Why Heckling The President During a Joint Session of Congress is Not the Smartest Thing You Can Do

I was amused watching MSNBC later last night and saw that he had issued a written apology. But not for lying about the lying, only for allowing his emotions to overcome him and interrupting Obama’s speech.

I think Joe Wilson still thinks he’s in the movie “Mr Smith Goes to Washington”, only without right being on his side.

Oh, I suspect he knows he’s screwed up.

You’re right. I should rephrase that. I think Joe Wilson “thought” he was in the movie… and so on. Still. 100 G’s makes me smile.

I did not the President’s speech last night because I was at my school’s open house. I do think thatMr. Wilson’s outburst was uncalled for and very disrespectful to the President of the United States. I did not vote for President Obama, but he is the leader of our nation and deserves respect. You can disagree with someone without being disagreeable. I hope our Congress does not start to look and act like the House of Commons in the United Kingdom.

What are the voter demographics of Wilson’s district? A depressing number of Congressional districts (for both parties) are drawn so as to be extremely “safe” for the incumbent. If Wilson’s district is like that, there might be enough red-meat “You go, Joe!” cheerleaders in it (as I saw in various forms on Twitter) that his re-election prospects are about as good as before.

I wonder whether the larger effect will instead be on the larger national perception of health-care reform. One of the things that Obama aimed to do in the speech was to make the case that much of the health-care reform opposition was unhinged knee-jerkery. Wilson’s outburst helped drive home the president’s point, more clearly than Obama could on his own.

I think people are starting to get wise to the fact that republicans aren’t just against obama’s healthcare plan, they’re against any healthcare plan.

I’ve been getting the feeling that the ideology that there should be no social safety net was a dirty little secret, and in public they were supposed to be talking about how bad “this particular” plan was.

So when you sneer at the message that we’re in a healthcare crisis, and it should be taken seriously, you shouldn’t be surprised when next year, your opposition steam rolls you in a steam roller made of money.

My reaction, once they identified the heckler was to think, “Congrats, dude! You’ve just activated every resource the DNC has to send you on a long vacation.”

Unintended consequences can be a bitch.

The electoral history of Joe Wilson’s district.

It’s hard to know without knowing the details, but it appears strongly Republican, but Rob Miller did manage to get 46% of the vote in 2008. Which is significantly better than prior opponents.

Honestly, I feel most sorry for Wilson’s staff right now. As I’m writing this, his website is completely down. That takes some doing. It’s not impossible, but the House network isn’t exactly a mom’s basement operation.

I just hope that people who feel the need to call in to his office about this have the decency not to emulate him when they do it. I might not like the guy’s politics (at all), but I don’t think his interns and junior staff deserve half the abuse they’re going to take over the next few days.

Thanks TransDutch for the pointer. Looks like Wilson may be beatable then. 46% is not a bad challenger score, and while the district’s Cook PVI is R+9 (meaning that the district’s vote for the 2008 Republican presidential candidate was 9 percentage points higher than the national average), every other South Carolina district with a PVI of R+9 or lower has a Democratic US representative (if you believe Wikipedia).

We’ll see what happens going forward. I suspect there may be a fair bit of out-of-district money coming in to both candidates in the coming days.

I just keep thinking about this:

I wonder if the private citizens can begin match (insert healthcare insurance company’s name here) dollar for dollar? Anyone have information on campaign contributions from healthcare companies for this guy? I bet we are likely to see those go up as well.

The most regrettable outcome from this type of behavior is that it dominates the water cooler discussion and interferes with constructive discourse over the content of the president’s talk.

Rabid

I live in Joe Wilson’s District, and while that district is bigger than my local area, things are changing right here. Many people (including me) have moved here from other states, and are not part of the good-old-boy network.

We have Democrats in both our State Assembly and Senate seats. Pretty smart Democrats, too. One of the things that irks me about local politics is the kind of behavior that I can only call ‘stupid’. I don’t mean to insult him personally, but really, what else can you call it when a married politician gets caught having an affair with another woman, and, while trying to recover from this, publicly announces that the ‘other woman’ is his soulmate.

Did he really thing that this would make things better politically? (only if he was going for the hopeless romantic vote.) Did he think this would help him fix things up with his wife?

I don’t know Jenny Sanford, or what she thinks, but I respect her choice not to stand smiling behind her husband while he announce that their marriage is basically a sham. I think her sons will have reason to be grateful in the future that there is no video tape of that scene.

Yes, the heckling issue will dominate the water cooler talk, but I think it then leads to a discussion of Obama’s points, which is what happened at the busstop this morning (the stay-at-home Mom’s version of a water cooler). I agree with a previous poster, in that this makes the Republicans just look like they don’t want to go along with anything, they aren’t willing to work to get a healthcare plan in place; hopefully this contretempts inadvertantly spurs the plan to passage.

@5: I note that calling another MP a liar in the House of Commons is one of the few things which MPs are not allowed to do… Unparliamentary language, and all that.

In his own fundraising appeal last month, Rep. Wilson made it quite clear that “President Obama Targets Wilson.” Fortunately, Mr. Wilson does provide a source for this, quoting in full the Organizing for America letter that apparently demonstrates the “hypocrisy and panic coming from President Obama” due to his own opposition to the “borderline socialist” reform beloved by “Nancy Pelosi’s San Francisco liberals.”

I loved the look on the Vice Presdient’s face. It was that look of a man who knows exactly what a shit storm someone else just stepped into.

I can’t help but think that this is the chickens coming home to roost. Those special Republican Crazy chickens that they’ve been feeding and breeding for a number of years now.

Is it too much to hope that this is the turning point in the previously ever-increasing levels of right-wing nuttery and hostility?

Joe Wilson stepped in it big time… plan and simple. We expect diplomacy from our politicians and clearly this guy can not provide that. Politics should never be ran on emotion. One should never heckle the Office of the President, no matter who holds it.

I think Wilson’s biggest mistake (after opening his mouth) was the way he apologized. If he were a good politician (note != good person) he would be raging back on any TV show that would let him on about how he just couldn’t let such a bold lie stand and that his constituents deserved the truth!

Of course it’d be partisan BS, but it’d fire up his base and might help him get his own 100K in donations.

I’d check all the facts before I’d start celebrating. Has anyone checked to see how much Wilson’s contributions have gone up since last night?

Here at my office in Franklin Park, IL (a close-in suburb of Chicago), the general reaction to the this congresscritter who heckled Obama was positive from literally everyone I’ve talked to this morning!

The common perception amongst my co-workers is that Obama seemed mean-spirited and that there was nothing new in this speech to convince people who are against the bill to support it. If people in the Chicago area are having this type of reaction, what’s the thoughts of citizens in areas where Obama isn’t so popular?

LizrdGizrd @21: Actually, I suspect that some “raging back” is in Representative Wilson’s future–that apology (by my reading of it) leaves him plenty of room to do just that. He apologized for being impolite, for letting his emotions get the better of him, which I suspect means that the scenario you describe could follow quite nicely. And if that’s what happens . . . we’ll see how his constituents react. Might be interesting.

I watched the President’s speech last night and was appalled at Wilson’s behavior. Since when is heckling ever a sign of good basic manners? I did love the look Pres. Obama gave him though, priceless.

Barry @20: “Politics should never be ran on emotion.”

Are you kidding?? Emotion is pretty much all that politics IS. Diplomacy is needed so you don’t hurt people’s feelings or piss them off when you’re trying to get them to do things. If people were actually logical and rational about things “politics” as we know it would be largely unnecessary.

The really impressive thing about the $100K+ is how fast it piled up. This would not have happened pre-WWW and Twitter/Facebook etc.

[Deleted for rather obvious racist jackassery — JS]

@26 – citation, please?

I’m having a hard time finding any references to that outside of the bat$#!] crazy papers.

Jas, I’ve deleted the comment, so don’t bother with a follow-up.

[Deleted because ELF wishes to allege he’s not aware the terms he’s using are racist, which I don’t believe. If you seriously don’t know what I’m talking about, ELF, e-mail me. Either way, ELF, you’re off this particular topic thread. Move on –JS]

[Deleted — ELF, please note you’ve been thrown off this thread. Try to post on it again and you’ll be banned — JS]

It was a massive loser move. That’s why Wilson came out to apologize minutes after the speech was over: the Republican leadership came down on him like a ton of bricks and shoved him in front of the nearest microphone.

Obama’s entire political career has been built around a rope-a-dope strategy. He baits his opponents into looking like mean, angry, unreasonable people while he sits back with a “can you believe how crazy these guys are?” expression on his face. Then, once he’s rhetorically positioned himself as the most responsible, centrist, even-handed person in the room, he lets loose and obliterates them. He did it to Clinton, he did it to McCain, and he’s doing it to the congressional GOP as we speak.

It’s why when Wilson screams “You lie,” you can see the faintest hint of a smile on the president’s face. It’s because Wilson has just played directly into Obama’s hands. You couldn’t imagine a better moment in a speech aimed entirely at establishing him as the adult and the Republicans as the squabbling children.

I don’t think the outburst was planned or coordinated at all. I think he was telling the truth when he said he let his emotions take over.

There are a lot of people in the house, and the lesser known members (the back-benchers, as they say across the pond) can sometimes be borderline nut-jobs that win poorly contested districts. He could be an alcoholic or a drug-addict, or could have some kind of under-treated mental health problem. We shouldn’t assume these congressmen are the best our country has to offer. Some of these guys are serious losers and still manage to get elected.

To be fair although the Democrats never directly called the President a liar, they have booed him before. Here is a clip of the 2005 SOTU address.

JimF @33

That’s true, but to be fair. The president had spent a lot of time leading up to that point demonizing congressional democrats (specifically) as obstructionists and partisans.

Well, it would have been nice if Wilson could back up his assertion, but he cannot. [ref: http://mediamattersaction.org/factcheck/200909090009%5D

I’m not sure I’m against what he did, *because* he can’t back it up. It just makes the opposition look more foolish.

But, advantage to our side aside, is this behavior ever called for? What if someone had called out “You lie!” when Bush made his case for war in Cincinnati on October 2002?

Oh, wait a minute. What am I thinking? That couldn’t have happened. They didn’t let anyone with an opposing viewpoint into that session.

Maybe if someone had done it when Bush lied to Congress. Or Powell lied to the UN. Or Bush lied to Congress, again. Or lied to the Congress, again. And again. And again.

This may change the terms of civility that we adhere to when lives are perceived to be at stake. I hope not.

Regarding the disruption Joe Wilson caused, I think a single rude remark to voice disasgreement is far LESS offensive to me than the constant heckling some Republicans have used to shut down discussion at those town hall meetings.

Joe Wilson looked like an ass last night, but he was clearly exercising his right to free speech to voice his honest opinion in an important debate. The fact that we all agree that his opinion is useless is mostly beside the point. The town hall jokers were abusing their right to free spech to prevent honest debate.

So yeah, Joe Wilson is a useless piece of baggage that the good people of his district should replace at the earliest opportunity. But as for the big to-do that it has become this morning, it seems like it is getting more attention than it deserves.

JimF @33: Do I need a hearing aid? I’m not being snarkly; that’s entirely possible–but I’ve listened to the clip twice, and despite the title, I hear far more Republican cheering than Democratic booing . . . not that it matters, I suppose, since I’m fairly sure that Democrats did boo Bush on occasion, during formal speeches. Booing a president as a group during an outbreak of applause is expressing one’s heartfelt disapproval; I would have had no problem with Republicans booing Obama, I don’t think. Breaking into the speech to shout “you lie” is a bit different, in my opinion. (Especially since I don’t believe that Obama was lying, but that’s another issue.)

@37 Mary It’s right at the beginning of that clip. In any case I agree with you if clapping is acceptable so is booing. What some people seem to be forgetting that this wasn’t an open debate, it was a set speech.

Man, when did this blog get so political? I have some bacon-related concerns that need addressing ASAP!

Also, I’m from Canada, so I’m not too familiar with US politics, but what’s the deal here? You can’t heckle the president when he’s making a speech? The Canadian Prime Minister gets yelled at every time he opens his mouth in our House of Commons…and he yells back. Everybody yells. It’s cathartic.

Cheering and booing is one thing, and is pretty standard in joint Congress speeches, SOTU, etc. It’s the audience responding to the merits of an idea, and showing their support or opposition to it.

Yelling “You LIE!” is completely different. It’s disruptive and rude, and it makes a clear statement about the character of the speaker.

Wilson was not saying that he disagreed; he was making the claim that the President was deliberately lying.

That’s why I don’t accept his apology. His conduct was only half the issue; the other half is calling the POTUS a liar. You damn well better be able to back that up if you do it.

I really think this goes back to the Town Hall strategies of disruption. Quoting directly from their memo:

– Be Disruptive Early and Often: “You need to rock- the-boat early in the Rep’s presentation. Watch for an opportunity to yell out and challenge the Rep’s statements early.”

– Try to “Rattle Him,” Not Have an Intelligent Debate: “The goal is to rattle him, get him off his prepared script and agenda. If he says something outrageous, stand up and shout out and sit right back down. Look for these opportunities before he even takes questions.””

@ #13

“Anyone have information on campaign contributions from healthcare companies for this guy?”

Here’s an article that summarizes that nicely:

http://rawstory.com/08/news/2009/09/10/obama-speech-disrupter-a-health-industry-darling/

Not that he wuold ever do it, and it would have been the wrong move, but I would have loved this

“You know, I just gave my education speech earlier today. Do we need to set up a behavior contract for you, Joe?”

er… yesterday. sorry.

Obama used the dad voice.

I don’t think I ever want to hear the President use the dad voice again.

Well, that’s not true. I don’t want him to ever use it on me. Others are fine because then there can be the laughing and pointing.

I am amused to see that Rob Miller is up to $234,000 already.

GMO @ 39: Regarding the Canadian House of Commons: heckling is one thing, but they’re not allowed to call one another liars (among other things), and get tossed out for a couple of days and are forced to apologize when they do.

Regarding that ELF character. I believe he might not have known that phrase was in poor taste (his Wikipedia link notes the phrase wasn’t originally racist, but is generally avoided now because it is considered racist). I was following both of your tweets and he was winning me over that he was blissfully ignorant of the connotations.

But then he drops this one:
“Isn’t it funny how the person calling you a racist, is usually the one who IS the racist in the first place?”

Allow me to channel Seth Myers: Really, ELF? Really?

Matthew in Austin:

Eh, he’s gone now.

GMO, I don’t think the issue is specifically that someone disagreed with the president. Or even how he did it. The thing that is really cheesing some people off is related to the specific context in which this incident occurred.

Obama’s speech went as follows:

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally.

It was at this point, the moron called the president a liar. The president specifically called out some right wing paranoid bullshit for being bullshit, and this fucking moron decided to defend right-wing paranoid bullshit rather than go with the truth.

This moron’s behaviour only exemplified the sort of assinine idiocy that’s been going on for the last few weeks, the sort of behaviour that Obama and everyone else sees as pure obstructionism.

And that’s what this asshole did, he obstructed by defending bullshit when the president was trying to get some real discussions going on.

Had it been Bush giving a speech about WMD’s in Iraq back in 2003, when everyone and his mother knew WMD’s were a lie, then calling out the president as a liar wouldn’t have cheesed certain people off. It probably would have gotten the neocon’s in an indignant uproar about patriotism, but basically the 8 years of Bush’s presidency were nothing more than 8 years of blind patriotism indignant at anything that wasn’t blind patriotism.

@36: Joe Wilson was not “exercising his right to free speech to voice his honest opinion in an important debate” last night — he was interrupting someone else’s speech, which puts him closer to your town hall hecklers in character.

I’d also make the case that “honest opinion” isn’t accurate either: Wilson’s “opinions” are tied to the old Upton Sinclair quote about how it’s hard to make a man understand something when his salary depends on him not understanding it. None of the proposed reforms will change the existing law (08 U.S.C. § 1611) that already bars illegal immigrants from receiving federally subsidized health care.

Keep in mind that in Canada and the UK, when the Prime Minister is heckled, it is while he/she is the head of the government. POTUS is not only the head of the government, but also the head of state. Heckling Obama is the equivalent of a Member of Parliament heckling the Queen.

Isn’t it ironic that Wilson shouts out “You lie!” (Incidentally, Wilson lied.) in the middle of a speech where Obama said if people spread anymore misinformation, they will be called out on it?

Reading through the thread it seems that we are returning to that “but you did it first” mentality. I will in no way defend any member of congress who boo’s, whistles, or shouts out dissent when the president (or another member of congress) is giving a speech or presenting his side of the argument.

I think it is important that we call this congressman out for his behavior and using past acts of stupidity by democrats does nothing to justify his actions.

Rabid

JerolJ, not quite. We don’t hold the head of state in quite the regard you hold the Queen. I am not a subject of President Obama. I don’t have to bow when he walks in.

I suspect this is in part because he’s also head of government. Her Majesty the Queen doesn’t technically work for you; Obama technically works for me (and all other US citizens).

Can’t really draw parallels quite that directly across the two systems. I do think it’s somewhat ruder to call the POTUS a liar during a speech than to do the same to a PM under similar circumstances, but there’s lots of complexity wrt how the offices are regarded, and the different traditions of the systems of goverment; we have no “question period,” for example. The POTUS isn’t required to go to Congress except once a year for the State of the Union address, and he doesn’t take questions then.

Another effect of Rep. Wilson’s disrespectful outburst was to render the official Republican response (by an obscure Louisiana congressman; I don’t remember his name–see?) a completely wasted effort. Once again: Well done, Joe Wilson. Well done, indeed.

Wilson’s opponent now over $300K and rising, according to John’s link at the top. That’s over $200K more in less than 6 hours.

He has broken this contribution type out and it is now at $137,000 for the largest anti-Joe Wilson

#55
The “obscure” Louisiana congressman’s name is Charles Boustany who represents the good people of the southwestern part of my great State of Louisiana (from the Lafayette area). In his other (real) job he is a heart surgeon. I think he knows something about the subject of heathcare. I for one belive that healthcare in America needs be reformed, I just do not trust the government (democrats or republicans) to fix it.

#58 “I for one belive that healthcare in America needs be reformed, I just do not trust the government (democrats or republicans) to fix it.”

Okay. So who (or what) will?

What is it with guys named Joe Wilson? Do they ALL accuse presidents of lying?

“I for one belive that healthcare in America needs be reformed, I just do not trust the government (democrats or republicans) to fix it.”

I don’t see why not ? The american government put a man on the moon, won WWII, invented TANG and created a nationwide network of highways unparalleled in the modern world.

The American government, peopled as it is by americans is fully capable of delivering and managing access to health care.

Leaving that aside, what are the alternatives ? Having your health care needs addressed by a group of unelected CEOs and accountants who answer to shareholders and not patients or doctors?

Faceless corporate bureaucrats are worse than government ones because at least the government ones (ostensibly) answer to the people.

Charles K. Bradley @58: I think my point stands, though. Whatever Rep. Boustany may have had to say, as a doctor or a congressman, or a Republican, or whatnot, was completely lost, thanks to Joe Wilson.

Charles K. Bradley:

I’m not real trusting of the government, either, but they’re doing a far better job with Medicare/VA than corporations are doing with insurance/HMOs.

@61
I think you sre right on that score.
@60 Your point is well taken.

Xopher @ 54:

Total derail, but hey:

I’m from New Zealand, so the queen is technically my head of state, and its ridiculous to say that anyone in the Commonwealth is the queen’s ‘subject’ in anything but the most tenuous ceremonial way. I am often surprised that Americans seem to think she’s at all relevant to anyone’s government.

People generally show a high level of respect for the queen out of tradition and a general sense of politeness, as far as I can tell. Not due to any “OMG my lord and master is speaking to me” reactions.

Which is to say, I guess: don’t overinterpret how much anyone other than weird monarchists (mostly old) give a shit about the queen. Still, I don’t think you’d find many elected representatives who’d be deliberately rude to her.

The thing that gets me is how many liberals and Dems are going off about how Joe Wilson was SO HORRIBLE for doing that yet they seem to have forgotten when Bush was boo-d by members of Congress during a 2005 State of the Union Address.

I didn’t like Bush. I still don’t like Bush. He was a liar and I think a number of his policies and decisions he made while in office have greatly hurt our country and will continue to hurt us for some time.

I also voted for Obama and at this time would vote for him again (despite not liking several of the things he’s done in office *coughcoughDOMAcoughcough*).

I just think people should remember that they’ve done things just as tactless and rude in the past and that complaining about Wilson’s outburst too much starts to smack of hypocrisy. Yes, it was rude, you’ve (i.e. Congress) been rude in the past too, move on.

Eddie, that last is my point. We’re allowed to be rude to the President if we want. It’s still rude, but it’s not the kind of outrage that being rude to the Queen would be.

If the Queen unexpectedly visited your workplace, would you stand and/or bow, or just try to keep working and pay as little attention as possible? If Obama visited my workplace, I’d stand if he actually came to my cubicle, but not otherwise; had Bush done it, I would have stood—to leave. And I would have snubbed him to his face and perhaps told him “you’re the worst President in the history of this once-great country.”

Unless, of course, I was afraid of his goons. Which I probably would be.

Wilson deserves all the ridicule, and hopefully the loss of his seat, that can be heaped on him, because of the particular circumstances surrounding his accusation that the prez lied (see Greg London at #49 above for well stated reasons why).

But, in the most general sense I have no problem with someone calling a high ranking politician, even the prez, a liar. I just do not see why people feel that you shouldn’t call the prez a liar, just because he is POTUS. POTUS is not sacred. I would consider it a duty of my representatives to call the prez, and anyone else, a liar, IF they are in fact lying about something that matters. Any type of lie, as in intentionally trying to mislead people about facts or the truth of a matter. Look where false politeness has gotten us. It should not be considered impolite to call a person, any person, a liar if they are lying.

And yes, I would expect my representatives (perhaps hope would be a better word here than expect) to exhibit intelligence in just how they go about calling someone on a lie. Timing and delivery are important.

Darrell E – You may be unaware of it, but there are actual written rules of decorum that all members of congress swear to obey, and can get censured if they violate. It’s not that he called Obama a liar. Plenty of congresspeople did that since he was elected after hours, and when congress wasn’t in session. It’s *when* and *where* he called Obama a liar.

Here’s what the Republicans themselves have to say on this issue at the house.gov site

Until the 109th Congress, it was not in order to make certain references to the Senate or individual senators. However, at the beginning of that Congress, the House removed the prohibition on making references to the Senate, leaving only the requirement that debate be confined to the question under debate and avoid “personality.” The precedents of the House allow a wide latitude in criticism of the President, other executive officials, and the government itself. However, it is not permissible to use language that is personally offensive to the President, such as referring to him as a “hypocrite” or a “liar.” Similarly, it is not in order to refer to the President as “intellectually dishonest” or an action taken by the President as “cowardly.” References to the Vice President, in spite of his role as President of the Senate, are measured against the standard used for the President rather than prior standards used to govern the Senate.

There’s a reason people were so shocked. What Wilson did wasn’t booing. It was specifically prohibited behavior. Prohibited by his own political party, in fact. Booing is technically different.

@65 Matt we addressed this further up the chain, the consensus is that booing and clapping are equivalent but calling someone a liar in the middle of a speech is a whole different level.

Rob Miller is up to 390K!

http://www.actblue.com/entity/fundraisers/19079

Miller’s contributions have gone up $40,000 in the last 30 minutes. Any questions on that point are now settled.

Booing the President is fine. Doing a rebuttal speech afterwards is procedure. Talking over the President when he gives a speech is not criticism but obstruction. The Republicans were holding up signs, making faces and noise, and while it made them look obnoxious, it was okay. Wilson went against Congressional policy. That will certainly make his base happy, and those folks in Illinois who think their job will protect them, but it probably cheesed a lot of swing voters off.

Charles Boustany, who did the after rebuttal, indicated agreement with the birthers and then backed off.

$391k and counting as of 3:55pm ET. That was an expensive outburst for Congressman Miller.

Charles K. Bradley @ 58

Boustany has been sued three times for malpractice that I am aware of. Judgment against in the first two and settled out of court the third. The first time his victim (er, patient) lost a leg.

I wouldn’t trust _anything_ this wanker ‘knows’.

Marvel @ 73 – just because a doctor has been sued for malpractice three times doesn’t make him an reliable source. Even if judgement went against him.

While I don’t think malpractice suits and tort reform are the only issue, they are Anissue in our itchy litigious finger society.

Hmmm. Clearly this guy was being a jerk.

However, I have to say that I enjoy watching video of Parliament and hearing the MPs of one party heckling the speaker or the MPs of the other party. It’s vivid and charming. Question Time can be particularly fun — especially when the government representative can hold his own against the hecklers, as some can (using the same sort of skill that stand-up comics use to shoot down hecklers).

Parliamentary rhetoric remains on a higher level than Congressional rhetoric despite all of this. And its vastly more watchable.

But this guy will not be the vanguard, I think.

I have no idea why my spell check switched your name to marvel. My bad for not catching it.

Regarding the actual rebuttal after last nights speech, I’d say it’s just weak when your major selling point is “we’ve got a website about this”.

Josh Jasper at #68

I was not clear enough, and also slightly off topic, so let me clarify. Except for the first paragraph in my earlier post (#67) I was not in any way, directly or indirectly, expressing a position, or opinion, on the subject of Wilson’s recent fuck up. I was trying to get across the idea that “in the most general sense” it is a good thing to call a person on a lie, if they are lying, when the lie is about something important. And also that it doesn’t matter to me who the person is or what their rank is. Actually, I would say that the higher the rank the more important it is to call the person on a lie. I understand that other people may not agree with this. I also think those other people are wrong. And yes there are many many people who think that it is a bad bad thing to be impolite to very important people. Very important people have been taking advantage of that since we developed into a social species.

With respect to this particular situation, even if Obama where indeed lying, Wilson was a fool to call him on it at the time and in the manner that he did so. The thing that should “shock” people about this is not that Wilson called the president a liar when it was against the rules (fuck that), but that he was so obviously wrong about his accusation that he was either lying himself, in a most unsavory way, or that he is criminally moronic, especially when one considers that he is a high ranking politician who is supposed to be informed about the relevant topic.

Most of the right-leaning sites I frequent haven’t been as critical of Wilson. They seem to be supportive and some have said they wished their representative would have spoken up. My guess is that most of the people that are angry are people that probably wouldn’t have voted for him anyway and the people that did vote for him aren’t going to vote for his opponent based solely on his outburst.

In an apples to oranges comparison, I remember when Bush was the target of a shoe. A lot of people thought he had it coming.

I also enjoyed the expression on Nancy Pelosi and Joe Biden’s faces…

and Obama’s look was probably the one he throws his kids when they act up, a perfect choice. sort of a ‘do not make me stop this car’ look.

poor mr wilson, he forgot he wasnt at a teabagger stuffed town hall, but rather a joint session of Congress in front of alot of tv cameras, not all of them run by Fox.

Steve Sundeen @78: I admired the shoe-throwing sentiment and abhorred the action.

Even if I thought the outburst correct, I can’t see it as justified. It’d be nice to have a more British parliamentarian-style format, but we don’t, and breaking it was as rude as throwing the shoe.

The matter simply wasn’t important enough to justify the yelling out.

Darrell E: “The thing that should “shock” people about this is not that Wilson called the president a liar when it was against the rules (fuck that), but that he was so obviously wrong about his accusation that he was either lying himself, in a most unsavory way, or that he is criminally moronic, especially when one considers that he is a high ranking politician who is supposed to be informed about the relevant topic.”

Agreed that the fact that his outburst was itself a lie should be shocking, but in the context of the last month (hell, the last several years), it’s not.

