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Krauthammer - Why Obamacare is sinking
Topic Started: Jul 24 2009, 04:20 AM (341 Views)
Mikhailoh
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If you want trouble, find yourself a redhead
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Why Obamacare Is Sinking

By Charles Krauthammer
Friday, July 24, 2009

What happened to Obamacare? Rhetoric met reality. As both candidate and president, the master rhetorician could conjure a world in which he bestows upon you health-care nirvana: more coverage, less cost.

But you can't fake it in legislation. Once you commit your fantasies to words and numbers, the Congressional Budget Office comes along and declares that the emperor has no clothes.

President Obama premised the need for reform on the claim that medical costs are destroying the economy. True. But now we learn -- surprise! -- that universal coverage increases costs. The congressional Democrats' health-care plans, says the CBO, increase costs on the order of $1 trillion plus.

In response, the president retreated to a demand that any bill he sign be revenue-neutral. But that's classic misdirection: If the fierce urgency of health-care reform is to radically reduce costs that are producing budget-destroying deficits, revenue neutrality (by definition) leaves us on precisely the same path to insolvency that Obama himself declares unsustainable.

The Democratic proposals are worse still. Because they do increase costs, revenue neutrality means countervailing tax increases. It's not just that it is crazily anti-stimulatory to saddle a deeply depressed economy with an income tax surcharge that falls squarely on small business and the investor class. It's that health-care reform ends up diverting for its own purposes a source of revenue that might otherwise be used to close the yawning structural budget deficit that is such a threat to the economy and to the dollar.

These blindingly obvious contradictions are why the Democratic health plans are collapsing under their own weight -- at the hands of Democrats. It's Max Baucus, Democratic chairman of the Senate Finance Committee, who called Obama unhelpful for ruling out taxing employer-provided health insurance as a way to pay for expanded coverage. It's the Blue Dog Democrats in the House who wince at skyrocketing health-reform costs just weeks after having swallowed hemlock for Obama on a ruinous cap-and-trade carbon tax.

The president is therefore understandably eager to make this a contest between progressive Democrats and reactionary Republicans. He seized on Republican Sen. Jim DeMint's comment that stopping Obama on health care would break his presidency to protest, with perfect disingenuousness, that "this isn't about me. This isn't about politics.

It's all about him. Health care is his signature reform. And he knows that if he produces nothing, he forfeits the mystique that both propelled him to the presidency and has sustained him through a difficult first six months. Which is why Obama's red lines are constantly shifting. Universal coverage? Maybe not. No middle-class tax hit? Well, perhaps, but only if they don't "primarily" bear the burden. Because it's about him, Obama is quite prepared to sign anything as long as it is titled "health-care reform."

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that money comes from? The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Didn't Obama promise a new politics that puts people over special interests? Sure. And now he promises expanded, portable, secure, higher-quality medical care -- at lower cost! The only thing he hasn't promised is to extirpate evil from the human heart. That legislation will be introduced next week.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Copper
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Shortstop
Mikhailoh
Jul 24 2009, 04:20 AM
Quote:
 
Why Obamacare Is Sinking

By Charles Krauthammer
Friday, July 24, 2009

It's all about him.



The surest path to oblivion.

If he made the debate into a “Manhattan Project” to improve health he could sell it.

It’s a political shouting match.

The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Red Rice
HOLY CARP!!!
Agree 100% with Krauthammer. Health care reform is D.O.A. without cost control, and tort reform is crucial to that. The universal coverage that Democrats point to as an example in other Western countries could not exist in the malpractice free-for-all climate we have here in the States.

The Democrats want industry, providers and taxpayers to bear the costs of health care reform but want to keep the malpractice lawyers happy. WTF.
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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Axtremus
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HOLY CARP!!!
Re: CBO cost estimate -- see http://s10.zetaboards.com/The_New_Coffee_Room/topic/7158750/1/

Re: "Tort reform" cost saving -- show me the numbers...

I asked before if there is any estimate or promise for malpractice insurance premium reduction that accompanies any particular "tort reform" proposal -- I have yet to see any.
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Red Rice
HOLY CARP!!!
Axtremus
Jul 24 2009, 06:14 AM
I asked before if there is any estimate or promise for malpractice insurance premium reduction that accompanies any particular "tort reform" proposal -- I have yet to see any.
That's not where the majority of cost savings will come from. The savings will come from decreasing unnecessary costs and procedures.

Here's some numbers, based on the Texas experience: http://www.physiciansforreform.org/index.php?id=17
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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QuirtEvans
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Red Rice
Jul 24 2009, 06:05 AM
Agree 100% with Krauthammer. Health care reform is D.O.A. without cost control, and tort reform is crucial to that. The universal coverage that Democrats point to as an example in other Western countries could not exist in the malpractice free-for-all climate we have here in the States.

