Politics

[DillonHall]

Why wouldn't they? How would a doctor even know?

They always ask if you have insurance while making the appointment, and they'll figure out what kind payment to expect from the insurer. It's very common for doctors to refuse Medicaid patients because the reimbursement is so low.

 

[pkt77242]

They always ask if you have insurance while making the appointment. It's very common for doctors to refuse Medicaid patients because the reimbursement is so low.

Medicaid I can understand but not the patients buying from the exchange.

Also I don't view Medicaid as Obamacare. Some doctors not taking Medicaid has been going on for a while now.

 

[DillonHall]

Medicaid I can understand but not the patients buying from the exchange.

Also I don't view Medicaid as Obamacare. Some doctors not taking Medicaid has been going on for a while now.

I know that there have been horror stories out there about having difficulty finding doctors who'll accept the plan. I just wanted to know if anyone had any stats to support/disprove the anecdotes.

Some doctors wary of taking insurance exchange patients

 

[IrishJayhawk]

A few interesting tidbits...I just read the study from above. The journalist who wrote the article came up with the $78 billion based on their data, but it didn't come from the researchers. I think he misrepresents some of the study just a bit. That said, here are some interesting speculations from the researchers (all MDs, by the way).

These data came from 39 physicians who self-reported how defensive each of their orders were from the previous day. It was a 5-point scale ("not at all" to "completely" defensive).

2.9% of the costs were rated to come from "completely defensive" decisions and the highest percent was for diagnostic cardiology (about 15-17% by the chart) and "Other Diagnostic" (about 15%).

That said, the physicians who made made the most self-reported defensive decisions did not make any statistically significantly more orders than those who made fewer self-reported defensive decisions. They also spent less per patient (not a statistically significant difference, but the mean was less) than those who made the least defensive decisions.

They acknowledge that the ratings are subjective. I would also posit that doctors, who generally favor tort reform, are more likely to rate their decisions as being defensive.

Their conclusion:
"...although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians' attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform" (Rothberg, Class, Bishop, Friderici, Kleppel, & Lindenaure, 2014, p. 1868).

 

[IrishJayhawk]

One more and then I'll stop.

Texas enacted aggressive tort reform in 2003. Here's the abstract from a study (2012) investigating the costs pre and post reform.

Pail, M., Black, B. S., Hyman, D. A., & Silver, C. (2012). Will tort reform bend the cost curve? Evidence from Texas, Journal of Empirical Legal Studies, 9, 173-216.

Will tort reform “bend the cost curve?” Health-care providers and tort reform advocates insist the answer is “yes.” They claim that defensive medicine is responsible for hundreds of billions of dollars in health-care spending every year. If providers and reform advocates are right, once damages are capped and lawsuits are otherwise restricted, defensive medicine, and thus overall health-care spending, will fall substantially. We study how Medicare spending changed after Texas adopted comprehensive tort reform in 2003, including a strict damages cap. We compare Medicare spending in Texas counties with high claim rates (high risk) to spending in Texas counties with low claim rates (low risk), since tort reform should have a greater impact on physician incentives in high-risk counties. Pre-reform, Medicare spending levels and trends were similar in high- and low-risk counties. Post-reform, we find no evidence that spending levels or trends in high-risk counties declined relative to low-risk counties and some evidence of increased physician spending in high-risk counties. We also compare spending trends in Texas to national trends, and find no evidence of reduced spending in Texas post-reform, and some evidence that physician spending rose in Texas relative to control states. In sum, we find no evidence that Texas’s tort reforms bent the cost curve downward.

(p. 173)

 

[dshans]

I find it (almost) humorous that "tort reform" has come to be the poster child for medical malpractice. Look it up.

I am not a lawyer – I blame Ralph Nader for that. After Unsafe At Any Speed I saw little future in crowding the field.

