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Aaron

Ted, you are of course free to reject the "insulting implications" of the truth. It's your prerogative.

Matt, that's an interesting point. The medical community largely calls for "reforms" which, while immensely profitable to the insurance industry, seem to do little to nothing to reduce malpractice premiums. As Tom indicates, and the same is true in Michigan, long-standing caps on malpractice awards did nothing to hold down malpractice premiums - they simply caused the most severely damaged plaintiffs to go without appropriate compensation. What did California do which finally caused a downward shift in premiums? It regulated the insurance industry.

It doesn't surprise me when the shills of the insurance industry and the nation's chambers of commerce misrepresent the facts and issues, as that serves there ends. You mention a key buzzword and they swoop in automatically (dare I say "Bunn-o-Matically") to present their distortions. But you would think that doctors, being well-educated people certainly capable of understanding the issues, of observing how caps have not worked for them, and that their own "best friend" in these debates - their insurance carriers - profit from their misery, and thus have a very different interest in the outcome of "tort reform".

So the insurance industry shills proclaim that the biggest problem with malpractice law is that it doesn't do enough to distinguish real malpractice from unfortunate maloccurrence? Well, then, that explains why their corporate masters are paying absolutely no attention to improving the detection and prevention of malpractice, and are focused instead on "reforms" which will render the existing system more profitable for malpractice insurance carriers.

David

It seems to me that lacking from this debate is the basic fact that nobody is discussing the other half of doctor's ability to pay for their malpractice insurance and maintain their standard of living, income. Doctors are fleeing southern Illinois and many other rural areas in "good" states (in terms of medical malpractice) because the opportunity to make a lucrative career is missing. An issue that does not seem to get much attention, but is highly relevant to this problem is how insurance companies calculate "reasonable and customary" for purposes of determining reimbursements.

Another thing that seems funny to me is how the ATRA crowd always claims that their opponents are using the wrong numbers or not looking at the complete picture (i.e., settlements). Insurers could solve this problem with relative ease, they could release their settlement figures, or allow the DOI to release those figures. My guess is both the insurers and the DOI oppose the release of these figures because it would expose the baseless claims of insurers and the incompetence of regulators at the DOI.

Finally, insurers like any other business, get into or out of a particular business based on the profitability of that business. In the case of St. Paul, they chose to get out of Med-Mal not because it was not profitable but because they were making significantly greater profit in their other lines.

Ted

David, did you not notice that I linked to precisely the numbers you say the insurance companies haven't released? I guess not.

What's your evidence that St. Paul was making a profit in med-mal when it left that line of business?

Matt

Ted, as you know, St. Paul did very well in med mal until the mid 90s. Then, like with all insurance, the risk cycle turned on them. It's the nature of insurance, which most of us recognize. You, however, seem to believe that there is some constitutional guarantee that insurers should always be profitable, that the bet on risk should never go against them.

That position continues to move us closer to universal health care.

Ted

Okay, we've established that you agree with me that St. Paul's med-mal insurance practice was not profitable in the short term. What's your evidence that it was profitable in the long term?

I never said that insurance companies should be guaranteed a profit. I said that accusations that insurance companies' medical-malpractice premiums reflect the expense of providing medical malpractice insurance rather than anything the insurance companies did wrong, and thus lawyers are wrong to attempt to blame insurance companies for the crisis caused by the current system of random wealth transfers from patients and doctors to lawyers.

Ted

Corrected comment:

Okay, we've established that you agree with me that St. Paul's med-mal insurance practice was not profitable in the short term. What's your evidence that it was profitable in the long term?

I never said that insurance companies should be guaranteed a profit. I said that insurance companies' medical-malpractice premiums reflect the expense of providing medical malpractice insurance rather than anything the insurance companies did wrong, and thus lawyers are wrong to attempt to blame insurance companies for the crisis caused by the current system of random wealth transfers from patients and doctors to lawyers.

