform. The way the system is now, bad doctors are escaping accountability.

 

[jackelgull]

No, that is curing tort deform. The way the system is now, bad doctors are escaping accountability.

The way it is though, what a doctor can reasonably be held accountable for is hard to define. Would you provide me with some cases in which a clearly culpable doctor got away with malpractice? I know I should do my own home work, but I'm so ignorant on the subject I don't even know where to begin.

 

[JollyRoger]

The Connie Spears case is one example from Texas. I am a general practice lawyer who will take cases in a variety of areas. The one area I steer clear of is medical malpractice because even a case with clear merit requires a lawyer to gamble quite a bit in time and money (expert fees) up front with many opportunities along the way for the doctor or insurer to get the case tossed on a technicality.

The $250,000k non-economic cap keeps away talented lawyers. The 120 day window to obtain an expert report creates all sorts of havoc (and the Texas Supreme Court has tossed many cases without the opportunity to cure as it hashes out the rules of the 120 report). The need to meet the willful and wanton standard rather than negligence makes winning a much steeper uphill climb, even when the doctor was clearly wrong. All these special rules and doctors are still clamoring to be coddled even more.

I am a general practice lawyer who will take cases in a variety of areas. The one area I steer clear of is medical malpractice because even a case with clear merit requires a lawyer to gamble quite a bit in time and money (expert fees) up front with many opportunities along the way for the doctor or insurer to get the case tossed on a technicality. And the damages cap limits the upside reward for taking on the risk.

 

[Farm Boy]

There's hobbling liability for negligence and then there is capping pain and suffering to make insurance a less insane marketplace. I mean crap, farm insurance is batty enough the government is hip deep and sometime it looks sane by comparison.

 

[JollyRoger]

“Our purpose had never been to have a procedural hurdle,” said Mike Hull, a lawyer for the pro-tort-reform Texas Alliance for Patient Access. “It had been to have the plaintiffs really get the case reviewed.”

Isn't that where the judge and jury comes in? Anything before that is a procedural hurdle.

 

[jackelgull]

Isn't that more of a problem with Texas' state laws than any nationwide standard of malpractice law? But I agree that Texas' laws are too much of a hurdle. The difference between negligence and active harm is minimal, and the doctor should make a reasonable effort to ensure the patients don't need to come back to them for the same problem.

 

[Timsup2nothin]

Isn't that more of a problem with Texas' state laws than any nationwide standard of malpractice law? But I agree that Texas' laws are too much of a hurdle. The difference between negligence and active harm is minimal, and the doctor should make a reasonable effort to ensure the patients don't need to come back to them for the same problem.

Texas is more or less the bellwether state for oppressive judiciary. Many states watch to see what they get away with and then do the same thing.

 

[El_Machinae]

What's the actual cost ($$$) of malpractice insurance vs. the over-testing CYA incentivises?