It’s worth noting is that the leaders of Wilson’s own party evidently wasted no time coming down on him like a ton of bricks. (Well, the official leaders did. The unofficial ones, not so much.) Considering their recent behavior, I doubt there was much to it other than a realization that Wilson’s outburst was politically beyond stupid. But that much was obvious, even to them.

Contributions to Wilson’s opponent will break $400,000 today. Contributions to Wilson? I hear he’s pulled in less than $1,000 … plus a wry thank-you note that’s unsigned but has a return address of 1600 Pennsylvania Avenue.

@78 Like him or hate him, Bush was our president. It doesn’t matter what the circumstance, you do not throw shoes at the POTUS. I can only wonder what the result would have been if the target was Ahmadinejad.
While not in the same league as a thrown shoe, Wilson’s verbal missile was not just remarkably bad form but, as noted earlier in the thread, against the RNC’s own rules.

Steve, Bush was the target of a shoe thrown by a man whose country Bush had just spent years blowing all to hell for excuses that were flimsy at best, and mostly outright lies. Muntadhar al-Zaidi threw his shoes at the man who decided to prove he had a bigger dick than his father by disrupting the country his father had better sense than to disrupt, and who was responsible for total chaos and widespread death in al-Zaidi’s beloved native land.

Apples to oranges, as you say. But more like an apple seed to the entire combined orange crops of California and Florida.

(Personally, I think al-Zaidi is a hero, and it’s too bad Bush’s nose wasn’t broken.)

melendwyr @ 80, I agree and I am certainly not trying to defend Wilson. I am just suggesting that his supporters probably won’t care.

Xopher @ 83, I wouldn’t call him a hero, but I can understand why he did what he did.

I do not understand the double standard. In 2004 and in 2005 the Democrats booed and hissed President Bush during a joint session of Congress. Why was that OK and this is not? Why is everybody quickly calling Wilson a liar for calling President Obama a liar? Are you telling me that hospitals will be able to request proof of citizenship prior to admistering any healthcare to patients? If not, then how are we not going to pay for illegal aliens’ healthcare?

I think what you folks aren’t remembering about the shoe throwing incident is that, culturally speaking, in Iraq shoe throwing is a grave insult.

See, if Wilson had thrown a shoe at Obama last night, it would have been okay. Because that isn’t on our cultural list of grave insults.

Do you remember how reporters went out of their way to include that tidbit?

Speaking truth to power is just fine. But in a joint session of congress during a presidential address it’s right out, whether or not the president is in fact a liar. Now, if that speech had taken place in Iraq, it’d be a totally different matter.

Ignoring the circumstances surrounding this particularly incident, wouldn’t it be better if the politicians were more concerned with the laws and substance rather than reelection?

Making all of your decisions based on what will get you re-elected is half the problem with the government anyway.

I’m not saying what he did was right. I’m just saying that if the first thing he is taking into account is how many donations he will get, he’s not doing his job right.

There’s a lot of reference to the more rough and tumble nature of Parliamentary politics when compared to American congressional style debate. This is true as far as it goes. There’s a lot of heckling, interjections and the like.

However, as far as I’m aware (awareness extending to NZ, Aus, UK, and Canada), almost all Parliamentary systems specifically prohibit calling someone a liar in their Standing Orders. If you call someone a liar, you’re forced to withdraw and apologise by the Speaker, or you get kicked out of the debating chamber.

In summary: Even in a Parliamentary system; not ok.

Can someone show me where to look in the house or senate bills where it discusses procedures for verifying citezenship before recieving health care subsidies from the government?

Steve Sundeen: “I am certainly not trying to defend Wilson. I am just suggesting that his supporters probably won’t care.”

Some subset of his supporters no doubt now think he’s God’s gift to America. Others approve less strongly, or don’t care. Others may actually realize that his behavior was politically stupid, and almost certainly helped Obama. They may not vote for Wilson’s opponent, but they be less likely to bother voting for him.

Meanwhile, Wilson’s likely opponent in 2010 has just had a huge windfall, even if one only looks at the money.

@Clifton #85 There’s no double standard. You seem to think it isn’t uncommon for the minority party to boo certain parts of a Presidential address to Congress. And has been stated here before, two wrongs do not equal a right. It’s the argument of children, really (well, they got to do it!). Also, there’s always been a response from the other party which airs immediately after which can outline those specific areas where they disagree. It’s not like Wilson had to say anything.

However, yelling at the President “You lie” crosses a line between respectfully showing your disapproval and impugning the character of the President during his own speech.

Honestly, it’s almost lucky that the Republicans had Wilson to embarrass himself. It neatly distracted any conversation from a number of other childish things they were doing during his speech.

Two ways I’m also looking at this. One, either he did this as a badly calculated ploy to embolden his base, which by the donation numbers would seem to have backfired greatly. Or two, he’s too much of a hot-head to sit in a chamber for an hour with people he disagrees with (yet still has to work with) and not yell something embarrassing. Either option does not look good.

Nearly 500,000 in less than a day? Is this site accurate?

Dave McFarland:Can someone show me where to look in the house or senate bills where it discusses procedures for verifying citezenship before recieving health care subsidies from the government?

Ah, this is the most recent line of attack, eh? So, when was the last time you were in a hospital? I am assuming that you needed to provide a SSN, drivers license, usually another form of ID and a bevy of phone numbers and contact information. Why is this so hard to fathom?

Dave @ 89:

Probably the same things that are needed to get access to most government systems – social security number, etc. Do you really want more than that? Do you want to have to show your passport every time you go to hospital? Or every time you use any government service? The library? A municipal swimming pool?

All of these are public services that should only be used by legal residents. Do you want anything more than a standard check for any of these things? Cos, you know, if you have blanket citizenship checks they will apply to you, too. Not just people with funny accents.

Tim – snap.

Is it too much to ask people to read the whole thread before commenting? @85 Clifton we addressed the whole both side booing/clapping much earlier. The most complete bill HR3200 specifically states that public assistance funds cannot be used to pay for illegal aliens health care. How much more specific do you want?

Cliftonon: “I do not understand the double standard. In 2004 and in 2005 the Democrats booed and hissed President Bush during a joint session of Congress. Why was that OK and this is not?

Because, as pointed out previously (Josh Jasper at #68 among others), a direct attack of that sort in that setting crosses a line that even Republicans have said should not be crossed.

Why is everybody quickly calling Wilson a liar for calling President Obama a liar?

Because it’s either that or calling him ignorant.

Are you telling me that hospitals will be able to request proof of citizenship prior to admistering any healthcare to patients? If not, then how are we not going to pay for illegal aliens’ healthcare?

What it means is that undocumented workers will be continue to be treated in the haphazard, short-sighted, incompassionate, and far-more-expensive-in-the-long-run way we do now. But at least it won’t make Glenn Beck cry.

Joe Wilson does not know what a “lie” is.

The Definition of Lying and Deception
First published Thu Feb 21, 2008
http://plato.stanford.edu/entries/lying-definition/

There is no universally accepted definition of lying to others (Kagan 1998, 113). The OED definition of lying is as follows:

To lie =df to make a false statement with the intention to deceive.

There are several problems with this definition. According to it, a person who makes a statement that she believes to be true — a person who makes a truthful statement — with the intention to deceive another person, is lying, if, unbeknownst to her, the statement is false. For example, if A tells B that there is not a board meeting on Thursday, which A believes to be true, with the intention that B believe there is no board meeting this week, which A believes to be false (since A believes there is a board meeting on Wednesday), then A is lying to B, if A is mistaken, and there is a board meeting on Thursday. Also, according to this definition, conspirators who knowingly make untruthful and false statements to each other, without the intention to deceive each other, but with the intention to deceive eavesdroppers, are lying. Both of these cases are controversial, and it is not clear that we should classify either of these cases as lies.

The most commonly accepted definition of lying that manages to avoid these problems is the following: “I take a lie to be an assertion, the content of which the speaker believes to be false, which is made with the intention to deceive the hearer with respect to that content” (Williams 2002, 96); or, more formally:

To lie =df to make an assertion that is believed to be false to some audience with the intention to deceive the audience about the content of that assertion.

This definition is normally unpacked as follows: “A person lies when he asserts something to another which he believes to be false with the intention of getting the other to believe it to be true” (Kupfer 1982, 104); “[lying is] making a statement believed to be false, with the intention of getting another to accept it as true” (Primoratz 1984, 54n2). More formally:

To lie =df to make a believed-false statement to another person with the intention that that other person believe that statement to be true….

Copyright © 2008 by
James Edwin Mahon

Well, given Wilson’s past emotional outburts, perhaps we should chalk it up to his character. Or to a dislike of miscegenation.

Nargel@73: Boustany has been sued three times for malpractice that I am aware of. Judgment against in the first two and settled out of court the third. The first time his victim (er, patient) lost a leg.

Er, what? The guy lost two malpractice suits out of three? And one case the patient lost a leg?

And then he gets up and says we need “Tort Reform”????

The reformers should be all over him like a cheap suit.

Forget rude. Forget protocol.

Wilson was lying.

And he was lying right after the president said enough of this lying crap.

That’s how far these nutters have gotten from reality. The truth no longer matters to them. Obstructionism is all that matters.

gwangung, ‘a dislike of miscegenation’ is delightfully mealy-mouthed, but why not just call ~~a spade a spade~~ it what it is? He’s a racist bigot, and that probably contributed to his willingness to call our racially-mixed president a liar.

#102….

Yes, but I wouldn’t get such amusing responses if I were more…forthright….

(Seriously…I was gob smacked when I heard of that).

Rob Miller is at $489K.

http://www.actblue.com/entity/fundraisers/19079

Oh, dear. It gets better for Wilson.

Can someone show me where to look in the house or senate bills where it discusses procedures for verifying citezenship before recieving health care subsidies from the government?

It’s right before the part where that information will also be used to put conservatives into the camps, where they will go before death panels.

Why do folks scream about government intrusion in their lives except when it might screen out illegal immigrants?

510k

I must say that I am very worried about the level of “discourse” about this issue. In our local paper, most of the online comments about Wilson are along the lines of “Good for him! It’s about time someone called the President a liar!” These people have already made up their minds, and no amount of pointing out the facts is going to change their minds. They don’t want their minds changed. They don’t want to consider another point of view. They want to be righteously angry. I know that for this particular paper, there are a lot of people who seem to have nothing better to do than troll about. This blog is where I come to see that there are indeed critical thinker who can form a coherent thought.

But there are so MANY others who just don’t want to bother. It truly scares me. How long before our country is indivisibly split? These people don’t want to get along or compromise. They want their rage.
Here’s a link to Peter Watts’ blog. In it, he discusses the fear response and how it comes out in politics. Guy writes some killer books, too. But the conclusion he comes to is truly chilling.
http://www.rifters.com/crawl/?p=184

Boerger @ 91

I did not intend to elude that Wilson was correct in his acitons. I agree, that as a professional Wilson should have kept his mouth shut. My comment was not ment to be inturpreted as a childish “they did it so why can’t we.” It was meant to say that we did not have a problem with the booing and hissing in past address, therefore we should not be in such an uproar for this comment. There is no doubt that there is a lot of passion in the debate over government run health care. The funny thing is that we are wanting to string a man from a yard arm for making a 1.3 second comment, but we are losing sight or at least ignoring the direction of this country. We are looking at another freedom being taken away from us ad our debt is skyrocketing. We are buying things that we cannot afford. Health care has problems, but my government wanting to run a business is not the answer. I do not think that I should have to pay for a deadbeat that sits at home all day smoking weed or snorting cocaine. We have the freedom to buy insurance or not. If I feel that I would rather buy a nice car than pay for insurance, then that is my right. If we truly want to fix health care, then lets reduce restrictions on insurance companies and allow companies to insure across state lines, create limits to law suits, and monitor doctors and ensure that they are not profiting from pharmaceutical companies. There is no solicitation of input from all parties, and in addition lets not lose sight of the fact that this bill was almost shoved down our throat with only 3 days to review the 1000+ page bill. Where are the cable televised bipartisan discussions that President Obama promised during his campaign?

Clifton:

Or you could adopt some variation of the many systems, all involving some government role, that produce verifiably equal (in some cases better) health care results that America, at a verifiably lower cost, in virtually every other first world country.

It was meant to say that we did not have a problem with the booing and hissing in past address, therefore we should not be in such an uproar for this comment

Uh, there *was* an uproar over the booing, at least among the rightwing commentariat.

You’re stuck with the logic. If the booing was bad, then so was Wilson. You ready to conclude that?

Er, just as an aside to #22:

http://www.boingboing.net/2009/09/09/opponent-of-republic.html#comment-584546

Cut-and-paste much?

Other Bill @86:
“See, if Wilson had thrown a shoe at Obama last night, it would have been okay. Because that isn’t on our cultural list of grave insults.”

But it would have been assaulting the POTUS, which the Secret Service would tell you is on the legal list of felonies. As a Congresscritter in the House chamber, he would have had the right to be tried by the House rather than an ordinary DC jury, but still…

@69, Jim and 71, KatG

I, personally, do not consider them to be the same as applause as booing is generally more of an obstruction than applause (as people will try to boo louder than the speaker to drown them out) although I see how booing is seen as the opposite of applause. Honestly, roast him an opposing speech, parody him on SNL, but at least let me get out his entire thought before expressing your opinion.

#114: I never said booing was the same as applause. I said that booing and the antics the Republicans were doing at the speech were “fine,” meaning not that I find them to be fine, but that such negative behavior had been accepted in the past in Congress as within acceptable but frowned on limits. What Wilson did, however, broke the rules of Congress he’d agreed to follow, because what he did interrupted the speech and obstructed the President from making the speech. Which is taken pretty seriously, as you can see from the reactions of other Republican Congresspeople.

Now, you can make the argument that booing also can interrupt a speech if loud enough, but that has not been evaluated by Congress to have been the case so far, from either Republicans or Democrats mistakenly thinking they’re in the British parliament. Wilson went the step beyond, from background objection to outright interruption. There will be much tut-tutting, but I doubt anything else will happen to him for it. The damage that was done to Wilson was done by Wilson. If he cannot hold his “emotions” in check during official functions, perhaps he should consider another career. Or if we’re lucky, it will be considered for him.

The President has accepted a second, personal apology from Wilson, saying that the man made a mistake and let’s move on, essentially.

Folks, there’s a light on inside Clifton’s head, but no brain in residence. He’s been asking the same question again and again, and despite a reasonable response, he’s too dim to get it. I suggest we move on.

Silbey @ 111

Yes I will concede that.

As much as I dislike booing, shouting out rude comments is a step worse and I hope it doesn’t become something that happens on a regular basis. If someone in the audience has something to say, wait until the speech is over. If there is a public comment opportunity, then use that. Otherwise, stage a press conference.

As for the substantive part of the speech, I hope we can now discuss the particulars and avoid the hyperbole that has seemed to be in the spotlight. I still have some questions and concerns and hope that nothing happens too fast.

Yes I will concede that.

Excellent! So you’ll be glad to hear that Wilson’s opponent has now gotten over 500K in donations since last night.

@ Clifton #109: Funny…you see when you ask a question, I would expect you want an answer. Seeing you brought up the whole Wilson thing even though there were several comments about it earlier in the thread, I guess I was just silly thinking that your comment was not rhetorical. What would you do if someone ask four seperate questions in their comment? *rollseyes*

But to get to the meat of your comment, this is what strikes me about your questions and positions. What “freedom” exactly is being taken away? Careful answering this because I would say that your credibility is at stake. I know it’s in vogue to throw the words freedom and liberty around (almost as much fun as calling people that disagree with you socialist fascists) but anyone paying attention to the bill itself would be hard pressed to find anywhere that a freedom is taken away.

Let me ask you something. What do you think should happen with people with a legitimate medical emergency or concern who do not have health care? Do you propose to turn them away at the door? Are you safe from your position that you can say that all those who do not have health care are in fact deadbeats? What do you do with them? You see these millions that are not insured are all deadbeats, but the great unfortunate underclass…the working poor, the people who don’t qualify for “pre-existing conditions”.

If they should be treated, as I believe, then the need for adequate, affordable health care is a manifest need. If you think that they should be turned out, then that tells me something of your character and we really have nothing further to discuss on this. However, I am going to assume that you do not believe that people should be turned out. If so, then it’s how we pay for them, because we’re already paying for them. Is the answer to keep the current trend when their only option is the emergency room and potentially financial ruin or is it to get people in for regular checkups, get people to get early treatments and keep them healthy at a low cost to society rather than dealing with ERs and ICUs, all at a vastly inflated rate because it’s too late for regular treatment.

I guess I would take the “reaching across the aisle” part of your comment more seriously if there weren’t prominent Republican leaders who have very vocally spoken about not trying to get health care done in any way…make this Obama’s Waterloo and break him, is how Senator DeMint put it (also from SC, what is going on down there?). Some of what they were proposing could be done, but it’s not really a fix…it’s not helping with cost control or quality. In fact I challenge you to find an instance of deregulation in the last thirty years that has actually lead to lower prices and higher quality.

Let me ask you this. Say you didn’t have to buy insurance and you did get that nice car. Well, we’re into game theory then aren’t we. Are you lucky enough to survive the odds…if you get sick, then what? Who takes care of you?

To be fair, Obama *is* a politician.

It wasn’t the right time, wasn’t the right statement to disagree with, wasn’t politically smart, wasn’t motivated by anything resembling the desire for truth. Wilson is getting spanked and he deserves it.

Yet I still find it immensely amusing that he’s getting into trouble for calling a politician a liar.

Couple of things the pro-health care folks who are supporting President Obama’s claim that no federal dollars will be spent subsidizing illegal immigrant health care.

1. While the language in HR 3200 does specify that illegal immigrants are not entitled to the low income subsidies to obtain health insurance, there is no specific legal requirement to verify citizenship or legal status in the US. It leaves it up to the Health Commissioner to determine eligibility for low income subsidies. All this means is the illegal immigrant can participate in the health care exchange system without any awkward questions about his or her legal right to live in the United States. Nice, that.

http://assets.opencrs.com/rpts/R40773_20090825.pdf

2. Medicaid is managed by the states, the federal government merely provides the money and legal guidance on coverage, etc. 46 states do not ask for any proof of citizenship while enrolling people on Medicaid, they accept a signed statement from the enrollee stating they are a citizen. Half of those states don’t even audit or verify those statements. So, right now illegal immigrants can lie and be enrolled in Medicaid if they live in a state with sloppy record keeping.

http://www.medicalnewstoday.com/articles/28666.php

As an aside, I work for US Citizenship and Immigration and I can attest that employers go through more of a hassle to verify the citizenship/legal status of their workers, as they should, than hospitals/Medicaid go through to verify citizenship/legal status. Heck, President Obama recently gutted a provision in immigration law that encouraged local/state law enforcement to assist in legal status verification when they place a person under arrest. Previously, local/state law enforcement could check, after being certified by ICE and undergoing training, the status of arrested subjects and if they were found to be in the country illegally, to turn them over to ICE custody for expedited removal. Now, the Obama administration requires that criminal charges must be pressed for all cases where local/state law enforcement has checked the legal status of the subject, regardless if the case is a misdemeanor or felony, before the federal government will accept custody for removal. This means that local/state jurisdictions have to go through the time and expense of prosecuting all of these cases even though the subjects are subject to removal under the INA. This is just a repeat of the Clinton administration, placing legal hinderances in the path of law enforcement .

these guys want to do everything the way it was done in the days of the Founding Fathers:

http://www.associatedcontent.com/article/1161398/ready_to_rumble_greatest_fistfights.html?cat=9

1798: Roger Griswold (CT-Federalist) v. Matthew Lyon (VT- Republican)

On January 30, 1798 in a debate over international relations, Congressman Matthew Lyon implied that Connecticut Federalists, including Roger Griswold, were corrupt. Upon hearing this Griswold called Lyon a coward on the Senate floor. Lyon responded, in turn, by spitting in Griswold’s face. A motion to expel Lyon from the Senate on this basis failed.

Thus, on February 15, Griswold decided to take matters into his own hands. On that date he charged across the Senate floor and began striking Senator Lyon about the head with a heavy wooden cane. Lyon arose and retreated to a fire pit were he grabbed hot tongs to defend himself, but Griswold was able to disarm him. The two locked up and exchanged blows briefly until they were broken up.

the illegal immigrant can participate in the health care exchange system without any awkward questions about his or her legal right to live in the United States

I bet they’re using our roads, too.

Quick, how do I dupe my nemesis into heckling the Prime Minister? I could do with the cash.
Well, not really, but it would be nice to have regardless of need.

Charles @ 5

The House of Commons is the only thing I watch on C-Span. LOVE IT.

Christopher@123

It sounds like you feel that deporting illegal immigrants is more important than reforming health care. That’s OK. You’re a grown-up and you’re entitled to your own priorities.

But from a health care perspective, it makes sense to provide risk-free, moderate-cost service to everyone, regardless of their legal status. It’s been said here several times: emergency-room treatment is one of the most expensive ways to visit the doctor. And the cost is frequently distributed to all of us.

If I can improve my access to treatment, raise its quality and reduce my costs simply by allowing an illegal immigrant to visit the doctor without getting deported, that’s OK with me. From my perspective, it’s not a matter of medicine interfering with law enforcement. It’s a matter of law enforcement standing between me and my doctor. I suspect that many people feel the same way.

@ 125 Silbey.

Snark will not cover this basic fact; the Democrats have no qualms with allowing unfettered immigration into the country. Comprehensive immigration reform is just a nice way of pandering to the Hispanic vote regardless of the scorn those illegal immigrants have shown to the laws of the country. I have seen, in the course of my job, petitioning immigrants who have followed the law and are told, sorry your visa isn’t available yet and have had cases pass before my desk where the petitioner has lived in the country illegally for years, gotten nabbed for some other reason (ie gotten pulled over for speeding, etc) and walk out of our office with an approved visa petition because Congress wrote them a blank check to legalize and will do it again to pander. My fiancee’s family has been forced to undergo separation because when their visas became available, the oldest daughter was over the age of 21 and thus not eligible to ride along on her mom’s visa petition. They spent 23 bloody years waiting for the visa to become available in the first place. So, again Snark and Guile will not conceal your party’s blatant pandering.

Christopher Schaffer:

What you’re basically saying is that in fact the claim that illegal aliens are ineligible to participate is correct. You’re also suggesting there needs to be a more robust process for assuring those who sign up for insurance are eligible. Which is of course an entirely legitimate concern.

However, these are separate than the rather bad logic that Wilson, et al seem to be employing and propagating. Rather than making himself look like an angry jackass with poor impulse control in front of the entire country, Wilson should have done what his actual job is, which is to offer a plan to strengthen the safeguards against the ineligible from entering the system.

@ PalookaJoe

I agree with your basic underlying premise., ie it is humane and decent to try to provide coverage to those who can not afford it and avoid having the expense of ER bills passed along to the general consumer. However, I disagree with the specifics and intent of Obama’s health care reform. His intent, in my opinion, is to shepherd the health care system, over time, to a single payer system. I simply think there are better ways to increase coverage to those who can’t afford it, like creating high risk pools/tax rebates for people with low income or pre-existing conditions. That, in my opinion, is a lower cost, more achievable way of helping contain health care costs rather than having the government manage the whole kit n’ caboodle through the proposed health care exchange.

the Democrats have no qualms with allowing unfettered immigration into the country

Oh bull. There’s no attempt in the Democratic Party to allow “unfettered immigration” into the U.S. At most, there’s an attempt to make things slightly easier. Stating it that way just makes you look completely non-credible.

(by the way, the Republicans are really determined to make sure that no Hispanic pulls the lever for the GOP ever again, aren’t they? Between the treatment of Sotomayor and the reflexive cries of “illegal immigrants” at every issue, no matter how silly, they’re doing a spectacular job of alienating a group that they had a shot with as recently as 2004. Good job.)

So, again Snark and Guile will not conceal your party’s blatant pandering.

Oh, Lord, you really don’t know what you’re talking about, do you? The largest immigration amnesty bill was passed in 1986, by a Republican Senate and Democratic House of Representatives and signed by–gasp, shock, horror!–Ronald Reagan.

Tend to your own house.

John,

The Republicans did in fact, offer amendments to strengthen the safeguards, offered by Rep Heller of Nevada and defeated it under a party-line vote in commitee. The Democrats excuse was it would be unnecessary burdensome to everybody who may be entitled to health care benefits.

http://republicans.waysandmeans.house.gov/UploadedFiles/Heller_Amdt_Text.pdf

@ PalookaJoe

“But from a health care perspective, it makes sense to provide risk-free, moderate-cost service to everyone, regardless of their legal status. It’s been said here several times: emergency-room treatment is one of the most expensive ways to visit the doctor. And the cost is frequently distributed to all of us.”

Well put. In fact, since illegal immigrants are disproportionately young and healthy, allowing them to participate in (and pay premiums to) the government plan for the uninsured would actually save the rest of us money, even over and above the savings in reduced emergency room care you cite.

It’s politically impractical to suggest covering illegal immigrants, but it would be good policy, both fiscally and morally.

It’s really amazing how much of the conservative position goes along the lines of “Well, I technically agree with Obama, but his super secret evil socialist plan that I’m sure really exists proves he’s an evil socialist”

Do you people realize how asinine that sounds?

Well, then, they should get back in there with another plan that would be less burdensome to those entitled. QED. If it’s actually a priority for folks, they should be willing to keep working at it.

clifton@110: I do not think that I should have to pay for a deadbeat that sits at home all day smoking weed or snorting cocaine.

I’ve been to a number of european countries, and I have to confess, the number of deadbeat, weed-smoking, cocaine-snorting people who sit at home sponging off their free healthcare is mindboggling.

mindbogglingly small that is.

Put another way, given all the real world examples of nations with completely socialized medicine and other forms, and given that health care reform being proposed in America is limited to regulating the existing private insurers to say they can’t boot people for preexisting conditions and creating some kind of public option that the people who join it have to actually pay for it, given all that, do have the slightest bit of reality-base in that statement? Cause I’m not seeing it. I’m seeing “cause panic by asserting completely outrageous nonsense to prevent any progress to a real solution” rather than “this is something that real world experiences in other nations with similar systems have run into.

Put another way: Your favorite band is a heavy metal group called “DEATHPANEL!” right?

Christopher@123: All this means is the illegal immigrant can participate in the health care exchange system without any awkward questions about his or her legal right to live in the United States. Nice, that.

Did you know that 63% of all public highways are used by illegal aliens? I say we stop building roads so the damn wetbacks can’t use roads we built with our money.

Oh, wait, the exchange system if for people with insurance and the public option will be paid for by the people who join it. The idea is it will be cheaper because it isn’t profit-motivated.

So, it’s like we’re proposing to build public highways that everyone can drive on, but they’re all toll roads. Which means if a wetback somehow slips into the system, they’ll be paying tolls just like everyone else.

As an aside, I work for US Citizenship and Immigration

As much as you hate immigrants, that’s like making Gargamel police chief of the smurfs.

Oh, yeah, and I almost forgot…

ALIENS!!!!!

@ Silbey

Does “slightly easier” translate into putting people who have been in the country illegally at the head of the visa line ahead of people who have petitioned for their sons/daughters/sisters/brothers and waited patiently for years for their visa number to become available? After a mere slap on the wrist, a meaningless promise to learn English and a green card? I’m in favor of allowing people who are currently here illegally to stay, provided they can provide means of support, a reasonably clean criminal record and wait their turn, just like everybody else.

The 1986 Act was well intentioned and sound in theory, but an utter disaster in practice. ICE/DRO agents will tell anyone who listens that employers face little sanction for going through the motions of checking eligibility (ie not reporting fake or suspicious I-9 forms).

