What evidence? Citations please. I think you’re confusing more expenditures being not equal to better outcomes with more specialists not being equal to better outcomes, and determining that latter would require some pretty specific in-depth patient population data. Like, how many people come to that area because the desired specialists aren’t available in THEIR area.

The core of our health care problem is that we don’t do enough preventive medicine. For preventive medicine you need General Practitioners,not Specialists.

We do indeed need more Primary Care physicians, but if they just refer anything other than basic care upwards to the specialists as occurs now, that’s not a cost-cutter but a cost-booster. Believe it or not, generally speaking overall preventative care is not necessarily that cost-effective, especially when coupled with universal coverage. Doctors and patients may be willing (quite often ARE willing) to spend more on screening and prevenative treatments than can be statistically justified by cost-benefit ratios. For the patient, their life and health is worth more to them than it is to an actuary. What is best for individual patients is often not remotely cheaper for the system as a whole when examined in terms of cost-effectiveness. Key concept there: rationing.

The top three known cost-effective “preventative care” items are things already available to the patient without any medical intervention. Exercise regularly, don’t smoke, and eat a healthy diet (and less of it). Next up? Take that baby aspirin every day to reduce the odds of heart disease and stroke, and get your flu shots every year. If you’re 50 or over, get regular colorectal screenings. If you’re a woman over 40, get regular screening mammograms. Past that it gets somewhat iffy. Preventative medicine is only cost effective when it actually reduces costs by preventing higher expenses for treatment than are spent on screening — and there’s also the question of treatment effectiveness.

The core of our health care problem is that we don’t do enough preventive medicine. For preventive medicine you need General Practitioners,not Specialists.

I’m not surprised people claim real tort reforms have not been implemented. The trouble is nailing down precisely what “real reforms”would be.

I’m talking about legitimate real reforms. Outright capping of what jury can award is simply stupid. Say a Doctor screws up and his infant patient now needs a full-time nurse for life. That alone is gonna be millions. Add in a few costly operations so the kid survives, a few drugs, constant attention from a specialist,etc. and you’re gonna break any cap to itty bitty pieces.

Regardless, you’d assume that if full tort reform was a good idea something would have worked over the years. Most states have tried some tort reform, and several have reformed the reforms.

But then, I am also under the impression that malpractice suits are nowhere near the primary driver of high rates of increase in healthcare costs. My sense is that the big drivers of these cost increases are high demand and the constant flow of new meds, new techniques, and new equipment.

AFAIK nobody claims the suits themselves are a major cost-driver. They start talking about something called “defensive medicine.” Basically that Doctors do all kinds of unnecessary tests to make sure they’re lawsuit-immune. Unfortunately it’s difficult to figure out which unnecessary tests are being ordered because a Doctor is paranoid about lawyers, and which are being ordered because the Doctor like kickbacks.

The AMA represents only 1/3 of all doctors, and does not speak for many physicians who are in favor of major reform. The system cannot be fixed from within.

http://www.politicalpragmatist.com

I see this statement in every discussion when it comes to the health care issue, and my response is that the insurance companies already do this! They already only pay what they think they should for services, procedures, and materials. Not that I disagree with you Alan, I think that the gov would do that. I’m just saying it’s no different than how it is right now.

Also doctors do need to be fairly paid for the work they do, which is more important than most of our jobs. There is a fair middle ground there, and I have 2 examples:
First example is my mom’s boss, he’s a foot surgeon. He got paid 300 dollars from the insurance company for a complex procedure that costs more than that in just materials. Needless to say, he doesn’t have a very high annual income.
Second example is my uncle. He makes 1.5 mil a year to read xrays. He lives in Denver but works in amarillo, tx and takes a jet to and from work. He’s listed as one of the top 10 radiologists in the country, but 1.5 mil is too much. there’s no reason for it.

In other words, the results we have seen suggest only that reform consisting of a watered-down hodgepodge of half-measures has been ineffective. No surprise there.

But then, I am also under the impression that malpractice suits are nowhere near the primary driver of high rates of increase in healthcare costs. My sense is that the big drivers of these cost increases are high demand and the constant flow of new meds, new techniques, and new equipment.

Everybody who does actual research into the issue knows this. Tort reform is one of many ideas that really helps in theory, but has never worked in practice. The pro-tort reform crowd simply ignores this fact, which somewhat reduces their credibility within the health reform movement.

That said I like that he’s offering to include tort reform in the final package. If included tort reform won’t actually do much (good or bad), but it will kill a BS excuse for opposing the final bill.

And if there’s one thing health reform needs in the US it’s less BS.