US Healthcare insurance

[Iskaral Pust]

My point was that so long as obesity is a large contributor to healthcare cost increases, and so long as our society still attaches a lot of judgment/personal responsibility lens to that situation (which won't change quickly), it will be difficult to get broad political support for subsidizing those costs.  I was not trying to express a judgment on the issue, I was trying to highlight that there would be large barriers to widespread support for subsidizing those costs of care.

This country, more than any other I have visited, still cherishes the idea of the individual, self-determination and personal responsibility.  The inverse of this is a low level of sympathy for perceived lifestyle-related conditions, whether addiction, obesity, lung cancer, etc.  If lifestyle-related conditions are one of the biggest growth areas, then it will be harder to garner consensus on universal health care. 

[Ser Scot A Ellison]

3 minutes ago, Kalbear said:

Sure, just like it's proper for the IRS to go after tax fraud and medicare to go after medical fraud. I don't see why there would be any issue at all, though they'd probably be going after actual damages and not medical costs precisely.

But an accident isn't fraud.  The two examples you offered involve intentionally conduct not accidents due to negligence.  If we are dealing with intentional actions or recklessness you analysis may hold but not with the simple negligence most tort cases involve.

[Ariadne23]

28 minutes ago, Ser Scot A Ellison said:

Interesting, in single payer the subregor would be the State.  If the cost of health care is shifted to everyone via taxation would the State suing as a subregor be proper?

Does the government do this right now on behalf of people with Medicare, Medicaid, and VA coverage? Not certain, but I doubt it.

Handy side benefit for the overly burdened court system.

Catastrophic for lawyers. Of course, anything that abolishes private health insurance will be catastrophic for lawyers.

[Tempra]

4 hours ago, Ariadne23 said:

Does the government do this right now on behalf of people with Medicare, Medicaid, and VA coverage? Not certain, but I doubt it.

Handy side benefit for the overly burdened court system.

Catastrophic for lawyers. Of course, anything that abolishes private health insurance will be catastrophic for lawyers.

Yes, Medicare and TRICARE have liens on insurance proceeds and PI judgments for medical care provided to covered beneficiaries.  The government does sue to recover on these liens. See 42 USC 2651.

[Ariadne23]

2 hours ago, Tempra said:

Yes, Medicare and TRICARE have liens on insurance proceeds and PI judgments for medical care provided to covered beneficiaries.  The government does sue to recover on these liens. See 42 USC 2651.

Good to know, but I think (?) the question was whether they employ their own lawyers to file personal injury cases to recover insurance costs on behalf of plaintiffs directly. Or at least that is what I was attempting to answer.

[felice]

13 hours ago, Ser Scot A Ellison said:

I'm not saying medicial schools will empty out but surely there will be some loss if salaries are capped and controled.

More than compensated for by making medical school free (including basic living costs) for anyone who meets the standards of entry. Replacing doctors who're in it for the bucks with ones motivated by wanting to help people seems like a pretty decent tradeoff to me. And it seems probable that there are plenty of potential doctors who are put off the profession or outright denied access to it due to the cost of entry.

[Ser Scot A Ellison]

1 hour ago, felice said:

More than compensated for by making medical school free (including basic living costs) for anyone who meets the standards of entry. Replacing doctors who're in it for the bucks with ones motivated by wanting to help people seems like a pretty decent tradeoff to me. And it seems probable that there are plenty of potential doctors who are put off the profession or outright denied access to it due to the cost of entry.

Felice,

Those standards would need to he quite high, would they not, particularly if admission is free foe anyone who qualifies?  

[Larry of the Lawn]

16 hours ago, Ser Scot A Ellison said:

56 minutes ago, Ser Scot A Ellison said:

Felice,

Those standards would need to he quite high, would they not, particularly if admission is free foe anyone who qualifies?  

larrytheimp (sorry bout wonky quoting):. So, what's the issue here?  Are you concerned they'll be so high no know human med student could qualify?  