I’m kind of in favor of letting the illegals get health care, actually. They make tasty food and I’d like to keep eating it. >.>

@ 137, Where the bloody hell do you get off assuming I hate immigrants, I’m marrying a naturalized US Citizen, you jackoff!

Christopher@131

I’m kinda ambivalent about single-payer systems. Here’s what I care about instead: I want to see the right to health care become a part of our legal system and culture. It’s an essential part of that whole “life, liberty and the pursuit of happiness” thing.

If the path to that cultural shift leads through a single-payer system, then I’m willing to give it a try. But if it leads somewhere else, I’m OK with that too.

John, I suspect that the Repubs could offer amendment after amendment till they’re blue in the face and that will not satisfy the House/Senate Dems till the verification process becomes legally and structurally toothless. E-Verify is a really simple system to use, but that was not good enough for the House/Senate Dems. Strange, ya think?

Let’s everybody try not to make personal attacks, folks. GregLondon, I notice you do have a tendency to go after people when you disagree with their ideas; try to do better. Christopher, please take it down a notch as well.

“His intent, in my opinion, is to shepherd the health care system, over time, to a single payer system.”

So you don’t think Obama is lying the way Wilson says he’s lying, since the bill clearly states that illegal immigrants are not covered, while Wilson claims — in a lie — that it does not. But you believe that Obama and the Democrats are lying in their repeated statements that they are not trying to create a single payer system, and despite having a reform bill that doesn’t attempt to create a single payer system. Let me guess, Obama is going to take all your guns away too with his fascist socialist police. Oh wait, you work for Immigration, you are the government and the fascist police.

The U.S. may one day have a national healthcare plan, but it will be long in the future before it’s at all possible. I predict about 100 years. Frankly, if we had one, it would be a lot easier to screen out and identify illegal immigrants from it, since it would all be centralized. But we don’t and we won’t. We still have a big sucking problem of healthcare. We also need to deal — humanely — with illegal immigration while making it easier for those who are trying to enter the country legally, whether their skin is white or not. But first, the big sucking problem and the actual reform bill, not socialism fantasies.

Bingo. Obama is always lying, it seems. Whenever it’s convenient to make a point.

@ Palooka; well then we are just going to have to disagree and fight within the system for the things we want to see passed into law. Me, I think a “right” to health care will lead to trouble because I believe the Founders were right to set up a system of negative rights (ie the government can’t do this, that or the other thing do you or infringe on your right to do such and such). A system of positive rights (ie a right to health care or a job) will lead to the encroachment of government into every single aspect of our lives, in my view. It’s statism, really and Marx/Engels’ system didn’t really pan out for any of the countries that have tried to implement it, ya know?

I was snippy and Scalzi reminded us not to be. I have no idea how you feel about guns, etc., Shaffer, and you also have a very tough job.

But the reality is that there is no national healthcare plan on the boards, nor plans for one.

“It’s statism, really and Marx/Engels’ system didn’t really pan out for any of the countries that have tried to implement it, ya know?”

Except, apparently, for every other developed country, who has “statist” health care, pays less – pays less per capita than the US government does, let alone total US healthcare expenditures, and has better outcomes.

Honestly, it’s really depressing when people’s sarcastic claim of “it never worked out for anyone else!” is so blatantly wrong.

@ Christopher Shaffer:

“Marx/Engels’ system didn’t really pan out for any of the countries that have tried to implement it”

This seems irrelevant to me, since the question at hand is healthcare.

The industrialized countries that have implemented a positive right to healthcare have found their systems to pan out very well indeed, relative to ours. They get better outcomes for lower costs than we do in the U.S.

Outcome ranking: http://www.photius.com/rankings/healthranks.html
Cost per capita data: http://www.nationmaster.com/graph/hea_spe_per_per-health-spending-per-person

Ah, I see some of the numbers I had seen were wrong; the US government pays less per-capita than Switzerland or Norway. So, the government alone is third. Still terrible in outcomes, still way too much spent.

Michael @ 148:

Its actually a different argument: it’s that what works fine for other countries is not good for the US because the US is a better country that any other.

This seems to be to be a basic article of faith in right wing american politics. Not that your country is really cool (which, largely, it is), but that’s its better than any country ever. Now I like my country just fine (NZ), its a great place, but I’ve also loved living in the UK and Canada. Its a stretch to say that any one of those countries is definitively ‘better’ than any other.

On the other hand, it seems to be heresy to republicans to believe in anything but extreme american exceptionalism. In fact, Lynne Cheney actually demanded that Obama say exactly that – “”America is the best nation that ever existed in history, and clearly that exists today.”

If that is your starting point, then of course the way every one else does it, although demonstrably just as efficient and/or more efficient, is wrong. Its the same reason that America is the only country in which there is genuine debate (spearheaded by Justice Scalia) about whether it is legitimate to rely upon comparative international precedents in court cases. If you are, as the Republicans tend to assert, by definition the best country in the world ever, of course you should ignore what everyone else is doing because they are, by definition, worse.

Miller is at $650,679 as of 11:05PM Eastern Daylight Time. If memory serves, he was a bit over $325,000 when I looked mid-afternoon. So in the eight hours since then, he’s raised $325,000.

If one assumes Miller had $0 when this started, it took about 20 hours to raise the first $325,000.

Do the math. The contribution rate is rising.

Wilson’s website is still just a stub.

Christopher@146

If the state did involve itself in every aspect of our lives I would be very unhappy. But it’s a long road between the right to health care and a totalitarian state. Human beings are gloriously chaotic creatures and outcomes like the one you describe are rarely guaranteed.

With all this uncertainty, it’s important to do the best we can with the situation in front of us. in other words, we gotta play the hand we’re dealt. And right now, we have the opportunity to improve the lives of ourselves and everyone else in the country. I don’t want to pass that up because I’m afraid of a hazy future.

GregLondon @ 101

Yes. Lost 2 out of 3 and would have gotten 3 for 3 but he settled out of court.
http://www.politico.com/blogs/glennthrush/0909/Boustanys_malpractice_history.html
source from politico of all places. :)

They try to whitewash it but it still sits there, case numbers and all. I love irony but this is too good.

OtherBill @ 75 & 77

If I’m who you’re talking to, no problem on the name. I also do not understand the relation between your comments and mine.

Taking a guess here that I might see where you are coming from, my response is simple. Some safeguards against nuisance suits are wise, yes. The current massive overreaction by the right is not wise and could quite easily be regarded as a defense by the monied intrests. Malpractice suits are typically make or break cases with the legal firm’s fiscal existence on the line. Massive amounts in research, documentation investigation, expert opinions etc. need to be invested before the case gets to the filling stage. When the ‘tort reform’ caps the possible return so low, even a good, deserving case can’t be undertaken. Thus the companies/doctors/corporations get away, sometimes with literal murder, because few firms will bet their life against a minor return.

Check out the Travolta film “A Civil Action” for the kind of thing, even before so-called tort reform, I’m talking about. The fact that the movie is about a true event makes my point even better.

To be fair, heckling the President appears to be slightly less hazardous to one’s political career than discussing sex with one’s mistresses while forgetting one is in front of an open mike.

Nargel @ 154 – I’m sure I flubbed my point. Night shifts with the new kid. My bad.

Two points to add on. As a preface, I’d agree malpractice suits and tort reform are not the silver bullet to fixing health care costs. First, doctors frequently have to deal with malpractice suits that are not related to their actual performance. Now that isn’t to say malpractice in general is fraud perpetrated by people to try and hit the lottery. If a doctor performs a risky operation to an unfavorable outcome that is grounds, today, for a law suit. The conversation is usually along the lines of not having explained enough about the particular complication encountered. Doctors frequently settle out of court as well because there they have an ability to negotiate a more favorable term of settlement. Just because a doctor has encountered multiple malpractice suits, or even settled out of court, is not *necessarily* an indication that they are at fault.

Second, it isn’t just the insurance companies that people sue. For example, a great many OB/GYNs are dropping their OB coverage because they either can’t afford their malpractice insurance or they don’t want their patients to be able to go after their personal assets.

In Florida, doctors have the option of surrendering their liscense to avoid a malpractice suit.

I don’t take umbridge with bonafide cases of malpractice seeking restitution for lost potential wages due to injury or recouping other losses. What I do have an issue with is substantial pain and suffering settlements.

As I said, I don’t think it is the silver bullet issue but is a substantial challenge for doctors to overcome, particularly those in high risk fields. And we can’t talk about improving health care costs in the US without addressing all of the many issues that serve as multipliers to the cost.

for example, When Obama says that they can cut costs by lowering the amount of unnecssary tests. I would guess that when one encounters an unnecessary test it’s much less likely to be a case of profit seekig than a case of needing to cover their bases against the very likely possibility of a malpractice suit. You can’t not talk about tort reform while promising to reduce unnecssary tests.

But agreed, it shouldn’t limit the rights of patients with legitimate grievances. And I dint know what the solution should be, just that it absolutely needs to be a part of the situation.

And, yeah, if my party weren’t currently being run by fourth graders it’d be nice if they’d step up and do their part. But when the party of John Edwards the millionaire retired trial lawyer neglects the importance of that issue I get frustrated.

Okay, cheap shot. But I’m not untyping it. That said, I was about ninety percent satisfied with what Obama included in his speech. So, at least at the end of the day we’ve got one calm rational pragmatic political leader.

Other Bill @156: So you’re totally OK with an incompetent surgeon leaving a scalpel in Grandma? After all, she didn’t lose any wages and probably has no ‘economic damages’, so why should she or her grieving children get to sue for silly things like ‘pain and suffering’?

Maybe you should join the party of people who think that the court system is reserved for the use of those whose last name is “Inc.” You’ve certainly regurgitated enough fact-free talking points to suggest that’d be a more appropriate venue.

Mythago @157 – yes. I absolutely think doctors are going to kill your grandmother. I voted democrat on the last election, so I suppose that’s the party line I Signed onto.

Look, whether we agree that malpractice suits are frequently abused by profit seeking trial lawyers, they are absolutely a part of the unnecessary tests issue that is frequently brought up. Whatever the solution to that is, and I hope it includes the ability for your grandma to seek restitution for that scalpel she’s carrying around, it needs to be a part of the discussion.

Interesting to note that one of the nation’s largest health insurers, Wellpoint, Inc. says medical malpractice is NOT driving policy premium increases. This quote and other related data here: http://www.bloomberg.com/apps/news?pid=20601087&sid=az9qxQZNmf0o.

The malpractice issue is a red herring. You could eliminate all medical malpractice lawsuits and we’d still have a health care crisis. And at the same time you’d worsen the medical error problem, which kills almost 100,000 people per year.

It could be worse for Joe Wilson. But for the grace of God, he could have been “Open Mike” Duvall of California. http://www.boingboing.net/2009/09/09/conservative-califor.html

It seems, judging by the majority of posts in this thread, that if you think the Prez and his “public option” health care plan is cool and all, heckling him during a joint session of Congress is “bad manners”, politically stupid and just flat out snarky.

If you think the Prez is a neo-commie, bent on “fundemental change” and “returning the nation’s wealth to its rightful owners”, then heckling him during a joint session of congress is speaking truth to power, politically brave and just flat out ballsy.

I’m of the second opinion. Joe Wilson rocks! I’m giving odds on his re-election.

Due to GregLondon’s outburst, the excellent point in the middle of his post seems to have been lost – If illegal immigrants join the exchange and buy the service… that’s *great* for us! It’s not a handout, after all.

As for immigration reform – while yes, I would like to see immigration made easier, I definitely would like to eliminate the perverse incentives to do it illegally.

