But the claim that malpractice costs are driving health costs is nonsense. Malpractice insurance is expensive for two reasons: because medical malpractice causes horrific, extremely expensive injuries and because there is a lot of malpractice. Combine high cost per incident and high frequency of incidents and you have expensive insurance.

Malpractice is more common than it should be because MDs do not, as a rule, police their own as they are supposed to. They will exclude a grossly negligent doctor from their own practice in order to avoid direct liability, but they will not invoke oversight boards and regulators and will not get bad doctors struck off. As a result, the bad doctors stay in the risk pool, raising everyone’s costs until they finally kill someone in some egregiously obvious way.

This is why so-called “tort reform” has made no difference in the states that have adopted it. The claim is that there are frivolous lawsuits being filed by scheming patients and lawyers. But, if there are, the statistics aren’t showing it. For example, Texas premiums are, I believe, as high as ever. Tort reform might even be making things worse. One might reasonably expect that, by making borderline cases impossible to litigate, “tort reform” keeps negligent doctors in business longer and raises the cost of the settlements that finally end their careers.

I suspect that, if anything, there are more unreported malpractices than there are successful frivolous suits. The caring professional has to behave pretty outrageously before incompetence and/or negligence are obvious to the layman. Patients also tend to be forgiving of a doctor who makes a mistake–after all, he is better educated and takes professional risks we lay folk would be terrified to even think about. I personally know of cases where patients did not sue when a more knowledgeable physician or nurse would have.

The hypocrisy of the Republicans knows no bounds: it’s OK to spend on a war in Iraq ‘off the books’ but not when it comes to Medicare.

What also fries me is that the Idiot Democrats only focus on the “spend” side of the budget.

Why not say, “look, your derelict Republican President, George W. Bush, spent this country into a hole AND cut the means for it to raise revenue. We’re going to bring some of that revenue back, and we’re going to get it from the same rich bastards to whom George was so generous.”

Is there REALLY a lot of push-back against a tax hike [or surtax] on the rich guys?

Why, since no one will look at the “cost” of the immoral wars, don’t folks get off this “cut spending now” kick and take a glance at the “raise revenue” side of the budget?

The medical practices that I know anything about appear to derive at least 30-50% of their cost of doing business from the overhead of processing insurance claims. If we ever do healthcare reform right–with a new single-payer system or expanded Medicare–that cost evaporates almost entirely. Doctors ought to be able to have as much real income while charging much less. I wonder whether that isn’t a big part of the lower cost of doctor’s care in Europe.

And here we are objecting to a doctor who is responsible for life and death decisions making $400K. I’ve seen less outrage about the multi-gazillion dollar football/basketball/baseball and other sports players. And boxers? $12 million for an hour’s work? Movie and TV stars – $20 million for a few months?

Priorities people!

I get my healthcare through the VA. My surgeon left a lucrative private practice in New York to come to work in the Montana VA. The reason? He was tired of the hassle. He likes the idea of a fixed salary, a reasonable schedule and no hassles.

My eye doctor has a reputation as one of the best eye specialists west of the Mississippi. He left his lucrative (supposedly) practice in Denver and moved here. For the same reason.

I think that lots of doctors in this country would be perfectly satisfied with less money if they had less hassle and less ridiculous bills to pay.

And in most other countries, doctors don’t come out of medical school owing a quarter million dollars for their education.

Only if a doctor does not accept assignment does the co-pay come into effect.

So this is something that depends on the doctor. If you have a doctor that accepts assignment, you don’t need the Medigap coverage. You still have to pay the $900 hospital deductible per year if you use it even if the hospital accepts assignment (most non-profit hospitals do).

Here again, the docs and hospitals are being paid far less then they get even under capitation from the insurance cartel. They are not getting rich off Medicare.

The very notion of deals with the AMA to fatten the pockets of their Medicare doctors in exchange for health care support is unseemly

Medicare doctors – exactly who are they? The same doctors who treat every other patient.

“Medicare doctors” are not getting fat off Medicare payments. For example. Our family doc got reimbursed by Blue Cross for a half-hour visit by my husband at about $65. Once he turned 65 and went on Medicare, that reimbursement dropped to $37. This is the exact same patient, who, as he aged required more care for a series of strokes and finally a malignant brain tumor. The doctor’s costs did not go down because my husband turned 65. If anything, over time, his costs like everything else in the economy went up.

Why is it that a doctor caring for an elderly patient gets paid almost half as much to care for them as they get reimbursed by the rip-off insurance cartel? And all of you think this is okay? Sorry I don’t.

Part of making our health care costs go down doesn’t have to do with reimbursing doctors less for the same care they provide to the elderly.

One of the things that is driving costs in any doctors office is filling out the interminable number of insurance forms. Each company has their own form, and there are so many and they are constantly changing that there is no computer program that can do this job. So here we are, still doing this job by hand. Our family doc had one other doc in his practice and they had THREE billing clerks to deal with this crap. C. Everett Koop proposed requiring all the insurance companies to accept the Medicare superbill as a claim form. At the time he made that recommendation, almost 30 years ago, he said it would have saved over $144 billion per year. Nothing like a quick, easy fix for something that really doesn’t have anything to do with health care.

One other thing, the Medicare reimbursement rates are so low in some areas that if you aren’t already a patient, most docs will not accept you as a new patient. Even having Medicare doesn’t guarantee you access to healthcare if you can’t find a doc to see you.

Also, our family doc told us horror stories of his own about spending anywhere from 2-4 hours out of every single day arguing on the phone with bean counters at the various insurance companies about payments for his patients. That is time that he cannot see patients, but the staff is still getting paid and the rent and the utilities and the malpractice insurance…

I know one doctor who quit his practice and re-started it. He said he would accept no insurance payments. Cash only. $25 per visit. Worked fine since he didn’t have to have billing clerks and spend hours arguing with the bean counters etc.

Just sayin’.

A 30% savings of current costs – wouldn’t we still be spending significantly more per capita on health care than the rest of the industrialized world?