The Democrats want industry, providers and taxpayers to bear the costs of health care reform but want to keep the malpractice lawyers happy. WTF.
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent. For some doctors, the only thing that makes them diligent is fear.

So, you have three choices. Encourage diligence through regulation (far more intrusive regulation than we have now). Encourage diligence through fear of lawsuits. Or accept that there will be some doctors that aren't diligent, and that people will be hurt or die as a result, but that that's just the cost of doing business.

Blaming the cost of health care on malpractice claims is just plain silly, unless you're willing to look at the potential consequences of tort reform.

And I say that as someone who isn't a litigator, and really doesn't care if lawyers make any money on malpractice claims.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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Red Rice
HOLY CARP!!!
QuirtEvans
Jul 24 2009, 06:19 AM
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent. For some doctors, the only thing that makes them diligent is fear.

So, you have three choices. Encourage diligence through regulation (far more intrusive regulation than we have now). Encourage diligence through fear of lawsuits. Or accept that there will be some doctors that aren't diligent, and that people will be hurt or die as a result, but that that's just the cost of doing business.

Blaming the cost of health care on malpractice claims is just plain silly, unless you're willing to look at the potential consequences of tort reform.
Nonsense. Countries such as Canada, Britain and France do a more than adequate job of protecting patients, without the use of lawsuits as a stick. In Canada for example, patient complaints first go to the provincial college of physicians, where cases are subject to binding arbitration before a panel of laymen and health care professionals. Only cases that are determined to demonstrate criminal negligence are allowed to proceed to the civil courts. The result: less costs, lower malpractice insurance premiums, and unclogged courts.
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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Larry
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Mmmmmmm, pie!
Quote:
 
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent.


You know, I've been to a hell of a lot of doctors in my life, and I've been friends with a bunch of them - I would be hard pressed to think of a single one of them who was less than totally diligent in the way they practice.

I've also used a hell of a lot of attorneys in my life, and I've been friends with a bunch of them, too. Half of them should be driving a truck for a living.

That isn't to throw rocks at you, but to make a point. Maybe we should have government provided legal assistance too. I wonder how may lawyers would like having to work for rates set by the government.

Of the Pokatwat Tribe

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Mikhailoh
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If you want trouble, find yourself a redhead
I think there has to be a balance, and I can't imagine that the premiums I hear of charged today reflect balance. Perhaps George can shed some light on this.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Red Rice
HOLY CARP!!!
Larry
Jul 24 2009, 06:28 AM
Maybe we should have government provided legal assistance too. I wonder how may lawyers would like having to work for rates set by the government.

I think we already have this in the criminal court system.
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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John D'Oh
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MAMIL
Red Rice
Jul 24 2009, 06:24 AM
QuirtEvans
Jul 24 2009, 06:19 AM
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent. For some doctors, the only thing that makes them diligent is fear.

So, you have three choices. Encourage diligence through regulation (far more intrusive regulation than we have now). Encourage diligence through fear of lawsuits. Or accept that there will be some doctors that aren't diligent, and that people will be hurt or die as a result, but that that's just the cost of doing business.

Blaming the cost of health care on malpractice claims is just plain silly, unless you're willing to look at the potential consequences of tort reform.
Nonsense. Countries such as Canada, Britain and France do a more than adequate job of protecting patients, without the use of lawsuits as a stick. In Canada for example, patient complaints first go to the provincial college of physicians, where cases are subject to binding arbitration before a panel of laymen and health care professionals. Only cases that are determined to demonstrate criminal negligence are allowed to proceed to the civil courts. The result: less costs, lower malpractice insurance premiums, and unclogged courts.
We have a friend who's a GP in the UK - she had a look into possible coming to the US but decided against it because of the horrors and costs associated with litigation - and I'd say she was a very diligent individual. So fear of litigation can stop more than bad doctors, it can stop good ones as well.

My opinion about the US is that the litigious nature of the society as a whole is a major obstacle against modern success - even more devastating than the curse of modern American 'liberalism'. I don't believe it's primarily the fault of lawyers as many do, I think everyone's to blame.
What do you mean "we", have you got a mouse in your pocket?
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Axtremus
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HOLY CARP!!!
Red Rice
Jul 24 2009, 06:18 AM
Axtremus
Jul 24 2009, 06:14 AM
I asked before if there is any estimate or promise for malpractice insurance premium reduction that accompanies any particular "tort reform" proposal -- I have yet to see any.
That's not where the majority of cost savings will come from. The savings will come from decreasing unnecessary costs and procedures.