And I definitely think that eliminating the underground of people afraid to talk to the police is more important than maintaining a consistent position of deporting them at the first encounter.
One could make a case that we ought to improve enforcement drastically, but I doubt we would get more than 90% of them, and we’d have to clobber that threshold to make it acceptable that those that remain would be an exploited underground.

~~~
As a last very procedural meta point — is there some way that a comment sent to the moderation queue can be granted a number anyway? That way when one is let in it won’t disrupt all our “name @ number” attributions. I think having gaps in the numbering system is a small price to pay.

@ Deuce

“If you think the Prez is a neo-commie, bent on “fundemental change” and “returning the nation’s wealth to its rightful owners”, then heckling him during a joint session of congress is speaking truth to power, politically brave and just flat out ballsy.

I’m of the second opinion. Joe Wilson rocks! I’m giving odds on his re-election.”

You misuse the quotation mark. It’s for setting off words that your subject actually said, not stuff you made up on the fly.

Opinions are persuasive to me only to the extent they’re supported by evidence, and you’ve offered none here.

What odds are you offering? I might be willing to take that bet.

Deuce:

That makes you either stupid or ignorant. Your choice [Scalzi, apologies if that counts as a personal attack. In this context I think its a simple statement of fact]. You use the word communist. I do not think it means what you think it means.

Mike mullen @159- malpractice being a smaller part of the general issue with health care costs doesn’t make it a red herring.

The article also supports the assertion that fear of malpractice is a driving factor in the rate of unnecessary tests. Tests which are frequently mentioned by the president as a prominent way to reduce the cost of healthcare and create some of the savings that they are talking about generating. Malpractice impacts the cost of healthcare in more ways then jury settlements.

My personal bias aside, that makes it malpractice important to, at the least, the discussion in general. Doctors will not stop performing unnecessary tests to protect themselves simply because a best practices document is generated by the government. At the bare minimum, and the article supports this, it could be important tothe politics of the situation in getting a greater health insurance passed.

And unnecessary tests impact all levels of the industry. As an example, I caught a bad bug just after a coworker developed strep throat. I went to the doctor to make sure I wouldn’t need antibiotics and she felt confident that I didn’t have strep but ran a throat culture to make sure. Maybe she was profit seeking or maybe defensive medicine has become so ingrained in US medicine these days that this was just her SOP for such situations.

I don’t follow how addressing medical malpractice increases medical errors. If additional tests are always required to prevent medical errors, wouldn’t that make the promise of savings through the elimination of those tests be sort of a cannard as well?

OtherBill @ various

I’ll admit that having a perfect loss record when it comes to malpractice suits tends to make me suspicious of ones competence. Even winning one out of three would look better.

From what I have been reading the last six months or so, most of the instances of overtesting are not defensive against the patient. They are in order to argue the insurance company into authorizing the procedure the doctor wanted to do in the first place but was refused by the company. THERE’S getting between the patient and his doctor!

I don’t know where the line on too much tort reform is but I can guarantee you that the line the Republicans (and, I believe, the companies that own them) want is way too far in the wrong direction. The insurance companies are also factually wrong as I have stated before. In the states where it was supposed to be a panacea against rising premium costs, it is barely noticeable if that.

I am aware of at least some of the impact that malpractice insurance has on a business. I have been involved for over 26 years in various civil, structural and architectural firms and have had long and in depth discussions with the principles involved at those firms. Yes, it is a tricky question and YMMV but I don’t see massive tort reform as the answer. I feel that a doable answer could be found after a long deep argument among people from all sides but they have to all be open to new ideas and all sides have been worked up by now to the point where that alone is going to be very difficult to get.

Luke @ 162

It would help if the companies that exploit the ‘illegals’ were to pay a heavy price. Get raided and found with over 3% non-carded and the company is shut down and the owners/operators are not allowed to be involved in a similar firm for 10 years, for example. Attempts to evade the restriction carry a prison sentence or a very heavy fine. That will give the guilty owners a strong reason to pay attention to documentation when hiring. Without the waiting exploitative jobs, most of the reasons to jump the border go away.

The problem is getting the employer-punitive laws on the books and enforced. After watching a mild law, that took years to get into place, get postponed for over a year on implimentation and watered down, then dropped when the Republicans thought they could get away with it, I know that is the big problem.

@Christopher

Does “slightly easier” translate into putting people who have been in the country illegally at the head of the visa line ahead of people who have petitioned for their sons/daughters/sisters/brothers and waited patiently for years for their visa number to become available?

Does an anecdote translate into actual evidence at any point or will you just keep repeating it over and over again? And exactly what does this have to do with the Democratic Party? Did Obama come down there and give out the visas himself? That the Dems may want to ease immigration restrictions has nothing to do with how well the current system is implemented. More, a saner immigration set up might well have *avoided* the situation you keep mentioning.

And you handwave away the fact that it was the Republican Party that awarded the amnesties in 1986. Why aren’t you mad at them?

It’s now closer to $800,000

$708,094 as of 8am

Oops. Read that as ‘780,000’, not ‘708,000’. Sorry.

Dave Neiweret would like to let us know that Joe Wilson is proud to announce his membership in a racist dominated outfit called “Sons of Confederate Veterans”.

Nice fellow.

The Southern Poverty Law Lenter has the dirt on the SCV.

Other Bill @158: What I’d actually like to agree on is that the discussion should be based on evidence, not “Boo! Lawyer gonna getcha!” Either you want to talk about facts, or you don’t. If you do, then you need to know what you’re talking about; understanding what non-economic damages really are, or the fact that there is no such thing as a “jury settlement”, would be good starting points.

Nothing in the linked article supports the idea of defensive medicine as a real problem – though I suppose ‘defensive medicine’ is a more palatable idea than ‘doctors who own testing facilities order more tests because they make money doing it’.

I really like the quote in the Bloomberg article by the AMA fellow who thinks protecting incompetent doctors and leaving their hurt patients in the cold is A-OK because, hey, you could like build a free clinic or something!

Other Bill: “I went to the doctor to make sure I wouldn’t need antibiotics and she felt confident that I didn’t have strep but ran a throat culture to make sure. Maybe she was profit seeking or maybe defensive medicine has become so ingrained in US medicine these days that this was just her SOP for such situations.”

You may have not had strep, but that didn’t mean you didn’t have a bacterial infection of another type in your throat. And she couldn’t be 100 percent certain that you did not have strep without the test, given that you’d been exposed to it. So rather than give you unnecessary antibiotics, she ran a test that would allow her to make a definitive diagnosis. It was a necessary test, and you’ve got a good doctor, who also kept you out of trouble with your insurer.

Part of healthcare reform, however, is reducing waste, such as duplicate tests, and despite all the hoopla reported, numerous doctors and healthcare professionals are currently working with the government about what they’re going to need and what they can do without. That would include malpractice issues. Of course, as soon as you start talking about reducing unnecessary testing and waste, your former party, the Republicans, start yelling that the Democrats are trying to “ration care.” If you say that you’re not trying to ration care, they say that you’re trying to spend too much. Stay over here with us Democrats where there is a little sanity. :)

Does anyone know how much ActBlue had raised for Rob Miller before this all started? In 2008, his grand total was $804, and there was an actual election in that year…which is a far cry from the $727K he has right now.

Deb, I can’t say exactly how much he had before it started, but I know that the first time I was linked to ActBlue, he had about $10,000. The donation flood has really been impressive.

Canada: $2100 per person for healthcare. $4 per person for malpractice insurance and costs

America: $5100 per person for healthcare. $16 per person for malpractice insurance and costs.

Those are the numbers. Tort reform might save at most $12 per person in a system that wastes thousands of dollars per person. Can we please stop with the nonsense that tort reform fixes anything significant at all?

Tort reform is conservative dogma. That’s it. The dogma is that the Free Market will find the best, most efficient, solution, and that lawsuits are nothing but inefficiencies. The facts show that an unregulated health insurance industry creates a far worse outcome than a regulated market, costing thousands of dollars per person MORE than a government regulated market. And while lawsuits add about 0.5% to the costs, many of those suits are valid.

The dogma is that the Free Market will find the best, most efficient, solution, and that lawsuits are nothing but inefficiencies.

Bwa? Free market advocates say that markets can find the best, most efficient states for an exchange system – which doesn’t necessarily mean what you seem to think it does – and you don’t seem to understand what they mean by ‘inefficiencies’.

Suzanne @ 176: Thank you! That’s amazing.

Free market advocates say that markets can find the best, most efficient states

Can? No, it’s not an option. The Invisible Hand will cause the best outcome possible. The only reason a market is inefficient, according to dogma, is because of inefficiencies like governmetn regulation holding back the invisible hand.

and you don’t seem to understand what they mean by ‘inefficiencies’.

anything less than the best possible outcome is inefficient. If, as you say, healthcare is strictly just a “product”, then if Canada gets that product for $2100 and America gets the very same product (but of lesser quality) but pays $5100 for it, then that’s $3000 of inefficiency.

If people are motivated strictly by getting the best product for the lowest amount, they’d support reform. If people are simply motivated by right wing dogma that says “government regulation is bad no matter what”, then they’ll oppose reform, no matter what.

If someone hates government regulation to the point that they’re willing to demand that EVERYONE pay an extra $3000 per person per year just to keep government regulation out of health insurance, well, they can demand that, but the rest of the nation doesn’t have to listen to them.

anything less than the best possible outcome is inefficient.

No, London, no. A market inefficiency is when prices don’t reflect the available information about a product, either because someone has relevant private information or because people haven’t thought out the consequences of what’s publicly known.

The whole point of markets is that they tend to eliminate such disjunctions, and people who can identify them are motivated to do so. (In a lot of cases, there’s no rational way to set the price for a product without letting the market reach equilibrium…)

Please, I beg of you – share your ideas about redesigning society to better match your convictions if you must, but at least get the terminology right.

The Deuceon: “It seems, judging by the majority of posts in this thread, that if you think the Prez and his ‘public option’ health care plan is cool and all, heckling him during a joint session of Congress is ‘bad manners’, politically stupid and just flat out snarky.”

It may or may not be bad manners to do what Wilson did, but even the Republican leadership believes it is — and I quote — “not permissible” in that context.

That Wilson’s behavior was politically stupid is a matter of simple observation, whatever one’s opinion of Obama’s proposals.

On top of all that, Wilson’s behavior might have been arguably the right thing to do … if he was right about Obama lying on that point. He wasn’t.

Unsurprisingly, Wilson is now putting up a oh-so-brave front (and not surprisingly showing his apology to have been a shallow thing). He knows that if he doesn’t, he’ll lose what’s left of his base. Politically, he’s toast. Now it’s only a question of whether he’ll stick it out through the 2010 election, or whether he’ll pull a Palin.

The point of Wilson’s “You lie!” outburst was that it was false. The bill specifically prohibits coverage of illegal immigrants. Obama was not lying. Wilson has now qualified that what he was commenting on was what our pal in Immigration brought up — that documentation requirements are slight and therefore illegal immigrants might sneak coverage under the bill. Which is not a lie of the bill but a policy issue about how best to enforce the part of the bill that bans illegal immigrants from coverage. It’s an important detail that needs to be worked out in the bill on the House floor, requiring possible amendments to the bill to make that part of the bill more effective. So Wilson was not simply mistaken, he was lying and making a false accusation.

Also of interest, healthcare stocks bumped upward today in the wake of the President’s speech. Seems the President showed the Democrats weren’t proposing anything different than what they’d already presented, and so not only would healthcare and insurers not have to cut off their little pinky toes, but had prospects to be even more profitable and thus attractive to investors.

melendwyr: No, London, no. A market inefficiency is

Well, there’s your problem right there. I wasn’t talking about “market inefficiency”, I was talking about Economic inefficiency

Economic efficiency occurs when nothing more can be achieved given the resources available. We can certainly achieve a lot more in reducing health care costs. So we’re not efficient.

Nargel @ 167 – I was thinking of that (put pressure on employers) as something that could come close. I think that if that started happening, the employers have a bit of room to get cleverer about how they hide their illegally-entered workers.

CNN is headlining this story”

“Wilson raises more than $200,000 after outburst”
http://www.cnn.com/2009/POLITICS/09/11/wilson.fundraising/index.html

But does mention near the end of the story this:
“The appeal for cash came as Wilson’s Democratic opponent in next year’s congressional race, Rob Miller, reported raking in $750,000 as a result of the outburst during President Obama’s address to a joint session of Congress. ”

I know everyone will chime in about how biased CNN is, but isn’t the more interesting headline the fact that Wilson’s opponent is outraising him 4 to 1? I’m probably more of a Republican than most Whatever readers, and even I can clearly see that the story isn’t emphasizing the most newsworthy angle. Why is Wilson’s moderate fundraising more important than his opponents 4x more massive fundraising?

Weak.

167/185 – as soon as the fed gov’t started putting more onus on employers to do that we’d never hear the end of ‘undue burdens on the small businessman’ or why does the small businessman need to do the job of law enforecemnt (that’s the gov’t job to get the illegal aliens) etc

IMO most employers that hire undocumented workers KNOW exactly what thy are doing/ what the legal status of those workers are etc.

what I don’t understand is WHY we have a multi-year long wait to get a visa- it seems to me the more people documented/working/paying taxes/ contributing to the economy the better – the current system perpetuates a semi-permanent underclass

@184: :I wasn’t talking about “market inefficiency”, I was talking about Economic inefficiency.”

Oh, really? Let’s double-check that. To comment #180!

The only reason a market is inefficient, according to dogma, is because of inefficiencies like governmetn regulation holding back the invisible hand.
and you don’t seem to understand what they mean by ‘inefficiencies’.
anything less than the best possible outcome is inefficient.

Look, it’s bad enough you can’t get the terminology right, but could you quit lying about what you’ve said? It’s annoying enough when done for literal speech – when we can easily look up the thread and check you, it’s purely insulting.

#187 “IMO most employers that hire undocumented workers KNOW exactly what thy are doing/ what the legal status of those workers are etc.”

This is true. Down here in Texas we have a large number of illegals in the workplace, and the employers know exactly who is legal and who isn’t. They hire the illegals because they are willing to work hard for less pay. Everyone knows this, and everyone is happy with it – yes, including the illegals because the low pay they get here is far better than what they would get back home.

When small businesses say that checking the legal status of their employees puts an undue burden on them, they are lying. What they really mean is that checking the legal status will force them to fire their cheap workforce, and force them to drive up prices and/or go out of business.

It is ridiculous that we can’t get some kind of guest worker visa for all the hard-working illegal Mexicans around here. They are a critical part of the economy, they want to be here, and we need them here.

could you quit lying about what you’ve said?

You just quoted me. I said “a market is inefficient”.

I said “market” because I was talking about Free Market and laissez faire nonsense.

I said “inefficient” because most people will understand what that means.

If you knew what it meant you would have assumed the technical term of “economic efficiency”. Instead, you are trying to play some very strange game of “gotcha” where I say “a market is inefficient” and you say, “Ah HA! You meant ‘market efficiency’ and used it in a way it doesn’t mean!”

No, I said “a market is inefficient”. That isn’t the same as saying “Market Efficiency”.

Since you’re the one who dragged out the dictionary definitions of terms and demanded exact meanings be exactly right, I would expect you to use exact quotes before twisting my phrase into something I didn’t actually say.

i.e. you pulled a strawman.

Not only that, you QUOTE me and even in that quote, I don’t say “Market Efficiency”.

I’m not the one who has a problem lying about what I said.

Greg, melendwyr is another one of those people it’s better not to engage. There’s no way to convince him of anything, because he believes he has All Knowledge. Also he’ll try to flamebait you (in this case he’s accusing you of lying about what you said, when you didn’t, primarily to get under your skin).

Just skip his posts without even reading them, especially if he addresses you directly. He’ll stop bothering you eventually.

KatG @ I think those are largely fair points. But I do think that there has to be a happy medium between rationing health care accusations and addressing issues related to medical malpractice.

@ Various other comments:
This is some of what the AMA has to say about it (at http://www.ama-assn.org/ama1/pub/upload/mm/399/medical-liability-reform.pdf ):

They note an HHS report from 2003 listing defensive medicine costs between roughly 75 and 125 billion dollars a year. I don’t care how much money we’re spending on health care in the united states a year, that’s a sizeable chunk of money worth looking at. And for that matter, the sizeable chunk frequently noted by Obama (who also notes that these costs are part and parcel with unnecessary tests) that the US can cut to generate savings required to help the reform break even.

They note that each case, whether found responsible or not, costs doctors 94,000 dollars to defend. And 19,000 dollars per dismissed case. In instances where they are found not legally responsible or the case is thrown out. The medical profession is the only profession where judges can seize all the doctor’s personal assets to fund a judgement. Their car, their retirement account (since most are self-employed), their kids college funds. And its easy to say in the simple cases where doctors did something malicious that this is okay. Most cases land somewhere in the gray area. Either you think doctors are out to steal your money and murder you with shoddy medical care or you think doctors are out to make you well. But, when a police officer makes a mistake that results in the loss of a life, their kids don’t lose their college funds.

In multiple places on their website, the AMA fully supports the notion that defensive medicine is a driving factor in unnecessary tests. I think you can either say that the AMA is totally unreliable because, hey, they represent profit seeking doctors. But, then, they also tend to support the rest of Obama’s speech. I think that they are on the side of reform and are an organization made up of doctors for doctors should suggest that some credence be lent to their position that malpractice places difficult demands on doctors and adds to the cost of health care in the United States. I don’t think that if unnecessary tests are wholly profit seeking endeavors that doctors and their representative organization would so loudly be asking for assistance that would mitigate their need to perform those profitable tests.

At some point you have to take people at their word. No one listens to what obama says and then they accuse him of deliberately misleading people to further his secret agenda. We think it’s appropriate to take the guy at his word because words matter. But, doctors, no they are the secret lying liars.

Again, I have in no way said this is the only thing required to fix healthcare. I haven’t said malpractice suits should be banned. What I have said is that reforming health care is much more complicated than generating a public option.

Medicare is often used as an argument for Government run health care. It is precisely this program that convinces me that Government run healthcare is a bad idea. The Medicare tax has built many a fine library. By this I mean that when the Government holds the moneys from special taxes the representatives spend it as part of the general budget. This means at some time later the base tax rate must be raised to pay for this spending.

I would favor a system where the government regulates but the individual spends the funds. A simple program would be something similar to the GI bill. The individual decides which health insurance program to spend it on. Just like the GI bill, the money represented by the program would only partially cover the cost of healthcare. This would represent the base level of care every citizen would be entitled to.

The whole point of markets is that they tend to eliminate such disjunctions, and people who can identify them are motivated to do so.

Except that this requires people to be able to make fully informed judgements. Seriously, you can make a fully informed judgement about your healthcare options?

I can’t, I’m prepared to wager that you can’t either.

I have no idea what meds are best for my type of hypertension.

If I fall over with a heart attack, get hit by a bus, come down with a (insert name here illness) I’m not going to be able to make much of a choice about what hospital or doctor or provider I go to either.

The market just isn’t designed to work in circumstances like this where you’re reliant on third party experts or chance.

OtherBill@192: whether found responsible or not, costs doctors 94,000 dollars to defend. And 19,000 dollars per dismissed case.

Jeebus. Tort reform again????

malpractice suits is less than one-half of one percent of total health care costs.

We’re looking at American health care costing twice as much as some place like Canada or Switzerland. That’s one-hundred percent.

And you’re harping about half a percent?

Tort reform won’t fix any of the massive problems with health care. None. It’s a nice right wing fantasy to think that American health insurance costs so much because of lawsuits so the solution is tort reform.

But it doesn’t fix the real problem.

James: I would favor a system where the government regulates but the individual spends the funds.

To quote the president’s actual speech:

First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

That means that there will still be private insurance companies and you’ll be able to keep that company if you want. If you’re employer pays for insurance, you’ll be able to continue doing that. If you don’t want that, you can pay your own money to buy insurance somewhere else.

in other words, the government will regulate, and you (or your employer) will be able to spend the funds.

Greg @ 195 – Malpractice suits, their settlements, represent only one half of one percent of what the US spends on healthcare. That number does not include the tests that doctors regularly include as part of their day to day operations that are not necessary solely to protect themselves from litigation.

You keep saying the same number over and over and I keep indicating that there is more to it then that number. I fully appreciate the value of your study and what that number indicates.

But, many people keep talking about the impact of unnecessary tests on the cost of healthcare in general and in specific as an inefficiency within medicare. These numbers are not included in your one half of one percent figure. The AMA indicates that these tests are undergone because of fear of medical malpractice suits. Doctors will not stop ordering unnecessary tests, that frequently cost them money as in the case of medicare reimbursement, to protect themselves from lawsuits just because the government releases a best practices options.

Doctors think the tests that Obama plans to eliminate to generate savings result from defensive medicine. We agree that they are unnecessary. In what way does that make malpractice not a part of the problem. If the doctors are saying they won’t risk their life savings and their kids college funds on a best practices paper by the government, and as such won’t stop the tests. How is not appropriate to discuss malpractice? if your response is to cut medicare reimbursements of what you decide are unnecessary tests doctors will stop working with medicare sooner than they’ll bet their life savings that that will hold in court.

This reform is about doctors and patients. At the least the doctor portion of the equation tends to believe that unnecessary testing and medical malpractice go hand in hand.

Wilson is apparently benefitting in the fundraising department from his lie allegation.

http://voices.washingtonpost.com/capitol-briefing/2009/09/scs_wilson_rakes_in_750000_in.html

OtherBill, so your entire argument boils down to: the AMA doesn’t like medical malpractice suits?

Because it’s been pointed out to you, again and again, that malpractice spending is such a tiny party of health-care spending that even if you eliminated malpractice lawsuits altogether, it would not have any significant impact on health-care spending. And again and again, all you do is regurgitate the same talking points from a special-interest group benefiting doctors — not patients.

@199 – If you aren’t going to read what I write and respond to what you heard some corporate shill say, you aren’t contributing anything to the conversation here.

Malpractice related spending is not one half of one percent. Malpractice settlements, full stop, represent one half of one percent of what is spent on healthcare in the united states.

The doctors that order the tests argue that unnecessary testing is predominately as a result of doctors being afraid of malpractice suits.

Doctors are not out to screw patients out of money and/or kill them with shoddy medical care. Why would you listen to the advice of your doctor regarding a complex surgery, but totally ignore everything they say about defensive medicine and unrelated tests?

otherbill: Malpractice related spending is not one half of one percent.

citation needed. If you can put it in terms of per person per year costs, that would be awesome.

Canada costs $2100 per person. US costs $5000 person per year.

How much do all these “unneccessary tests to avoid malpractice” cost per person per year?

Doctors are not out to screw patients out of money and/or kill them with shoddy medical care.

Well, I would say that people don’t become doctors to screw patients with shoddy medical care. And I would say that people don’t join the police to shoot innocent people.

But not all people who become doctors should remain doctors. Not all people who become cops should remain cops.

Why would you listen to the advice of your doctor regarding a complex surgery, but totally ignore everything they say about defensive medicine and unrelated tests?

Oh, I might listen, but I wouldn’t take it as gospel truth. The same way I’d listen to a cop who just shot an unarmed man in the back, but I wouldn’t take it as gospel truth.

But, I guess what you’re saying is there are no bad doctors. Just like there are no bad police.

Yeah, I guess that’s one way to look at the world. Not the way I would look at it, but one way to look at it.

Greg @ 201 – I didn’t say there are no such thing as bad doctors. All I’m saying is that an organization of doctors argue that unnecessary testing is part and parcel of malpractice.

Second, as far as a citation for cost of defensive medicine, I provided one back at 192. I agree that isn’t the end all be all of statistics. It is just one source.

Third, mostly I was referring to your statistic regarding the cost of medical malpractice settlements in relationship to the over all spending on health care in the US. Where I have seen that statistic cited, the language used for that statistic only refers to the penalties and judgements issued at the end of medical malpractice cases.

This statistic does not reflect the cost of unnecessary testing in the US. Now, democrats argue that this testing is part of the inefficiency that can be eliminated to produce savings. Doctors are suggesting that these tests take place because of their fear of malpractice suits.

I agree that there are bad doctors. And I agree that people wronged by these doctors need to be compensated. I agree that I don’t know what the solution to fear of medical malpractice suits. I have not once said otherwise.

My point is that it absolutely is important to the conversation if the group of people ordering the tests you want to eliminate to help pay for reform argue that they do them because they are afraid of malpractice.

I think the overwhelming majority of doctors are good doctors, who may or may not make mistakes, interested primarily in the health of their patient. Given that, when I see a number of doctors standing up to argue their concern I assume they aren’t from the minority of doctors that are profit centric douches who don’t care about their patients. This doesn’t make them right, automatically. This just means I don’t degrade their point to be the same as believing the courts should only be for the defense of the corporate man at the expense of the common man.

I’m not taking what they say as gospel. Again, I’m just arguing that it isn’t a red herring in terms of its relevance to the conversation about the reformation of health care in the United States.

Otherbill: you may want to consider oiling those goalposts; that way you can move them faster.

You haven’t quoted “a majority of doctors”. You’ve quoted the AMA, which is an advocacy group. The AMA’s point of view is indeed relevant to the conversation, but not in the way that you think; it shows that the AMA is apparently unwilling to discuss how “defensive medicine” is a cover for “profit-driven medicine” (doctors who own testing facilities order more tests than those who don’t), or to consider how doctors’ own practices drive malpractice costs.

I don’t care to see the debate about health care used as an excuse to protect doctors who harm their patients because doctors don’t like lawyers. And that’s all “tort reform” is.

OtherBill, I’d believe you if your evidence was something other than the doctors themselves. That’s like getting a report from the police union about use of deadly force and why a cop has to occaissionally shoot an unarmed man in the back.

The congressional budget office has their own report about Limiting Tort Liability for Medical Malpractice over here

It was written in 2004.

Here are some clips:

Why Have Malpractice Premiums Risen So Sharply? higher costs for insurers (particularly from increases in the size of malpractice awards), lower investment income, and short-term factors such as cyclical patterns in the insurance market have all played major roles.

Proponents of limiting malpractice liability have argued that much greater savings in health care costs would be possible through reductions in the practice of defensive medicine. However, some so-called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.

Some observers argue that high malpractice premiums are causing physicians to restrict their practices or retire, leading to a crisis in the availability of certain health care services in a growing number of areas. GAO investigated the situations in five states with reported access problems and found mixed evidence.

In theory, the kinds of limits on malpractice liability that are being considered in the Congress could either enhance or detract from economic efficiency, depending on the current state of the liability system.

Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency–through changes in defensive medicine, the availability of medical care, or the extent of malpractice–is at best ambiguous.

Defenders of current tort law sometimes argue that restrictions on malpractice liability could undermine the deterrent effect of such liability and thus lead to higher rates of medical injuries. However, it is not obvious that the current tort system provides effective incentives to control such injuries. One reason for doubt is that health care providers are generally not exposed to the financial cost of their own malpractice risk because they carry liability insurance, and the premiums for that insurance do not reflect the records or practice styles of individual providers but more-general factors such as location and medical specialty.(18) Second, evidence suggests that very few medical injuries ever become the subject of a tort claim.

In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency. Thus, choices about specific proposals may hinge more on their implications for equity–in particular, on their effects on health care providers, patients injured through malpractice, and users of the health care system in general.

So, now, I listened to what the doctors say about malpractice. Does that mean you’ll listen to what the CBO says about malpractice?

Other Bill: You seem to think that there’s no interest in dealing with medical malpractice issues in healthcare reform, even though the doctors are involved in that reform development. Which is not the case, and beyond that, we have a much bigger, more complicated problem to deal with.

You also are claiming that doctors do unnecessary tests purely to avoid lawsuits. But there’s another reason — to bill Medicare and private insurers to get more money. We can’t pretend that isn’t going on too. We also can’t pretend that “unnecessary” is an easy thing to figure out — you thought your doctor was maybe trying to profit off you with an unnecessary throat culture that sounded perfectly necessary. You also are proposing that since doctors order tests to protect (badly) from lawsuits, we should cut down on the lawsuits to solve the problem. But unless you eliminate the lawsuits completely, the doctors will have the same fear — it won’t significantly lower costs. And there’s another way to keep them from doing unnecessary tests — set regulated standards, second opinions, etc. to eliminate the tests, not lawsuits. Which private insurance already does. Whatever reason doctors have for committing fraud, it’s the fraud we have to deal with, not give the doctors a free pass in the hopes that they’ll voluntarily stop committing fraud. You’re also hoping that if they get a savings on costs, they’ll pass that on to the patients, which is far from a given. Malpractice suits are also not the leading cause of profiteering in premiums by the private insurers.

“Either you think doctors are out to steal your money and murder you with shoddy medical care or you think doctors are out to make you well.”

It is nowhere near that simple. It’s not either/or. I can no more pretend that all doctors act nobly than I can pretend that no doctors act nobly. Doctors have good intentions and also respond to pressures and may give in to greed, or the institutions they work for do. Doctors make mistakes. Doctors can both steal my money and give me excellent medical care — just for more than they really need to charge me.

It’s really not about the individual doctors, nor in witchhunting them. It’s about the big numbers. It’s about cutting costs, while improving care. Tort reform does not cut costs, since there is little incentive to pass savings for the doctors and private insurers on to customers, (not none, but little,) because there are other reasons for performing unnecessary tests, because it does not create more competition to lower costs, and because it makes it harder for people with reasonable cause to sue and get redress, leading to further costs. Tort reform does not improve care and does not get the uninsured coverage. It can certainly be considered, but it is not nearly as important to reform as the public option. And it’s not the only nor necessarily the best way to cut down on unnecessary tests waste and fraud.

Two new items on Wilson:

1) Wilson and his Democratic opponent are now in a dead heat in polls.

2) Wilson voted for government funding healthcare to illegal immigrants as part of the 2003 Medicare prescription and modernization bill under Bush. A section provided government reimbursements to hospitals for their costs in treating specifically illegal immigrants. The program is proposed to be made permanent in a bi-partisan bill in Congress. Apparently, a part of a bill that demands money for illegal immigrant healthcare in a Bush initiative did not require removal for the Republican congressperson, but a part of a bill that prohibits healthcare money for illegal immigrants that may possibly be violated by immigrants buying health insurance is Armageddon when it’s coming from Obama. Neo-con double-think, once again.

Wilson voted for government funding healthcare to illegal immigrants

I… I… I know I shouldn’t be surprised by this sort of hypocritical crap, but daaammmmnnn.

He is from the state that kept reelecting Strom Thurmond, though, isn’t he?

