Archive for March, 2010

Is Tort Reform An Example of “Free Markets”?

March 28th, 2010 No comments

This has come up quite a bit amongst Republicans as their solution to the healthcare costs skyrocketing and I thought I would offer my thoughts here. Tort reform is the idea that limiting caps on insurance settlements will in fact reduce costs. The argument is that by limiting caps, doctors will not be in the business of providing unnecessary tests and medical care i.e. act as “Defensive Doctors” for fear of being sued.

Tort Reform however, does not have many of the arguments of true conservatives, that being “Free Markets”, something that I find slightly odd and at the same time also find it odd that democrats do not support it either.

The total costs of malpractice is approximately 1-2% of total healthcare costs. I honestly believe that tort reform is necessary, however, my opinion is neither that of liberal or conservative viewpoints.

Costs associated with malpractice insurance will adversely affect certain specialties more often than others. For example, Obstetrics and Gynecology pays much more for malpractice insurance than your Internal Medicine physician.

However, even with Tort Reform, I do not believe that “Defensive Medicine” will become history. Fact is, doctors still do not like being sued. All it would do would be to lower the chances of outrageous liability suits occurring.  It might have some calming effects but it will not be the silver bullet either.

Tort Reform still does not answer the big issue with malpractice insurance in that one of the biggest costs of tort reform is the administrative and legal costs defending physicians. Just because a physician is being sued does not mean that the physician is liable, and in most cases these cases are either dropped or dismissed.  And because of these high costs, many times lawyers will not recommend to patients suing expecting lower settlements.

At the same time, with malpractice insurance rising, it is squeezing out certain specialties more than others. Also, we have to look at the situation where some states do not have the same insurance crisis as others might.

What I will argue and also find a bit humorous about the argument for Tort Reform is that it is not even ideologically based. Tort Reform is essentially having the government set up a “Regulated” market protecting physicians and and the health industry while not supporting the Legal Industry.  The common idea here is that its also a mandate to keep costs low for patients.

Next, we also have to realize that Insurance Companies are like large banks and they need a hefty amount of assets to stay afloat. Thus, investment income is a big component. They have shown that in situations when investment income takes a loss, that insurance rates rise due to the additional capital that needs to be undertaken to support malpractice claims.

So when investment income is high, the related costs for malpractice insurance will normally stay down but that in times when it is low malpractice insurance will rise in those states without caps but stay moderate in states where caps are in place.

Don’t you find this ironic? That the “Regulated” industry is being supported by conservatives that promote the “Free Market” system and liberals who do not?

The same time, this model would suggest that it is not the “Silver Bullet” which will lower costs but rather regulate them preventing the shocks within the malpractice market. I guess my message is that I would hope that liberals see that this is a good idea but to conservatives it is not the only idea.

Maybe to me, this is why I typically believe that you have to go beyond the talking points to find out the true story and in this case, I always find this funny because the argument here is more based upon what industries give to what party vs. actual ideology.  In this case they flipped.  Point being is that if you are a liberal democrat you can rest assured that this is okay.  I really do not think that suing a doctor for 10 million vs. 2 million will really make a difference. If the point is to send a message, it will get sent irregardless of the monetary amount.

However, in the long run I would really question whether lawsuits have a huge role in the Patient Care Model. This is also to liberals have a way of thinking that the best way to make sure nothing happens again is to punish and sue. (see Bush Administration War Crimes).  Yes, there will be situations where it will open eyes to current behavior but limits will not prevent this from happening.

Read as you may, and change your opinion as you may.





Categories: Politics Tags:

A Moment Alone Thinking About Healthcare

March 23rd, 2010 1 comment

Last night my wife and I sat in front of the television watching MSNBC and the vote tally coming in. Choosing to not go through the desperate process of watching ‘CSPAN-type’debates and desperate politicians aiming for Prime Time television coverage we were able to turn it on at the perfect moment when the vote was being counted.


As the votes came in the shock of the moment has still not worn off. Healthcare for every single damn American is pretty much possible.