Granted, there are "nuisance" medical malpractice suits filed day in and day out, a guaranteed right. Most are dismissed or settled. The hoops to be negotiated are many, though, to bring a suit to trial. I tend to view the "crisis" as a means for insurance companies to artificially jack up the premiums for their profit.

What a shame.

 

[IrishinSyria]

<iframe width="480" height="373" frameborder="0" scrolling="no" allowfullscreen="true" marginheight="0" marginwidth="0" id="nyt_video_player" title="New York Times Video - Embed Player" src="http://graphics8.nytimes.com/bcvideo/1.0/iframe/embed.html?videoId=100000003765330&playerType=embed"></iframe>

While the Supreme Court's decision yesterday will impact the lives of millions, I knew nothing about the lead plaintiff before I watched this video. Worth a watch I think, no matter what you feel about the decision the story is touching.

 

[dshans]

While the Supreme Court's decision yesterday will impact the lives of millions, I knew nothing about the lead plaintiff before I watched this video. Worth a watch I think, no matter what you feel about the decision the story is touching.

Good, good, good shit.

Thanks.

 

[IrishLax]

One more and then I'll stop.

Texas enacted aggressive tort reform in 2003. Here's the abstract from a study (2012) investigating the costs pre and post reform.

Pail, M., Black, B. S., Hyman, D. A., & Silver, C. (2012). Will tort reform bend the cost curve? Evidence from Texas, Journal of Empirical Legal Studies, 9, 173-216.

(p. 173)

....ok?

I just Googled "Texas Tort Reform" and found half a dozen articles on the front page categorically stating the opposite. Among my favorite examples:

CHRISTUS Health, a not-for-profit Catholic health system with hospitals throughout Texas, saved so much on its liability costs that it expanded its charity care by $100 million per year starting in 2004. Total cost-basis charity care in Texas was $594 million greater in 2006 than it was in 2003. Sister Michele O’Brien of CHRISTUS stated that the expanded charity care is a direct result of the lawsuit reforms.

Texas chose to adopt reasonable, common-sense lawsuit reforms. As a result, the malpractice insurance premiums paid by Texas doctors have fallen by more than 60 percent on average. Consequently, most Texas doctors are paying less than half of what they were paying 10 years ago. In contrast, malpractice premiums in New York have increased by 60 percent. As a result, almost 2,000 physicians have moved their practices from New York to Texas. To stem the loss of New York doctors moving to other jurisdictions, New York enacted legislation requiring the State of New York to subsidize the malpractice insurance costs of doctors

But sure, tort reform clearly isn't important because it only benefits those 1% doctors or whatever blah blah blah if Republicans like it then it must be wrong.

 

[Wild Bill]

....ok?

I just Googled "Texas Tort Reform" and found half a dozen articles on the front page categorically stating the opposite. Among my favorite examples:




But sure, tort reform clearly isn't important because it only benefits those 1% doctors or whatever blah blah blah if Republicans like it then it must be wrong.

Personal injury attorneys have to feed their families and buy their whores the finer things in life too. Quit messing with their fees, man.

 

[phgreek]

....ok?

I just Googled "Texas Tort Reform" and found half a dozen articles on the front page categorically stating the opposite. Among my favorite examples:




But sure, tort reform clearly isn't important because it only benefits those 1% doctors or whatever blah blah blah if Republicans like it then it must be wrong.

We need some level of tort reform. But we also need to clearly delineate research institutions and procedures from "common" procedures, and establish some guidelines for what risks you sign up to as a patient.

If you go to a university wherein you are within their research facilities getting treatment, you and yours probably shouldn't be in a position to bring a suit...

If you are having a common procedure, and attain a virus or other disease from the facility ...it is completely and totally avoidable but for procedural or Human failure...and there should be ZERO tolerance for ANY of that. I'm good with those places getting slammed.

