The Sad Case of the Patient Protection and Affordable Care Act

[duper]

Re: The Sad Case of the Patient Protection and Affordable Care Act

All of what you posted is true. I don't want to stop the suits that are legit for the people that have suffered. I would like a way to get rid of the vulture lawyers who encourage and seek people to file for the stupid things like the chick who sued re the vasectomy. That was a lot of cash with a forgone conclusion. The lawyer should be ashamed that he filed. The woman was already planning on how to spend the money before they got shot down

How to eliminate frivolous suits is definitely a problem. I think there are two main issues.

Legislators want to pass laws such that no one has to think. And lots of people seem to believe that this is a good idea. Part of the thing about the legal system is that, without thought it fails, regardless of the goodness of intention.

Insurance companies know that, on average, it is cheaper to settle a relatively small suit than to fight it. And because insurance companies have so much power over the civil justice system, a defendant doesn't get to say, eff you, I did nothing wrong, I want to fight this.

I admit right up front I have no suggestion for fixing this, but it is clear to me that damage caps which further reduce the possibility of a judge or jury thinking, and taking a case only on its merits, is not the answer.

(Another issue would be that many Americans think lawsuits are BS, and will, if on a jury, automatically be biased toward the defendant regardless of the case. Meanwhile, other Americans think that the insurance companies who represent the defendants are inherently evil, and are automatically biased toward the plaintiff regardless of the case. That is a long-term, nationwide PR issue, that can probably only be fixed by several consecutive decades of people seeing the system work.)

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

...(Another issue would be that many Americans think lawsuits are BS, and will, if on a jury, automatically be biased toward the defendant regardless of the case. Meanwhile, other Americans think that the insurance companies who represent the defendants are inherently evil, and are automatically biased toward the plaintiff reardless of the case. That is a long-term, nationwide PR issue, that can probably only be fixed by several consecutive decades of people seeing the system work.)...

I had the misfortune to be the foreperson of a jury where there were 2 people who wanted to stick it to the state because they thought the law was wrong. the case was medical (pi55 me off, if I am going to miss work, I want to do something interesting, not work like). The minutia people chose to get stuck on was incredible. At one point in one of the documents someone had put a wrong date and then correctly put one line thru it, initialled it and put the correct date and continued the note. This was a conspiracy to change the record. The guy was there one day. How could they have tried to change the day to another day?

In a lot of medical cases the sympathy factor over-rides the medical evidence. I actually have a case in my own extended family where they didn't follow medical advice and got a multimillion $ settlement (talk about uncomfortable!!). The person has legitimate lifelong deficit but the Doc and the staff did the right stuff. The reason the deficit is there is because the person did not follow the advice given. The spouse is a leech- pushed the case and then when it was over- poof- tried to take the $ and run. If this was adjudicated by a jury of peers (medical people) they would have gotten nothing.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

As far as contingency fees are concerned, they are not an attempt by lawyers to milk the system. They are THE way (not a way, the way) that people who are struggling to get by can afford to file suit when they are injured by someone else's negligence. Without contingency fees, the civil justice system becomes HEAVILY tilted toward the wealthy.

No disagreement there. I merely tried to describe the natural consequences: plaintiff lawyers will only accept on contingency two kinds of cases: (1) suits they think they can win, or (2) actions they can file to collect "go away don't bother me" money. Certain kinds of tort reform will leave the former untouched while addressing the cumulative costly impact of the latter.

I did not realize that some states wanted to cap "punitive" (or as you phrased it, "non-economic") damages at $0 however.

Someone else asked about empirical evidence, I have heard people cite Texas as a good example. It may surprise many to know, but 20 years ago Texas was one of the very best states in the country for plaintiffs' attorneys (for those who are familiar with the phrase "forum shopping" it was in the top 5). They passed a tort reform law that, if I recall correctly, both put caps on non-economic damages and also (the bigger piece as far as I can tell) required plaintiffs who lose at trial to pay defendants' legal fees (note that most civil cases do not even make it to trial!). Now Texas is consistently ranked as one of the most "business-friendly" states in the Union; despite its reputation, that was not always the case!

