Nixon's the One - to Imitate on Education
By Matt Miller
Local
control of schooling - which means local financing of schools - is an
injustice, masked as a virtue, so deeply ingrained in the American mind
that no politician in either party dare challenge it. But America's
obsession with local finance, which made perfect sense in the 19th
century, is now sinking us morally and economically. To fix it, Barack
Obama needs to steal an idea from Richard Nixon.
Drive
around Chicago, Detroit or most other big cities and you'll see
dilapidated schools staffed largely by rookie teachers. The districts
spend, say, $10,000 a child. Twenty minutes up the road you'll find
suburban schools that sport Olympic_quality pools, Broadway_style (or
maybe Off Broadway) theaters and the best teachers in the state. Those
schools spend more like $17,000 per pupil.
This
is what local control hath wrought, with financing schemes under which
less than 10 percent of the money spent on primary and secondary
education comes from the federal government. The grim equation by which
accident of birth determines educational quality in the United States
is straightforward. The poorer the district and the state, the lower
the local tax base, with less money for students. No other advanced
nation tolerates such inequities.
Money
isn't everything. Some high_spending districts, like Washington and
Newark, are dens of mismanagement. But communities like these are
distracting exceptions. If you compare most poor, urban areas to their
nearby affluent suburbs, the suburbs typically spend thousands of
dollars more per pupil.
Because big
chunks of district budgets go to teachers' salaries, local financing
means we systematically assign the greenest, least_qualified teachers
in America to the children who need great teachers the most. Research
shows that after a few years in such classrooms, these children never
catch up.
In the early 19th century, the
property tax was considered the fairest way to pay for schooling.
Property was the main form of wealth, and rich and poor people didn't
live in separate taxing communities. The wealthy paid more than the
middle class and the poor paid nothing, yet all enjoyed access to the
same public schools.
Since World War II,
however, we have segregated ourselves into a multitude of tiny tax
enclaves. The last important official to look hard at the consequences
was Richard Nixon. His commission on school finance, headed by the
chairman of Procter & Gamble, issued a report in 1972 that urged
states to equalize financing disparities, and proposed spending a
little federal cash to help.
Nixon's
commissioner of education said publicly that the federal government
should pay 25 percent to 30 percent of the cost of public education.
His domestic policy staff considered a new national tax, with the
proceeds distributed to states that drastically reduced state and local
property taxes while closing the financing gaps among their school
districts.
In the end, of course, Nixon
found he had bigger problems to deal with. But he left a blueprint for
Mr. Obama to follow. The federal government contributed just $45
billion of the $488 billion spent on primary and secondary schools in
2004 and 2005 (the most recent data available). That's just nine cents
of the nation's education dollar.
Going
to 25 percent to 30 percent of the overall tab by using a Nixonian
revenue_sharing plan would lift the federal contribution by $80 billion
to $100 billion a year, and replace an equivalent amount of state and
local taxes. A little more federal money might be needed to sweeten the
pot, round up the votes and give a boost to the poorest schools.
Federal
cash could also be offered to lift teacher salaries for high_poverty
schools. States or districts that accept the money would have to allow
higher pay for the best teachers or those in scarce specialties like
math and science, defer or eliminate tenure (or link it to student
achievement gains), and make it easier to fire bad teachers. These
districts could pay top teachers up to $150,000 a year, attracting a
new generation of talent to America's toughest classrooms.
Mr.
Obama says rebuilding rundown schools will be part of his stimulus
plan. That's a start, but a one_time construction boon can't solve the
perennial woes caused by the very structure of American school finance.
At a moment when we've basically
nationalized the banking, mortgage and insurance industries, a little
nationalization of school operating costs is in tune with the times.
***
Matt
Miller, a senior fellow at the Center for American Progress, is the
author of the forthcoming book "The Tyranny of Dead Ideas."
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Comments
If LRC considers a replacement for Ms. Huffington, they should consider some radical rightwing pundent to get a better balance to the show. When Arriana occasionally drops by, the show becomes Custer's last stand with poor Tony in the role of general rightwing.
Without Ariana it's just Miller refereeing between the Bickersonians, which is boring.
I see Sarah trolls through this blog from time to time, but never any of the principles. MM's always flogging the LRC Blog, but really, what's the point? He never mentions any of the conflict on the blog or the ideas generated here. None of the principles engage here, even occassionally.