 

[Redbar]

Good thing, because now that they have this happy power, the floodgates are open. They can make you buy a gun, a gym membership, a Prius, life insurance, or a vasectomy. You've conceded in principle that the government can FORCE you to buy things "for the greater good" and there's nothing unique to limit that to health insurance. They have you and me by the balls on whatever crackpot scheme they come up with in the future.

How do you feel about the government telling you what you can and can't put in your body under threat of VIOLENCE or imprisonment? Or mandating their cut of your income? If they can VIOLATE you in these most basic ways, why wouldn't they be able to go further. The slippery slope you are complaining about didn't begin with this issue.

On another note "force" IMO is different from "violence", one can be the legitimate response to the other.

 

[IrishJayhawk]

....ok?

I just Googled "Texas Tort Reform" and found half a dozen articles on the front page categorically stating the opposite. Among my favorite examples:




But sure, tort reform clearly isn't important because it only benefits those 1% doctors or whatever blah blah blah if Republicans like it then it must be wrong.

There are lots of opinions and claims. I wanted to find a data-based, peer reviewed study on the topic. I looked around and found one. Then I shared their findings on a message board where we were discussing the topic.

Here's another one:
Low Costs Of Defensive Medicine, Small Savings From Tort Reform

I'd be more than happy to look at other data. I don't find anecdotes to be as useful because they don't control for unrelated factors.

Here's one citing a review of ten studies by the AMA. But I can't find the actual review right now.

Making the case for caps in tort reform - amednews.com

As I've said several times. I think tort reform is worth pursuing. It's just not the silver bullet that people think it is.

 

[Bishop2b5]

We need some level of tort reform. But we also need to clearly delineate research institutions and procedures from "common" procedures, and establish some guidelines for what risks you sign up to as a patient.

If you go to a university wherein you are within their research facilities getting treatment, you and yours probably shouldn't be in a position to bring a suit...

If you are having a common procedure, and attain a virus or other disease from the facility ...it is completely and totally avoidable but for procedural or Human failure...and there should be ZERO tolerance for ANY of that. I'm good with those places getting slammed.

Incompetence, negligent care, misleading patients, and all that are one thing. Nobody, doctors or patients, wants to see that or thinks it should go unpunished. What drives us crazy and makes malpractice insurance so expensive is suing or threatening to just because you don't like the results even though everyone did their best, frivolous lawsuits that won't win, but are cheaper to settle than fight, etc.

 

[IrishinSyria]

I would support a cap on noneconomic damages. The discrepancy in "loss of companionship" awards, for example, is crazy, and often amounts to a windfall for wealthy plaintiffs. Maybe cost shifting as well and a requirement that all high-risk operations be recorded.

 

[phgreek]

Incompetence, negligent care, misleading patients, and all that are one thing. Nobody, doctors or patients, wants to see that or thinks it should go unpunished. What drives us crazy and makes malpractice insurance so expensive is suing or threatening to just because you don't like the results even though everyone did their best, frivolous lawsuits that won't win, but are cheaper to settle than fight, etc.

No argument here in terms of lawsuits designed to extort vs. help someone deal with real harm, and associated problems.

 

[connor_in]

OK...question for you guys on ALL sides...

I have been reading various articles on the decisions made by SCOTUS this past week and what I have seen repeated a few times is that there are a group of people out there who are upset at the same sex marriage situation NOT because they have a problem with same sex marriage, but that it was done through the courts and not the legislature. Basically, the argument goes that this should have come about through passed laws and not judicial interpretation. The defense of marriage act passed by Congress and backed and signed by Clinton in the 90's was written law and thus had set a particular scope. However, since ssm is now approved simply by case law interpreting of Constitution, people can use that interpretation precedent for other things and thus the scope of the case law decision is far larger than on a passed law.


Whether you are for or against the SCOTUS SSM decision, please discuss whether or not this would have been better settled with passed law instead of case law.

 

[IrishJayhawk]

OK...question for you guys on ALL sides...