Here's some numbers, based on the Texas experience: http://www.physiciansforreform.org/index.php?id=17
I agree that malpractice insurance premium is not where the major savings will come from. But the premium is what reflects the risk, which in turn drives the "unnecessary costs and procedures." To the extent that people are not willing to link reduction of premium to tort reform, it indicates that they really do not believe the risk will actually come down, or that the insurance companies are unwilling to actually pass down the reduced risk premium to the physicians they insure.

I am quite happy to see the "Texas experience" you linked to pointed out a 21% decline in average malpractice insurance premium -- yet it doesn't say anything about the savings presumably cut out from "unnecessary costs and procedures."
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Mikhailoh
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If you want trouble, find yourself a redhead
And how exactly would you like to measure that? You'd have to have a pretty long timeline of ordering data by physician per patient. Some of these protective procedures are ingrained in current medical protocols, not just physicians covering themselves. It will take time to realize the changes and the savings. I assure you no one determining the protocols is openly saying 'oh, we do it this way to cover our ass from litigation' and they also will not be saying, 'Oh, good - we can quit doing all these things right away'.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Red Rice
HOLY CARP!!!
Axtremus
Jul 24 2009, 06:46 AM
I am quite happy to see the "Texas experience" you linked to pointed out a 21% decline in average malpractice insurance premium -- yet it doesn't say anything about the savings presumably cut out from "unnecessary costs and procedures."
Ax, right under it on the same link you see:

Quote:
 
The Pacific Research Institute estimates American physicians spend $124 billion each year in defensive medicine-more than half of the total 2006 U.S. national deficit! A 2003 Health and Human Services report estimated tort reform would save Medicare and Medicaid between $30 and $50 billion dollars every year.
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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QuirtEvans
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I Owe It All To John D'Oh
Larry
Jul 24 2009, 06:28 AM
Quote:
 
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent.


You know, I've been to a hell of a lot of doctors in my life, and I've been friends with a bunch of them - I would be hard pressed to think of a single one of them who was less than totally diligent in the way they practice.

I've also used a hell of a lot of attorneys in my life, and I've been friends with a bunch of them, too. Half of them should be driving a truck for a living.

That isn't to throw rocks at you, but to make a point. Maybe we should have government provided legal assistance too. I wonder how may lawyers would like having to work for rates set by the government.

If a lawyer screws up, you don't lose an arm or die.

Same for a plumber, or an accountant, or a musician, or a computer technician.

Medicine is just a different sort of category. Kind of like airplane pilots.

Besides, no one is saying you shouldn't be able to sue a lawyer who commits malpractice. At least, not me.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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QuirtEvans
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I Owe It All To John D'Oh
Red Rice
Jul 24 2009, 06:24 AM
QuirtEvans
Jul 24 2009, 06:19 AM
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent. For some doctors, the only thing that makes them diligent is fear.

So, you have three choices. Encourage diligence through regulation (far more intrusive regulation than we have now). Encourage diligence through fear of lawsuits. Or accept that there will be some doctors that aren't diligent, and that people will be hurt or die as a result, but that that's just the cost of doing business.

Blaming the cost of health care on malpractice claims is just plain silly, unless you're willing to look at the potential consequences of tort reform.
Nonsense. Countries such as Canada, Britain and France do a more than adequate job of protecting patients, without the use of lawsuits as a stick. In Canada for example, patient complaints first go to the provincial college of physicians, where cases are subject to binding arbitration before a panel of laymen and health care professionals. Only cases that are determined to demonstrate criminal negligence are allowed to proceed to the civil courts. The result: less costs, lower malpractice insurance premiums, and unclogged courts.
If there's an effective system of ensuring diligence and punishing malpractice, that's fine with me. I don't particularly like the idea that a plaintiff can get punitive damages to punish the wrongdoer anyway. Punitives should go, in large part, to the government. (Not in whole, because you need to give the plaintiff some incentive to work for them.)

However, calling what I said "Nonsense" is foolish, because what you've described is what I would call greater regulation.
It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010.
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Mikhailoh
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If you want trouble, find yourself a redhead
Question: How do the countries who have single payer or national healthcare do it? What regulations have they put in place? Are they effective?
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Red Rice
HOLY CARP!!!
QuirtEvans
Jul 24 2009, 07:11 AM
However, calling what I said "Nonsense" is foolish, because what you've described is what I would call greater regulation.
Fair enough, but it's important to note that the greater regulation in the example I gave is not being applied to doctors; I'm sure that most doctors would find having cases settled before a well-informed panel under the auspices of the state much less onerous and costly that having them settled before a jury of laypeople in a civil court. Rather, the greater regulation is being applied to malpractice lawyers and plaintiffs, by subjecting them to binding arbitration and removing the incentive of massive claims. Tort reform, in other words. Other countries feel this is a fair and necessary condition for state-sponsored healthcare, and it is remiss of Obama and Democrats not to address this. If they continue to refuse to do so, health care reform deserves to fail.
Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool.

