D.C. Circuit guts ObamaCare

This article explains what physicians and their patients are up against. I wonder how many medical errors are simply caused by the transformation from the regular relationship between physician and patient into the abortion of managed care.

Less physicians due to malpractice costs and risks, less docs due to being fed up and dissatisfied with patient perceptions, less docs due to reductions in income, inadequate staffing, insufficient med school class sizes, all of these are imploding American healthcare.
http://www.dispatch.com/content/stories/local/2012/04/16/lawsuits-against-doctors-have-declined.html

"Ohio’s tort-reform law is having a dramatic impact on medical malpractice cases in the state, with closed claims dropping 41 percent between 2005 and 2010, and average payments declining 38 percent over that period.

The Ohio Department of Insurance annual report also shows more than 3 of 4 closed claims resulted in no payment.

Depending on your point of view, that’s either good news or “justice reduced,” as Columbus lawyer Gerry Leeseberg puts it.

The legal fight over curbing lawsuits and settlements in medical malpractice cases reached a tipping point in 2003 when the General Assembly passed and Gov. Bob Taft signed Senate Bill 281. The law capped non-economic damages, commonly known as “pain and suffering,” at $500,000 per occurrence. Other changes followed.

The results are clear in the 2010 annual report: Closed claims dropped to 2,988, the lowest level since the state began keeping records in 2005, and total payments dropped to $175million, more than $100million lower than five years earlier.

In addition, doctors’ medical malpractice rates have dropped more than 26 percent, according to Tim Maglione, of the Ohio State Medical Association.

“It’s not only good news and a good trend, but it is proof that tort reform accomplished what it set out to do — slow the growth of what we thought were runaway lawsuits and to stabilize the market for physicians.”

Taft and GOP lawmakers responded to complaints from physicians that malpractice claims, and the resulting skyrocketing cost of malpractice insurance premiums, were forcing them out of business, or at least out of the state.

Maglione said more changes still are needed, including reducing the volume of claims. “There are a lot of lawsuits still today being filed that should never be commenced.”

The numbers have also gone down, Maglione said, because doctors and hospitals are working harder to improve safety and cut down on mistakes. “The best error is the one that never happens.”

Leeseberg sees the statistics in a very different light.

He is supportive of one change, which requires attorneys filing malpractice lawsuits to submit an “affidavit of merit” from a qualified medical practitioner attesting that there are grounds to make a legitimate claim. Beyond that, however, Leeseberg says lawmakers have conspired with the medical association and insurance companies to make it more difficult for Ohioans to file legitimate medical complaints.

“We have turned away people with legitimate malpractice claims. No matter how outrageous and catastrophic their injuries, the payment is capped. It’s justice delayed and justice reduced.”

There is no cap on claims for medical bills and loss of income, but the $500,000 cap on “pain and suffering” makes it impractical to pursue some cases, Leeseberg said."


For a time period, malpractice premiums rose by 15% a year. In some specialities they rose by 100% a year. Could any business sustain that sort of increase?

That's why tort reform happened.
http://www.dispatch.com/content/stories/local/2012/04/16/lawsuits-against-doctors-have-declined.html
 
There is no question that way too many medical errors occur. Exhaustion and insufficient staffing is part of that equation. Turning back the clock to allow anyone to sue under the old laws would be a regressive manner to repair the issue.

We need more time to disagnose paitent's ailments and not just treat their symptoms with a pill, and hence never fix the underlying issue. But who is often responsible for the underlying issue?

The patient's lack of self-care and common sense.
 
Seems like the patient's part of the fault would be a great defense in litigation. What I don't get is despite all this extra coddling doctors are receiving in the litigation realm, they are still whining.
 
Seems like the patient's part of the fault would be a great defense in litigation. What I don't get is despite all this extra coddling doctors are receiving in the litigation realm, they are still whining.

They're whining as is anyone who works in healthcare, for they can see the handwriting on the wall with the impending loss of staff coupled with a massive increase in patient load. It's logic and pragmatism and self-preservation that's the rationale for the reaction.
...
Earlier I mentioned that within Obamacare, you will begin to see some counseling of your personal health conditions. This will occur under a screening process as that results in an economic advantage for the government to control costs.