I have been reading various articles on the decisions made by SCOTUS this past week and what I have seen repeated a few times is that there are a group of people out there who are upset at the same sex marriage situation NOT because they have a problem with same sex marriage, but that it was done through the courts and not the legislature. Basically, the argument goes that this should have come about through passed laws and not judicial interpretation. The defense of marriage act passed by Congress and backed and signed by Clinton in the 90's was written law and thus had set a particular scope. However, since ssm is now approved simply by case law interpreting of Constitution, people can use that interpretation precedent for other things and thus the scope of the case law decision is far larger than on a passed law.


Whether you are for or against the SCOTUS SSM decision, please discuss whether or not this would have been better settled with passed law instead of case law.

I see the argument. But I tend to think that discrimination (that's what I think this was, obviously) shouldn't be left to popular vote or legislation. Equal rights shouldn't be left to the opinions of the majority. I tend to think it actually serves as a protection to both religious and non-religious people.

 

[Whiskeyjack]

OK...question for you guys on ALL sides...

I have been reading various articles on the decisions made by SCOTUS this past week and what I have seen repeated a few times is that there are a group of people out there who are upset at the same sex marriage situation NOT because they have a problem with same sex marriage, but that it was done through the courts and not the legislature. Basically, the argument goes that this should have come about through passed laws and not judicial interpretation. The defense of marriage act passed by Congress and backed and signed by Clinton in the 90's was written law and thus had set a particular scope. However, since ssm is now approved simply by case law interpreting of Constitution, people can use that interpretation precedent for other things and thus the scope of the case law decision is far larger than on a passed law.

Whether you are for or against the SCOTUS SSM decision, please discuss whether or not this would have been better settled with passed law instead of case law.

I don't think there's any doubt the cultural and legal "progress" achieved by Obergefell would have been stronger had it come about via legislative action rather than judicial fiat. See Ginsburg's comments about Roe v. Wade reversing momentum in favor of abortion and creating one of the most bitterly contested divides in the culture war. The Obergefell ruling may create similar blowback.

I see the argument. But I tend to think that discrimination (that's what I think this was, obviously) shouldn't be left to popular vote or legislation. Equal rights shouldn't be left to the opinions of the majority. I tend to think it actually serves as a protection to both religious and non-religious people.

Not for long. The "rights" of secular liberalism's autonomous individual are incompatible with the more community-oriented rights of Freedom of Religion. SCOTUS has reliably sided with the former every time those two principles have collided, so the latter is slowly but surely being whittled down to the Freedom of Worship. As someone who is deeply concerned with the religious freedom, I have zero faith that SCOTUS will defend it.

 

[Emcee77]

OK...question for you guys on ALL sides...

I have been reading various articles on the decisions made by SCOTUS this past week and what I have seen repeated a few times is that there are a group of people out there who are upset at the same sex marriage situation NOT because they have a problem with same sex marriage, but that it was done through the courts and not the legislature. Basically, the argument goes that this should have come about through passed laws and not judicial interpretation. The defense of marriage act passed by Congress and backed and signed by Clinton in the 90's was written law and thus had set a particular scope. However, since ssm is now approved simply by case law interpreting of Constitution, people can use that interpretation precedent for other things and thus the scope of the case law decision is far larger than on a passed law.


Whether you are for or against the SCOTUS SSM decision, please discuss whether or not this would have been better settled with passed law instead of case law.

ALWAYS better to take any action via democratically-elected legislatures. The problem arises when the majority, through its elected representatives, wants to take some action that violates the constitutional rights of the defenseless minority, and that's when courts have to step in.

 

[EddytoNow]

OK...question for you guys on ALL sides...