I had some very sad personal experience, as my best friend died in a freak accident in Texas and his widow won a sizeable lump-sum settlement based on the negligence that led to his death (the facts of the case were so compelling that they did not even go to trial; she had to watch for 45 minutes as he struggled for his life before he finally succumbed...mind-numbingly gruesome). People with "legitimate" grievances still find justice, scam artists have to go elsewhere (like New York, for example; it seems like every other month we read a story about an insurance fraud ring of one kind or another).

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Have a bit of an "out of the box" idea. Recently here in Mass there's been an effort to limit lawsuits, not for health care but for development. Simply put, whenever somebody wants to build anything in the city, NIMBY's (for Not In My Back Yard) crawl out from under the rocks they live in, form some 3 person "citizens group" with a catchy name (like Neighbors Against Manhattenization of Boston'), get really favorable press from lazy reporters and basically tie up any building in court unless the developer pays their extortion demands (usually free parking spaces, a reduction in the size of the project, and some donation to a pet cause of theirs, followed by a press release stating how the project is now better thanks to their input). To speed up this arcane process and stop the waiting them out strategy of these clowns, the state proposed to send all disputes to land court and then have a quicker appeals process who's details escape me (maybe send the appeal immediately to the highest court or something).

Why am I telling you this? As malpractice suits must take up a lot of time and space in court, why not set up its own system, like Land Court, to handle these cases? Small cases under a certain amount could receive a quick decision by a judge. Larger cases go before a jury, but there would be some familiarity with grifters, shyster lawyers, and scam artists if the same people kept showing up in the same courtroom. I have a feeling that shining some extra light on this process might make the roaches scatter a bit quicker than they do now. Actual malpractice awards would still get paid of course, but I also think a court specializing in these cases might have a better sense of what is appropriate vs giving people a windfall.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Have a bit of an "out of the box" idea. Recently here in Mass there's been an effort to limit lawsuits, not for health care but for development. Simply put, whenever somebody wants to build anything in the city, NIMBY's (for Not In My Back Yard) crawl out from under the rocks they live in, form some 3 person "citizens group" with a catchy name (like Neighbors Against Manhattenization of Boston'), get really favorable press from lazy reporters and basically tie up any building in court unless the developer pays their extortion demands (usually free parking spaces, a reduction in the size of the project, and some donation to a pet cause of theirs, followed by a press release stating how the project is now better thanks to their input). To speed up this arcane process and stop the waiting them out strategy of these clowns, the state proposed to send all disputes to land court and then have a quicker appeals process who's details escape me (maybe send the appeal immediately to the highest court or something).

Why am I telling you this? As malpractice suits must take up a lot of time and space in court, why not set up its own system, like Land Court, to handle these cases? Small cases under a certain amount could receive a quick decision by a judge. Larger cases go before a jury, but there would be some familiarity with grifters, shyster lawyers, and scam artists if the same people kept showing up in the same courtroom. I have a feeling that shining some extra light on this process might make the roaches scatter a bit quicker than they do now. Actual malpractice awards would still get paid of course, but I also think a court specializing in these cases might have a better sense of what is appropriate vs giving people a windfall.

Wow, Rover actually came up with a good idea for addressing health care costs! It should be done anyway, as it would be enforcement of the 6th amendment.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Interesting, and what needs to be happening (crack down on fraud) IMHO:


Competition cuts down Medicare fraud
By Ricardo Alonso-Zaldivar | Associated Press April 19, 2012


WASHINGTON - A yearlong experiment with competitive bidding for power wheelchairs, diabetic supplies, and other personal medical equipment produced $200 million in savings for Medicare, and government officials said Wednesday they are expanding the pilot program in search of even greater dividends.

The nine-city crackdown targeting waste and fraud has drawn a strong protest from the medical supply industry, which is warning of shortages for people receiving Medicare benefits and economic hardship for small suppliers. But the shift to competitive bidding has led to few complaints from those in Medicare, according to a new government report.

The report found only 151 complaints from a total population of 2.3 million Medicare recipients in the nine metropolitan areas, including Miami, Cincinnati, and Riverside, Calif.

As a result, the program is expanding to include 100 cities next year, along with a national mail order program for diabetes supplies such as blood sugar testing kits. Eventually the whole country will participate.

Medicare has struggled to manage medical equipment costs. Officials say the program often paid more than private insurers for comparable equipment and was vulnerable to fraud by unscrupulous suppliers ordering expensive but unneeded products for unwitting beneficiaries.

