Now I want to return to the Health Care debate where there continues to be a great deal of deliberate misinformation (lies) and also a great deal of just plain misunderstandings. Some of these can be found in the fears engendered in my own generation who have the best overall health insurance of any segment of the American population and it is a “Government plan” – in fact it is a single payer plan. But it was vigorously opposed by the same groups who now oppose reform for the rest of Americans and who now try to convince us that reform will either undermine Medicare or that somehow Medicare is in fact bad. Thus when we look at the Letters to the Editor column in the NY Times of October 6, we find, e.g. this, “Medicare, is riddled with fraud and waste, has trillions in unfunded liabilities and is not accepted by many of the best doctors.” I think this would be news to most Americans and particularly those over 65. Let me take that reverse order.
1.) Without doubt some doctors don’t take Medicare, though in my personal experience I have not encountered one. On the other hand most doctors don’t take one or more of the private insurance companies and I constantly see signs in doctors offices to the effect that they no longer take United Health Care or Aetna or some other private insurance carrier.
2.) “It has trillions in unfunded liabilities”. That is simply not true. Medicare is now having some relatively small short falls and the same people who oppose reform of the whole system, oppose taking the steps that will make Medicare viable for the foreseeable future. The Bush Administration imposed an unsustainable burden on the Medicare fund when it instituted Medicare Advantage.
Here is what one of my Libertarian physician friends, one Gerry Wachs had to say about it:
“The government pays the companies a fortune to offer them to Medicare beneficiaries. I pay $0 (that is free) each month and get doctor co-pays, $2500+ in free medications, twice a year free dental cleaning, a health club membership… free glasses, free hearing aid etc, etc. That replaces all the ancillary plans out there for backup coverage. The government was paying my plan administrator, Oxford, $9,000/year to cover me so of course they could offer all these benefits.”
I frankly question the $9,000 as an exaggeration, but whatever it is, this windfall for insurance companies cannot be sustained, but it is trumpeted as an attack on Medicare. In fact the reform plan, while cutting back on payments to insurance companies, increases payments to doctors to make sure they stay in Medicare
3.) “Riddled with fraud and waste.” It is well established that the costs of administering Medicare are way below those for private insurance, and while there surely is fraud and waste, that is unfortunately true in every plan, more so in private insurance than in Medicare.
Another letter to the Times from an ophthalmologist that Medicare doesn’t reimburse him for a cheap off label drug so he uses a more expensive one, which costs the government millions. He doesn’t say what items the private insurance companies refuse to reimburse, and examples of insurance companies refusing life saving cancer treatments are legion. He doesn’t even tell us whether private insurance companies reimburse for the drug, which Medicare has removed from its formulary, nor does he tell us what, “off label” means. An “off label” use of a drug means that the drug is being used for a purpose, which has not been proven to be efficacious and has not been approved by the FDA. Physicians use such off label drugs on the basis of their own anecdotal experiences or sometimes obscure articles in Medical Journals.
Finally, I come back to that favorite hobbyhorse of Republicans, Malpractice claims. In previous articles I have pointed out that none of the reforms that have been proposed or have been enacted in the states do anything to prevent or discourage frivolous claims. In fact we have protection against such claims at the present. If the facts proven at trial don’t support it judges can throw the case out and not let it go to the jury. If the judge finds the case to be frivolous he can penalize both the claimant and the attorneys. If that is not enough we could set up special courts, so malpractice cases would be tried before a panel of experts, but that is not what is being proposed. Reform in the states has meant, and means to its advocates in the Congress, limiting awards to “economic damages”, plus a maximum of $250,000 for pain and suffering, which as I have pointed out in the past, means that those who earn large incomes get millions, while a bank clerk who has lost his eyesight only gets that small amount which his/her earning capacity justifies, plus what is left otf the $250,000 after fees and expenses. This is not justice except to those who believe that only the rich have rights, and those who have less are the flotsam of our society to be discarded and disregarded.
The NY Times had an interesting article on the subject on August 31 entitled, “Would Tort Reform Lower Costs?” which is definitely worth reading. It quotes a law professor at the Pennsylvania School of Law as describing tort reform as “a red Herring” and points out that, “As the cost of health care goes up, the medical liability component of it has stayed fairly constant. That means it’s part of the medical price inflation system, but it’s not driving it. The number of claims is small relative to actual cases of medical malpractice.” He adds, “Medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. He adds: “We have approximately the same number of claims today as in the late 1980s. Think about that. The cost of health care has doubled since then. The number of medical encounters between doctors and patients has gone up — and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries.” He adds: “…studies looked at the rate of claims and found that only 4 to 7 percent of those injured brought a case. That’s a small percentage. And because the actual number of injuries has gone up since those studies were done — while claims have remained steady — the rate of claims is actually going down.”
What we need is less medical malpractice – not a cap on the ability to be compensated for the harm done.
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