I have been reading various articles on the decisions made by SCOTUS this past week and what I have seen repeated a few times is that there are a group of people out there who are upset at the same sex marriage situation NOT because they have a problem with same sex marriage, but that it was done through the courts and not the legislature. Basically, the argument goes that this should have come about through passed laws and not judicial interpretation. The defense of marriage act passed by Congress and backed and signed by Clinton in the 90's was written law and thus had set a particular scope. However, since ssm is now approved simply by case law interpreting of Constitution, people can use that interpretation precedent for other things and thus the scope of the case law decision is far larger than on a passed law.


Whether you are for or against the SCOTUS SSM decision, please discuss whether or not this would have been better settled with passed law instead of case law.

I agree with IrishJayhawk on this one. If we had to wait for individual states to pass a law before any action was taken, there would still be some states where slavery was legal. If I'm not mistaken I think there is wording in the 14th amendment to prevent states from passing laws that deny individuals rights freely available to other groups. That was the basis of Justice Kennedy's argument legalizing same sex marriages.

The bottom line is that individual states cannot pass laws to get around the provisions of the U.S. Constitution. Of course, you can always join Rick Perry and secede from the union.

 

[IrishJayhawk]

Not for long. The "rights" of secular liberalism's autonomous individual are incompatible with the more community-oriented rights of Freedom of Religion. SCOTUS has reliably sided with the former every time those two principles have collided, so the latter is slowly but surely being whittled down to the Freedom of Worship. As someone who is deeply concerned with the religious freedom, I have zero faith that SCOTUS will defend it.

Let's play it out though...

Hypothetically (very hypothetically, obviously, but it's a thought experiment), let's imagine that a Radical Islamic sect takes over Vermont. They hold a majority in the legislature. Can they not vote to disallow voting for women? Interracial marriage?

They can't. Because the courts rightly said that a majority cannot take away equal legal protection for a minority. How is it different?

 

[JughedJones]

Whiskey: I'm not sure if I agree with you. You're saying that the rights of the community are incompatible with the idea of individualism?

That can't be what you mean, right?


EDIT: May I ask you why you are "deeply concerned" about your religious rights?


What could possibly concern you?

 

[Whiskeyjack]

Let's play it out though...

Hypothetically (very hypothetically, obviously, but it's a thought experiment), let's imagine that a Radical Islamic sect takes over Vermont. They hold a majority in the legislature. Can they not vote to disallow voting for women? Interracial marriage?

They can't. Because the courts rightly said that a majority cannot take away equal legal protection for a minority. How is it different?

Why get hypothetical? The ACA's promoters promised exemptions for religious institutions, but Sebellius chose to interpret those exemptions as narrowly as possible, forcing hundreds of Catholic organizations to sue for injunctions (which HHS is still appealing). States that legalized SSM in recent years have been forcing Catholic adoption agencies to either secularize and place children with same-sex couples or to shut down. Catholic hospitals have been forced into similar choices by the ACA. And this is only going to get worse post-Obergefell.

The Catholic Church's right to religious liberty apparently ends wherever someone else's "rights" begin, and SCOTUS is expanding the latter all the time, which necessarily means a contraction of the former.

 

[JughedJones]

Why get hypothetical? The ACA's promoters promised exemptions for religious institutions, but Sebellius chose to interpret those exemptions as narrowly as possible, forcing hundreds of Catholic organizations to sue for injunctions (which HHS is still appealing). States that legalized SSM in recent years have been forcing Catholic adoption agencies to either secularize and place children with same-sex couples or to shut down. Catholic hospitals have been forced into similar choices by the ACA. And this is only going to get worse post-Obergefell.

My right to religious liberty apparently ends wherever someone else's "rights" begin, and SCOTUS is expanding the latter all the time, which necessarily means a contraction of the former.

good grief, man.

take a step back from the ledge.

I'm pretty sure your idea of what "The Dude" needs some help.

 

[wizards8507]

Let's play it out though...

Hypothetically (very hypothetically, obviously, but it's a thought experiment), let's imagine that a Radical Islamic sect takes over Vermont. They hold a majority in the legislature. Can they not vote to disallow voting for women? Interracial marriage?