There'll likely be a need for more doctors to provide care to those who go without insurance now.  Just set the bar where it is right now and adjust it as needed.  

First you're worried about no one wanting to do it, now about having to raise standards of admission.  I'd imagine that by not lowering standards, and giving priority to students who excelled on the premed track and who can demonstrate some dedication to the medical field beyond their course work, it'd be possible to attract the 'goldilocks' number of doctors you seem concerned with.  

[Ser Scot A Ellison]

LtI,

Calling something "free" doesn't mean it can be provided without any expense.  How many get into Med School?

[Aemon Stark]

6 hours ago, felice said:

More than compensated for by making medical school free (including basic living costs) for anyone who meets the standards of entry. Replacing doctors who're in it for the bucks with ones motivated by wanting to help people seems like a pretty decent tradeoff to me. And it seems probable that there are plenty of potential doctors who are put off the profession or outright denied access to it due to the cost of entry.

The "costs of entry" are more around going to university in the first place *and* having the resources to perform well enough to get in. Banks are quite happy to loan money for med school otherwise, so I'm not sure that tuition in itself is a major barrier. 

In any case, med schools already look for "well-rounded" applicants who show a lot of sustained interest in non-academic pursuits. 

[Ariadne23]

As one professor told our incoming class on the first day of law school "You all must really want to do this for the love of it, because it doesn't make any financial sense for most of you."

CBS News estimated that it costs $1 million in lost wages to become a doctor. Probably more if you consider that the people I know who didn't make the cut are things like PhD neuroscientists at top-ranked universities, etc. Average cost of tuition alone is nearly $170K. 

I'd guess that people want to be doctors for the perceived prestige and expected job satisfaction, i.e., to do something with their lives that has meaning. I doubt a decrease in pay would change that much.

 

[felice]

8 hours ago, Ser Scot A Ellison said:

Those standards would need to he quite high, would they not, particularly if admission is free foe anyone who qualifies?  

Is that a problem?

6 hours ago, Ser Scot A Ellison said:

Calling something "free" doesn't mean it can be provided without any expense.  How many get into Med School?

As many as needed to train the number of doctors the country needs. Ideally increasing the pool of doctors to the point where none of them need to work more than 40 hours a week.

[sologdin]

kids, every complaint that i file regarding a physiological or psychological injury involves medical expenses, and often enough there is a collateral source to pay those expenses, which leads inexorably to coordination of benefits and subrogation claims.  the carriers need to serve their liens or file their interventions, however, lest the claims prescribe out.  it's all fairly standard?  

normally i can't take a fee off of a medicare set-aside account, and my clients will normally lack standing to recover expenses paid by medicaid.  but otherwise one makes the demand for all medical expenses, outstanding vel non, past or future, &c.  normally the contingent fee will be sufficient from loss of wages and general damages.

if one is really concerned that the plaintiff bar will suffer under single payer, one need only adjust the MSPA to allow counsel to take a fee off of conditional payments recovered on behalf of the united states.  louisiana allows a 1/3 fee for claimant's counsel, say, in recovering an employer's workers' compensation lien from a third party tortfeasor (lsa-r.s. 23: 1103( c )).  such amendments are easy to draft.

[Ariadne23]

8 minutes ago, sologdin said:

If one is really concerned that the plaintiff bar will suffer under single payer, one need only adjust the MSPA to allow counsel to take a fee off of conditional payments recovered on behalf of the united states.  louisiana allows a 1/3 fee for claimant's counsel, say, in recovering an employer's workers' compensation lien from a third party tortfeasor (lsa-r.s. 23: 1103( c )).  such amendments are easy to draft.

Sounds like a plan.

But what about all the Rainmaker-described "Mrs. X, you are stupid, stupid, stupid" insurance defense lawyers jobs?

[Larry of the Lawn]

1 minute ago, Ariadne23 said:

Sounds like a plan.

But what about all the Rainmaker-described "Mrs. X, you are stupid, stupid, stupid" insurance defense lawyers jobs?

