From: jlove@ivrit.ra.itd.umich.edu (Jack Love)
Newsgroups: talk.politics.medicine
Subject: Re: The future of medicine
Date: 13 Jan 1993 01:58:16 GMT
Organization: /usr/local/trn/lib/organization
NNTP-Posting-Host: ivrit.ra.itd.umich.edu

In article <1993Jan12.142403.3086@cnsvax.uwec.edu> nyeda@cnsvax.uwec.edu (David Nye) writes:
>I didn't make myself clear.  Both perform services  but they are
>financial ones which don't directly affect health care quality. Perhaps
>the public, when apprised of the costs of having multiple payers and of
>the right to sue for malpractice, will feel that they are worth what we 
>(70%)are paying for them, but I'll bet they won't.
 
Perhaps we are approaching agreement here. If you would consider
looking at the Tobias book that I have mentioned several times now (The
Invisible Bankers), you will find a well-reasoned set of proposals
which take into account many of the points that you are making.
Insurance companies have to pay a large amount of money for sales
costs; that is the only way they can increase market share. They spend
money on all of the cutesy HMO commercials you see and hear, and spend
it on visiting, wining and dining corporate benefits people, etc. If we
can find a way to reduce or eliminate the sales portion of their costs
we can utilize many of the services that they perhaps do perform better
than government agencies, such as basic administration and customer
service.

In my view, the problem with the current malpractice industry is that
it is very inefficient. Even when a person successfully recovers funds
because of a successful suit, the likelihood is that such recovery will
take place years later than the incident and attorney's fees will
absorb a large percentage of the award. To compensate for this, juries
have a tendency to make large "pain and suffering" awards from which
the attorneys can be paid. The solution proposed by Tobias is roughly
as follows. In a system where all people are covered under some form of
national health insurance, the victim does not need to worry about
receiving whatever care is necessary to repair damage caused by
malpractice. In the event that such damage cannot be repaired, or there
is substantial loss of wages, the victim is awarded compensation via
binding arbitration. The victim benefits because there is never any
doubt that the bills will be paid, and payment is immediate.  In
return, people give up their right to sue. It is a given that in any
such system there will need to be some provision for appeal (because
any arbitration panel is subject to a variety of forms of error), and
attorneys may need to become involved at that point. But the savings to
the system as a whole by moving almost all ordinary claims out of the
courts would be enormous.

>>I'm not sure why you are specifying that the panel be composed of
>>physicians. Any such panel would have to have the public's trust, and
>>this would seem to me to mandate a more diverse composition.  >
>Because medicine is complicated enough that someone who is not trained
>as a physician will have trouble telling when malpractice occurred.

Although I suspected that this was your rationale, I'm sorry to
discover that my suspicions were correct. Medicine is indeed
complicated, but not any more so than many other disciplines.  Should a
computer programmer who is accused of malpractice be judged only by
other computer programmers? How about a nuclear physicist? A
geologist?  I don't think that anyone would question the right of a
physician who is accused of malpractice to avail him or herself of
expert witnesses in the form of other physicians who could testify as
to the wisdom or care taken in a given situation.  But once the facts
are laid out, judgement can be fairly made other trained
personnel--legal, administrative and even lay.  We are so far away from
implementing any such suggestions that it is probably premature to
discuss them at length.
-- 
________________________________________
Jack F. Love	| 	Opinions expressed are mine alone.
		|	(Unless you happen to agree.)
Newsgroups: talk.politics.medicine,sci.skeptic