KatG @ 205 – I absolutely agree that it is definitely not so simple as a single binary metric. Murderous doctor or true blue noble doctor. Agreed.

But what I’ve been suggesting is that the doctors concerns need to be taken seriously. Not that they should be granted the primacy and all knowing privelege of faithful devotion totheir word.

My statement that this concern should be incorporated into the conversation was met with absolutism fromthe other side of the coin. My whole argument has been that addressing healthcare reform is a complex and highly intricate series of interlocking issues.

As far as malpractice being discussed as a driver of the unnecessary testing, Wednesdays speech was the first time I’d heard a democrat (and remember that’s the party that I voted for in 2008 because I was happy with whatthey wanted to do) acknowledge it’s relevance in a meaningful way.

I never said tha the conclusion should be to eliminate malpractice suits. I think the idea of some sort of body deliberating on what approrpiate tests are in certain circumstances has merit. I think that’s more likely to be productive than eliminating malpractice suits. Doctors fear not making tests because if they don’t order the tests to cover the one percent chances they could literally lose everything. And a best practices document, while a start, would not be authoritative enough or meaningful enough to stand up as a defense in court.

I agree the test my doctor performed seems reasonable. But, she acknowledged at the time that based on the visual of the situation and my reports of symptoms that I didn’t have the strep. But she suggested running the culture anyways. I said if she felt confident I was fine without. She said it’s best to be safe and that was that. I didn’t really care, because mainly my insurance covered it, but it was a reasonably expensive test for just a walkin appointment.

As far as ordering tests to make money. I think that there are a lot of issues concerning the reimbursement of physicians for their time and labor with Medicare and Medicaid. But given the republicans propensity for tryin to cut reimbursements in general and democrats in general trying to expand said coverage, I would say that that issue is more complex than whether they profit of the tests. And at that, doctors only profit off lab work or imaging if they own the imagig center and if they own the lab. This may be frequently true in major hospitals, but I don’t think it’s the case for most private practices.

In general I think we largely agree. It’s a complex issue that requires a lot of delicate conversation with multiple players in the game. And given the cooperation of the AMA in supporting pretty much all the reform initiatives it’s fairly disingenuous to tout the import of their support and ignore the o e thing they ask for as totally irrelevant.

207 @ greg – first of all he probably didn’t read the whole bill before he voted on it. Second of all, Strombo was an all American hero. Did you see the quote where Wilson got angry that people were talking about Thurmond’s half black half white love child, that he admitted to having had and taken care of, because it would defame the good mans character?

Strom Thurmond once pinched a girl I know on the ass in the elevator of the Capitol Building while she was working as a page (read as in high school). True story. That dude was one well known horny racist old goat of a man. And dogonnit, some people liked the guy.

Boerger @ 121

“We the people of the United States, in order to form a more perfect union, establish justice, ensure domestic tranquility, provide for the common defense, promote the general welfare…”

look at that, promote the general welfare, not provide the general welfare. Our forfathers must have mistaken….or maybe they just didn’t care how they worded things…..oh no, that can’t be it, why did they choose those words. Maybe they were afraid of the government having too much power over the people. Maybe they thought that individual people should be responsible for themselves when it comes to their welfare. Maybe I am responsible for ensuring that my children and I are taken care of. Maybe others should be responsible for themselves. Maybe just maybe you should get your hands out of my pockets, and if you feel so inclined to pay for someone elses health insurance, then you and your fellow libs can pool your money together and pay for it. Oh wait, that won’t work, becuase your are only giving, when it is other people’s money.

Do you want to talk about character? I take care of my family. My family comes before me. And, until about 2 years ago, this country came before me. After 13 years in the Marine Corps and two combat tours ensuring that ungratful and short memoried libs are protected from the lions that are beating on our door. My wife finally begged me to get out. I did for my family.

You smug attitude does nothing for me. At what point do we require people to take care of themselves. For all others there is already a social security and medicare/medicaid system. But of course that is going broke now. After seeing all of the liberal programs falling to pieces around us, why do we think that the federal government can run a socalized program that will work. Why do we trust them with our money? Where do we get our confidence? As said by a private business in Jacksonville, Florida on their sign

“Socialism works until you run out of other people’s money”

Clifton @ 209

All the other people’s money was stolen by Bush and company. Yell at the right target.

OtherBill @ various

Your harping on malpractice continues to ignore the point I made about the fact that a large portion of the non-fraud extra tests were done to get (force) approval from the insurance providers who were refusing to approve procedures the doctor already knew were needed. This is not defensive against the patient but rather defensive for the patient and has nothing, I say again nothing, to do with malpractice much less tort.

FWIW, the AMA does not directly represent or even speak for more than a tiny minority of doctors. I imagine their statements represent an equally small percentage of reality where medicine is concerned. Not necessarily wrong but don’t give it more weight than it deserves.

If Wilson was wrong why did the Democrats close the illegal loophole in the bill? Obama lied, or if you prefer misrepresented, all through his speech and when he wasn’t misrepresenting he was calling everyone who disagreed with him a liar or blaming everything on Bush. That after weeks of being called right wing terrorists, the american taliban, teabaggers and worse. But as Obama told the right, sit down and shut up. You think that’s going to work?

Canada, the UK, the VA and medicare or Maine’s failing Dirigo health, Tennessee’s failed program, Massachusetts failing program are all strong arguments against government run health care. All of them clearly demonstrate runaway costs and rationing as the result of a government take over of health care.

Other Bill: “My statement that this concern should be incorporated into the conversation was met with absolutism fromthe other side of the coin.”

There’s a reason for that — it’s consistent with right wing rhetoric that seeks maximum profits for businesses at the expense of all else. Democrats are well aware of the malpractice issue. But they’re not going to let it be used as a wedge for neo-cons. But Obama, again, actually does listen to people, including doctors.

Flyfish: “If Wilson was wrong why did the Democrats close the illegal loophole in the bill? ”

The Democrats didn’t. There is not one bill yet. There are several versions of the bill proposed by five different Congressional committees. Only the committee headed by Baucus, which is made up of three Republicans and three Blue Dog Democrats, (the Gang of Six,) is putting in the new material about the “loophole.” And that probably was already in discussion by many involved in reform before Wilson’s outburst. The next stage is that all these versions get hashed out in Congress and with the presidential administration into a final version of the bill, which is voted on.

Wilson accused the President of lying when the President told the truth. The bill contains a ban on illegal immigrant healthcare. Strengthening that ban was a matter of fine-tuning the policy. Wilson lied and misrepresented that the ban did not exist in any version of the bill at all during the President’s speech.

You also are misrepresenting healthcare reform, because you are claiming that it’s the government taking over healthcare, which no version of the bill does. You want to criticize parts of the reform plan, fine. You want to make stuff up, your claims that others are lying are not to be taken seriously.

Miller is up to a million, but Wilson is catching up — $750,000. Wilson was Thurmond’s aide. Thurmond started as a progressive Democrat and then became a segregationist Republican.

Nargel @210- Im not harping on it and I’m not ignoring your point. I’m not even saying that you are necessarily wrong.

I’m just pointing out that doctors believe those tests to be defensive. In either case, yours or mine , doctors are the group that need to be won over to address that particular issue.

As far as the AMA representing a tiny minority of doctors. Fine, but I’m not the one lendin their opinion creedence. That is a direct function of Obama and the democrats. And their position is that defensive medicine and fear of malpractice suits are he drivers of unnecessary testing. I do think most doctors are on board with that sentiment. No doctor that I have personally discussed this with has said otherwise. I’ve pointed to the evidence offered by a professional organization representing doctors. One can either accept whatthey say as a part of the discussion or not. The democratic party relied on their endorsement of reform and then supporters of that reform discredit their one position not actively supported by the administration because it isn’t real of isn’t relevant.

It’s as much a debate as it is a negotiation between the parties concerned. They aren’t going to get what they want if try utterly fail to take one partys concerns seriously. And these aren’t my points. I’m trying to broaden the conversation. I kist think it’s disingenuous to discount what they say because t doesn’t fit your world view of how things are. That’s negotiating with preconditions. Even Obama in his speech recognized the importance of that particular position. Why is it harping to suggest that it should then be a more recognized portion of the debate and negotiation?

I’ve offered my evidence. I’ve said what I felt appropriate. But the “they’re just a minority and they’re just wrong and your evidence is biased” speech is why I left my party for democrats and what’s wrong with the healthcare debate in this country.

Agree with us or die. Both sides. The government will sodomize you. Corporate profit seeking doctors will sodomize you. You’re a corporate shill. You’re a socialist shill. An entire professional organization of doctors thinks it is important enough to be included. You may be right about the basis for the tests, they disagree. I’m nit saying take their word for it. I’m saying they should be included. They are the healthcare professionals that we are talking about.

Ring ring. It’s the pot calling. Kettle, It says you’re black.

KatG – duly noted. And I dint disagree. But being consistent with right wing rhetoric doesn’t make the statement come from a right winger or necessRily make it wrong. I fundamentally believe republicans are generally the wrong party to address healthcare reform, to include government provided health care. Their policies are largely what have screwed doctors over.

But it’s an overreaction to put fingers in ears and scream you’re wrong jus because I think the conversation merits inclusion in the general discussion.

The problem, not the proposed republican solution, absolutely merits discussion.

But, I thought this was one ofthe threads about how the adults in the room need to have a polite back and forth. Democrats don’t do themselves any political favors when they respond absolutely to a person trying to have a conversation. I’m not ignoring anyhing that people have said back and have largely conceded the validity of their points. My concern has been met with unbridled scorn that I could be so foolish as to have been propagandized by corporations.

And that’s fine. But this thread was in part based on resentment of that exact sentiment. It’s hard to have a conversation abou someehting so important with people who disagree with you. But it isn’t wrong.

And as far as the AMA is minority organization: they largely represent a figure head that speaks for doctors in general. However, each medical specialty has its own professional organization. For example, ACOG, the American College of Gynecologists. These function largely as professional organiaztions that sponsor professional conferences and such. However, each college has a representative on the board of the AMA. So, saying the AMA is a minority organizaion is disingenuous, which is why it’s a republican talking point for why the AMAs endorsement of the sweeping healthcare reform shouldn’t be viewed as meaningful.

AMA represents the interests of a great deal of doctors who are not officially members throguh the representatives of their particular field of specialty that serve on the board.

Other Bill @ 213

“I’m just pointing out that doctors believe those tests to be defensive”

You’re just pointing out that, according to the AMA, doctors etc. I am just pointing out that the AMA is not all the doctors. I also said “not necessarily wrong”.

I am not Obama nor ‘the Democrats’ and have made my occasional disagreement with them clear, perhaps too much so for some, as well as when I do agree. Do not mistake my informed opinion or disagreement on something to mean that I’m some kind of Obama-bot.

You can call me on something I have said on this or any other thread and fair ball. If you ask why something was said or did I say what you think I said, that is also reasonable.

If you want to claim that I am responsible or required to back up something ‘Democrats’ say, when I haven’t said either way? Expect a chilly reception.

“they’re just a minority and they’re just wrong and your evidence is biased” “Agree with us or die”
Show me where I said that. Or even implied that. When I disagree with you, you will know. I said there was information you were missing not that you were biased.

And, if I were black I would likely be even more pissed at today’s America than I actually am. :)

Nargel @ 216 – Ouch on that last line. I’m not black and I agree with that. I don’t think that you have to defend what other democrats have said, but I do think I was expected to defend my position as that of a crazy right winger. And in fair ess, that wasn’t really directed at you (though the last post about the AMA I think I responded to was from you).

Through the transative process of crazy talk because words I used were used by crazy racist I had to somehow prove I wasn’t also crazy. Though, that was from mythago and that dude just starts shtuff.

I mean I get that it is a hot button issue. I jus don’t think the tests are entirely a result of dealing with insurance companies. And I appreciate tha point and wasn’t trying totalk past it.

Based on the absolutely correct point from KatG and one other (tha it is a wedge that could screw up passing any legislation) I agree that it is problemmatic. But based on the concern of the AMA I’m concerned that we might pass legislation that would otherwise have been self sustaining were it not for the incorrect interpretation of the cause of unnecessary tests. And I don’t know who is right. But, I do tthink that merits making it a part of the discussion.

Passing easier legislation and filling in the chunks later is not the best idea. Good legislation is tough to get. But we need to do this right so it doesn’t unravel.

Other Bill @ 217

No problem, I was just making myself clear.

AS far as your response to my AMA comment (most likely), I will go dig a little deeper into the AMA’s make up. Until then, I probably won’t put a massive lot of weight in the expectation of a collection of ‘figureheads’ (your words) actually and accurately representing an unknown number of people. Further research may change that.

My dad was an engineer, I have worked closely with many good engineers over the years and I took enough engineering classes that I almost went a bit farther and became one. I have been told that I think like one.

So, thinking like an engineer and reducing the non-effective values:

There have been plenty of chances for the Right’s claims that tort reform is the magic bullet to have been born out. It has been proven to be a chimera and has been shown to be a non-significant factor in the health care equation. While it may be a large factor in certain doctor’s concerns, it is small enough in overall effect that it would be likely to become a bargaining chip. Wouldn’t it be better served to be considered on it’s own merits and issues? Not in relation to it’s usefulness vs. more functionally effective variables?

Nargel @ 218 – I think that’s a pretty fair assessment. The republicans have definitely burned their bridges in terms of opinions on health care. And I’m extremely disappointed that they haven’t done better.

My only quibble would be that the AMA aren’t the Republicans. In terms of respectability for what they say, I think the AMA have gone a long way in earning some faith in what they say by largely endorsing the health care reform as is. It’s a big deal for the doctors to go up against the insurance companies. In their, and their patients interest, to be sure, but definitely notable that they’ve signed on. I don’t think they endorsed Clinton’s attempt, but I’m not a 100% on that. And if my interpretation of how the AMAs representative system works, that’s a pretty sizeable chunk of the medical community. And if I’m wrong, point conceded.

I’m not sure I totally agree with your last sentiment on issues in their own merits. That even reads as retarded as it sounded in my head just now, but stay with me.

I agree, I think, with spirit of how I interpret your statement. But, doesn’t that pretty much rule out politics of an issue in general? And while I enjoy a good political debate, I prefer the value of good policy. But, the chance of passing meaningful health care reform is largely a political issue at the end of the day.

Other Bill @ 219

You may be right on the representativeness (that’s a word?) of the AMA system. I’m going to be doing a fair bit of looking into it before I feel properly informed on it to argue either way.

Yes, you’re right. The AMA were almost over the top in the negative response to Clinton’s try at reform.

I probably just phrased it awkwardly. On it’s own merits and about it’s own issues. The issues involved in a debate and the merits involved in various ways of dealing with those issues are not always the same things.

The chance of passing a bill is apt to be a political factor. The ability to pass a meaningful bill is a matter of understanding the relevant and/or functionally important factors. The better understood those factors are, the more effective and useful the final bill becomes. For example, a strong alternative to the insurance companies, that they cannot destroy, bribe or coopt, provides a feedback mechanism that on it’s own induces the companies to treat their cash cows, I mean customers, better. You don’t have to call it PO, it just needs to be functionally equivalent.

In our case, it is more important to pass a meaningful effective bill than a political bill. If the wingers kill it in their ongoing, racist temper tantrum, they will pay the price politically and the good bill comes back in a couple of years. If the bill that passes is not meaningful or effective, for example if the mandates start immediately and the PO starts in 4 years and has been caved in so strongly that it sails out to signing, it will quickly kill the Dems and any chance of passing a good bill.

We already know from experience that massive tort reform will make it harder to sue doctors, good or bad. That’s it. It doesn’t lower costs anywhere and doctors still feel pressure to run extra tests. That is the sum total of it’s functional effect on the system. The only effective use is as a bargaining chip. Politically.

If we approach the question with a successful reform bill having been out there for a few years, the goodwill from that could help propel a new law using some other way to restrain bad doctors without restricting good doctors. What that other way would be, I admit I do not know. I do know that remaining tied to ‘tort reform’ is worse than useless and we will not find the new way until we look for it. And that won’t happen until we quit trying to force tort reform to work.

I’ll give you this, London: you’re on-topic. Never apologize, never admit error. I can admire that.

Wait – no, I can’t. That’s a large part of what’s wrong with this larger debate: the disconnect from reality.

To return to the general topic: I can’t help but be curious how the problems and possible failure of these sorts of plans will be explained when they occur. It seems to me that the most valuable ally of the Democrats is the Republicans, as they can be blamed for “forcing unworkable compromises and making things fail” regardless of where actual responsibility lies.

Given the low utility of the (R)s, it seems it’d be worth it to have them abolished, just so the (D)s no longer had a convenient whipping boy.

Clifton@209: At what point do we require people to take care of themselves.

Well, a few posts back, you said: I do not think that I should have to pay for a deadbeat that sits at home all day smoking weed or snorting cocaine.

I’m pretty sure that is a complete fabrication of reality, a demonization of the truth, and completely illuminating of how far off the reality of the situation you really are.

The program being proposed is regulations of the health insurance industry to keep the operating fairly. half of all bankruptcies are due to medical costs. MOST of them were people who had insurance but the company dropped them.

Do you oppose that? Do you think its nothing but a bunch of “ungratful and short memoried libs” who want to put a stop to that business practice?

We have the freedom to buy insurance or not. If I feel that I would rather buy a nice car than pay for insurance, then that is my right.

In the last 8 years, the right to due proccess, the right to protection from illegal search and seizure from the government, your right to be free from torture, your right to free speech, your right to freedom of and freedom from religion, have all been trampled by the Bush White House.

But the right you’re demanding is the right to not buy insurance?

If we truly want to fix health care, then lets reduce restrictions on insurance companies

Laissez faire doesn’t work when it’s a one time transaction. What happens is people pay their insurance bills every month for years. And then when they get cancer, the insurance company throws them under the bus. And then the guy now has a preexisting condition, so he can’t get insurance anywhere else. Most states have maybe 5 main insurance companies. It’s not enough for competition. And the way they operate, customers don’t have enough recourse when they get screwed by these companies.

create limits to law suits

The congressional budget office in 2004 reported that medical lawsuit reform doesn’t have much evidence to show that it would do anything to reduce costs, and that it could potentially allow bad doctors to continue operating.

Pushing tort reform means you’re pushing a political dogma, not a solution to the facts at hand.

social security and medicare/medicaid system. But of course that is going broke now.

No it isn’t. It’s a nice bit of obstructionism, like “Deathpanel!” but is isn’t true.

After seeing all of the liberal programs falling to pieces around us

liberal programs like due process? freedom from religion? protection from torture? Protection from cruel and unusual punishment? The right to peacably assemble?

Yeah, those programs have gone in the toilet the last few years. I don’t think you can blame the democrats for that.

why do we think that the federal government can run a socalized program that will work.

It’s not a socialized program. That’s not what is beign proposed. most of it is regulating the existing private industry. A public option would not be free, it would be paid for by the people who join it. The idea is that it would be cheaper because it won’t be driven by profit motive. But people who join it will still be paying premiums.

You can still go out and buy that new car for yourself.

otherbill@211: And their position is that defensive medicine and fear of malpractice suits are he drivers of unnecessary testing..

Did you even bother to look at the link I provided in 204? Cause the CBO report says the evidence regarding the effects of tort reform is ambiguous at best as to whether it will help or harm. The report says it could just as easily make things worse.

I do think most doctors are on board with that sentiment. No doctor that I have personally discussed this with has said otherwise

Yeah, and a lot of cops will come to the defense of another cop who has shot an unarmed man in the back. What does that prove? Nothing. You keep asking the people who would profit most from tort reform whether it would make the world any better.

Go ask a mining company if they’re on board with lowering the limits for how much arsenic they can dump into the ground. I’m sure they’ll tell you that they’re on board and that if you get rid of those restrictions that the cost of coal will go down.

What the CBO reports says is that there is no evidence that savings from tort reform would be passed on to patients.

Tort reform is not based on any facts. It’s based on fear mongering scary numbers out of context from the overall costs. It’s less than half a percent of total cost.

And asking the AMA about medical tort reform is like asking the fox about how the chickens should best guard the henhouse. Stop it.

An Immodest Proposal. I, [name], an elected officer [title], hereby disclose that on this date I received sexual favors from registered lobbyist [name/number] including [check all that apply] () Genital, () Oral, () Anal, () Manual, () Other [describe]. I offered nothing in return. I reserve the right to campaign on “Family Values.”

melendwyr: Never apologize, never admit error.

you misquoted me.

OtherBill: Through the transative process of crazy talk because words I used were used by crazy racist I had to somehow prove I wasn’t also crazy. Though, that was from mythago and that dude just starts shtuff.

If by “starts shtuff” you mean “expects you to back up what you say, and notices when you start backpedaling,” then I’ll cop to starting shtuff. Over and over again, you repeat the same talking points – doctors are forced to practice defensive medicine, this affects health-care costs, nobody is listening to the poor white-knight doctors and we ought to start – and when it’s pointed out to you, over and over again, that you’re full of it, you simply nod and say “Yes, but….” before repeating yourself.

That’s not an attempt to join the conversation in a meaningful way; that’s parroting talking points.

Your doctor, by the way,was not practicing defensive medicine; she was following the appropriate standard of care. The risk to you of any side effects from a throat culture was minimal compared to the benefit of the test. Please note that your doctor did not say “There’s a .000001% chance you could have throat cancer, so I better do a biopsy” out of fear that, if you had throat cancer, she could get sued. (And, fwiw, strep is not the only infection they test for. Just saying.)

Mythago: Your doctor, by the way,was not practicing defensive medicine; she was following the appropriate standard of care.

If doctors test too much, it’s “ZOHMYGOD! Defensive Care! Tort Reform!”

If doctors don’t test enough, it’s “ZOHMYGOD! Rationing Care! Killing Grandma!”

If you try to set some standards of what is the appropriate level of testing, it’s “ZOHMYGOD! Death panels! DEATHPANELS!!!”

Anyone else notice that the opponents to health care reform piss their pants no matter what solution you offer? If I didn’t know better, I’d swear what they wanted was no solution at all.

Greg @ 222 – jeebus man, are you still harping in your own distorted view of reality? You can readily see that Clifton is totally wrong about how all poor people stay home and do coke. But all doctors are unreliable on their interpretation of defensive medicine because the CBO says it’s unclear. Oh and because doctors can’t be trusted on that particular issue.

I get it. One half of one percent. Fear mongerer. Right wing crazytalk biased professional organization. Unclear. And one half of one percent.

You got me. I surrender.

OtherBill @227: A passive-aggressive snipe about how everybody is really wrong and still being mean to doctors, and you’re forced to throw up your hands in the face of such militant anger? Still no facts and still not persuasive, I’m afraid.

What would actually benefit doctors is development of a consensus on the appropriate standard of care. Because following the appropriate standard of care in a competent manner is the best way to avoid malpractice claims.

I think we have a cross-talking going on in the discussion, which happens. Other Bill is not a far right profits-monger, guys, chill it down. You brought up evidence, he brought up stuff he encountered; you are sure of what those numbers mean, he’s less sure.

What will be fun will be Wilson’s claim that he saved the healthcare reform bill from disaster when it passes.

@ Gregg – Look, I just don’t think our conversation is going anywhere. I say malpractice should be included in the debate. You say malpractice represents only one half of one percent of total us expenditure on healthcare. I say, that number only refers to court decided settlements and that malpractice also impacts unnecessary tests issue. You say the CBO says that’s unclear, which subsequently makes you right. I say, I agree it may not be all of it, but the AMA a professional organization representing doctors writ large disagrees with that. You say the AMA is as reliable as FOX News, which I guess means they’ll lie and misrepresent their position to deliberately muddle the debate. I say that’s utterly ridiculous. They’ve been anything but muddled and unclear, and in fact very supportive of legislation. You say malpractice only represents one half of one percent.

Fine. If the conversation can only end you, GregLondon, are entirely and 100% correct in your every assertion, fine. We disagree, I’m okay with that. It’s a big issue, and we won’t always agree. Such is life.

KatG @ 229 – Well, of course he saved it. If he hadn’t stood up on national television and called the president a liar, there is no telling what chaos Obama might have brought down upon this country.

I mean, good god. If Obama had been allowed to secretly give the illegals the good medicine while giving everyone else the poison, which IS what he was going to do…who knows what crazy things might have happened?

And, that’s really all you have to do to stop secret godless muslim socialist fascist demons from hell. Is yell the magic words, “you lie”. and they are powerless. It’s a more literal translation of the original aramaic version of what, until recently, was translated to english as “get thee behind me satan”.

Greg 224: For gods’ sakes, man, won’t you just ignore him?!?!?! He’s in this to make you respond, and to make you angry. Of course he misquoted you, and he’s sticking to his misquote as if it were the truth. He will continue to do so, because a) it’s frustrating to you and b) he’s not trying to have a real conversation.

OtherBill @230: What is a “court decided settlement”?

otherbill, Fine. If the conversation can only end you, GregLondon, are entirely and 100% correct in your every assertion, fine.

Dude. Find something other than the AMA or someone who would profit if tort reform were enacted. Find some evidence that isn’t as questionable.

Otherwise, you’re basing your entire claim that clean coal is a good thing off of a report by the coal industry. Seriously. Get some independent evidence.

No, I don’t trust the AMA when it comes to tort reform. Sorry. I don’t trust the Department of Agriculture to determine the healthiest food pyramid either.

Thing is, I haven’t heard your tone shift since I introduced the CBO report. You seem to still insist that tort reform is the only way to go. If you were willing to look at other evidence, then the CBO report should have caused you to tone down your defense of tort reform, but you haven’t. You’re still it’s ardent defender.

And rather than find some other, more reliable evidence to support your point of view, you are now portraying me as “I AM 100% RIGHT!”.

That’s not part of a logical argument. You just went into a strawman ad hominem.

Find some evidence from a neutral source. And I’ll reconsider.

I found some evidence from a neutral source, and your position remains unchanged.

That should tell you something about your position not being evidence based.

xopher@232, sorry, it wasn’t bothering me. Didn’t realize it was bothering others. I’ll ignore him.

Yeah but your evidence from the independent source (which the CBO is only independent when it agrees with whoever is citing it) said it was unclear that the two were related, not that they weren’t.

I’m not talking about the way republicans have handled fort reform being correct. And you’re quite right that caps don’t work for all sorts of reasons. That doesn’t mean the issue is nonexistant.

And yeah, you are acting as though you are 100% right. The numbers that I cited from the AMA are based on reports from HHS.

And as I said that’s fine. But you don’t get to play the I’m the calm coolnmr rational when your rational point isthat the organization that represents and works to set doctrine for doctors are as reliable as Fox news. That isn’t an open minded interpretation of their position by any stretch. You’ve got two sources I’ve got two sources. Yours are unassailable mine are propaganda.

So yeah. Whatever man. But that’s fine. I’m expressing my position and you yours. And that’s how political discussions go. You know your right and I’m an idiot and I know I’m right and your an idiot. It’s all good. Just don’t talk smack about how I haven’t changed my position and I’m being lazy or stubborn whereas your unchanging position is, of course only natural and just. Your shit smells too man.

Otherwise it’s all good.

From wikipedia. (external sources can be found there)

A recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors.

A 2006 follow-up to the 1999 Institute of Medicine study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates.

Most (73%) settled malpractice claims involve medical error. A 2006 study published in the New England Journal of Medicine concluded that claims without evidence of error “are not uncommon, but most [72%] are denied compensation. The vast majority of expenditures [54%] go toward litigation over errors and payment of them.

Claims not associated with errors accounted for 13 to 16%

About 10 percent of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing due to defensive medicine, according to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans…The figures were taken from a March 2003 study by the U.S. Department of Health and Human Services that estimated the direct cost of medical malpractice was 2 percent of the nation’s health-care spending and said defensive medical practices accounted for 5 percent to 9 percent of the overall expense.”

(snip)

So, HHS says about 2% of costs go to medical malpractice cost and 5 to 9% come from defensieve medical practices. I’ll have to dig around some more to find out where those numbers came from.

But it also says that most (73%) malpractice lawsuits involve medical errors. And lists a shitload of poeple who died because of medical error every year. Only a small percentage, 13 to 16%, of lawsuits do not involve medical error.

So, if it’s 10% of the total cost, but most malpractice cases involve actual doctor errors, what exactly is the point of tort reform? Allow doctors to continue making medical errors but not have to pay for them?

If you got rid of doctor screw ups, it sounds like you’d get rid of three-quarters of all malpractice lawsuits. Maybe I’m reading teh numbers wrong, though.

Greg @236 – so you are seriously arguing that a statement that 10% of health care costs inthe US result from defensive medicine (1.5 % of the US GDP) is insignificant? Seriously?

As far as letting the doctors make mistakes, no, I’m not for that. The numbers prove that malpractice leads to a substantial surcharge in defensive medicine. I don’t know what the solution is, but you are making my case that we need to find a solution.

My general feelings on malpractice are that doctors risk losing everything for honest mistakes and negligent mistakes. At least if a cop makes a mistake in discharging his weapon, a board can review his actions and information available at the time and determine if it was negligent and deserving of punishment. In malpractice suits there is no distinction between an honest mistake and a case of negligence. And don’t say you can’t honestly accidentally leave a scalpel in someone. First, I agree that’s always negligence and second that one isn’t even the doctor’s fault. It’s the surgical team that closes people up.

But, I’m not asking you to change your personal philosophy regarding tort reform and what works and what doesn’t work. I’m just saying it adds a cost to healthcare and that needs to be properly addressed in the debate.

Look, I guess this didn’t come across in my last post. But I’m just saying agree to disagree. Okay? We can argue about any other political subject you like. to the death, if you prefer. But this one is making me tired.

London @ 222
“I’m pretty sure that is a complete fabrication of reality, a demonization of the truth, and completely illuminating of how far off the reality of the situation you really are.”

No sir, I would say that is the reality. People today do not want to take responsibility for themselves, they want to blame everyone else and have the government to take care of them due to their lack of personal accountability.

“The program being proposed is regulations of the health insurance industry to keep the operating fairly.”

That is not the program being proposed. Princess Pelosi and Prince Reid have made it clear that the only way that the bill is brought to the floor is if there is a public option. Yes, I oppose that. Take the public option off of the floor. The restrictions that I was speaking of earlier were the restriction preventing insurance companies from selling insurance across state lines. Eliminate these restrictions and this will create the competition that you say that you crave so much.

“In the last 8 years, the right to due proccess, the right to protection from illegal search and seizure from the government, your right to be free from torture, your right to free speech, your right to freedom of and freedom from religion, have all been trampled by the Bush White House.”
I am sure that you do not want to go to far into the torture aspect, because lives were saved due to the methods that you consider torture. Your ignorance is amazing but is also common amongst libs. I am telling you that you do not want to go into this. Not only is it way off subject, it is something that, due to confidentiality reasons, exact proof cannot be brought forward.

“What happens is people pay their insurance bills every month for years. And then when they get cancer, the insurance company throws them under the bus.”