By shifting to competitive bidding with a limited number of approved suppliers in each area, Medicare will save nearly $26 billion from 2013-2022, the government estimates, and reduce costs for seniors without cutting benefits.

“What we see is that costs are lower and there is no impact on the health status of our beneficiaries,’’ said Jonathan Blum, deputy administrator for Medicare. ’

The home-care supply industry questioned that conclusion.

“With respect to the number of complaints [the report’s] information is downright laughable,’’ said Walt Gorski, a senior lobbyist for the American Association for Homecare. “It defies logic.’’

The industry says hundreds of economists at academic institutions around the country have concluded that Medicare’s competitive bidding model is flawed and could lead to shortages or force beneficiaries to use less desirable cut-rate equipment.

Nine categories of medical equipment are included in the program: oxygen supplies, standard power wheelchairs, complex power wheelchairs, mail-order diabetic supplies, tube-feeding supplies and equipment, sleep apnea machines and equipment, hospital beds, walkers, and certain types of mattresses.

The major components of the $200 million saved last year were $59 million from oxygen supplies and equipment, $51 million from mail-order diabetic supplies, and nearly $40 million from power wheelchairs and similar devices.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Interesting, and what needs to be happening (crack down on fraud) IMHO:


Competition cuts down Medicare fraud.

Did someone hack your account? Isn't this a market solution? just kidding...

Interesting that you chose this example, as the Medicare Part D prescription drug benefit is actually costing less than was initially projected because it also included competitive bidding in its design. I also very much like the idea of introducing more competitive bidding and less centralized price-fixing into the process as well.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Did someone hack your account? Isn't this a market solution? just kidding...

Interesting that you chose this example, as the Medicare Part D prescription drug benefit is actually costing less than was initially projected because it also included competitive bidding in its design. I also very much like the idea of introducing more competitive bidding and less centralized price-fixing into the process as well.

Not at all! Reminds me of Obamacare's setting up of state by state exchanges in order to control costs via competition.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Not at all! Reminds me of Obamacare's setting up of state by state exchanges in order to control costs via competition.

Which in isolation is not necessarily a bad idea....it's merely those other 1,985 pages.....

[Plante26]

Not at all! Reminds me of Obamacare's setting up of state by state exchanges in order to control costs via competition.

Problem is, the government will be doing such things as choosing providers, mandating coverage specs and imposing price controls. It is an awfully loose utilization of the word "competition".

That said, I like the "land courts" solution you suggest.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Problem is, the government will be doing such things as choosing providers, mandating coverage specs and imposing price controls. It is an awfully loose utilization of the word "competition".

That said, I like the "land courts" solution you suggest.

I would feel less sad about that if there wasn't already a system in place that does all that. Insurance companies make deals with various pharma companies, force people to deal with poor medical supply companies, poor mail away pharm companies, set prices and manipulate access to providers with no consequence that I have yet seen. The difference is they have all different rules, can change any of them when ever and there is no recourse. Maybe making one set of rules would at least give us a running chance.

[manurespreader]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Let me give you a personal example of how this works in people's lives.
We recently changed health care providers at work to a southern based firm. This company is extremely profitable. They have a terrible reputation locally and most providers don't accept them. So I go in for a mandated procedure due to family history. The charge was over 5000 dollars. Under the old provider my responsibility was about $1200. Under this provider, my responsibility was the whole amount. The insurance company said it owed nothing on a covered event, so even though they accepted the insurance, the provider got nothing and of course billed me. So yes I have benefits, but no in reality I don't.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Let me give you a personal example of how this works in people's lives.
We recently changed health care providers at work to a southern based firm. This company is extremely profitable. They have a terrible reputation locally and most providers don't accept them. So I go in for a mandated procedure due to family history. The charge was over 5000 dollars. Under the old provider my responsibility was about $1200. Under this provider, my responsibility was the whole amount. The insurance company said it owed nothing on a covered event, so even though they accepted the insurance, the provider got nothing and of course billed me. So yes I have benefits, but no in reality I don't.

Time to call the Attorney General. Not that it will help you but it may help get them booted from your state.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Time to call the Attorney General. Not that it will help you but it may help get them booted from your state.

I'd also call the State Insurance Commissioner, and your union rep (if you have one) and your HR person. If they are "misinterpreting" the terms of the contract these parties likely will help you as much or more as the Attorney General.