They can't. Because the courts rightly said that a majority cannot take away equal legal protection for a minority. How is it different?

From Justice Thomas' dissent: "In the American legal tradition, liberty has long been understood as individual freedom from governmental action, not as a right to a particular governmental entitlement. To the extent that the Framers would have recognized a natural right to marriage that fell within the broader definition of liberty, it would not have included a right to governmental recognition and benefits. Instead, it would have included a right to engage in the very same activities that petitioners have been left free to engage in — making vows, holding religious ceremonies celebrating those vows, raising children, and otherwise enjoying the society of one’s spouse — without governmental interference."

In other words, gay marriage already was legal. If two men wanted to rent a hall, hire an officiant, invite their friends, and say some vows, they have always been free to do so. Nobody from the Alabama State Police would have been breaking down the doors to prevent it. Freedom to marry is not the same thing as demanding state benefits in recognition thereof.

To prove how bullshit the "equal protection" argument is: A single mother of three earning $23,000 per year is eligible for Medicaid and food stamps. I am not. I could use the exact same legal arguments that led to this decision to argue that I am being denied equal protection. But the point is, benefits and protection are not the same thing.

 

[JughedJones]

From Justice Thomas' dissent: "In the American legal tradition, liberty has long been understood as individual freedom from governmental action, not as a right to a particular governmental entitlement. To the extent that the Framers would have recognized a natural right to marriage that fell within the broader definition of liberty, it would not have included a right to governmental recognition and benefits. Instead, it would have included a right to engage in the very same activities that petitioners have been left free to engage in — making vows, holding religious ceremonies celebrating those vows, raising children, and otherwise enjoying the society of one’s spouse — without governmental interference."

In other words, gay marriage already was legal. If two men wanted to rent a hall, hire an officiant, invite their friends, and say some vows, they have always been free to do so. Nobody from the Alabama State Police would have been breaking down the doors to prevent it. Freedom to marry is not the same thing as demanding state benefits in recognition thereof.

To prove how bullshit the "equal protection" argument is: A single mother of three earning $23,000 per year is eligible for Medicaid and food stamps. I am not. I could use the exact same legal arguments that led to this decision to argue that I am being denied equal protection. But the point is, benefits and protection are not the same thing.

So, you're saying this ruling did nothing?

Or did it say that I have every right to carry on my marriage in any state, no matter if the majority tells me I can't.

I'm married in Oregon, tell me... is my marriage legal in Ohio?


EDIT: I really want you to tell me if it is or not.

What if, in South East Portland, we decide that Hetero marriage is not recognized.

We say that marriages can have the city tax exemptions, but the couple has to suck dick.

We put it up to a vote. Majority rules, right?

 

[Whiskeyjack]

Here's NYT columnist Mark Oppenheimer arguing that, post-Obergefell, it's time to revoke tax exempt status for all religious organizations. As I mentioned previously, given the tight margins most of thems operate under, this would force huge numbers of churches and charities to close.

And here's Politico's Fredrik de Boer arguing that it's time to legalize polygamy. Many of IE's Progressives vehemently insisted that the logic of SSM wouldn't justify polyamory as well, so I'd be curious to get their reactions to it.

 

[JughedJones]

Here's NYT columnist Mark Oppenheimer arguing that, post-Obergefell, it's time to revoke tax exempt status for all religious organizations. As I mentioned previously, given the tight margins most of thems operate under, this would force huge numbers of churches and charities to close.

And here's Politico's Fredrik de Boer arguing that it's time to legalize polygamy. Many of IE's Progressives vehemently insisted that the logic of SSM wouldn't justify polyamory as well, so I'd be curious to get their reactions to it.

Well...

Moses did rise up a full Six foot Ten....

He said you can't close the door when the wall's caved in.



So, that explains that.

 

[ACamp1900]

I'm expecting a 'the Christian Cross is a symbol of hatred' movement soon...