Comments on Secondhand Smoke: Your 24/7 Seminar on Bioethics and the Importance of Being Human: Big Bailout Will Sink National Health Insurance

The big worry I have with any national plan is tha...

2008-09-24T18:47:00.000-07:00

The big worry I have with any national plan is that certain large employers who don't like to pay benefits (won't name any names, but one rhymes with Gall-Mart) will cut ALL employee health coverage and tell their employees to go on the federal plan. There needs to be some disincentive there; they won't care about high deductibles and co-pays.

"I note that for many patients making malpractice ...

2008-09-24T11:23:00.000-07:00

"I note that for many patients making malpractice claims it's all about the money, not punishing the doctor at all."

Well, yes. If you've lost your earning capacity and require ongoing care that has to be paid for by somebody, you'd like to get that covered, I would think.

I have a problem with importing a criminal standard of proof (beyond reasonable doubt) into a personal-damages compensation system. Several problems, in fact. First, that bar is probably too high for 99.9% of the cases. Second, the vast majority of medical malpractice cases don't involve actions that amount to criminal acts. Third--and I don't know if it's the case in the US, but it is where I live--if you're going to convict someone of a crime, you have to show intent. What you're proposing, effectively, is a regime in which a patient could be compensated for malpractice only if the treating physician intended to harm him/her.

National health insurance as in any kind of single...

2008-09-24T01:45:00.000-07:00

National health insurance as in any kind of single-payer plan was always unlikely anyway. Tort reform would be necessary, and the lawyers of both political parties in Washington and the 50 state legislatures would never allow that.

But with serious tort reform, savings to the system might well pay much of the tab. If doctors were freed of the onerous cost of malpractice insurance on the grounds that the federal government would investigate and reimburse true instances of malpractice using mandatory arbitration, that would tend to minimize frivolous claims.

In fact, arbitration could be made contingent upon the doctor being found guilty in a criminal proceeding of malpractice-related charges first. The threat of criminal charges would in turn get the few truly incompetent docs out of the profession. I note that for many patients making malpractice claims it's all about the money, not punishing the doctor at all. You would think that supposed victims would want some sort of professional or criminal punishment, but this rarely appears in the news--only big payoffs instead.

My only concern with single-payer would be the effect on some of the alarming trends in medical care that you note. But maybe here, too, potential criminal charges would save some patients who even now face poor fates in the hospital. Or maybe I'm just dreaming...

I'm with you on this one, Wesley, with a few minor...

2008-09-23T21:28:00.000-07:00

I'm with you on this one, Wesley, with a few minor suggestions:

- Regarding deductibles and co-payments (#4 on your list), it will be a bit of a balancing act to ensure that they are high enough to discourage overuse but not so high as to discourage appropriate care.

- Regarding limited mental health (#7), I'm not sure what's behind that. Mental health is not just middle-class patients lying on a psychiatrist's couch and moaning about how their mother didn't understand them. Properly approached and utilized, mental health services can pay for themselves in terms of reduction of social problems.

- Regarding limited prescription payments (#7 again), it may be otiose to pay for a patient to consult a physician if the patient doesn't have sufficient funds to follow the physician's advice.

I have one point to make here."Sorry, but to quali...

2008-09-23T17:02:00.000-07:00

I have one point to make here.

"Sorry, but to qualify for coverage, someone will have to be a citizen or legal resident."

If not for humanitarian reasons, then for public health reasons people will have to either get health care or leave the country. We can't have, for instance, a tuberculosis outbreak among a non-cared-for population.