At one job, we had an insurance company that routinely denied every claim the first time it was submitted for one technical detail or another. You always had to go back a second time, sometimes a third. Eventually they'd pay, but back then, interest rates were pretty high, and they were making good money on the "float." Despicable scum. Those are the kinds of companies that reputable insurers (yeah, both of them) should try to put out of business for giving the whole industry a bad name.



On a related note, if you are trying to find a good specialist, if you can get the data, find one that belongs to a self-insured group for malpractice coverage. They know who the dangerous doctors are, and don't allow them into their risk pool for malpractice coverage in the first place. Too bad they won't publicize this, though I can understand why.

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Interesting article from a Mass state healthcare insurance person. Now only if we knew a medical professional who could comment on it for us....

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GUEST OPINION: Commonwealth Care rates go tumbling downBy Glen Shor
Massachusetts Health Connector.
Posted Apr 19, 2012 @ 02:54 PM



There was plenty of reason to celebrate on April 12. Not only did it mark the sixth anniversary of Massachusetts health reform, but it also provided more solid evidence that health care reform is working.

In the commonwealth, 98.1 percent of our residents have health insurance. That includes 99.6 percent of our seniors and 99.8 percent of our children. No other state can lay claim to anything close to that.

The number of companies offering health insurance in Massachusetts has grown from 69 to 77 percent over the past 10 years. The nationwide average is 69 percent.

More people are receiving cancer screenings, and we’ve seen a 36 percent decrease in cervical cancer. More women are getting pre-natal care, too.

And despite the fact that some predicted that Massachusetts reform would be a budget buster, it isn’t. In fact, additional state spending attributable to our health reform law accounts for only 1.4 percent of the state budget.

One of the linchpins of Massachusetts health reform has been the Health Connector’s Commonwealth Care program — designed for low-income residents who don’t have access to employer-sponsored health insurance. Of the 439,000 Massachusetts residents who are newly insured since 2006, about 173,000 are in this program, and enrollment is expected to grow to more than 200,000 this year. Keeping costs down without sacrificing benefits has never been more important.

And that brings us to the other bit of good news that happened on April 12. Our board of directors met in Boston and approved bids from our five managed care organizations (insurance carriers) to continue providing coverage for next year.

Last year, the bids came in five percent lower than the previous year. On April 12, they came in five percent lower than that. That’s a 10 percent decline in what we have to pay the insurance companies to cover someone over two years. It amounts to $91 million in savings for the state with no benefit reductions or member co-pay increases.

And it didn’t happen by chance. For too long, restricting enrollment, cutting benefits and increasing copayments has been the nation’s cost containment policy. It’s not ours.

Our new fiscal reality demands that we change the way government does business to stretch every taxpayer dollar as far as possible to preserve critical programs and services. Our innovative procurement strategy is a change that has yielded the results we need to achieve this goal.

We chose a path that encouraged competition and innovation among the carriers. During the past two years, they have reduced their costs in a variety of ways such as directing members to more cost-efficient treatment centers, re-negotiating contracts with providers and implementing new medical management programs

And this year there were no major changes to health provider networks. The two lowest-cost plans collectively cover 66 of the state’s 73 acute care hospitals.

Since the program was created in 2006, the per member per month rate the state pays to insurance carriers has increased by an annual average of less than two percent. Member satisfaction remains consistently high. In the most recent survey conducted a few months ago, members rated their Commonwealth Care experience favorably, with 77 percent of all members being satisfied or extremely satisfied with the program.

There are also other signs of progress in the marketplace. Two years ago, Governor Deval Patrick directed the state’s insurance commissioner to disapprove excessive premium hikes. Since then, hospitals and insurance carriers have reopened their contracts and cut rate increases. Annual premium increases for small businesses and individuals have dropped from 16 to two percent.

That’s not to say we’ve cracked the code on cost containment in the commercial market. Gov. Deval Patrick continues to work with the key stakeholders to revamp our payment and delivery system. The goal is to stop paying for the amount of care we get and start paying for the quality of the care we receive.

Meanwhile, we’ll continue working hard to keep costs down at the Health Connector. Two consecutive years of five percent declines is a great start.

Glen Shor is executive director of the Massachusetts Health Connector.