That is the same son-of-a-gun that put on his/her insurance form that they are non smokers. Then when they are diagnosed with emphysema or lung cancer caused by prolonged smoking, he/she is surprised that the insurance company dropped them.

“The congressional budget office in 2004 reported that medical lawsuit reform doesn’t have much evidence to show that it would do anything to reduce costs, and that it could potentially allow bad doctors to continue operating.”

Read previous posts. The CBO accounted for the effects on the cost of malpractice insurance if limits were placed on civil cases. They did not include the cost savings if doctors did not feel compeled to order pricey tests that are not needed. Look at Florida, where great doctors are leaving the state because of the cost of malpractice insurance. But on that same note, Douglas Emendorf said “the House plan to cover the uninsured, for example, would add more than $1 trillion to federal health spending over the next decade, according to the CBO, it would trim about $500 billion from existing programs — increasing federal health spending overall.” How are we paying for this???

“social security and medicare/medicaid system. But of course that is going broke now.”
“No it isn’t. It’s a nice bit of obstructionism, like “Deathpanel!” but is isn’t true.”

“Growing annual deficits are projected to exhaust (HI) reserves in 2017,” (This is referring to Medicare). “The deficits will be made up by redeeming trust fund assets until reserves are exhausted in 2037” (This is referring to Social Security) No, these quotes were not pulled from Fox News, they were pulled from http://www.ssa.gov. On you strategically placed Deathpanel remark, I did not believe that this was in the bill. Even if it was, I cannot imagine that a government employee could recommend to someone that they should just die.

“It’s not a socialized program.”

Socialism – 1 Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy.

A government run insurance program? Sounds like a social program to me. Your response should have been, what is wrong with socialism. That would be a good little lib. The problem with socialism is:

Socialism – 2 the stage following capitalism in the transition of a society to communism, characterized by the imperfect implementation of collectivist principles.

Both definitions were from dictionary.com

The bottom line is that Wilson was wrong to call Obama a liar during the address. He should have saved his words until after the speech was over. But of course, there is no ability to redress grievances with the President. He is hiding in the White House and Martha’s Vineyard. Like I asked before, where are the bipartisan conferences on healthcare that are supposed to be televised on CSPAN? Is it because, the President, Pelosi, and Reid do not want the public to see what their true intentions are?

Clifton:

A government run insurance program? Sounds like a social program to me. Your response should have been, what is wrong with socialism. That would be a good little lib.

I quote scalzi in that other thread :

and remember that slapping down the “Obama = Socialist” card will get you laughed at or deleted as a troll.

Clifton, you’re a troll.

You’re a troll who’s too ignorant or ill mannered to follow simple instructions put in place by the host who’s blog you’re visiting.

You have no manners, troll. I find that laughable.

Clifton@238: I am sure that you do not want to go to far into the torture aspect, because lives were saved due to the methods that you consider torture. Your ignorance is amazing but is also common amongst libs. I am telling you that you do not want to go into this. Not only is it way off subject, it is something that, due to confidentiality reasons, exact proof cannot be brought forward.

Oh, man, see that? That right there? That is why I cannot possibly take you seriously.

Even the CIA inspector general’s report in 2004 says torture didn’t save lives. Ever.

No proof harsh techniques stopped terror attacks

an ABC story dated August 2009

I know you won’t click on it or read it, but other’s might find it enlightening.

potential gains and “power” of the waterboarding to get detainees to talk was “exaggerated” and “appreciably overstated.”

It was not effective

As far as torture costing lives, back around January of 2002, we tortured Ibn al-Shaykh al-Libi. What did he tell us? What we wanted to hear. That Al Queda went to Iraq for weapons and training. Colin Powell ends up using this bullshit intelligence in his speech to the UN to argue for war against Iraq. That tortured intelligence got us into a war in Iraq that killed thousands of americans, and left 50,000 with permanent traumatic brain injuries.

Meanwhile, during the month of March 2003, the month we invaded Iraq, we waterboarded Abu Zubaydah 83 times and Khalid Sheikh Mohammed was waterboarded 183 times. link

What did they tell us? The locations of the WMDs? The location of the mobile labs? The locations of the iraqi intelligence officer in Praque?

We have repeated documented proof of torture getting us false intelligence that pushed us to invade Iraq. We have document proof from the CIA inspector general himself that torture did not save any lives.

And yet people like you cling to Dick “Palpatine” Cheney’s jedi mind trick that torture saved lives. that these are not the droids you are looking for.

Meanwhile, there are all the known documented cases of people who were INNOCENT but were tortured for months and years before finally being released.

khalid

lakhdar

this guy, this guy the CIA cut his balls with a razor blade while he was in prison.

Some statistics for you.

Number of US personnel convicted of abuse: 54
Number of US personnel serving prison time for abuse: 40
Number of detainees who have died while in US custody: at least 100
Number of detainees deaths ruled a homicide: at least 30

Out of 800 prisoners through Guantanamo, 3 have been convicted.

And this one always makes me smile. Bush pushed to make sure that anal rape was legal. Why? Because we knew Americans were anally raping prisoners.

Greg @ 240 – dude, that’s one I agree with. We’ll have to find a different issue to switch to in order to get a good old fashioned stubborn off going again.

Clifton: “People today do not want to take responsibility for themselves, they want to blame everyone else and have the government to take care of them due to their lack of personal accountability.”

So all the people who responsibly worked and responsibly paid private insurers premiums, and then developed breast cancer or a blood infection, and the insurer dropped them from their rolls and refused to pay, leaving them uninsured with a pre-existing condition and no way to get coverage and facing bankruptcy because the private insurers cheated them — thousands of them making up half of all medical bankruptcies which make up most of the personal bankruptcies — it’s all their fault and they should just die?

Your problem is that you don’t think those people’s problems are costing you anything if you leave them alone to be responsible or not for the numerous medical conditions that are not avoidable, from cysts to hyperthyroidism. You’re wrong. And your wrongness costs me more money.

“The restrictions that I was speaking of earlier were the restriction preventing insurance companies from selling insurance across state lines. Eliminate these restrictions and this will create the competition that you say that you crave so much.”

The opposite is true. The state restrictions currently encourage more competition because the national insurers are very big and the restrictions allow smaller, statewide companies to compete. Take away the restrictions, and Blue Cross, which is already the main insurer in most states, then will not have to compete, they’ll just come in and take over and establish more of a monopoly, leading to fewer companies and less competition. And this will happen without any incentive for private insurers to lower prices or stop cheating customers. Nonetheless, lifting state restrictions can certainly be considered if other regulations keep the insurers from abuses they currently now enjoy at our expense. These regulations are a huge part of the healthcare reform bill that most of the politicians, including the Republicans, agree on. Just because there’s a debate on the public option doesn’t mean that these are not part of the reform.

“But of course, there is no ability to redress grievances with the President.”

You mean when the President met with Wilson and accepted his apology for making a false accusation, and they talked? You mean when Baucus, a Democrat, took Wilson’s objection to problems with the ban — which had nothing to do with his false accusation that the President was lying about the existence of the ban — and proposed amendments to deal with that concern that could be considered by Congress for the bill? (Actually, the meeting I’m more interested in was the one where the other Republicans reamed Wilson for completely screwing things up. Boy, were they angry.)

“where are the bipartisan conferences on healthcare that are supposed to be televised on CSPAN? ”

They tried to have them, but most of the Republicans refused. They said they’d rather kill the bill altogether than have any reform under a Democratic president, because apparently the dead people versus political profit assessment was a no brainer for them. Nonetheless, some bipartisan work is continuing on the reform bill, the Gang of Six particularly. If the far right Republicans would stop showboating and throwing temper tantrums, the other Republicans and Congress could get more done faster.

Clifton – I think actual socialists might also resent being referred to as the retarded half child of capitalism and communism. Or, I guess as the definition put the “imperfect implementation of “collectivist” principles.

Though, that’s really the dictionarys fault I guess. Is anyone else annoyed by the reliance on a dictionary of all things to really lay down the law on the difference between highly complex systems of social and economic philosophies and their relationship to styles of government?

London @ 240

Get your information from trusted sources do you? On a side note, I do not listen to Cheney. I will say this, if using enhanced interrogaton techniques or even torture is what was needed to save my wife and children’s life, then I say go for it. Yes, I hold American lives above that of another nation’s.

“The Central Intelligence Agency told CNSNews.com today that it stands by the assertion made in a May 30, 2005 Justice Department memo that the use of “enhanced techniques” of interrogation on al Qaeda leader Khalid Sheik Mohammed (KSM) — including the use of waterboarding — caused KSM to reveal information that allowed the U.S. government to thwart a planned attack on Los Angeles.

Before he was waterboarded, when KSM was asked about planned attacks on the United States, he ominously told his CIA interrogators, “Soon, you will know.””

-from CBS News (April 21, 2009)

Otherbill @ 243

You have a problem with a dictionary? So you have problems with facts. Maybe that is why you like President Obama’s promises so much. I mean according to Politifact.com, Obama has only kept 8% of the promises that he made during his campaign. I bring this up because I voted for him based on the majority of his promises. He has not held up his side of the bargin, and now him, Pelosi, and Reid are running this country into the ground, and our children are going to suffer for it.

I’ve been watching some of the town halls that were broadcast on CSPAN, or at least I was a few weeks ago. Howard Dean was at one of them. I don’t remember where it was, but it was certainly lively.

He said that there was no way they could pass the bill if they did put tort reform in it. Because the gains that would give them among republicans would be small compared to the damage the trial lawyers’ lobbyists would do to the bill. As he said, the bill has enough enemies without taking that on.

He did, however, agree that it is something that needs to be done. Because he is also a doctor. And I am going to take his word that malpractice laws currently hurt good doctors as well as bad ones, and contribute to rising costs. But it is not believed to account for enough of our health care costs to risk sinking the whole bill just to include tort reform. We should fix the biggest problems first.

So, Other Bill and everyone arguing with him, according to Howard Dean you are all correct. It’s a problem that needs to be considered eventually, but it’s not a big enough part of the problem that we need it in this bill.

Oh, and isn’t this entire bill basically about putting restrictions on insurance companies to prevent people from being denied coverage, providing a public option as an affordable alternative, and some kind of exchange that would make private insurance more affordable? If so, wouldn’t they screen for illegal immigrants when they tried to sign up for either the public option or vouchers for the exchange? It seems just silly to say they’d be asking for proof of citizenship at the hospital, they’d ask for your insurance card. And if you’re an illegal immigrant you won’t have one unless you paid out of pocket with no government assistance.

Actually, if they really do put in something that says everyone has to get insurance, then if someone goes to the hospital and doesn’t have any, wouldn’t that be a red flag to call the authorities about a possible illegal immigrant? Which means the illegals who aren’t paying an American insurance corporation and contributing to that part of our economy would die or get caught if they were ill or injured. You’d think the right wing would like that.

Clifton – for words, yeah I think dictionaries are generally the place to go. But for philosophical systems I’m going to need more than a one or two sentence definition of the word to comment intelligently on the system as a whole.

Encyclopedia at the least. But there are hundreds of books written by academics researching the subject. Thousands of pages of study reduced to two sentences is not good enough.

CatG @ 242

Please don’t use the Sixpack of Stupid as a ‘bipartisonship’ example. They’re just Bought Off Baccus and a couple of buddies using the Republicans as a useful excuse and the Republicans using the Dems as useful idiots.

Remember Grassely and Enzi making public boasts all August about how they were able to kill everything in committee.

Clifton @ 244

So a statement made well before 2005 using the word “soon” has any ability to concern a sane person -now-?

Otherbill @ 247

OK, if the dictionary isn’t good enough for you, look up Lenin and Russia around 1917. There you will see what happens when a capitalist country attempts to move toward socialism. You will see how miseribally the country failed, and had to move back to capitalism and later communism. Are we ready for communism? Are we ready for a Cuban, Chinese, or USSR lifestyle? I can already feel the blood of you and Greg London boil. You are probably in denial that the libs want to move in the direction of socialism. We have bailed out big business with billions of dollars. We are part owners in AIG, General Motors, and Diamer Chrystler, as well as numerous banks. Now they want to run insurance. If you have an insurance company that is run by the government, and it does not work for a profit, how are insurance companies that do work for profit survive. This means that over time, the “Government Option” will not be an option. It will be all that is left. And that, my fellow bloggers, is socialism. And when the government is the only option, the government will give the same option to illegal aliens. Which means that we will have to pay for the illegal aliens’ health care. Which means, Mr. President, You Lie!

Nargel @ 248

You are right. He said we will know soon. That is the only thing that he would say until he was waterboarded. Then he gave the information that helped us to stop the terrorist attach in Los Angeles. What more do you need???

OK, if the dictionary isn’t good enough for you, look up Lenin and Russia around 1917. There you will see what happens when a capitalist country attempts to move toward socialism.

Russia was capitalist in 1916? Are you on drugs?

Clifton: “Obama has only kept 8% of the promises that he made during his campaign. I bring this up because I voted for him based on the majority of his promises. He has not held up his side of the bargin,”

He’s only been in office for a little over 8 months, that’s a pretty good rate so far. Slow and steady wins the race and is less likely to make mistakes. The man is dealing with a contentious Republican minority, powerful international corporations with lobbyists who hire/trick mobs, two wars, exploding international situations on which we are expected to be the pointman, a massive deficit he inherited from Bush, re-staffing government departments gutted by Bush, cutting pork spending programs initiated by the Republicans that cost too much, the worst economic crisis since the Great Depression, a financial community still intent on eating its young for short-term profit, the collapse of the middle class because of the financial shenanigans of the wealthy — but you’re upset because he doesn’t have the magic wand and fixed everything right off the bat?

You know, Democrats get a lot of fake flack about how we “worship” Obama. Instead, Democrats continually criticize and fight among themselves, which is why quite often the “do not question your leaders” approach of the far right works better. But it’s the swing voters, like yourself, Clifton, who worship him by demand of instant solutions, who expect everything to work like it would in a movie or t.v. show — such as torture, when every professional interrogator in the world says torture doesn’t work as a method and is not reliable — who don’t forgive failures, and who have the patience of a four-year-old.

Bush really, really broke this country. It takes time to glue pieces back in place, especially when dealing with a minority but still large group, like yourself, who refuse to think gluing some of the pieces is necessary, no matter how much evidence is handed to you.

The biggest promise Obama made was healthcare reform. So that’s what he’s working on now, and what he has to exert most of his resources on. They are now also introducing the bill to repeal DOMA, which will be another battle. There will be a battle each time, even on things the Republicans might actually want, like reducing Medicare waste and costs, because they want Obama to fail so that they can get more seats and a shot at the Presidency. That’s okay, that’s the name of the game.

But enough with the country being driven into the ground nonsense. The country has already been driven into the ground. What we are doing now is digging the way back out, and that requires looking at the whole game, and planning long-term strategy. If you’re going to quote statistics from the CBO, you can’t then ignore the other statistics from the CBO, like the estimated $500 billion in savings from cutting Medicare waste, or the projection that the reform plan will cost $1 trillion over ten years, the funding for which they’ve already partially dug up or figured out how to get. You can’t ignore that the “taxes” being proposed are not on the middle class, but are repealing Bush’s unnecessary tax cuts to the top 1% of the population and business world.

Part of reform are things to improve the situation with Medicare and Social Security — whose funding problems come in part from money raids by Congress, not an inability to fund it. Before Social Security and Medicare, the number one cause of poverty in the U.S. was old age, because old people, who worked hard and saved still didn’t often have retirement benefits, had fewer additional ways to get income, had skyrocketing medical bills and couldn’t get insurance because they were old. Social Security and Medicare stopped that crisis. (Now the number one cause of poverty is divorce, mainly for women.)

The Department of the Treasury’s new report estimates that all of us under 64 will be without healthcare insurance at some point in the next ten years, many for longer than a year. Hard-working people who can’t get health insurance, can’t afford healthcare. That means the private insurers are cheating people worse than I thought. And that the uninsured are going to cost us more than they do now.

You can say that it isn’t your problem, that you don’t want your children paying for these people. But you are already paying for these people — and you will keep paying unless we change how the private insurance industry operates so that it stops cheating customers. You can’t just say, well government needs to change, but everybody else can keep doing what they’re doing. Because we tried that already and it didn’t work.

Clifton: From this article:

the CIA believes that it would have been unable to obtain critical information from numerous detainees, including KSM and Abu Zubaydah, without these enhanced techniques,” says the Justice Department memo.

But that sort of conflicts with this article, talking about an anti-torture op-ed piece by Ali Soufan, a former FBI special agent and perhaps the most successful U.S. interrogator of al-Qaeda operatives.

Soufan says the use of those techniques was unnecessary and often counterproductive. Detainees, he says, provided vital intelligence under non-violent questioning, before they were put through “walling” and waterboarding.

Soufan says Abu Zubaydah gave up the information between March and June 2002, when he was being interrogated by Soufan, another FBI agent and some CIA officers. But that was not the result of harsh techniques, including waterboarding, which were not introduced until August. “We were getting a lot of useful material from [Abu Zubaydah], and we would have continued to get material from him,” Soufan told TIME. “The rough tactics were not necessary.”

So, the problem is this: the CIA say they had to torture Abu Zubaydah to get information out of him. But Ali Soufan says he interrogated Abu Zubaydah without torturing him and got useful information.

Meanwhile, the CIA is in cover-its-ass mode to avoid war crimes trials, so they’re going to say they saved the world through torture, even though Soufan was able to get information without it.

Oh, and you completely ignored all the false-intelligence that we ended up getting from torture. And you completely ignored that all that false-intelligence is what got us into a 6 year quagmire in Iraq. There were no WMD’s, there were no al queda links in Iraq. All that intel extracted through torture was false and it got us into a stupid war that killed a lot of americans needlessly.

If you accept the alleged positive outcomes of torture, then you must accept the documented NEGATIVE outcomes of torture. And torture gave us false intelligence that needlessly sent American troops to their death in Iraq. We should have been focused on Afghanistan, where Al Queda was actually located. Not Iraq.

Out of curiosity, did you serve in Iraq or Afghanistan or both?

So, there’s this article, which reports that in 2005, a justice department memo says that torturing Khalid Sheik Mohammed (KSM) got intel that thwarted an attack on Los Angeles.

But this kind of contradicts that. It’s an op-ed piece by Al Soufani, FBI interrogator, dated 5 September 2009. quoting:

They have asserted, for example, that harsh treatment led Mr. Mohammed to reveal the plot to attack the Library Tower in Los Angeles. But that plot was thwarted in 2002, and Mr. Mohammed was not arrested until 2003.

And for an whole list of facts, this article confirms that KSM was captured in Pakistan in 2003, and the article says that President Bush said that in 2002 officials foiled a plan by terrorists to fly a hijacked plane into what was then called the Library Tower, now known as the U.S. Bank Tower.

Attack foiled 2002. KSM arrested 2003.

Soon, Clifton, soon you will know, that it’s a lie.

London @ 253

I served in Iraq twice. Don’t go there, because I do not believe that you know what you are talking about. Like I told you before, you are wrong about intelligence and what was and wasn’t found in Iraq, and I can’t go into it. Maybe in about 10 to 15 years more information will be released, and you will know how ignorant you are on the subject.

Here is some useful information for you. It does not matter if you are a Dem or Rep. They are both there for only one reason….Power. It does not matter if you are speaking about President Obama, Pelosi, Reid, Wilson, Steele, Bush, Cheney, or Biden. They will lie in order to get power. The representatives and senators in our Federal Government (With the exception of Joe Lieberman) are not there to do what is best for the people of the United States, they make decisions on what is best for their party. Take the blinders off. This bill in which there MUST BE A GOVERNMENT OPTION, just gives more power to the govenment. We are giving too much power to the government and we need to end the growth. And before you say it, yes I know that Bush increased the size of the government, but it was done, by providing for the common defense (required by the Constitution), not through welfare programs (which is outside of the requirements of the Constitution).

Clifton:

Saying “I know something you don’t know and I can’t tell you, but one day you’ll see I’m right” is not an argument. It’s an assertion. You can’t reasonably expect to come in and make an assertion without proof and then be taken seriously.

Clifton: you are wrong about intelligence and what was and wasn’t found in Iraq, and I can’t go into it. Maybe in about 10 to 15 years more information will be released, and you will know how ignorant you are on the subject.

Woah. Secret information that Iraq had WMD’s that can’t be proven? Cool!

Wait, you’re not talking about all the stuff that inspectors inventoried but didn’t get around to destroying back in the 90’s, are you? When Blix went back in in 2003, they found all the inventoried stuff that hadn’t been destroyed yet, and then they started finishing the job of disarmament. So you would find old WMD stuff in Iraq, but it either had been inventoried or was in the proces of being inventoried. I think part of the problem is that safely destroying chemical and biological weapons is a really hard thing to do.

But you’re saying this is new stuff? Stuff that would justify Bush and Cheney’s invasion and occupation of Iraq? Stuff that Bush and Cheney instead decided to sit on and keep classified? Wow. That means they essentially allowed the entire world to villify the US and themselves so that they could keep this secret information secret. That must be some really, really, really, really, super sensitively secret information.

Or it isn’t at all true. One or the other.

People who really know things that are THAT secret don’t ever say that they know anything. Especially in writing on a public comment thread.

Clifton – based on what you are saying, why on earth would you have voted for Obama? I mean, it isnt survivor. The one who gets the most votes gets the island, not kicked off.

Pretty much every major campaign promise of Obama seems to be against what you believe should be happening with our country.

As far as Early 20th century Russia and the now US, your analogy would make George bush a czar, right? And the peaceful election of Obama was a violent bloody overthrow of government? Bailing out some major US companies, right or wrong, doesn’t make either of those so.

Clifton: “They are both there for only one reason….Power. ”

Yeah, so, we know this already. Though it’s not socialism power they’re after, (and they couldn’t take it anyway because you have to have the miitary with you and you might have noticed that the military tends to be a little conservative.) It’s just that the Democratic party has found that helping people as well as business is useful for power, so we get more out of them, whereas the Republican party feels that only helping business gets them power, so we get far less out of them, and usually it ends up costing us more. See:

http://politics.theatlantic.com/2009/09/closing_the_book_on_the_bush_legacy.php

You served in Iraq. And there was another guy, more conservative than you, who said he served in the Marines. That makes you two part of the bravest people on the planet. I’ve been privileged to know a number of military families and personnel, and they risk and sacrifice more than anyone.

But that’s just it. You’re willing to risk your life, sacrifice it, to save mine. You do this for all American citizens, regardless of their income, lifestyle choices, religion, political affiliation, whether they’re on Medicaid or not. But here at home, people are dying too. They’re dying because of healthcare, because the industry needs reform. Hard-working people, people who paid their taxes, paid their insurance premiums but didn’t get service, and do the best they can. The people whose lives you risked yours to save are facing another kind of threat.

We have social service programs — schools, vaccinations, Medicare, VA, etc. — not as charity but as self-preservation. The benefits of providing those services outweighs the costs, not just to the people who are getting the aid in Medicare, etc., but to the society as a whole, in productivity, in lower costs, in innovation, in economic stability, opportunities for prosperity, etc. It’s a form of defense, just as our armed forces is a form of defense. Because if your neighbor is sinking, he’s going to take you down with him.

And because people are a resource. And we’re wasting them when we don’t have to be. So the politicians can do all the political maneuvering they want, I don’t give a crap, as long as it results in improvement of the problems we face. I am much happier when they don’t have an ideology, when they aren’t like Wilson, who is apparently a member of the Sons of Confederate Veterans and led the 2000 campaign to keep the confederate flag flying in South Carolina’s capital building. (So his yelling at the black President for his own aggrandisement, damaging the welfare of his own political party, is perhaps not so surprising.)

So okay, we’re seeking reform. You disagree with the public option. You think the costs of it outweigh the benefits. I don’t, for reasons I’ve put up in other discussions on this. The public option lets individuals and small businesses — and only them — buy a basic government plan, so that they definitely will have access to coverage. Right now the big insurers don’t want these people as customers, but when regulations say they can’t turn them down or hike the bill because the business is small, that’s a whole new customer pool for them, and they become a little more attractive.

But not entirely. The big insurers who own most of the market like Blue Cross and AIG don’t really compete with each other because they don’t have to as everyone wants/needs health insurance and they’re huge. Which is why they can keep hiking their prices way above costs. If we tell them that they can’t preclude taking customers on the basis of pre-existing conditions and small size, there’s still little competition incentive for them to lower their prices. So the people we’re trying to insure can’t be denied health insurance under the new regulations, but they still won’t be able to afford it. They’ll remain uninsured, they’ll keep costing you and me money. Plus, a government program can be used as legislative leverage to get the healthcare industry to lower costs for both government and private insurers.

With a public option plan, we cover them and put market pressure on the insurers to lower their prices to keep the small businesses and groups that have barely managed to afford health insurance with them. They lower their prices and then other small businesses and individuals can afford their plans. Capitalistic incentives, lower costs, improved service and choice.

Now, can we afford the people who’d buy the government’s insurance? They’ll be paying for it, and a lot of the additional funding for the program has already been found, such as reducing Medicare waste. A large part of reform is reducing healthcare costs to make healthcare affordable, because as has been noted, we’re already paying way too inflated costs for the same services that other countries get cheaper.

Alternatives to public option — so far no one’s come up with anything except things like co-ops, bribe private insurers in hopes that they’ll lower premiums to customers, but then we’re still paying the inflated costs. The system wouldn’t be fixed. And a lot of the screaming over the public option — that’s the private insurers negotiating. They’ve made a lot of money thanks to Medicare, but they want to try and get every advantage. Which is okay, but it’s not practical to give them a free pass or bribe them, because the problems that cost us money will remain and get worse.

The government has to pay for the uninsured either way. They are already responsible for and in power over these people. The way we have now is unworkable in terms of accelerating costs. Reform without a public option does not lower costs enough, does not reduce enough of the uninsured.

That doesn’t mean we can’t jerry-rig the public option to work better, cost less. But without it, we lose a lot of leverage to reform the insurance and healthcare industries so that they don’t just make themselves profits at our expense, but actually work.

Clifton @ 250

Obviously my definition of ‘soon’ differs from yours. Also, LA? You by any means talking about that bunch of yahoos, unaffiliated so far as we know with AQ, that were so clueless that they thought that putting a match near one end of a pipeline blew up the hose on the other end?

And Lieberman? Bwahahahahahahaha!
The person who was turned down by the party he was backstabbing and went and got elected by the uninformed and the other party. And isn’t going to be so lucky the next time?

You need to add a snark tag to these comments.

KatG

You make some good points, although I still believe that my government should not be in the business of running a business. Create regulations, create an commission, like the SEC, that monitors the insurance and medical industry.

Also, I see that you listed the VA as a social program. I would have to disagree with that line item. The benifits that are provided through the VA i.e. GI Bill (Education assistance), and medical coverage. If you are injured at your job, does it not cover those injuries for the rest of your life under workman’s compensation? The GI Bill, I paid into. It is no different then any benifit that many business have for their employees. Tuition assistance is very common.

KatG, I would have to say that of all of the libs in this blogg, you make the most sence, even if I still do not agree with your beliefs, you have still given me some food for thought.

Clifton: “I still believe that my government should not be in the business of running a business.”

I really don’t think they want to be, any of them. They certainly, Dems and Republicans, didn’t want to bail out the banks. But they already are in the business of dealing with the uninsured. If the private insurers hadn’t been quite so greedy, the government might not have needed to step in, and certainly not with a public option. But this is the problem when we’re dealing with something that is and isn’t a business because it’s also the nation’s health.

“Also, I see that you listed the VA as a social program. I would have to disagree with that line item. The benifits that are provided through the VA i.e. GI Bill (Education assistance), and medical coverage. If you are injured at your job, does it not cover those injuries for the rest of your life under workman’s compensation? The GI Bill, I paid into. It is no different then any benefit that many business have for their employees. Tuition assistance is very common.”

You’ve certainly earned everything you get, and I’m glad that Obama is planning to improve the GI Bill and aid to military families. You all have been going without too long while they buy fancier weapons. But my sister works for a small business that’s still trying to afford worker’s comp, and can’t do health insurance or any other benefit. The VA is a special program for veterans. It’s one of the more efficient, low cost programs out there, and seems to be being used as a model for parts of the healthcare reform. The public option has people paying for the insurance. So it’s the question of how much supplemental money is going to be needed to run it, how much to pay claims, etc. From all that I’ve seen so far, it’s cheaper than the way we’re going now.

I lose it regularly on this blog. It’s easy to go overboard because these are big, scary issues in big scary times. But I will say there are a lot of smart people here with a lot of good info. And Scalzi always has his mallot if we get too out of line. :)

Clifton @ 262 – I think the point about the VA is just that it is a government run, publicly funded healthcare program.

And you certainly did earn those benefits, full stop.

otherbill@237: so you are seriously arguing that a statement that 10% of health care costs … is insignificant?

The numbers I’ve seen was half a percent per person. 10% is starting to get above the “noise” level. I haven’t had time, however, to see how those numbers translate into the $2100 per person for canada versus $5500 per person for US. So I don’t know if they’re on the same scale or not, so I’m not quite ready to say it translates into $500 per person in the US.

The thing is that same source that says 10% also says that 74% of malpractice actually involved doctor error. That’s definitely not insignificant.

I’m not sure how any approach to tort reform can solve that problem without harming the people who really were injured by doctor screwups. Lower the amount that can be paid? Why? The doctor screwed up. Raise the requirement of evidence to bring a case initially? Why the doctor screwed up.

Please explain how you justify making it harder for a patient injured by a doctor to have a lawsuit when 74% of current cases involve doctor screwups.

Most tort reform proponents push it from the point of view that most cases are frivolous and a lot of people get settlements who shouldnt’ get them. If 74% of cases involve doctor screwups, that sort of destroys the whole idea of being “frivolous”. Most cases are legitimate.

My general feelings on malpractice are that doctors risk losing everything for honest mistakes and negligent mistakes.

Hm, “losing everything” sort of implies award caps. Does your tort reform proposal limit award amounts? I don’t have statistics regarding how much patients are paid to know if they were “overpaid” in some way. Do you want to put a fixed price on a doctor killing someone? $50k for a lost arm? How does this work?

And your invocation of “honest mistake”, well, that’s one I haven’t heard before.

The stats that that I quoted that said malpractice is 10%? those same stats also said 74% of cases involve “medical error”.

What’s “honest” if the doctor screwed up and caused your wife to die?

At least if a cop makes a mistake in discharging his weapon, a board can review his actions and information available at the time and determine if it was negligent and deserving of punishment.

And the victims family can still sue the city.

In malpractice suits there is no distinction between an honest mistake and a case of negligence.

I think maybe we need a lawyer in here for this: Mythago? What’s the difference between an honest mistake and a negligent mistake? Is there a difference in malpractice lawsuits?

(Yes, I’m asking a lawyer for free advice. No I won’t ask you to read my manuscript)