Of course it will be severely denounced by medical staff and patients due to HIIPA as it violates privacy.

The government plans many types of screenings from cradle to grave. Some of this is already being done with newborns such as PKU, which is a metabolic enzyme defficiency. Certain individuals are born without the ability to produce enzymes, and as such, even though they might consume the proper food and get good nutrition, they cannot digest and absorb nutrients, nor convert them into the proper parts of the Metabolic Pathways.

But there are terribly intrusive screenings that might occur as a result of consulation with your wellness counselor, and so you could have STD tests ordered, be placed into the system, and so it could be disclosed to other medical and nonmedical staff. STD testing could become compulsory.

An incident in which one entered a routine physical, and answered some vague questions, might then be used to deny you the right to bear arms.

Screening for the use of drugs and alcohol could be utilized to more properly link your premiums with your insurance i.e. a massive increase in the premium.

What we have now with such election of testing, would then be lost to compeling people to test, and at the whim of a government official. This puts the physician and medical staff into a strange relationship that bows to government pressure to get reimbursement instead of the sacred relationship of trust directly to the patient.

See:
http://obamacarefacts.com/obamacare-preventive-care/
Spoiler :
Adult Services
Included in the 15 preventive services for adults are immunizations, screenings for depression, blood pressure, colorectal cancer, and high cholesterol. Diet and alcohol abuse counseling, though not screening services are also included as no out-of-pocket services.

Children are entitled to 26 preventive services. These include a host of developmental and other screenings and immunizations.

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use to prevent cardiovascular disease for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Diabetes (Type 2) screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for everyone ages 15 to 65, and other ages at increased risk
Immunization vaccines for adults–doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Syphilis screening for all adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users

Women’s Preventive Services ObamaCare
In 2012, women became entitled to benefits under specific provisions of the Affordable Care Act. These provisions include well-woman visits, counseling for domestic violence victims, domestic violence screenings, and contraception counseling and dispensing.

Anemia screening on a routine basis for pregnant women
Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers, and access to breast feeding supplies, for pregnant and nursing women
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
Domestic and interpersonal violence screening and counseling for all women
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
HIV screening and counseling for sexually active women
Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Sexually Transmitted Infections counseling for sexually active women
Syphilis screening for all pregnant women or other women at increased risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Urinary tract or other infection screening for pregnant women
Well-woman visits to get recommended services for women under 65

Children’s Preventive Services ObamaCare
Autism screening for children at 18 and 24 months
Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Blood Pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years, 11 to 14 years, 15 to 17 years.
Cervical Dysplasia screening for sexually active females
Depression screening for adolescents
Developmental screening for children under age 3
Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Fluoride Chemoprevention supplements for children without fluoride in their water source
Gonorrhea preventive medication for the eyes of all newborns
Hearing screening for all newborns
Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for adolescents at higher risk
**Hypothyroidism screening for newborns
Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
Diphtheria, Tetanus, Pertussis
Haemophilus influenza type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Inactivated Poliovirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Rotavirus
Varicella
Iron supplements for children ages 6 to 12 months at risk for anemia
Lead screening for children at risk of exposure
Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years , 5 to 10 years ,11 to 14 years , 15 to 17 years.
Obesity screening and counseling
Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
Phenylketonuria (PKU) screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years,11 to 14 years, 15 to 17 years.
Vision screening for all children.
Senior’s Preventive Services ObamaCare
Medicare Part B (Medical Insurance) covers:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis C screening test
HIV screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time “Welcome to Medicare” preventive visit
Prostate cancer screenings
Sexually transmitted infections screening & counseling
Shots:
Flu shots
Hepatitis B shots
Pneumococcal shots
Tobacco use cessation counseling
Yearly “Wellness” visit

Screenings will ultimately catch pathological states early as well as early onset of mental disorders or predeliction to them. The problems are complex as it also will add a lot of time to perform these tests, diagnose them and evaluate results, and then treat them. Can you see the problems?