*             *            *            *            *            *            *            *


When Alexander Hamilton began beginning the idea of writing the Federalist Papers, he did so with the idea that he needed to sell the American people the very idea of a “United States of America.” Hamilton was not totally dead set on the Constitution and had his doubts. The Constitution was a compromise clear and simple. It was a document aimed at creating a national government but at the same time providing a backdrop for individual states rights.


Hamilton, arguably the father of American Economics sought the idea that these United States become an empire like England, even preferring its structure of Monarchy but his opinions were overruled and never materialized among the larger Southern States.


*             *            *            *            *            *            *            * 


The very idea of a healthcare bill being passed was never an easy one. In an era of American life whereby we are provided a level of convenience in our daily lives, there were many that were impatient at the debates, the time and energy wasted debating this idea ad nauseum. For many of us we live in fear, fear for the health of ourselves and those that are closest to us.


If we are part of the “Haves” we might have quality healthcare. We have access to good doctors, we have fairly cheap rates and while a doctor visit might be unpleasant with unusual wait times, we thank our lucky stars that we are healthy.


We might be a senior. The parts don’t move as fluid as they used to. The tests are more difficult but at the end of the day, generally speaking, Medicare is not a bad plan.


And to the “Have Nots”, they might pay high premiums that offer very little protection, they might be students right out of college that have not received a job offer and are playing a game of Russian Roulette hoping their youth will prevent them any serious health issues or they are from an increasingly growing population that was denied healthcare because of pre-existing conditions, their coverage was halted because they got sick or at their place of employment they are not provided insurance.


*             *            *            *            *            *            *            * 


We think of the Constitution as a pretty unique and amazing document, providing a sound backdrop to our government. We can argue both on the left and right that people have a high regard for it and while it might be interpreted differently it has been used by liberals as well as Conservatives to provide a level of unalienable rights to citizens.


What Hamilton did with the help of James Madison and John Jay with the Federalist Papers was provide the idea of what our nation would look like, but also to calm fears to bring upon the difficulties of how the weak Articles of Confederation did not provide for the freedom and security necessary to act in unison with each other. By acting in unison, a future attack on South Carolina would be an attack on the entire United States and so forth


*             *            *            *            *            *            *            *


I never thought of Obama as a true liberal but a moderate. His initial healthcare proposal for example was more “Conservative” in nature than the bill that was recently passed. If you remember the Presidential debates, it was Obamas intention that any public plan would not be deemed to be a mandate on the public, that is that the entire public did not have to buy into this proposal.


Sometimes we have to give credit to the black man born with the weird name to pass the largest piece of social legislation in decades.


Details of the bill here


*             *            *            *            *            *            *            * 


Hamilton’s view of America did not shift after the Constitution was passed. Being brought on as the Secretary of the Treasury it was his intent that America create a National Bank to assume the debts of the States. Hamilton’s premise by doing this was  for several reasons including:  assuming state debts incurred during the Civil War it would bring upon nationalization of that debt and by doing so would make the nation stronger and prevent secession. He also looked at this as a mechanism that could be looked at by foreign countries. With the nation creating revenue streams they would also be allowed to provide aid to other countries on top of the idea of building up the United States. 


Many including Thomas Jefferson found the national bank unconstitutional. They found this notion dangerous and impeded on the states rights to act independently of the Federal Government.


And what we see from this battle even further is that this is the beginning of the fight for the interpretation of the Constitution. You have on one side of the aisle the Hamiltonians fighting for a broad interpretation of the Constitution vs. the Jeffersonians who were fighting for a strict interpretation of the Constitution.


*             *            *            *            *            *            *            * 


The fight for healthcare has often been about the idea that it is “Government Run” or “Socialized Medicine”. However, pitting the debate of healthcare into simple phrases such as this does not make to understand the depth of the problem of healthcare.


If you are a citizen such as myself a portion of your paycheck is deducted which is your employee policy cost. This is on top of the taxes as well as Medicare that is also deducted from your plan. And while there is an element of American life that distrusts the very idea of taxes, we have to remember that the cost of that healthcare plan that is being deducted from your paycheck inevitably pays not just the cost of care of you (and your family) but also contains an additional tax of all the benefits received from others that are uninsured, underinsured as well as other Medicare patients.


