Direct primary care tries to put market forces back into healthcare

[carpnter]

Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.

Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves?  How about providing some context for your stats.

Um,  yeah.  Two percent.  And thats being generous.

Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.

Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.

I simply want to know what costs the 2% encompasses.  You shouldn't make assumptions on what I think when I made no statement about malpractice itself. 

Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication.  From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications.  Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.   

[JFman00]

I don't know the TIME article Bitter Pill has yet been referenced. It's stunning how effective the healthcare industry has been at shifting the debate from "why does everything cost so much" to "who is going to pay for it". When Medicare reimbursement rates for something like CT scans are 3-4 times more expensive than other countries, it's no wonder than healthcare is bankrupting us.

Talk to doctors. By and large they have no idea how much the services they're providing cost, or even who's responsible for setting the prices. They talk about malpractice reform and defend their own pay because those are the only dollar signs that affect them. I'm not saying that malpractice reform isn't necessary or that doctors are paid too much, just that first-line providers are entirely disconnected from price and instead rely on very specific guidance like this for what labs and tests they order.

carptner what are room charges/facility fees for then? Why are washable hospital gowns that cost $30 to purchase billed at $80 time after time? Shouldn't that $1,500 room charge cover the labor and materials needed or does hospital laundry really cost $50 bucks an ounce? Why is the fact that chargemaster costs are entirely arbitrary, and thus entirely negotiable, a deep dark secret?

[carpnter]

Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.

Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves?  How about providing some context for your stats.

Um,  yeah.  Two percent.  And thats being generous.

Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.

Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.

I simply want to know what costs the 2% encompasses.  You shouldn't make assumptions on what I think when I made no statement about malpractice itself. 

Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication.  From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications.  Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.

hmm.  CVS found a way to store all of that tylenol and still manage to get the costs under 12 dollars per pill.  Are you under the impression that hospitals hire the swiss national guard to watch these tylenol pills while they are beings stored?  In an underground vault constructed purely of titanium, tungsten steel and gold?

Nice straw man comparing a CVS to a hospital.  Do you know what regulations apply to hospitals when it comes to storing medication?  I certainly do not know all of the requirements AHCA has regarding it.   

[carpnter]

Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.

Are those costs the actual payments made for malpractice claims or is that the cost of malpractice insurance that doctors carry to protect themselves?  How about providing some context for your stats.

Um,  yeah.  Two percent.  And thats being generous.

Interesting that you think that the problem with malpractice isnt the lives ruined or the deaths, but the cost of the insurance to the people committing the malpractice.

Maybe you ought to ask yourself why tylenol costs 12 dollars for a pill in the hospital.

I simply want to know what costs the 2% encompasses.  You shouldn't make assumptions on what I think when I made no statement about malpractice itself. 

Tylenol costs $12 because there is more to the cost than just the cost to the pill, there are all of the administrative costs involved in dispensing that medication.  From the person getting the medication from storage, to the person dispensing it to the patient, to the systems or people used for tracking the inventory of the medications.  Whether that cost is fair or realistic for the hospital to charge is something that should be discussed, but without all of the information it is impossible to make any determination if that cost which on its face appears to be ridiculous, is actually justified.

hmm.  CVS found a way to store all of that tylenol and still manage to get the costs under 12 dollars per pill.  Are you under the impression that hospitals hire the swiss national guard to watch these tylenol pills while they are beings stored?  In an underground vault constructed purely of titanium, tungsten steel and gold?

Nice straw man comparing a CVS to a hospital.  Do you know what regulations apply to hospitals when it comes to storing medication?  I certainly do not know all of the requirements AHCA has regarding it.   

this certainly hasnt kept you from invoking them after every paragraph, has it?

But I do notice that in the multiple reasons why you mentioned that would explain the unreasonable and crazy cost of tylenol, you didnt list 'insurance and litigation', which I think answers your original question.

Stephen, my answer was not meant to be all encompassing.  I was listing some of the reasons, the costs could be so high.  The problem is we do not see those other costs so we cannot make a judgement on whether the cost for the Tylenol (or any other medication) is justified.  It may or may not be. 
Neither insurance companies or the government (Medicare/Medicaid) pays anywhere near the bill rate for medical care. 

[JFman00]

Even the insurance/Medicare rates are still entirely out of line with what they are in other countries. Regardless of who ends up with the bill in this country, they're both paying too much and not getting better outcomes.

[fsquid]

Malpractice costs account for somewhere less than 2% of healthcare spending, and 90% of those claims come from the same 10% of doctors. I know towing the party line saves cracking a book, but that really isn't the problem, nor will tinkering with it do anything to solve the problem.

That depends on how you define malpractice costs. One study says 2%. Other studies say as much as 40%. It depends on the methodology--what costs you count--and assumptions underlying the study. The "90% of those claims" comment suggests strongly that the study you cite is counting only actual malpractice claims, and the 2% number is pretty consistent with that. When you get to malpractice insurance premiums paid, that is spread much more evenly across the entire medical industry, with more obviously attributable to docs in certain specialties. When those costs are included, the number is a lot bigger than 2%. What I've seen is about 10% when malpractice insurance premiums are included. From there you get to the costs of defensive medicine procedures that are probably unnecessary and would not be performed outside of the malpractice threat. The problem measuring them is that these are very soft costs and it is hard to nail down exactly what should or should not be included. The 40% number comes from counting everything that could possibly be driven by malpractice. A smaller number is probably more reasonable; the 40% is unrealistically high, just as the 2% is unreasonably low. I tend to think somewhere in the 10-20% range, probalby near the high end of that range, is about the best estimate we can give.

One thing for sure, medicine would be practiced very differently without the threat of jackpot malpractice claims. I am personally partial to the Swedish "no fault" approach, for several reasons, not the least of which being that it has mechanisms that will get bad docs off the street faster than in our system.