Say your family has a history of schizophrenia. It's usually detected in early adulthood, classically from pulling a couple of all-nighters to cram for an exam while being stressed and manifesting. Will people in risk categories then have higher premiums due to them? Will people get labeled as pre-schizophrenic? What if it never manifests due to a great caregiver or spouse who strongly supports them? Will the pre-schizohrenic take medication even though they haven't manifested symptoms?

If you don't want a flu shot, for their efficacy is determined by random luck in guessing the strain, and statistically offer a 50-50% chance of doing anything to help, then must you get a flu shot if you don't want one?

Screenings are not without problems. Let's say you have no back pain, but get an Xray while in the course of other diagnostic tests to determine a totally different health issue. 50% of Americans who have atrophy (degeneration or herniation) of the spinal disc have no back pain. We don't know why. Others do manifest this as pain. Will we then treat both the same regarding medical premiums or not?
 
Getting more customers and complaining? The entire profession is off its rocker.

Believe it or not, more times than not, physicians and medical staff enter medicine, not to make money, but to alleviate human suffering. People should ponder the fact that it takes a LOT of time without income to become a physician, and by no means is it guaranteed, but weeds out people from the onset. Physicians sublimate their desire to make money for that entire period, so to think it would be about money or customers is absurd.

A system which adds more and more customers (they're human beings who are suffering patients...NOT Customers) while reducing the amount of diagnostic time, adding on tests without patient consent, alters the relationship such to make the physician an employee of the government vs the advocate and facilitator of health for the patient, well that is an Abortion and Travesty of Medicine.

I cannot condemn it more highly than that.

I'd think the pro-choice people would be up in arms.
 
If it is not about the money, a physician could take the time he needed with a diagnosis simply by accepting a smaller pool of patients and accepting that his per minute income will be reduced.
 
so were do these suffering patients come from - its not the system that creates them I gather - so who cared for them before if not medical personnel - and why was this in any shape or form acceptable?
The suffering have always been there, but why? That's obviously a function of economic stress, educational training, pragmatism, genetics, human relationships, and epidemiology.

The system doesn't make the patient sick. The system fails to completely heal the patient because people fall between the cracks, catch an illness, are ignorant, don't perform self-care, are broke, can't get a decent job, etc.

The huge loss of Middle Class jobs is directly associated with a loss of American healthcare. Historically the preponderance of the American public had health insurance from the 1950's outward, but declined from about 1990 on. Why? We lost those jobs that could pay healthcare benefits. Managed care attempted to control the rising costs of the declining health of the American people.

No system can make a person take a walk or eat a balanced meal. The impoverished could get Medicaid and SCHIP in order to care for them. Was it perfect? By no means. People who made too much money but an inadequate amount to pay for health insurance had poor quality of health upon having an accident or developing an ailment.

If it is not about the money, a physician could take the time he needed with a diagnosis simply by accepting a smaller pool of patients and accepting that his per minute income will be reduced.

Hah! How? Shadow a physician and see and make inquiry about that. Some physicians have simply gotten fed up and left for even though it was their desire to do family practice and see patients, it was impossible to do it without pulling your hair out.

Some physicians have gone to boutique medicine in which a yearly contract is made such to do more thorough testing. That's largely for the wealthy. With less patient load, and a guaranteed income (versus the unknown of reimbursements), then the physician KNOWS how much income they will receive and plan accordingly.

I wonder, what would lawyers do if the three biggest subsegments of their clients would bargain with payments as physicians must do? That would be a sight to see. We need some Managed Care for lawyers' clients. Some Legalaid and some Legalcare. Hoo boy. Please make that so.

Some physicians are going to law school to do malpractice law. I wonder why? :lol:
 
I wonder, what would lawyers do if the three biggest subsegments of their clients would bargain with payments as physicians must do? That would be a sight to see.

I don't get a client that doesn't agree to my fee (and this often involves negotiation) and they are paying out of pocket, unlike many patients in the health care industry, so they have more of an eye on the budget. I could make more money as a specialist, but I've got what I consider an old fashioned general practice. I do not see how that would be impossible for a doctor in this market with surplus demand.
 
I don't get a client that doesn't agree to my fee (and this often involves negotiation) and they are paying out of pocket, unlike many patients in the health care industry, so they have more of an eye on the budget. I could make more money as a specialist, but I've got what I consider an old fashioned general practice. I do not see how that would be impossible for a doctor in this market with surplus demand.