Think of it this way. You are out with some friends, 4 of whom are doing pretty good economically and successful and the other 4 which are struggling from week to week. Dinners great. You get a couple nice bottles of wine and party it up. . . until the check comes. You then realize that the 4 people cannot put in for all that they consumed and the four that are more economically well off end up paying for part of their dinner as well as their own.  So you end up getting less for what you paid for.


A conservative might find this unfair. Why should those that are in more affable positions have to pay for those that cannot afford it? Why should I as a consumer, a responsible citizen have to pay for the misfits?


We would then have to argue how is healthcare delivered. While it is true there is a handful that do make you upset. There are people out there trying to buck the trend. At the same time there are plenty of responsible and hard-working Americans that are not given the same benefits as the “Haves”. I believe that this bill tries to make things a bit more equal.


Consider the aspect of a young and healthy individual without insurance is injured, has to go to the ER and have major surgery. It is later realized that this individual cannot afford their bills and the hospital is forced to absorb those costs and those costs make prices rise for all patients which then incurs increases on the insurance end. There is no fault here. The healthy individual might not have had coverage with their employer, between jobs, out of college, etc.


By creating a mandate, i.e. that all citizens must carry a healthcare plan, we try to make that more equal. By paying into the system, there is a greater pool of resources available to the insurance companies. This is not a socialist program but a basic inherent belief that creating a mandate encourages all citizens that are not covered to participate.


The bill is similar to the “Romneycare” program enacted in Massachusetts by then Governor Mitt Romney.


*             *            *            *            *            *            *            *


The arguments over Broad vs. Strict interpretation of the Constitution have been going on for years. Many “Tea Party” members point to the idea that it was never the intent of the Founding Fathers for our federal government to have so much power in our nations activities. My argument would that it would depend on the Founding Father.


Jefferson, for example, did not envision America as being a Superpower but of an agrarian society. And of course there are those that feel that these powers have shifted inordiantly and what you see among the Tea Party is this intent to remove many of the powers of the Federal Government. Historically speaking however, that is easier said than done.


Many Tea Partiers could probably blame Abraham Lincoln for this demise. Many controversially point to his decision to levy a war against the South and in doing so defied the Constitution. There is no doubt in my mind Lincoln’s actions shaped the Constitution differently than it had been in the past but I also believe that by doing so it made the nation stronger.


The New Deal and it’s policies also shifted many economic burdens over to the Federal Government during the Great Depression. But again, most economic professors would agree that during times of downturns, the Federal Government should be looked onto to stimulate the economy.


*             *            *            *            *            *            *            * 


Obamacare is not the New Deal. Hospitals are not being taken over by the government nor are insurance companies or pharmaceutical distributors. Instead, we can argue that the policies are very much based in conservative ideology including regulations.


Some might argue that our nation was founded on the idea of “Free Markets” and I would totally discredit that. “Free Markets” is a catchphrase used by conservatives to invoke the idea that capitalism=democracy. Our nation, even from it’s inception, regulated markets, corporations, etc. They understood the need to work with wealthy but never trusted it.


Consider a recall of a food product. Quite simply there is a concern about the safety of the product and if it is not safe we will take it out of the store. We cannot completely rely that the company that is producing the product is doing it in a safe manner and by setting up regulations we create that protection for consumers.


We might hope that the company acts in an ethical manner but in a true free market system they are truly on their own.  A good example for this is Chinese products which have received a high level of scrutiny over the past few years. China is a country that is dealing with these very issues as they have to understand that we want safe products.


Back to healthcare. If we live by the belief that “Free Markets” will solve the problem we forget the solution does not always cover all individuals. The healthcare package tries to address these problems with market-based approaches and without becoming too socialized.


*             *            *            *            *            *            *            * 


As I watched a bit of Fox News tonight and wondered aloud about how the other side will take this debate, I see a nation that is very polarized in nature. A bill such as Obamacare is moderate and truthfully speaking should have engaged some more moderate republicans to vote for it (if there are any left).