Lenny

I'm an ob/gyn who moved from IL to WI last year. My med mal carrier wasn't ISMIE- it was APCapital. Granted, I have a new practice start up discount, but just for the record, my insurance for 2002-2003(July1-June30) was $115,000. The increase for the next year was to $171,000. In WI, my new rate (discounted, new practice) was $11,000, plus a contribution to the State's Excess Compensation Fund of $7,500. If there was no discount, my annual rate would be approx. $30,000. It doesn't take a PhD in Econ to figure this one out. Also, all the ATLA arguments on bad insurance investments kind of fall apart. I have nothing against attorneys- I'm related to 2. Is it the big, bad insurance companies? Organized medicine? Trial Lawyer lobbies? Greed?
I just want to practice medicine. I am not a politician. It is clear that those who have the gold(ie, big contributions to the party in power) call the shots. Medmal reform has to include all parties- bad docs must be weeded out; a lawsuit over $300,000 for an unpreventable bad outcome shouldn't happen; attorney fees greater than $1000/hour?
Medical tribunals sound great- what would the attorneys say?
Sorry for the rant.

Evan

Lenny: Don't apologize for the rant--it wasn't really even a rant. I'm glad you added your comment. At least you are willing to propose, hypothetically, that the insurance companies might play a role in the "med-mal insurance crisis."

Lenny

Thanks, Evan. I just finished reading Neil Vidmar's work on Medical Malpractice and the Tort System in Illinois. Very well researched, but missing some important information. According to Prof. Vidmar, the numbers of Illinois Physicians is increasing, and there is no crisis. There is no consideration that many docs have stopped accepting high risk patients, or poorly paying insurances. The cost of defense litigation doesn't seem to a consideration, either. An interesting story- I was involved in 2 suits about 10 years ago. The first I lost. The jury awarded $62,000. My defense cost less than $12,000. The second case I won at trial. My defense cost $100,000. As docs, we get all upset about being on trial; being accused of trying to hurt our patients.
To the legal system, its how good your lawyer is. To the insurance companies, its only money.

iwebstreet

You've got to love people like Ted and his friends over at the Chamber of Commerce.

-Every article (not funded by AMA or the tort "reform" movement) I have ever read about the exodus of doctors from Illinois or any other state has shown that there is nothing more than anecdotal evidence to support the argument. For Illinois in particular, there was a Crain's Chicago Business article back in early July, 2004 that provided Illinois specific numbers.

-The states cited as "good" states are those that have aggregate caps on damages (e.g., Colorado which caps economic and non-economic damages combined at $1 million). When doctors fail to pay for their mistakes, the cost of taking care of their injured patients falls to society at large.

jodigirl1000

I certainly support and empathize with honest, competent, professional physicians and surgeons.

However, we are currently in a social; and political environment that is pushing medical tort reform and universal health care. In addition, physicians openly and unapologetically encourage one another to resist the temptation to criticize colleagues. Professional organizations (such as the AAOS) even bring ethics grievances against orthopedic surgeons who, in the opinion of the AAOS, testify beyond their level of comptency.

The Illinois DFPR is not willing to hold "bad doctors" to account.

The truth is that all empirical evidence supports the conclusion that the "Sorry Works" initiative is effective in requiring physician accountability in a sincere effort to comfort the grieving patient or family.

The injured patient is duty bound to hit the pavement and find a "hired gun" expert for a med mal claim. That's because the treaters usually don't want to get involved. Many medical clinic and hospital risk management offices preclude physicians from serving as expert witnesses.

Then, the natural question is - given (1) no accountability by doctors, (2) no professional discipline by the licensing agencies, (3) public revulsion at the med mal system and (4) trends towards tort reform and (5) trends toward universal health care . . .
who is protecting the vulnerable and trusting patients?

john

Blogs are good for every one where we get lots of information for any topics nice job keep it up !!!
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