I agree that when Arianna is away you should have some a substitute with some different viewpoints, maybe from other countries.
I get annoyed at Blankley's constant sniping about Obama's victory which took up his first few talks on the show. Worst was about how the media was so unfair and didn't investigate Obama, so we are going to find out about Obama from the proscutions of all these Illinois politicans (although not Obama of course since he didn't do anything. So what are we going to find out?) Next Blankley will be joining in the right wing conspiracy theory that Obama was secretly born in Kenya and can't be president. When will the Republicans admit that conservative George W. Bush did messed things up so badly that his candidate wouldn't or couldn't run from his record and voters did what is supposed to happen in a democracy and voted for the other guy. Since most of the way-of-life Republican vote held up so well in the face of this disaster and got 47% rather than 27% of the vote (the Republicans mostly lost the middle class suburbanites who value competence in dealing with the nation's problems) they will be back if they come up with some answers to the problems America faces instead of just negative campaigining and repeating "tax cuts" over and over as if that was the cure all for all problems. If they insist on rejecting and resisting everything at all costs like they did Clinton, with no positives, or keep pretending that the Bush Administration somehow fell from the sky into office and had nothing to do with them and their lock step support, hopefully they will get the marginalization they deserve.
The part at the end of the show about this high-tech gadget that is so great for bloggers and pundits left me totally in the dust.
but Toady is defending the indefensible: the failed, discredited right wing policies of the GOP and their faith based governance. They had all the levers of power for 7 years--presidency, both houses and the courts--and utterly failed the nation.
Toady and the Right have been reduced to sounding like people who defend magic when it fails. It's not that the magic's flawed or their magical thinking, but that the person holding the wand is inept. Nobody can make a cogent argument for the Right anymore, so Toady's as good an apologist as any.
Tony's tank does seem to be on empty. The guage has been showing that yellow warning light for a few months now.
And I'm talking as someone yearning to hear some congent conservative perspectives, not as a knee-jerk right-wing basher. Who, by they way, need all the bashing they can get.
In 2008, Tony has become a metaphor with everything that's wrong with the Republican Party.
Tony’s answer to Matt’s question as to what he considered the outstanding event of 2008 struck me as odd. There were so many things with which Tony could have responded that would have indicated to me that he is not the partisan panel member that, at times, he appears to be.
His party has left our country with 2 unresolved wars, a failed economy and a President who is completely impotent and ineffectual in his final months. Then there is Vice President Cheney’s recent confession that he ordered torture (but it’s not really torture because their lawyers say it isn’t) without one single indication of regret or concern as to what this decision has meant for our country or our moral standing in the world.
There have been many failures of this government and its leaders over the past year(s). As such, I must continue to remind myself of H.L. Mencken’s comment: "Democracy is the theory that the common people know what they want and deserve to get it good and hard." In other words, we are all responsible for this mess.
From this perspective, as there has been absolutely nothing to suggest that Obama was anything less than ethical during his Chicago years, Tony’s suggestion that there has been a media missed opportunity to report on this period sounded somewhat churlish and hollow. In any case, as Tony is very much inside the Beltway, I assume he has “heard things”. In which case there is either proof of wrong doing or it is only gossip and Republican wishful thinking. If there is proof, it will come out. In the meantime, it should be considered as gossip and it has no place it this discussion.
On a more positive note; I am very appreciative of what LRC has to offer on a weekly basis. Each panel member generally brings their reasoned, thoughtful perspective to the show.
Cheers and best wishes to LRC and my fellow bloggers for 2009.
As far as holding all the levers for 7 years, you are mistaken. Sure, Bush had the Presidency but he lost the Senate in May of 01' when Jeffords switched (Gained it back in the '02 election). The GOP then lost both hoses in '06. And keep in mind that you only really control the Senate when you have 60 votes which the GOP never had.
As far as the courts, nobody really controls them, they do what the hell they want.
There's some truth in that, but conservatives have been driving the bus since 1994 and have had control of all the major instruments of policy since 2000. Bush is the most conservative President in history and to some extent stood on the shoulders of earlier conservatives like Reagan and Nixon to enact more conservative policies than they could. While Democrats were complicit in some of this, many, particularly Clinton, modified their positions to accomodate to conservative power.
Admittedly there is some ideological and social diversity within the conservative movement, and the pro business free market deregulation group prevailed over the small government or more libertarian groups, while the military industrial complex and neoconservatives dominated foreign policy. Social and Christian conservatives got less but some victories on issues like stem cell research, sexuality and religious authority issues. Some of these who got the least have been the first to denounce and abandon Bush.