I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss!

- Cecil Lewis
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John D'Oh
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MAMIL
In the UK:

NHS litigation authority
What do you mean "we", have you got a mouse in your pocket?
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Jolly
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Geaux Tigers!
It takes more brainpower to make a single first-class physician than it does to make two second-class lawyers.

Alas, Washington is filled with second-class lawyers...
The main obstacle to a stable and just world order is the United States.- George Soros
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Mikhailoh
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If you want trouble, find yourself a redhead
Thanks, John. Very informative link. From their Claims Management link:



Quote:
 
Our schemes

The NHSLA handles negligence claims made against NHS bodies through five schemes. Three of these relate to clinical negligence claims (CNST, ELS and the ex-RHAs scheme), while two cover non-clinical risks, such as liability for injury to staff and visitors and property damage (LTPS and PES, known collectively as RPST). While only NHS bodies are eligible for membership of these schemes, Independent Sector Treatment Centres, treating NHS patients, may benefit from CNST cover via their referring Primary Care Trust.


NHS indemnity

Under NHS indemnity, NHS employers are ordinarily responsible for the negligent acts of their employees where these occur in the course of the NHS employment. See guidance on NHS indemnity for further details.

Legal advice

With effect from 1 April 2008, our panel for clinical cases will consist of the following eleven firms:
Barlow Lyde & Gilbert
Beachcroft
Bevan Brittan
Browne Jacobson
Capsticks
Eversheds
Hempsons
Hill Dickinson
Kennedys
Ward Hadaway
Weightmans
The non-clinical panel contains nine firms, details of which can be found in our Annual Report.

Statistics

Factsheet 2 provides overview statistics on expenditure incurred by the NHSLA on claims, while Factsheet 3 provides information on the number and type of claims received. Factsheet 5 provides more detailed information on claim numbers and payments in 2004/05.

Approach to claims-handling

Our remit, as set out in our Framework Document, is to ensure that claims made against the NHS are handled fairly and consistently, with due regard to the interests of both patients and the NHS. We seek to settle justified claims efficiently and to defend unjustified claims robustly.

Currently, fewer than 2% of the cases handled by the NHSLA are litigated in court, with the remainder being settled out of court or abandoned by the claimant. Where appropriate we participate in mediation or other forms of alternative dispute resolution (ADR). As a member of the Mediation Working Group set up by the Clinical Disputes Forum, we participated in the creation of the Forum’s Guidance on mediation, with its accompanying Users’ guide.


Only 2% of their claims go to court. Pretty desirable situation, if it works. Britain paid 769 million pounds last year in clinical claims. I can't discern from that how much their trusts pay, or how that works out per physician.

Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Renauda
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HOLY CARP!!!
QuirtEvans
Jul 24 2009, 07:11 AM
Red Rice
Jul 24 2009, 06:24 AM
QuirtEvans
Jul 24 2009, 06:19 AM
I've said this before ... not all doctors are diligent. Doctors put people's lives on the line when they are less than diligent. For some doctors, the only thing that makes them diligent is fear.

So, you have three choices. Encourage diligence through regulation (far more intrusive regulation than we have now). Encourage diligence through fear of lawsuits. Or accept that there will be some doctors that aren't diligent, and that people will be hurt or die as a result, but that that's just the cost of doing business.

Blaming the cost of health care on malpractice claims is just plain silly, unless you're willing to look at the potential consequences of tort reform.
Nonsense. Countries such as Canada, Britain and France do a more than adequate job of protecting patients, without the use of lawsuits as a stick. In Canada for example, patient complaints first go to the provincial college of physicians, where cases are subject to binding arbitration before a panel of laymen and health care professionals. Only cases that are determined to demonstrate criminal negligence are allowed to proceed to the civil courts. The result: less costs, lower malpractice insurance premiums, and unclogged courts.
.)

However, calling what I said "Nonsense" is foolish, because what you've described is what I would call greater regulation.
Greater perhaps, but it is at least not government regulation. Here the doctors and other professionals such lawyers, engineers, accountants, pharmacists etc. regulate themselves through their Registered Professonal Organizations that are mandated through legislation to regulate. The government has virtually no say in how these organizations license and regulate these professionals to practice. It works and works very well.
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Mikhailoh
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If you want trouble, find yourself a redhead
That would be very worthwhile looking at for our country. It makes more sense to me to look around worldwide and see what is working well and would it work well here than to try to have Congess crafting legislation based on what will not infuriate their contributing constituencies.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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