Their supposed cure of course is bringing this to the courts to battle it out. The new “In Vogue” amendment for Conservatives, replacing the 2nd is the 10th which reads:


The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.


This has essentially what the conservative movement has become, a complete denial of the Federal Government. Their best solution has in the words of Rick Perry is to secede. They are a bunch that finds it’s disciples in those that make them feel better about themselves. Their entertainers like Beck and Limbaugh who find ways to trample the weak. They are predominantly white and most likely not thinking in a manner that is relevant to public debate.


Using terms of hate, spitting on congressmen is not an example that I would hope we should be setting as a nation. Too often, as these debates persist, people too often busy to see what is going around them.


*             *            *            *            *            *            *            *


When I flipped on my iPod this morning I went directly to the R.E.M. Political mix that I had created. Still in shock and awe from this moment, the band and the music seemed perfect for the occasion.


I look at this bill as a compromise. I never thought that a true 1 payor system would ever succeed and while some progressives might be upset at such an idea, I realistically point to the idea that about 42% of this country thinks that this bill is too liberal to begin with.


I do not think that come November this will be Waterloo. I see the premise that conservative lawmakers are taking, as a great way to raise funds for the mid-term elections.


I would encourage people to become informed about this bill and read on it’s provisions. For many out there, your healthcare will stay the same. I would also remind you that the Republican plan out there would strip employer based coverage and make you purchase this on your own, which would, in turn, be a much more drastic approach to healthcare overhaul. You would lose all benefits that your employer is presently covering and in many cases pay a significantly higher rates. There is also the danger that these healthcare insurance companies would reside in states where looser regulations could mean a drop in coverage.


And while I do believe that Tort Reform is necessary I do not believe it will solve every dilemma in healthcare.


I also do not see eye to eye with the social conservatives as a whole who have chosen a path that sees God through a different pair of glasses than I do. Jesus was around during a time when government failed to protect many of it’s citizens and I truly believe that Judeo-Christian principles are necessary in providing social justice to all beings. I really do not think that Jesus would want insurance companies denying coverage or setting pre-existing conditions.


Don’t get me wrong, there are plenty of uncertainties with this bill but as a whole it is much better than our current system. Those abnormalities can always be worked out once they go into place and we see this plan in action.


As I have grown older I have become much more disillusioned with my conservative counterparts in life. Greedy business practices are the culprit of our economic demise, something that will take years to rebound from. But you see people through a different lens.


So I guess in R.E.M. terms, should we talk about the weather?

Categories: Politics Tags:

Spring Cleaning Podcast

March 21st, 2010 No comments


When do you start working on the setlist they play at your funeral? While this is something that I have not started thinking about, I did feel the need to work on a setlist of songs that seem to be budding up this springtime.


Springtime in Chicago is exciting with several good shows coming up (Thom Yorke, Spoon/Deerhunter and Air) several shows that I enjoyed (Woods and Netherfriends) and some shows I wish I went to (Deakin).


There are many shows to look forward to this summer, (PitchforkMonday Free Shows at Pritzker) and that does not count the plethora of new music to look forward to this year.


Every once in a while there is always a need to put my mouth behind the microphone and speak to my imaginary friends as to what I have been listening to. Anyone that is willing to put up with this trainwreck, feel free to indulge yourself in the fractured fairytaile mind of a 37 year old deviant who is just trying to find sense to the maddening world we live in.


And any time that we can find ways of escaping the monotony is a good thing. For my imaginary friends out there wondering what is good and listenable I would encourage you to check this out. The podcast is a mixture of young and old. Some artists reflect the nature of Generation X, boombox over your head music like Peter Gabriel. Some reflects the younger generation musicians/audiophiles listening to their angels and demons make music and interpret that how they may like, (see Woods and Netherlands). Still others are dug up relics finding their light of day (The Method Actors) and finally there is always plenty to celebrate the bands whose movements are still being examined 40+ years after they started making music (Velvet Underground).


So here you go. An imaginary podcast for an imaginary world

Categories: Music Tags: