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View Diary: Medicare also going over the "cliff" (108 comments)

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  •  Yes. It was the opposition of the AMA (12+ / 0-)

    that prevented the US from getting a national health system when the rest of the developed world did. Doctors helped to create the US health care mess, even if in more recent times the greed of the insurance industry has become a bigger factor than the greed of the AMA.

    •  That's not accurate or fair. (2+ / 0-)
      Recommended by:
      frostbite, Lujane

      I worked for doctors in the '70's (primarily). At that time, doctor office visits were reasonable, and most people didn't fear seeing a doctor because of the cost. Doctors started raising their fees when malpractice insurance skyrocketed. Then, since it cost so much to see a doctor, people expected the doctors to never make mistakes, and sued more often. You see where this is going.

      •  lawsuits aren't the problem. (9+ / 0-)

        Stupid investments by poorly regulated insurance companies are the cause of high malpractice insurance premiums.  and next time I see a poverty-stricken doctor I'll let you know.

        •  Correct: no reduction in rates in 'tort deform' (5+ / 0-)

          states despite legislating malpractice out of effective existance in most cases.  In Texas, few lawyers will take such cases unless the victim is very young or very welathy bc they can't fund the litigation due to all non-economic (lost wages basically) being capped at amounts below the cost of preparing a case for possible trial, let alone actual trial.  Yet, malpractice rates continue to rise at roughly similar rates (adjusted for overall inflation etc.) irrc.

          One study: http://www.justice.org/...

      •  The AMA opposed the creation of Medicare (6+ / 0-)

        and Medicaid in the 1960s. And they opposed to anything like the British or Canadian systems in the US. Their opposition was purely about keeping up the incomes of doctors: they were against any form of government cost containment back then, because the costs of health care mostly went into their pockets.

        Eventually, corporations rebelled against paying these costs for their employees, so Ronald Reagan handed the reins of health care over to insurance companies. Now most of the cost of health care goes into the pockets of the insurance companies, and doctors, though still generally well paid, are no longer in charge of the system.

        •  just as a reminder (2+ / 0-)
          Recommended by:
          Alden, david78209

          most physicians working today are NOT members of the AMA. I'm not, and neither are most of the docs I work with.

          •  AMA doesn't represent me either (3+ / 0-)
            Recommended by:
            Alden, mudfud27, david78209

            The membership percentage is in the 15-20% range. They'd already lost much of their liberal membership. They lost some of their more conservative members recently over their support for ACA.

            Membership number is heavily inflated by the non-issue oriented memberships as well.

            The AMA very heavily recruits medical student members. They offer educational products that are valuable to medical students, and they bundle these into membership. It was considerably cheaper to get my essential anatomy textbook (Netter's Atlas) this way.

            For more established docs, they offer insurance products that are (sometimes) cheaper than you can get elsewhere as well.

            I get more junk mail from the AMA than I've ever gotten from anyone else (which is surprising for someone who has been a member of multiple lefty groups and has been a volunteer and donor).

            The AMA is a cross-specialty group, which therefore includes the very richest of doctors, who are in the procedural specialties. The salaries and trend in political outlooks tends to differ between these doctors and primary care docs and those in cognitive specialties. Neither set of doctors is monolithic in belief of course.

            I care much more about what the specialty organizations say. The largest specialty organization (the American College of Physicians, which is the group for internal medicine doctors) is on record as supporting single payer, for example.

            The plural of anecdote is not data.

            by Skipbidder on Wed Jan 02, 2013 at 09:03:05 AM PST

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            •  I've never been an AMA member, and I still get (0+ / 0-)

              a lot of junk mail from them.  They get my address from the county medical society and the state medical association, which I joined over 30 years ago.  
              I'm probably going to quit those organizations -- what they do doesn't come close to justifying the dues they charge.  The one thing that held me back for years was that I had life insurance through them.  Recently I got other (cheaper) life insurance so I'm just about out of any reason to pay almost $800 a year in combined state and county dues.

              Years ago I seriously considered telling the AMA that I'd died.  Men are (still) supposed to stay registered for the draft from ages 18 through 25, but the government wanted to keep doctors registered to age 50, so they could draft some if there were a big war.  The AMA made a deal, offering to make available its fairly comprehensive list of names and addresses of all the doctors in the country, in exchange for doctors not having to stay registered and presumably carry a draft card.  I might have tried it, but at the time I wanted to stay in the county and state organizations, so I didn't think I'd get away with it.

              We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

              by david78209 on Wed Jan 02, 2013 at 06:11:11 PM PST

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      •  They could have had sane malpractice coverage (2+ / 0-)
        Recommended by:
        Lujane, divineorder

        under a system like the British NHS, but they opposed that out of greed.

      •  Tort reform has been passed (2+ / 0-)
        Recommended by:
        radarlady, afisher

        in Texas. Not surprisingly, the cost of health care has continued to rise, at the same rate as the rest of the country.
        Even the cost of malpractice insurance has gone up, though not at the rate of previous years.
        In short, Texas removed the right to sue for pain and suffering to help insurance companies- not doctors or patients.

        In 2003, Texas voters approved Proposition 12, tort reform which capped medical malpractice payouts and made it more difficult for patients to sue hospitals. Republican politicians, led by Gov. Rick Perry (R), claimed that doctors were providing less services to patients because they feared getting sued. Republicans, joined by a “Yes on 12” campaign funded by the health insurance industry, promised that the amendment would lower health care costs and bring an influx of doctors to the state. Since 2003, Republicans nationwide have touted Texas as a model for tort reform.
        Now, a group of researchers studying Texas Medicare spending have found no decrease in doctors’ fees for senior citizens between 2002 and 2009. Medicare payments to doctors rose 1 to 2 percent faster than the rest of the country, Northwestern professor Bernard Black, a researcher on the study, said.
        In urban and high population counties, the study’s authors expected to see lower health care costs stemming from a reduction in medical tests doctors previously used to protect themselves from lawsuits. However, the researchers found no decrease in costs and a slight increase in medical tests performed. “This is not a result we expected,” said Bernard Black, a co-author and a professor at Northwestern University’s Law School and Kellogg School of Management.
        http://thinkprogress.org/...

        “We are not a nation that says ‘don’t ask, don’t tell.’ We are a nation that says ‘out of many, we are one.’” -Barack Obama

        by skohayes on Tue Jan 01, 2013 at 04:46:39 AM PST

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      •  No, sorry, but people are not (0+ / 0-)

        suing more often. In fact the rate of suits is way down. The malpractice insurance companies are running their own scams and charging much higher rates than needed.

        In fact the rate of law suits compared to actual incidence of malpractice (which is more than "a mistake") is shockingly low. Most people, even after horrible situations do not want to go to court.

        Different responses by doctors and hospitals are showing different and better ways to go.

        But it does come down to changing systems and getting rid of bad doctors. In most areas  studies find that a few docs cause most of the suits. In Calif among obstetricians one study showed, 93% of claims were caused by 7% of the doctors.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Tue Jan 08, 2013 at 04:17:01 AM PST

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    •  the AMA doesn't represent me (5+ / 0-)

      And the AMA is not representative of doctors in general. Their membership is inflated by the fact that they give members discounts on insurance as well as educational materials for free to medical students and residents (apprentice doctors). These are expensive, and most med students I knew joined. (It was a free Netter's Anatomy Atlas when I joined. I've since unjoined. The Netter's would run you $80 today.)

      The AMA also keeps itself relevant to the discussion based on proprietary control of the coding.

      My real professional society is the American College of Physicians. (I have two other subspecialty societies as well.) The ACP is the largest physician's group for any one specialty.

      The ACP is in favor of single payer. Here's an excerpt of their position paper on universal coverage:

      Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

      Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals' freedom to make their own health care choices.
      Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector.
      http://www.annals.org/...

      The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn't seem like a difficult choice.

      The plural of anecdote is not data.

      by Skipbidder on Tue Jan 01, 2013 at 11:46:08 AM PST

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      •  A healthy dose of fact is always refreshing (0+ / 0-)

        ------
        Ideology is when you have the answers before you know the questions.
        It is what grows into empty spaces where intelligence has died.

        by Alden on Wed Jan 02, 2013 at 09:51:05 AM PST

        [ Parent ]

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