In either case, if a doctor causes you to lose an arm, I think you deserve a chunk of money, whether it was an “honest” mistake or a “negligent” one, or whatever. I don’t think it matters, really, whether he’s a nice guy or a drunk. He chose to take on a life and death profession and he screwed up. If the doctor’s decisions caused you to lose an arm, the doctor should be paying you a chunk of money.

Are you saying that if you lose an arm as a result of a doctor’s “honest” mistake that you shouldn’t get paid anything? Otherwise, I’m not sure why you’re making this honest/negligent distinction.

The thing is, I found the stat that says malpractice is 10% of the cost. but how will tort reform lower this amount if 74% of those cases are legitimate screwups? Sure 10% is above the “noise”, but how will tort reform save money if most of those doctors screwed up?

lowering payout limits doesn’t change the number of screwups or the number of lawsuits. making it harder to sue lowers the number of lawsuits, but most cases involved medical error and are legitimate complaints.

I see no modification to the system that saves money except by allowing doctors who screwed up to not get sued.

So, 10% is big enough to get my interest. Now you’ll have to explain how you’ll actually make it only 2% or some other number.

Clifton, since you seem to think I’m ignorant about torture and since you seem to think your service in the marines in Iraq gave you a view into secret information that would justify torture, I thought you might have more respect for the opinion of Former Marine Corps Commandant Charles Krulak who wrote an op-ed piece this Friday condemning torture and condemning Cheney for still defending torture.

We now see that the best intelligence, which led to the capture of Saddam Hussein and the elimination of Abu Musab al-Zarqawi, was produced by professional interrogations using non-coercive techniques. When the abuse began, prisoners told interrogators whatever they thought would make it stop.

Greg @ 265 – okay.

Regarding the honest versus negligent debate. My personal feeling, based on what I’ve gleaned from discussions with doctors on the subject. So, take it as it is.

I’m the case of the police officer that you mentioned, the right of the family to sue the city regardless doesn’t mean the officer loses his house for having made what the review board would have determined (in our hypothetical case) a fair in the circumstances but if wrong, ultimately, decision.

Doctors have indeed chosen to take on a life or death practice. And that means that on any given day, when things go wrong, the stakes are for everything for the patient. One of the problems, that I see, though is that there is no limitation to responsibility. If a nurse on a staff makes the mistake, the patient or patients family has the ability to sue the hospital, the nurse, the doctor or whomever else was involved on that team. Now to the extent that the buck always stops with the leader, I appreciate that response. But, judges can use the doctors personal assets (personal retirement savings, house, kids college funds) to fund the payment of the damages awarded. I don’t think that’s right. And, if it were my wife and I had to choose between money from their kids college funds and nothing I wouldnt take the money. No bullshit. Money from an insurance provider or fromthe company, yes. And I also wouldn’t sue the doctor if it weren’t a case of negligence. e.g. She went in to have her appendix out and came out missing an arm instead. But that’s me.

The problem is patients also sue over unfavorable outcomes. Here’s an anecdote or two that I’ve heard from friends that are doctors. One had a women come in for her yearly visit to the GYN. One of her tests came back odd, but indicating cancer. The woman was referred to an oncologist specialist. Rather than go to the oncologist she sought a second opinion. The second opinion was that yeah her tests are still indicating cancer and she should go see the oncologist. A year later, the woman returned for annual visit and the doctor asked what happened with the oncologist. The woman said she didn’t go. The doctor immediately started to investigate the cancer herself and found that it had spread uncontrollably. Ultimately the woman died. After her death, the husband sued the doctor for not carefully explaining the consequences of nit treating cancer. After a lengthy court battle the doctor was found to be not responsible.

The second doctor operates an ER. A waitress broke her finger one night and needed treatment immediately. I forget what the cause was. The doctor stitched the lady’s finger up and put a cast on the finger so that it would heal correctly. This was explained to the lady. After leaving the hospital, the woman decided to remove the cast because it itched. As a result her finger didn’t set correctly and lost mobility. She sued the ER for 12.5 million dollars over lost wages. As a waitress she could no longer balance a tray on her hand.

Of the 26% of malpractice cases these are the types of cases that are brought against doctors. I agree that the other 74% comprising genuine doctor errors deserve attention. But I see a system in which only three fourths of cases being legitimate as not functioning to any reasonably expected degree of efficiency.

Regarding the numbers. From the source you cited, the language indicates that 2 to 3 percent of us medical costs result from damages And such awarded in malpractice suits. 5 to 9 percent of us medical costs result from the practice of defensive medicicine due to fear of those malpractice suits. So, 1.5 percent to 2.25 percent of US healthcare costs are associated with legitimate damages awarded in malpractice cases. Leaving from as small as 6.5 percent, to as much as 10 percent of healthcare costs in the US to be associated with unnecessary expenditures. That’s alot.

I agree that caps don’t work. In Texas, they insituted a cap. However, they didn’t cap lawyers fees. So, if the judge awarded a flat 250k dollars, the attorneys would work with that. But, if the judge awarded the 250k and legal fees, the attorneys were free to remoderate their fees. The language in the capping legislation didn’t require attorneys to disclose their fees publicly upfront.

And in general relation to my personal feelings on malpractice, but less so to our discussion. Do you know how much of malpractice awards actually go to the families? The you don’t pay unless you win variety, which I think we can agree that the majority of people requirig restitution to survive will frequent, charge up go 60% of the award or settlement as their fee. That, most of the award is paid over to the lawyers and not the people requiring restitution.

Again, I agree tha caps aren’t really the way to go. Contrary to some opinion, I’m not on the side of keep the courts free of the common man. So, your exactly right vitriol to malpractice suit caps aside, it leaves a very real and very sizeable problem that needs to be dealt with.

I think it merits inclusion in the discussion because part of the savings promised comes from eliminating defensive medicine costs. And I say it ain’t gonna happen if they don’t take the malpractice issue seriously. I don’t know what the solution will be. But it is a sizeable problem. up to a dime of every dollar spent on healthcare in the US is a result of fear of malpractice and awards for malpractice suits with mo doctor error involved. Good doctors are afraid of being the 26% where they didn’t do anything wrog but are required to give up their livelihood or their life savings. And that’s what is driving the 5-9% figure. And the plan to break even will certainly not be realized if they don’t find a way to deal with that.

But, agreed i don’t know te solution, and agreed it definitely shouldn’t be at the expense of those who were legitimately the victim of doctor error.

And, take my anecdotes for what they are. Just some things that I have heard as the personal stories of doctors working in the business. They are by no means meant to represent that 74% of legitimate victims of doctor error.

But, seriously, a 74% success rate is okay with you on that? At the very least I’d think you’d be lissed tha one in four cases were clogging an already clogged court system, slowing down the justice deserved by those genuinely wronged.

Arthur. IN not I’m. I’m not a police officer.

Regarding Clifton’s issue, I met a retired marine one star once. He did not have a very high opinion of the torture gets good information perspective either. I don’t think any genuine interrogation professional does. And by genuine, I mean not a person that watched a shit ton of twenty four as their training and then charged into a room and, well, tortured a person.

Also, spell correction on an iPhone can really suck ass.

Argh. Not Arthur. I blame the phone for my typos.

OtherBill: But, seriously, a 74% success rate is okay with you on that?

10% of costs is malpractice. But 74% of malpractice cases involve actual errors. In my book, that means that 2.5% of costs is wasted on malpractice. The rest were legitimate cases of malpractice.

Once you get down to 2.5% of costs, you start getting into the noise, and I start de-prioritizing it.

Especially considering other statistics like: 50% of all bankruptcies come from people overwhelmed with medical billa. And 80% of those people had insurance when the got sick. Or statistics like Canada spends 2100 per person. America spends 5500 per person. a 100% difference.

how is it 2.5% gets such a high priority in light of these massive numbers?

Greg @ 270 – I think we disagree on our intrepretation of the numbers and their implications. I spelled out what I thought in the previous post. Interpreted your way, I understand your conclusion. I still think your intrepretation incorrect, but I’ll grant you you’re conclusion is right if your interpretation is.

Regarding your mention of bankruptcies, absolutely. I think that is, as it should be, the clarion call to action on the adminstration of healthcare in the united states. And, as such, it is rightly the driver of a number of other issues outside of our discussion, like the the insurers right to drop clients when they suddenly become sick.

However, I fundamentally believe that you can not fix healthcare in the united states without addressing all of the problems. Arguments that this or that detail is insignificant or worth too little for the struggle to right them are nonsense. Has it been so easy to get to the point where most people involved would be willing to sign on to fix even some of the problems? and for that matter, we aren’t exactly there. The democrats are selfdestructing over their inability to agree on what to address and how. And republicans, well as if republicans haven’t been a party to many of the drivers of what isn’t working in healthcare. How embarassing it is for them to preach about the sanctity of medicare and what the proposed reforms will do to it.

Healthcare presents a difficult challenge. And its solutions will require creative thinking from all parties and difficult work to make any reform work.

Greg @ 270- I reread my post. I didn’t say it explicitly, and I’m not sure that didn’t obscure one point.

The 74% that you refer to reads, in the language of the source provided, to apply *only* to the 2-3% mentioned as costs due to malpractice suits. It does not apply to the 5-9% figure mentioned reflecting costs of defensive medicine due to fear of malpractice.

My interpretation, what it’s worth.

you can not fix healthcare in the united states without addressing all of the problems.

Except we’re trying to enact Health Care Reform, not health care perfection. So, we just have to make it better than it was. putting an end to 50% of bankruptcies in America is a pretty damn good start. If someone figures out a way to lower malpractice costs from 10% to 5%, they can still do that down the road.

Direct question: How will tort reform make malpractice cost less?

Don’t give me the things you know won’t work. Don’t give me anecdotes about lawsuits you didn’t like. And don’t tell me it has to be on the table.

Give me one example of tort reform change that would lower costs and keep the level of care the same. And walk me through the basic idea of how it would accomplish this.

Here’s an example explaining how I’d fix a problem: I’m in favor of fixing the medical bankruptcy problem. Most of those people had insurance. Making it illegal to dump a health insurance customer, get rid of annual and lifetime limits, and get rid of preexisting conditions exclusions, will make it impossible for people with insurance to get dumped as soon as they get sick. Insurance will have to pay. That will reduce a major chunk of the medical bankruptcy problem.

It does not apply to the 5-9% figure mentioned reflecting costs of defensive medicine

So, 74% of 2-3% is pittance to be ignored. That leaves about 7% that tort reform might address, assuming tort reform does its job perfectly. Otherwise, you’ll probably end up saving maybe half or a third of that. So we’re talking about maybe only 3% total savings from tort reform.

That’s down below my noise threshold. But, you insist, so, please provide a concrete example of how tort reform would save money and maintain level of care as requested in my previous post so I can at least grasp how it might work and and maybe see potential pitfalls.

You say it must be on the table. I say I’ve yet to see any reason why other than the other side demands it and it may be a political bargaining chip. But I don’t see how it would save money. An example will help.

Greg @ 274 – Its only below your threshhold because you’ve Talked the numbers down from what they are in the paper to what you’d already decided they represent in your head.

5 to 9 percent is not a pittance. Despite your using tort reform as a curse word it isn’t unreasonable to include it in the conversation. If healthcare reform had started as a debate over existing solutions it would be done by now.

I’ve stipulated I agree that reform of that cost should not be at people suffering genuine wrong. So, we are agreed on that. We are left with trifling over what is “too hard” to solve.

My point was never that I was talented enough to come up with a solution myself, but only that the issue would ultimately require a resolution to cover cost savings already promised.

I’ll do some reading and talking and see if I can’t come back with a possible solution. Not because you’re a goading stubborn mule of a man but because it might be stimulating to see what other solutions have been proposed from less corporate centric ideologies.

(can goading and stubborn be used together or are they mutually exclusive principles? I think I’m mixing my animal metaphors.)

GregLondon @ 274

Texas and MN did tort reform up the wazoo and, when all was said and done, not only was there not any real policy price improvement (rose about as fast as the states that didn’t change tort) but there was no improvement on the ‘defensive testing’ end either. That’s why I keep saying that we already know it won’t help.

Clifton

I agree with those who have said that you certainly deserve your benefits. That said, I still reserve the right to point out when you post inane stuff.

Nargel @ 276 – agreed tha their tested solutions, award caps, didn’t work. That is not a testament to the unimportance of defensive medicine costs as a problem, or the existence of the problem, just that those solutions don’t work.

Greg – A couple of thoughts. First, one might cap lawyers fees. 60% is a ridiculous sum and drives up the cost of malpractice. But, agreed, that only improves the bottom line of maybe a percent of US health care costs overall. That one doesn’t make it wrong though. Would the democrats ever conceivably do this, either? I doubt it. But, it doesn’t injure the ability of patients to seek legal counsel and restitution.

Second, medical errors doesn’t translate exactly to doctor error. When an oncologist with a private firm performs an operation, they do so with the assistance of the hospital’s teams. One thing that might prevent doctors from so continuously covering their asses is limiting joint liability for operations. Right now, if the nurse on the hospital staff makes a medical error, the doctor who is unrelated professionally in any way to said nurse would be liable for the hospital staff’s mistake. This may alleviate, as I said, their drive to cover their asses as thoroughly as possible by ordering their own tests to cover any possible error on the part of the hospital.

As far as introducing evidence in court. Right now, there is not a requirement to prove that the medical error resulted in the negative outcome. Currently, they have only to prove that an error occurred. For example, one of the most common lawsuits that OB providers lose is ‘birth injury’. If your baby is born with a problem and the lawyers can prove that a problem occurred during delivery that is the end of it. However, they aren’t required to prove the two are related. So, if the doctor doesn’t get the baby out fast enough and there is oxygen deprivation the family could sue if the baby had cerebral palsey. But, the two aren’t proven to be medically related. This example would fall into unnecessary procedures and interventions. As in, if your wife doesn’t dilate in a timely fashion, they will immediately move to a C-section. not medically necessary, but it limits OB liability in court in terms of ‘birth injury’. and it is a procedure which apparently bills as nearly a 20k dollar procedure where a natural delivery would be roughly 3500 all said and done, with room and board after the delivery. So, OB fear of liability causes them to, as a standard procedure these days, perform an operation that is more than five times as expensive as medically required. In this country, the C-Section rate is roughly 30%, while in Europe it is 2%.

So, a couple examples. Make of them what you will.

Greg – in addition, once a woman has a c section there are almost no practices that will allow them to attempt a vaginal birth for any subsequent children. This is for two reasons. Te first is that because of the way c sections heal, it can be dangerous for mother and child. Her womb may rupture at the scar during the birthing process. This risk is not anywhere near one hundred percent, but it is increased. As a result, OBs will not allow themselves to increased liability risk, and that policy is almost absolute.

So, if you have five kids and your first birth was an unnecessary C Section your next four kids will be born via C Section, whether necessary or not.

I confess I’m doubtful about a 2% c-section rate in Europe.

The rate in the UK is around the 25% mark, and all the European countries I’ve been able to find data for have a rate over 10% (usually significantly over 10% – more than 40% of births in Italy are by c-section).

OtherBill: Despite your using tort reform as a curse word it isn’t unreasonable to include it in the conversation.

It certainly is unreasonable if there is absolutely no proof that it would improve anything.

All you’ve done is give horror stories and mostly anecdotal evidence about a problem. What you’ve failed to do is explain how tort reform would be a solution. But you insist on it. That should tell you something.

You’ve told some lawsuit horror stories. But you haven’t explained how you’d make those suits go away without making it harder for the 74% of cases that are legitimate to get their day in court. You’ve told some defensive medicine horror stories. But you haven’t explained how tort reform would lower those numbers.

from the Houston Chronicle: If you’re going to be killed accidentally during surgery, it might be better for your relatives if it happens outside of Texas.

The article says that reform cut lawsuits in half. But if 74% were legitimate, then there’s a serious problem. The article then goes on to say this:

State records show, for example, that a doctor who lost her license in Virginia and New Mexico was granted a restricted license in Texas.

This is a good thing? Imagine this nationwide. Doctors who would have lost their license get to continue practicing.

many cases, especially ones involving the deaths of children or other nonwage earners, cost so much and net so little the families skip the heartache of reliving their losses in court.

nonwage earners? Sounds like they capped awards to be a function of income. Your death is only worth some function of how much money you made last year. Is this what you want?

Over here is another article. It says
Liability premiums, which had doubled before reform, have declined more than 30 percent. But then it also says: Healthcare spending has grown faster in Texas than the rest of the country. Patients are paying more for health insurance and medical bills. Doctors do more tests and scans, an indication that so-called defensive medicine hasn’t declined here.

Insurance premiums are down. Health care costs are UP. patients didn’t save anything. All it did was make more profit for those in the industry. Great. then it says this:

The Congressional Budget Office reached the same conclusion in 2004, writing that “even large savings in premiums can have only a small direct impact on healthcare spending.”

followed by this: Malpractice lawsuits, lumped together with medical errors, account for maybe 1.5 percent of the $2 trillion spent on healthcare annually, experts say.

So, yeah, I’m thinking maybe it is in the noise level.

It’s easy to keep talking about tort reform in some vague nebulous gaseous concept. It’s a lot harder to defend specific implementations, like Texas, when it becomes painfully clear how those specifics will play out in the real world.

#5 – Charles K Bradley

“I hope our Congress does not start to look and act like the House of Commons in the United Kingdom”
The House of Commons is far from perfect, as UK voters are very much aware. However, it does have quite strict rules on unparliamentary language and a similar outburst from Joe Wilson during a House of Commons session would have seen him directed to leave for the rest of the sitting.

Re the larger healthcare debate – the devil’s definitely in the detail on how you implement universal healthcare and what the mechanisms are, but those in the US who appear to think it’s a bad thing in principle bewilder me. Aside from the human arguments, it can’t be cost-effective to have uninsured people wait until their condition becomes an emergency and then force hospitals to treat them at the cost of the insured. The British NHS isn’t as great as we all wish it was, but we can all visit a doctor at any time, for any medical issue, without having to worry about the bill.

Other Bill 279: once a woman has a c section there are almost no practices that will allow them to attempt a vaginal birth for any subsequent children.

This was true once but no longer is. C-sections are better than they were, and I know many women who’ve had one and had subsequent vaginal births.

New updates. Still under 30 pages. Hopefully this is the last iteration:

Prisoners_Dilemma_and_Laissez_Faire.pdf

From the summary: Regulating one-time and short-iterated prisoner dilemma games achieves the most efficient and most fair outcome. But to achieve regulation, you must have political support. But people who tend to distrust others will tend to oppose regulation and tend to support self-interest, non-cooperative solutions instead. They may present various arguments to disprove a regulated cooperative
outcome. And while it is important to disprove the errors in these arguments, it may not be enough. You may have to find a way to reassure them, dispel their fear, and win their trust.

(snip)

I think if nothing else, Obama is good at reassuring people. At least most people. After his last speech, public support for health care reform went from ~50% to around 65% or more. That’s pretty good.

That doesn’t mean you have to implement something bad to try and get the last 5% to trust you. but trust seems to be the central issue of the opposition when government regulation is proposed.

The other bit that seems especially relevant to teh health care reform debate:

A person’s trust regarding a real-world prisoner’s dilemma scenario can be indicative of where they land on the political spectrum. Extreme right individuals don’t trust anyone, tend to not cooperate, and view government as an afront to their liberty. Moderate right individuals don’t trust that someone might take advantage of their cooperation if they were to offer it. Moderate left individuals tend to trust, and tend towards cooperative solutions. They also tend towards government regulation t achieve the most efficient and most fair outcome.

What this debate has clearly demonstrated to me is that people are opposing hrc out of their distrust of others, not out of facts. Deathpanels being the perfect example of something completely non-factual, but propagated even now because it reinforces the fears a distrustful person has.

This has been an extremely illuminating debate about human behaviour.

Oh, and KatG, would you read my manuscript?

:)

Greg – you ignore your own numbers that you provided for the discussion. You’ve deliberately misrepresented and talked them to down to nothing so that they match your world view.

This conversation with you continues to be a waste if time. You ignore anything that doesn’t suit you. You appear not to be an ignoramous, so I will assume you are doing it to be deliberately provacative. You find new numbers, ignore their significance, and return to the only two numbers you have from one study. I get it. One half if one percent and 2200 versus 5500. Everything else is wrong. Whatever dude.

David @ 280 – hm. You may be right about that. I’m going to check around and see if I can find better numbers for the rate of cesarean sections.

Xopher @ 283 – based on my recent experience with this and the discussions with doctors, I’d have to disagree. It is less medically necessary to avoid going back to vaginal birth. But, in terms of liability most doctors won’t take the risk. The practices that do usually do so only if they were the ones to perform the c-section.

David @ 280 – I believe the roughly one in three US women undergoing cesarean is correct. I continue to be skeptical of the 2% figure for Europe. My bad on that one.

The WHO holds 15% as an appropriate threshold for c-section rate, with 5-10% being an optimal level. Most sources seem to concur with this. Also, less, most sources seem to be saying, is likely to indicate a lack of access.

But, that leaves rates in the US twice as high as they should be and at three times the optimal level.

OtherBill: you ignore your own numbers that you provided for the discussion.

Dude, I was looking for infomation about Texas and found a third set of numbers. Why should I ignore them? My first set was .5%. My second set was 10%. The third set was 1.5%. You didn’t get mad when I found the second set which disagreed with the first. I can only assume you didn’t get mad because set #2 agreed with your position, so you let that slide. Then looking for info about Texas, I found another set of numbers and included them. Now you’re mad because #3 takes the numbers back down again and disagrees with your worldview. And me, I’m just including them into the list of numbers I’ve found about how much malpractice costs and I see no reason to ignore them.

But here’s your even bigger problem. It doesn’t matter if the cost is 2% or 10% or even 20%. The problem is that you assert that tort reform will make costs go down. But Texas had tort reform and while malpractice costs went down, total healthcare costs went up. It sounds like the CBO is correct in saying that there is little correlation between tort reform and health care costs. i.e. the costs are not driven by lawsuits. But you still cling to tort reform.

How am I the one ignoring the data when the data in Texas says tort reform doesn’t work? How am I the one who ignores anything that doesn’t suit me when you ignore Texas? Give me an example of how you’ll lower costs, explain how tort reform will work when Texas didn’t, and then we’ve got something to work with.

Otherwise, all we’ve got to work with is your word that tort reform will somehow lower costs, but you can’t explain it and you can’t explain why it failed in Texas.

More fun stuff: A Robert Wood Johnson Foundation study published in the new New England Journal of Medicine issue shows support for healthcare reform with a public option at over 70% from physicians. 10% wanted the single payer, and 63% want reform with a public option and private insurance. Only 27% support private insurers only. Of those doctors in the survey who belonged to the AMA, 62.2% of them want a public option with private insurers, even though the AMA has taken the stance of private only, claiming that a public option will destroy private insurers. So they’re not even listening to their own membership, Other Bill, which might be worth looking at in your discussion. Also 58% of them wanted to expand the age range on Medicare to start at 55 instead of 65.

Less fun: in eight states and D.C., getting beaten up by your spouse is considered a pre-existing condition which can get you denied health insurance or kicked off of it. In 2006, the Democrats tried to end this idea, but the amendment got voted down by the Republicans in the Health, Education, Labor & Pensions Committee, including a no vote from Sen. Enzi, who is part of the bipartisan Gang of Six committee. Oy.

Greg – you asked for examples on my part and I gave you a couple not involved in the way Texas attempted tort reform. Your response was a littany of things that I largely agree with you on about how the previous proposals didn’t work out.

Saying that one set of solutions didn’t make the cost go down does not equal that malpractice is a driving factor in unnecessary tests. Of which, I provided an example for both how malpractice is a driver for unnecessary procedures and tests and how it might be countered in a way that I believe was not a part of texas’ experiment on tort reform.

As far as switching numbers around, you’re right you brought in separate numbers. But, when talking about the importancce of ten percent of the expenditures you whittled them down by saying there isn’t a way to perfectly alleviate them, so they are unimportant. You started by making the conversation about numbers. Then you manipulated the numbers to say something they didn’t or make them seem unimportant.

From my perspective, you’ve asked for other numbers. We both found them and you ignored them. You asked for positive examples of how reform might work, and I provided examples. You ignored them by discussing things that already didn’t work.

But when you talk about numbers like reducing the number of bankruptcies by increasing the rights of insured patients (somethig we both whole heartedly agree on) I don’t whittle them down to unimportance by suggesting that it will be hard to get the insurance companies total compliance. There will still be battles between hospitals and insurers over what should be covered and how much should be paid out at any given time. And it will take a lot of hard work to nail that down and get it working right. That doesn’t mean we throw out the problem. That means we keep working for a solution.

I keep agreeing with you on the majority of your complaints about the way tort reform has previously not worked and about how that shouldn’t negatively effect patients rights.

I also keep jumping through the hoops tha you ask to keep up my side of te debate. When I do, you ignore the points that don’t work for how you have decided tort reform works internally. That’s why I say the conversation seems pointless. You keep thinking what you’ve decided without acknowledge any ofthe counterpoints that you or I come across.

I’m not saying you have to change your mind because I have a difference of opinion with you. I’m totally okay with that and I definitely respect your right to your position. But don’t base a conversation on your willingness to consider other numbers and other examples and then ignore them. If you don’t want to change your mind, that’s fine. I’m not frustrated with that. I’ve enjoyed the debate inasmuch as it has given me a reason to look up information on a subject of interest.

But you keep saying things I’ve told you I agree with as though we are on opposite sides of those issues in response to the very different information you’ve asked me to provide.

KatG @289- thanks for that tidbit. I’ll look ip and read the journal article later tonight. Much appreciated

Other Bill 278

One of several posts you ignored mentioned the fact that tort reform, by using the large upfront costs required in a malpractice (medical or otherwise) suit, strongly reduces the likelihood of a valid case even being filed. So now your argument is to make it even harder and unlikely to file a valid suit.

I posit that tort reform is not, and will never be in any form, the answer. Stop wasting time, yours and everybody else’s, and energy in a futile quest. Find a different, better concept that might actually work but quit complaining about the current attempt at health care improvement in a quixotic chase of the ‘tort reform’ miracle.

Nargrl @ 292 – I’m not complaining about the current health care reform attempt. I’m quite in board with it. I don’t accept the argument that a solution can’t be found, or that it won’t eventually be resolved or successful.

It is important because the doctors ordering unnecessary tests and procedures are arguing that those exist because of fear of malpractice. Those tests will not be eliminated if that issue is nit addressed. And that is part of the proposal right now to pay for the changes to be made. That doesn’t have anything to do with whether or not tort reform will work. It has to do with the reform currently proposed and the cost savings measures proposed. Where will the money come from if they don’t fix that?

Regaring your first paragraph, I don’t understand what you are saying. Which post was it, or will you give a couple more sentences to clarify?

Other Bill

You say we need to do something about the extra tests. I am not arguing against that. I keep pointing out something else.

Tort reform is not, and never will be, the answer to that.

In practice it has failed in several ways. When stressed it has only made things worse. In areas other than medicine, it has failed in similar ways.

You complain about the surgeon getting blamed if the nurse makes a mistake. Isn’t he getting the big bucks for, among other things, being in charge? IIRC, counting sharps and other tools is on the check list before ‘close the patient up’. If that step is forgotten, the responsibility is not 100% the nurse. Maybe the guy with the scalpel in his hand should have considered it.

Please come up with a mechanism that could act like you want tort reform to do. I would be glad to discuss that and it’s plusses/negatives. Anything that would have a chance to work.

I agree with you on many points. But.
Tort reform is not The Answer. Insisting that it be MADE TO WORK NOW is not something that will, in any way, help the process. I do not want a lesser bill. I am already cranked off at the likelihood that mandates will show up four years before a functional alternative to the big seven companies does. Wasting political effort to crowbar in something we know in advance won’t work? Not optimal.

Little confusion here. ActBlue has Miller climbing toward 1 million, but other sources are saying that Miller actually has 1.5 million now and Wilson is up to a million.

Other Bill

Why do I assume that tort reform is your Big Issue?

Because it seems to be the only answer you will accept. When shown that it is not working, instead of suggesting an alternative, the response I see (rightly or wrongly) is always a version of “Then maybe if we tweak it like so” followed by something that won’t logically work like making it harder to file in the first place. And then pointing out that tort reform needs to be incorporated now.

No that’s wrong, just that malpractice issues and defensive testing do.

O.K., make a suggestion other than tort reform that could functionally work and now may really be the time to discuss it and bring it on board. If not, let’s get a positive on the record first and use that to push the next fix.

You are right, I was wrong. The post I was thinking about was 220. The post with the up front cost consideration was 154.

KatG @ 195

Bear in mind that there are several ActBlue donation groups and you may be seeing the total for only one. There should be a spot at the bottom with a grand total as well. There are also several places other than ActBlue that are collecting.

I’ve been very involved in the health care “debate” (if such a one-sided and thus rather low form of discourse can be termed such), contacting officials, berating and supporting the Obama administration as I felt was needed, talking directly to any number of people, etc. I’m not an admirer of “personality cult” politics, and do not find ANY Democrat above reproach, nor do I tend to personalize/sentimentalize them: they are first and foremost instruments of power and wealth. But even I was shocked by the outburst. A tactical error on the GOP side I think, and I am almost certain most of the GOP knew it instantly. The striking thing to me came the next day, as Wilson stepped out of some meeting, after announcing his “apology” – a rather tame one. He seemed quite rattled and whipped to me: he could scarcely lift his eyes from the floor. I suspect the ranking members of his party gave him a screaming beat down. They would realize how ignominious and hillbilly this made them seem. It’s really quite ugly, this leaking over of the equally ugly townhall madness into the legislative body. I’ve got nothing against spirited political debate, and am actually a fan of the British “face to face” Parliamentary system. But this is both a different context (a different set of traditions) and a comment that hardly ranks up there with Socrates. Wilson seems like another fine South Carolina public servant….

But, seriously, a 74% success rate is okay with you on that? At the very least I’d think you’d be lissed tha one in four cases were clogging an already clogged court system, slowing down the justice deserved by those genuinely wronged.

Holy fuck! How did you get away with saying that and not get dogpiled?

You honestly think that the only cases that should go to court are those where the one bringing the case will win? Really?

You don’t think that, just maybe, the entire point of the courts is to find out the truth, which means sometimes stupid cases have to be brought to trial?

You think the only cases that should even go to trial are the ones that the defendant will lose?

If anything, the fact that 74% of malpractice cases involve clear errors by the doctor tells me that it’s probably too hard to bring suits.

Nargel @ 294 – okay.

I think, obviously, we just disagree about whether or not tort reform can be effective. I think it’s important and take kind of the Edison lightbulb approach to ways that didn’t work. I think award caps are just so wrong in reality that I don’t want that idea to derail something I see a problem. I don’t want to pontificate, so I’ll leave that at that.

As far as joint liability in the surgery. The doctor is the leader of the team in that he is the primary surgeon. Yes. But he doesn’t hire or select his team in any way. He uses the team as provided by the hospital. And when the surgeon is done, the way medicine is practiced, the doctor does not close up the patient. The doctor doesn’t prepare or clean the tools used in the surgery. So, I do fundamentally believe the responsibility in that example is not that of the doctor. The team puts the scalpel in the doctors hand and takes when they are done with it. Ince done the doctor leaves the room. If the assistants jostle the tray or make a mistake then, it isn’t the doctor fault, but he is still liable for it.