I'm sure the country clubs across this great land could always use a few more surly and washed-up bartenders.

[Ser Scot A Ellison]

44 minutes ago, felice said:

Is that a problem?

As many as needed to train the number of doctors the country needs. Ideally increasing the pool of doctors to the point where none of them need to work more than 40 hours a week.

I'm sure your system will be simple and without pain or difficulty.  

[White Walker Texas Ranger]

On 10/17/2016 at 2:44 PM, Ser Scot A Ellison said:

That's a fair point.  I'm not saying medicial schools will empty out but surely there will be some loss if salaries are capped and controled.

The insane cost of higher education is a thread unto itself.

Well, it's definitely causing problems in England. There were talks about doctors going on strike not too long ago.

[Aemon Stark]

15 minutes ago, White Walker Texas Ranger said:

Well, it's definitely causing problems in England. There were talks about doctors going on strike not too long ago.

Well, that wasn't all physicians but just "junior doctors": http://www.bbc.com/news/health-34775980 

They're roughly equivalent (and at least include) people who would be called interns, residents, and fellows in North America. It's pretty funny that they refer to call hours (nights, weekends, any free time you have) "unsociable" hours. Indeed. 

In any case, I think the idea of a 40 hour work week is fairly ridiculous. Perhaps some weeks in some specialties can be like that, but hours are typically more like 7-4 or 8-5 on many days. Of course, some GPs work only part-time, so it is possible, but simply putting a blanket limit on hours and having more MDs around is not really the best way of going about this. 

[Ser Scot A Ellison]

3 minutes ago, Aemon Stark said:

Well, that wasn't all physicians but just "junior doctors": http://www.bbc.com/news/health-34775980

They're roughly equivalent (and at least include) people who would be called interns, residents, and fellows in North America. It's pretty funny that they refer to call hours (nights, weekends, any free time you have) "unsociable" hours. Indeed.

In any case, I think the idea of a 40 hour work week is fairly ridiculous. Perhaps some weeks in some specialties can be like that, but hours are typically more like 7-4 or 8-5 on many days. Of course, some GPs work only part-time, so it is possible, but simply putting a blanket limit on hours and having more MDs around is not really the best way of going about this.

Exactly.  Being a physican isn't just punching a clock.  You shouldn't just walk out on a patient because a shift is over.  The idea that it could be that is scary unto itself.

[White Walker Texas Ranger]

17 minutes ago, Aemon Stark said:

Well, that wasn't all physicians but just "junior doctors": http://www.bbc.com/news/health-34775980 

They're roughly equivalent (and at least include) people who would be called interns, residents, and fellows in North America. It's pretty funny that they refer to call hours (nights, weekends, any free time you have) "unsociable" hours. Indeed. 

In any case, I think the idea of a 40 hour work week is fairly ridiculous. Perhaps some weeks in some specialties can be like that, but hours are typically more like 7-4 or 8-5 on many days. Of course, some GPs work only part-time, so it is possible, but simply putting a blanket limit on hours and having more MDs around is not really the best way of going about this. 

http://slatestarcodex.com/2016/05/12/solidarity/

Quote

Technically European law caps junior doctor work weeks at 48 hours a week. Then again, technically American law caps junior doctor work weeks at 80 hours a week. My first week on a non-psychiatry service as an American junior doctor, I worked a bit over 100 hours – and so did everybody else I encountered. When I asked about the law, everyone just gave me that “oh you sweet summer child” look.

Such caps seem to be honored more in the breach than in the observance, and this is the British custom too. Physicians Weekly describes it as “the 48 hour trainee work week sham”, and the Telegraph and The Daily Mail both seem to agree that many British doctors are working 100 hour shifts. They seem to circumvent the law either by giving them a few weeks off afterwards and saying it “averages” to 48 hours/week, or else by doing what my hospital did – carefully schedule a 48 hour shift in big bold letters, assign 100 hours worth of work, and then get angry if anyone goes home before their work is done.