Any physician may refuse to accept Medicare, Medicaid, and any Managed Care and only accept cash. Some established physicians are doing this.

A new physician, unless born wealthy, probably couldn't do it and get established.

Physicians bill patients and get paid back a portion of what the government or the health insurance will pay as reimbursement. No other business is this way. It's one of the reasons physicians leave.

If the government decided that legal representation was a fundamental right and that all lawyers must accept pennies on the dollar, then lawyers would be up in arms. Say you were forced to do 30% of your business by fulfilling legal aid for the indigent and not do it when you desired to do so.

Yes, physicians specialize. Far too many. It can easily DOUBLE the amount of time to get out of residency. As such, it's a big financial HOLE which then must by necessity result in higher prices to pay for that education. Many young medical students intuit that if they go into Pediatrics or Family Practice or Geriatrics, then they will be unable to make an adequate amount of money to make ends meet and keep the practice financially sound.

I cannot understand why people do not get these practical elements to practicing medicine. The physician is NOT out to get the patient. Major forces have fundamentally altered health care delivery to the patient and physicians struggle to get them care.

What could any physician surmise save that everyone else can be a capitalist save themselves in America?
 
If it is not about the money, a physician could take the time he needed with a diagnosis simply by accepting a smaller pool of patients and accepting that his per minute income will be reduced.

This is inarguable, however due to economics as taught in medical schools many doctors would disagree.
 
This is inarguable, however due to economics as taught in medical schools many doctors would disagree.

How would they pay for freakin' medical school, Tim? Sheesh.You know, that 250K minimum (and 500K for specialists or those who go out of state) monkey on their back? The one that doubles in interest for they cannot pay it in a lump sum but slowly over time.

How'd you like to be saddled with no income for YEARS plus a 500K bill? Nuts.
 
I didn't suggest a doctor go all cash. You could certainly choose to take on private insurance patients and turn a profit without resorting to the 9 minute diagnosis.
 
How would they pay for freakin' medical school, Tim? Sheesh.

I wouldn't.

That has absolutely nothing to do with the point that spending more time per patient can be done if the number of patients is reduced and the corresponding reduction in revenue is acceptable...which is inarguable mathematical fact.
 
Perhaps budget challenged doctors should be pursuing a MBA rather than a JD. If you are already 500k in debt, taking on another 200k for law school to become a malpractice attorney in the tort reform era is just making matters worse for yourself.
 
I choose to take on public defense cases, but the pay is terrible compared to other parts of my practice. I certainly don't restrict myself to a 9 minute diagnosis of my clients' cases, though the payment model would seem to suggest that I do that so I can have time to play golf on Wednesdays with the doctors.
 
I didn't suggest a doctor go all cash. You could certainly choose to take on private insurance patients and turn a profit without resorting to the 9 minute diagnosis.
Private insurance today NEGOTIATES repayment, JR. It's become universal now. Once the Federal government got involved with Medicare and Medicaid and negotiated payments, then private insurance said, "Hey, we'll do that too!" See insurance companies stiff the patient and the doc.

The only no-negotiate for physicians is the poor Cash patient who has no insurance and who must come up with it. It's why there are payment plans (which are awful higher interest loans due to risk). The current system is the WORST for those who couldn't get health insurance either by being indigent or by private benefits. The people who most cannot pay are stiffed with a higher bill. It's cruel.

Note that doctors KNOW this type of patient won't be able to pay. A large percent of them don't pay, but stiff the bill. And there are few legal remedies to collect. Most write them off as uncollectable recievables. Some sell them to debt collectors who guess what? Are LAWYERS!
Isn't legal representation a fundamental right? I mean if I understand the Gideon case right, the Supreme Court required that every defendant has the right to legal representation.
Yes, you have minimal representation by any jack leg who they can muster, and it definitely shows in the quality of that representation. But the government cannot say, knock off 50% of the legal fee as they do in Medicaid. The government cannot compel a lawyer to represent a client for little to no money.

What would lawyers do if suing their own lawyer up to 18 years later became normalized?:crazyeye: Great favorable statue of limitations, right?
 
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