Regarding alternatives. I’m not really sure what another mechanism might be. I appreciate that a lot of previous effort on this sort of reform has pretty much left most people on the other side of the debate feeling like they bare handed a hot pot.

Closing off joint liability only ensures that the person making the mistake is held accountable. In the situation I described, it doesn’t limit the righ of the patient to seek restitution from the offender in any way.

As far as a mechanism that does that with out reform, I just don’t know. Major surgeries have to take place in accredited hospitals. But mos doctors venture out into private practices, which does help with general access to healthcare. I’m also not sure what would cost more, malpractice insurance and the unnecessary tests or the cost of hiring a full surgical attending team for each practice.

But, in terms of options that limit access to healthcare or the right of the patient to seek restitution, I don’t think any of the options I proposed do that. I too would be glad to toss around any alternatives that you think of. And I will continue to think on ways outside tort reform.

Regarding your last paragraph. I’m not insisting that tort reform be wedged in now or failure is imminent. I’m not in any way opposed to non tort reform soluions that accomplish the same ends as the alternatives I suggested.

I share your sentiment about mandates now for options that won’t show up for four years. And I add to it the concern that part of the cost savings proposed will never materialize if they don’t address doctors concerns, whether through tort reform or non tort reform alternatives. I’m not hung up on tort reforms so much as I’m hung up that the problem won’t be fixed if the drivers aren’t addressed in some way.

But I would say thatthe way the bill is worded now is by mo means optimal either. Just considering the issue you mentioned outside of tort. We have a bill full of half measures and half solutions. I don’t want that. But, we both agree that full measures on allthe reforms being discussed are appropriate. I’m not fighting the completion of the bill, I’m drawing attention to another half measure area. I don care how it’s addressed, just that it is.

Tort reform has been pretty well trodden into the ground by non well meaning parties that have made that zone scorned earth. But whether it’s scorched earth or not, the bill is promising savings in an area it can’t deliver on if they don’t address it in some way.

And as a general rebuttal to your assertion, sir, that I am wasting time: go suck an egg. I’m pretty sure that we’ve all got time to waste as much as we sit around here and jaw at each other. Or have you found the secret gun I keep next to your head to keep you here?

It’s all in the spirit of debate here and I enjoy the conversation. But unless the mallet of loving correction comes down, I assume we are all enjoying a back and forth. Yours and gregs challenges have been largely welcome. It’s helping me to think about how I would argue my point more convincingly next time. Oh, and it’s been nice to hear thoughtful opposing positions. I have indeed learned a thing or two and I hope the feeling is mutual. And if it isn’t, go suck an egg.

Michael @ 299 – ouch. Stone cold stomp down. I like how you said that. no sarcasm intended.

74% of cases are proven to have a medical error involved. However, lawyers are not required to prove that the negative outcome was in any way related to the medical error. Which is still a problem for me. I defintely don’t know the non tort reform solution forthat one.

Nargel – one other thing. Doctors get the big bucks too because they start out their careers two hundred thousand dollars in debt for an incredibly demanding trade at a job that doesn’t even service their debt for the first several years on the job while they work more hours than most guys with three jobs do.

Other Bill @ 300

Obviously we have been cross posting a bit here. I doubt your 300 would have ended as it did if you had read my 296. :)

I didn’t say that you were wasting MY time. I was just trying to get you to see that TR was not going to be The Answer and maybe the answer was elsewhere.

And I don’t suck eggs. I fry them or throw them. Some fresh ground lemon pepper, grilled onion, a little sour cream… Yessss.

Nargel @ 303 – ha. A bit a bit perhaps. I know I won’t sell you on the tort reform in general. I think a bit if my republican side shows in that I see a nail and tort reform as the answer.

But I really do get what you are saying. Pragmattically, it will have to be some non tort reform idea to correct the problem. And, if we agree the problem exists, I’m sure we can find some non tort reform mechanism that would be more palatable to the debate in the national forum. I’ll continue to think on it and see if I can’t find the work of someone more well versed to steal some practical ideas from for our discussion.

Other Bill @ 304

Works for me. :)

KatG@289, it’s kinda weird that the AMA isn’t doing what their members want. I wonder how that happened. Spouse abuse is a preexisting condition? My god. The states that allow that ought to be publicly shamed.

OtherBill: you asked for examples on my part and I gave you a couple

You gave me anecdotes of things not working. Woman dies of cancer because she doesn’t listen to her doctor, husband sues, loses, doctor still has legal bills.

That’s an example of a problem. I keep asking you for an example of a solution. Yeah, it’s a problem that greenhouse gases are raising temperatures on earth. No, wood-burning cars is not a solution.

How would you save the doctor that money? Make it harder to sue? When most cases are legit? You present all these problems, which may very well be anecdotally true, but statistically, how do you fix the problem without creating a different problem?

You keep thinking about individual problems. And apparently, you are implying individual solutions. But you’re not thinking systemically. How do you protect the doctor from legal fees from bad lawsuits without making it harder for real lawsuits to get through?

You might as well propose Maxwell’s Demon. Some thing which takes no energy and requires no work, and somehow separates hot from cold and raises entropy.

Sure, it would be great if you had some system that could detect bad lawsuits without costing any money or requiring any overhead or having any salaries to pay, and separate the bad lawsuits from the good lawsuits, but it doesn’t exist. That’s what the court system does.

I’m asking for an example of a working solution. I don’t need any more anecdotes about the problem.

How would tort reform be implemented to lower defensive medicine? How would you solve the problem of defensive medicine without resorting to a Maxwell’s Demon type solutions? How do you separate what is defensive medicine and what is helpful medicine without any overhead, without costing anything, and without lowering the quality of patient care? It can’t be done.

So, give me a real world solution that would cause the cost of defensive medicine to go down without adding its own cost that’s even greater.

Wilson and Miller are now claiming equal donations at 1.5 million apiece. I’m giving two links to columns by liberal commentators, but they are interesting re what we’ve been discussing, one on conservative arguments on the public option and another on Wilson and far right behavior. You can see what you think:

http://www.huffingtonpost.com/dean-baker/the-public-plan-option-an_b_286790.html

http://www.huffingtonpost.com/lorelei-kelly/screaming-joe-wilson-newt_b_287073.html

Greg @ 306 – back at 278 and 279 I think I provided nonanecdotal ideas for ways that I thought tort reform could both address defensive medicine and nit limit the ability of the patient to seek restitution from the offender responsible for the negative outcome.

Addendum, Dave pointed out that 2% c section rate in Europe was wildly off base and I concurred. There’s a place in the US called the farm, where women can go to have a very earthy/hippy version of an all natural birth. Their rate is 2%. even though they’ve only lost two mothers, I’d concur with what in a later post I noted the WHO says. 15% should be an upper limit. 5-10% would be ideal. Anything less indicates not enough access to medicine. I have no idea how I mixed the farms rate for Europe. I can only plead sleep deprivation.

OtherBill: back at 278 and 279 I think I provided nonanecdotal ideas

278 has two ideas:

limiting joint liability for operations. Right now, if the nurse on the hospital staff makes a medical error, the doctor who is unrelated professionally in any way to said nurse would be liable for the hospital staff’s mistake.

I don’t know anything about that one. Would have to do some research.

As far as introducing evidence in court. Right now, there is not a requirement to prove that the medical error resulted in the negative outcome. Currently, they have only to prove that an error occurred.

Causation is difficult to prove. The Schiavo case comes to mind. She ended up in a coma. What caused the coma? Years were spent between the husband and Shiavo’s parents arguing over whether it was her diet or that he had physically abused her. I’m not convinced on this one.

279 doesn’t have any suggested solution that I can find. It just says c-section rates are higher in the US than in Europe, which David contradicted in 280.

WHO says. 15% should be an upper limit. 5-10% would be ideal.

The US is 30%. (I do wish you’d provide links for numbers like this) The assumption is that the additional 15%-20% is defensive medicine?

How do we know the excess C-sections isn’t doctors trying to pay for their yachts? Maybe they’re just overcharging to make money and then blaming lawsuits.

And what is your proposed solution to lower this excess rate of C-sections in the US? Maybe I missed it.

Greg @ 309 – fair point on the links.

“Causation is difficult to prove.” But, medical malpractice cases are not trying to decide whether her husband forcibly starved her or she starved herself. Medicine is a science, and I absolutely disagree that causation is difficult to prove. I appreciate, I think, where you were coming from on that point. But, and I know you weren’t using it like this, the causation is difficult to prove argument is what the parents of kids with no vaccinations against some pretty serious diseases say when backed into a corner about their fear of their kids being given autism by said vaccine. I can’t think of any other types of court cases where the defendant can be convicted without anyone having proven that he or she actually did anything that caused the negative outcome.

As far as 279 and the rates (and i noted david’s quite right contradiction) they are there to support the causation argument as a real world example of how a standard practice has been created as a result of fear of malpractice suits.

As far as how do we know the doctors aren’t just trying to pay for their yachts. I think because doctors approve of measures that will allow them to stop these kinds of tests and procedures. As far as my experience, 1100 of the almost 20k that the insurance paid out was programmed for the OB surgeon.

Kind of relevant, but slight offshoot. We used a midwifery group for my wife’s primary care, partly because their c-section rate was about 11%. And because their medical philosophy was nothing pushed that was not required medically. And because they stay with you the whole time. Did you know that with normal practices, it can literally be just you and your wife in the hospital room right up until just before a baby pops out? Complications, etc. so forth, when the midwife ordered the c section, I think she got paid an extra two hundred dollars.

Overall, the lion’s share went to the hospital itself. Run by an administrator, but not the doctor performing the operation. I’m not sure how my case stacks up though, because since our primary care was not an OB, the OB they used for the surgery is, i think, a private company that has a contract to provide services directly for the hospital.

I do think fixing the requirement for causation will bring down the c-section rate. If the WHO argues that 15% is roughly a medically appropriate/acceptable rate. Then we do have some issue here in the US with it. I appreciate that the case has not been proven with the numbers as yet that fear of ‘birth injury’ lawsuit is the driver there. But, between the doctors are just looking for money and the fear of the birth injury lawsuit, I think the latter is more likely. However, a third option is a possible contributor. Convenience. It might just be easier, with all the doctor’s time demand, to schedule a c-section and be done in half an hour than to wait around indefinitely.

And it may be that fear of malpractice has led to increased c-section rates. and as a result, more people have been exposed to the opportunity to push a c-section on those indifferent to make a bit of extra money and protect themselves. I don’t think it’s an absolute every doctor feels that way. But, I am arguing that the fear is the primary driver.

I’m trying to find info or research on c-section rates for Tricare beneficiaries in military hospitals. I don’t think you can sue your doctor there and it might be relevant to the conversation to see what the rates are and why studies think they are what they are.

But, overall, it was just meant to be an example of how I think fear of malpractice can lead to an altering of the way medicine is practiced.

Just announced in the news:

http://news.yahoo.com/s/ap/20090915/ap_on_go_co/us_health_care_overhaul_41

Health care bill advances without bipartisan support.

Click link for details.

The news that a Max Baucus backed bill has cleared is – in reality – a disappointment. The plan is closely related to the one Mitt Romney got when he was governor, and it’s a windfall for insurance companies: we will all be required to have insurance, and there will be a government cash penalty if we don’t buy into this boondoggle. It won’t even cover all Americans, and has no way (such as the public option) to really hold insurance companies to rational increases in premiums. Max Baucus is an insurance-company whore – not that that is rare. So is Joe Wilson, and many of the other Congressional members, and that’s the main reason we are being screwed. Obama is in a political bind, since he desperately wants to sign something into law, but in the long run this will not contain costs, and will not move the U.S. out of 36th place in the world health care rankings. Also, at least 86 members of the House (including Nancy Pelosi) have already stated in writing that they will not sign on to any health care bill that excludes a public option, so the whole thing is a mess. The fight – of course – is not over, and the bills have to be eventually reconciled. And – overall – the political numbers favor the House bills which include the public option, but then they are open to filibusters and the falling off of the “Blue Dogs”. So it’s still open to influence, although I think those most “favored” (i.e. bribed) by insurance corporations have turned off their hearing aids. If a Baucus-like bill eventually makes its way to the White House, I would prefer it not get signed, because such a “Pyrrhic victory” will delay real reform that much longer. Better we drop it, point fingers, and get back to electing real statesmen in place of the company men we’ve got now. A disappointment at this juncture…

The Supreme Court last year sent a case down to be enlarged and returned this year.They got it back the same day that Wilson was grabbing all the attention. Today’s corporate minded court is showing every sign of ruling against a hundred plus years of precedent.

If they rule as expected, corporations will be allowed to directly and legally bribe politicians thru campaigns and not even amount restricted to the per person limits.

If they don’t do robust health care reform now, it is about to get exponentially harder.

Information sources:

http://www.politico.com/news/stories/0909/26843.html

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/07/AR2009090702040_2.html?hpid=moreheadlines

Note: These sources are not considered “liberal” by any stretch of the imagination. I’d like some feedback from the declared conservatives. Do you really buy into this?

Nargel @ 314 – I was a republican of the non-Conservative variety. I generally think less money in politics is a good idea. I looked at the politico article that you provided. I didn’t check the Washington post one, the other page is behind an email wall that I don’t feel like overcoming on my phone at the moment.

Based on what I saw, it looks like what the corporations will be able to do is run issue related ads to the tune of many dollars, but the cap TBD in the decision. If the decision is in it’s favor. Is that correct. I’ve only seen snippets of the story to date.

If that’s the case, I’d still agree it isn’t a good trend to start, but it isn’t wholesale funneling of money. But don’t take that statement for anymore than it is: my offhand remarks from a snippet of a news story.

From the general standpoint that corporations rights to free speeh are being infringed currently, I’d agree with the original ruling. Not so much as the danger from where the other end of the pendulum was prior to the initial ruling. And the smarmy quote at the end of the politco piece where the guy says basically sometimes corporations know better. Jesus. Their PR representatives need to slap the hell out of that guy. He had to be way off message. What a stupid thing to say. Put that quite in the mouth if the insurance industry reps. Sometimes we know better how the business of health insurance should be run.

I’m not too thrilled with what I saw in the politico piece. But it also doesn’t seem like the nuclear bomb of campaign finance unreform. Again, that just how it comes off. But, when I get back to the full computer I’ll look up some mire info.

Thanks for drawing attention to that.

Oh, and pertinent to our previous conversation. Tonight Anderson Cooper is running a piece on doctors and malpractice reform. I think they may have run a piece from the lawyers perspectives earlier. He may have the story on his site.

Other Bill @ 315

I did explicitly link to Politico and WaPo to avoid the “that site is too liberal” bs that tends to show up with a huffington post article or such. My point being to point out what the conservative and corporate leaning sources are saying. Look at what overruling the cases listed in just the Politico piece alone could open up.

When a bit was added to a SC ruling by a -clerk- not even the judge, we got ‘corporate personhood’. That is not something we should be enlarging on.

Nargel @ 317 – I agree. It could open it up. I’m not a particular fan of that track.

What goes around comes around.

It wasn’t that long ago that a freshman senator from Illinois, among nearly the entire Democratic side of Congress, heckled President George W. Bush during his address by standing up and clapping so loudly he couldn’t be heard even with the mic at full. I guess people forgot about that.

Anyone who’s still following along The Washington Post has this article which I found informative.

A major business lobby weighed in Tuesday, saying that if current trends continue, annual health-care costs for employers will rise 166 percent over the next decade — to $28,530 per employee.

“Maintaining the status quo is simply not an option,” said Antonio M. Perez, chief executive of Eastman Kodak and a leader of the Business Roundtable. “These costs are unsustainable and would put millions of workers at risk,” Perez said in a statement.

Rather than letting the trends go unchecked, employers will probably adopt a variety of cost-saving measures, said Helen Darling, president of the National Business Group on Health, an alliance of corporations. Those steps could include giving employees financial incentives to participate in weight-loss programs, order prescription drugs by mail and undergo health assessments, she said. In addition, before workers pursue costly procedures such as back surgery, they could be required to receive briefings that explain the potential downside of the treatment, Darling said.

Gosh, that sounds an awful lot like the “rationing” that Republicans were screaming about.

Almost two-thirds of corporations surveyed by the Mercer consulting firm plan to call on employees to pay a greater share of health plan costs next year, according to a report last week.

For which, I’m sure, Republicans will blame Obama.

The Kaiser Family Foundation survey, released Tuesday, obtained in-depth responses from more than 2,000 private firms and non-federal public employers. The foundation focuses on health issues; its collaborator, the Health Research and Educational Trust, is affiliated with the American Hospital Association. Annual premium increases for families, which totaled 13 percent in 2002 and 2003, have held steady at 5 percent since 2007, the groups reported. Premiums for single coverage did not rise significantly in 2009, breaking a long-standing trend.

However, premiums have continued to rise faster than wages and overall inflation, the survey found. Though family premiums for 2009 rose 5 percent, during the 12-month period ending in April, general inflation fell 0.7 percent.

Of course, middle class wages have been stagnant since Bush Jr. took over. The incomes of executives, however, have always gone up faster than inflation.

There was a class war. And unless you’re really wealthy, you lost.

J.M. Cornwell: “It wasn’t that long ago that a freshman senator from Illinois, among nearly the entire Democratic side of Congress, heckled President George W. Bush during his address by standing up and clapping so loudly he couldn’t be heard even with the mic at full. I guess people forgot about that.”

Bullshit. And more to the point, the Congressional code of conduct which Wilson swore to uphold as part of his office specifically prohibits calling the President a liar on the floor of the House. Further, the accusation was false. The President wasn’t lying, Wilson was deliberately misleading and antagonizing for his own personal political gain with his base, at the expense of his own political party. He’s a scumbag, and his fellow Republicans think he’s a scumbag; they’re just trying to save face. He owed an apology to Congress as well as to the President because he broke his word as a Congressman and deserted his responsibilities. But he won’t, because he’s manipulating people like you who think he’s being a kick-ass cowboy.

What’s clear is that even when Baucus gave the Republicans supposedly everything they want, a total gift to the insurance industry, they still won’t back it. It’s clear that the Republicans have decided overhauling the healthcare system is not as important as elections. Which means we’re still stuck in a shoot yourself in the foot country.

Kat, the Republicans have put forward more than 33 bills on health care reform, but that isn’t getting any press. I’d say that points to the Reps doing something about reform and saying it in print that it’s important.

What the president said was partly untrue. In my book, that’s a lie, so Wilson was right, although his actions were wrong; I didn’t say they weren’t. I just pointed out that this is not something earth shaking or new and that the president has done the same thing, as have most of the Dem side of Congress.

As far as I am concerned, an apology has as much validity and power as a judge telling a jury to disregard illegal evidence they’ve already heard.

“Kat, the Republicans have put forward more than 33 bills on health care reform, but that isn’t getting any press. I’d say that points to the Reps doing something about reform and saying it in print that it’s important.”

Yes, at the bequest of the private insurers to get them more money, and to gut Medicare. Sorry but Republican “plans” have teetered between utterly vague and empty to destructive. That’s not to say that they shouldn’t and aren’t involved in the debate — they should and are. But several Republican politicians have freely admitted to the media that they’re trying to kill the bill for political gain.

That Baucus can’t get his version of the bill through his own committee, which consists of three Republicans and three conservative Democrats, when it provides all the terms the Republicans demanded should be in the bill, that signals that the Republicans have little interest in bi-partisanship or trying to get any real kind of reform. The Republicans’ track record on healthcare is lousy and a large part of why the system is in the mess it is now.

The proposed bill specifically prohibits illegals from healthcare coverage. That the ban MAY be hard to enforce does not negate its existence or intent. The President did not lie. Wilson lied, he knew he lied, he knew he was hurting his own party, and he did it anyway. What he did was also specifically what he had promised not to do, and as such was a breach of his office. It’s not the “same thing” at all. More to the point, a Southern white Congressman — who belongs to the Sons of Confederate Veterans, worked for Thurmond, and lobbied to keep the Confederate flag flying over the SC capital building — shouting that the black president is a liar has a racial impact in the country that any decent human being would have refrained from trying to invoke.

And Rush Limbaugh and the other mouth-breathers have picked it up. Now we have the Obama Nation where black people lie, beat white people and try to steal their money. So no, I don’t think what Wilson did was wrong but inconsequential.

KatG: If what Wilson did was so inconsequential, you wouldn’t be still griping about it.

Universal (socialized) health care is not the panacea you and others like you believe it is, but it is the road paved to hell by good intentions. Tug on the heart strings and load on the guilt long enough and intelligent discussion and wisdom go out the window. Socialized medicine has done so much for other countries around the world, like the UK which has gone nearly bankrupt funding a failing system. It’s one of those ideas that looks good but falls apart in practice.

After Rep. Joe Wilson showed his stupidity by interrupting the Pres. speech by calling out “YOU LIE” in a joint session of congress, he called his wife, and she said “Joe who was the nut that hollered out you lie” -Wilson said “it was me”, and she said NO really-who was it? I guess she really didn’t think he was that stupid.
In my opinion Wilson lost his 2010 election that night with just 2 little words.

“Universal (socialized) health care is not the panacea you and others like you believe it is…It’s one of those ideas that looks good but falls apart in practice.”

Nope. No doubt the UK is having financial problems – as is most of the known world. But the facts are facts: the U.S. pays nearly twice as much as the rest of the “advanced” world for health care and ends up about 36th on the list of best health care systems. So, the fact is the U.S. is already paying for its health care system, but at double the price as others. So while the U.K. might be having problems with its system, they are not having as many problems as we are. I doubt very seriously (and the facts back me up) that any country that already has a health care system such as France, Canada, England, etc. – despite any current financial problems – would elect to solve their problems by tearing down their system and replacing it with our model – and that’s more telling than a (rather irrelevant) comment that this or that nation is facing economic concerns: we ALL are. And besides, maybe you hadn’t noticed, but the U.S. is going bankrupt also, and a big part of that is the large cost we pay for inadequate care. These are just facts. Nobody says a better health care system would be a “panacea” for our society, but when you are paying twice as much for something than everyone else, and getting worse results…well…anyone can tell you that you are being screwed. Maybe your neighbor is having financial problems also, but if you are paying double for a worse service he gets for half the cost, both of you would realize that he has a better deal.

There’s a petition specifically opposed to Max Baucus’s bill and demanding a public option. If all we do for “reform” is mandate that everyone must have insurance, all we do is send sheep to the slaughter. If we’re goign to mandate everyone have insurance and impose penalties on those who don’t, we need to provide a public option that provides insurance that is cheap because it isn’t profit driven.

Petition is here:

http://act.credoaction.com/campaign/publicoption_reid/?rc=ol_091509

Nobody says a better health care system would be a “panacea” for our society, but when you are paying twice as much for something than everyone else, and getting worse results…well…anyone can tell you that you are being screwed. Maybe your neighbor is having financial problems also, but if you are paying double for a worse service he gets for half the cost, both of you would realize that he has a better deal.

Except that it’s not going to be a better deal: reduced care, increased taxes and ancillaries, etc. Who do you really think will be paying for your neighbor’s, indeed all your neighbors’, health care if you’re working and he’s not? Do you think the money will just magically appear or that your taxes won’t increase? That’s the magic of hidden taxes and fines. And we won’t go into how well the government has managed Medicare. Do you really want the gov’t managing socialized medicine and standing between you and your doctor in making critical, or even non-critical, medical decisions?

The root of the problem is in insurance and med costs from pharmaceuticals. Reform those, make the insurance industry more competitive, cut out frivolous law suits and exorbitant malpractice costs and health costs will come into line. Don’t you find it interesting that insurance companies pay less and less, refuse to pay for preventative procedures and methods, and yet still manage to pay their executives millions of dollars? More govt is not the answer, not until they can manage Medicare better.

Even the Dem legislators admit that there will be no appreciable difference for the rich or the poor, just the middle class. No doubt.

GregLondon: Yes, nothing like government mandated protection rackets, and that’s what insurance is — a protection racket founded in gambling and based on giving you as little of what you put into the pot as they possibly can. Insurance was once a good thing, but when the cost of group health insurance goes from no deductible and $15/bi-weekly to $350/bi-weekly and a $1000-5000 deductible, increased co-pays and more procedures denied than approved, the problem isn’t cost, especially when insurance companies are posting the biggest profits in history. And guess where some of those profits are going? Right into the president’s pocket last year for his campaign and legal war chests. Kind of makes his outrage at AIG execs getting their bonuses a little disingenuous, don’t you think?

Except that it’s not going to be a better deal: reduced care, increased taxes and ancillaries, etc. Who do you really think will be paying for your neighbor’s, indeed all your neighbors’, health care if you’re working and he’s not? Do you think the money will just magically appear or that your taxes won’t increase?

“OMG welfare queens!!!” is not actually an inteligent argument against a public option.

And yes, actually, if we spend money on insurance, rather than emergency care for those who can’t afford insurance, we do save money. Unless you’re promoting a system in which, if you can’t afford health care, you should just die. Most conservatives come close to proposing this, but don’t actually have the guts to say it out loud.

I doubt you have the guts either.

Do you really want the gov’t managing socialized medicine and standing between you and your doctor in making critical, or even non-critical, medical decisions?

And here we go again with the idiocy of the idea that a public option means that somehow the government will be running my insurance. No it won’t. I have private insurance. Unless you’re on medicare/medicaide or tri-care, so do you if you have insurance.

Why are you involved in this debate if you can’t understand a single simple truth about it?

Can you understand the word “option”?

Josh Jasper: I said nothing about welfare queens and stick to the facts. Attacking me only proves the conservatives right, and I am not a conservative, but an independent.

The “option” is no option. Read the bill. If at any time you have to sign up again for your insurance, you will be forced to take the govt backed insurance or be fined by the IRS when tax time comes around. Although it’s not stated, it is a TAX. And there are other loopholes and fines.

At no time did I state or advocate anyone dying, but I do strongly advocate insurance reform, such as a moratorium on pre-existing conditions, expanded health prevention and maintenance, much lower malpractice insurance rates, no denials for needed surgeries or caps on spending, time in hospital, testing, etc., and more competitive insurance rates. Do you actually know how the insurance business works, or rather doesn’t work, and what you get for your money? The answer is not and has never been govt control. The answer is and has always been a freer and more open marketplace with realistic coverage.

It is a fact that less money is spent on preventative and maintenance measures than on unnecessary surgical procedures and that doctors and hospitals are forced to limit hospital stays, not because they are not needed, but because insurance companies determine how long a person needs to stay in the hospital. It is insurance that drives up health care costs and it used to be insurance that kept costs low, but that was a long time ago — like about five years ago. I have worked in government, in medicine and in the insurance industry and I know first hand how it works. The answer is not more government, but reform.

This country is already so far in debt our great, great, great grandchildren will be paying for it. The proposed bills in Congress will increase the national debt by trillions and will not result in adequate or better health care for anyone. Regulate the insurance industry and reform insurance and pharmaceutical practices and then get busy bringing down the national debt and cutting government spending and the size of government; that is where our efforts should be expended, and not in useless debate.

The “option” is no option. Read the bill. If at any time you have to sign up again for your insurance, you will be forced to take the govt backed insurance or be fined by the IRS when tax time comes around.

Damn, you’re not reading it, are you.

If you’re *without* insurance, then you either have to have private insurance, get the public plan, or pay a fine. You always have the option to sign on for a private plan.

Hence “option”. If you have private care, you don’t have to take the option. Going without health care isn’t something anyone sane wants anyhow.

At no time did I state or advocate anyone dying, but I do strongly advocate insurance reform, such as a moratorium on pre-existing conditions, expanded health prevention and maintenance, much lower malpractice insurance rates, no denials for needed surgeries or caps on spending, time in hospital, testing, etc., and more competitive insurance rates.

Of course you advocate people without insurance just dying. You simply haven’t got the guts to admit it. If someone unable to afford insurance, and can’t pay out of pocket for medical treatment, you’d rather not pay for that persona’s medical costs, and want them to just die.

The other option is that you think that using ERs as primary care physicians is an acceptable alternative, which is possible, I guess, but it still results in deaths, because ERs don’t treat minor health problems that will eventually kill you if not treated. They refer you to doctors, who, without insurance, will just bill you. So if you can’t afford the care, you die.

The end result is the same. People without healthcare are dying, and you’re pretending that it’s because malpractice costs make it too expensive, and that magically, everyone will be able to afford treatment if there’s no public option.

Mandating that people get health insurance the only rational solution, because only an idiot would want to be without health insurance. And I’d rather not have idiots packing in the ER wards.

As for how deep in debt our country is, it’d have been much worse if we didn’t bail out the banks. Admittedly, more regulation and compensation caps should have been put into place, but if 50% of the worlds credit markets collapsed overnight, we’d probably be looking at 30% unemployment.

Being without health insurance when you have the choice of getting it at a reasonable cost is stupid.

Having a word credit market that’s 50% collapsed is also stupid.

But what I think you missed in the bailout was that those dollars were loans. Currently, they’re being paid *back*. It’s the FDIC picking up the tab for banks that actually did fail that’s money we’re not going to see again, because there’s no bank to pay us back when that happens.

Cornwell: “If what Wilson did was so inconsequential, you wouldn’t be still griping about it.”

You misunderstood me. I was saying that you were saying that Wilson was wrong but in an inconsequential way. I was saying that what Wilson did was not inconsequential.

“Universal (socialized) health care is not the panacea you and others like you believe it is,”

Please do not give me views that I have not expressed. I am not advocating universal healthcare for the U.S. and none of the forms of the bill being proposed are universal single-payer reforms.

Mandatory insurance is being suggested in one version of the bill — Baucus’ one — which was designed to placate insurers and Republicans. They want mandatory insurance so that the private insurers can jack up their premiums higher and businesses will have to pay. And they want to have mandatory insurance without a public option. It’s a scam. But it is part of the negotiations of the various parts of the bill that are now going on in Congress.

When there is a final bill that goes to vote, it is to be hoped that it doesn’t have mandatory insurance requirements (or if so, in a way that is not punitive,) and a public option, so that we can have not socialized medicine but a reformed private industry. If the bill does have mandatory insurance requirements without calculations as to how to keep this from punishing people, it will be courtesy of industry and the Republicans, with the Democrats giving in to get the bill passed. So it will be your own damn fault. Shoot us all in the foot mentality.

What we have now will have our kids in debt for generations and most people without health insurance in ten years. Unless we get reform. And unless people like you stop letting far right mouthpieces feed you a bunch of lies for short-term profit.

cornwell@329: Yes, nothing like government mandated protection rackets,

the concept of insurance is explained with pretty pictures here: http://www.salon.com/comics/tomo/2009/09/15/tomo/index.html

cornwell@331: I am not a conservative, but an independent.

Who did you vote for in the last presidential election?

Wilson is now apparently claiming he knew the president lied because he, Wilson, has been an immigration attorney. No one has been able to find any evidence so far that Wilson ever practiced immigration law. (Ya lie, Wilson.) If I get more details on this, I’ll pass it on.

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