And of course some issues, particularly those involving the use of the military to support American economic empire, have had bipartisan consensus on the underlying policy, if some differences on how best to execute it. (Is the Iraq war a good idea or a bad idea?) And both parties' executive branches have sought to enhance their own power against other branches. And of course Congressmen from both parties have sought pork for their districts.
But conservatives should admit that they were in charge and made the decisions that lead to the results we face. One reason is that they went pretty much in lock step, seeking to turn narrow electoral victories in to landslides of power. When McCain who voted with Bush nearly 90% of the time tried to paint himself as the candidate of change after things went bad, that just shows how little caution and nuanced thinking there was on the conservative side. Had there been more, perhaps some of these bad results could have been avoided.
You're forgetting that conservatives had a record amount of filibusters during the Bush years and drove the legislative bus during that time.
Well said.
The Democrats have had control over congress for two years and control Bush by holding the purse strings for the Iraq war budget. What miracles have they performed? They spent their time fighting the regulation of Fannie and Freddie Mac, trying to shut down the Iraq war in such a way as to create a greater catastrophe than it already was, and debating the impeachment of Bush. Pelosi and Reed are great examples of how partisan politics makes an impotent government.
The sooner we get out of partisan politics financed by big money, the better we will be.
You views had 22 years of ascendancy and 7 years of total control and you failed the nation miserably.
I'm amazed how many conservatives spent 7 of the last 8 years in the same one-hole shitter when the gun went off--Wasn't me, I wasn't there, I didn't do it, I never approved, don't know nothing about it.
The last conservative caused economic depression left the conservative movement in political wilderness for 45 years. I'm hoping people have longer memories this time.
There was a cynical and concerted conservative-led effort to deny the dems any legislative progress to campaign on in November, regardless of the damage it did to the nation.
The Democrats have been in control for two years and I don't see any stellar changes. In fact, I still see Chris Dodd presiding over the banking committee, even after taking bribes in the form of mortgage discounts from the one of largest perpetrators of our current banking dilemma, Countrywide Savings. Hmmm, didn't a certain Presidential-elect do the same thing in his democratically controlled city and state, Chicago Illinois? I still Barney Frank flapping his gums, even though he opposed Fannie-Freddie Regulation so that those subprime loans could still be handed out to people who couldn't afford them.
Seems to me, we're tallking about a two-holer, one for Democrats and one for Republicans.
Actually, if you care to look at the study reported out by the Center for Responsible Lending a couple of weeks ago, you'd know what you're saying is false. The greatest majority of the bad subprime loans were refinancing for current home owners, not new origination loans for poor people.
Most amazing according to the study is that almost all of the bad subprimes were with people who had--and could again--qualify for a regular loan but were guided into the sub primes by loan originators who would make more money when they had to refinance the loan after 5 years.
As long as the right insists that there is nothing wrong with their agenda, they will continue to lose political influence. I came into voting as a Reagan Democrat, and supported the ’94 Republican agenda, but the fact is that Republicans say one thing and do something completely different has lost me. They say they are for a strong national defense, fiscal responsibility and a traditional social agenda. The reality is they are only for an overly-moralistic social agenda. You can say that the Republican Party isn’t dominated by the fundamentalist Protestants, but that doesn’t make it so.
Bush had 8 years to end such ridiculous money sinks as “The War on Drugs”, which we are now 20 years and trillions of dollars into. I don’t care if college kids are smoking pot or the urban urderclass is smoking crack. Give me a balanced budget, and quit distracting the public with crap like gay marriage.
At any point in the last 8 years he could have said, “Yeah, we shouldn’t have overthrown the Iranian democracy in 1948 (I believe it was 1948) and subjected that nation to three decades of tyranny under the Shaw. We’re sorry and hope the Iranians will work with us for a stable Middle East.” And made a huge leap forward to American and international security, but he had to hold the Fundamentalist’s anti-Islam line.
Don’t tell me the right has gotten a bum wrap; they’ve gotten the wrap they deserve for giving only lip service to the issues that really matter to the middle when they had the chance to make a difference.
This reminds me that there's nothing so dangerous as a little knowledge. Markets are only self-correcting and self-regulating when they are competitive/free. When companies are allowed to grow to the size where they are “too large to fail”, they distort the market, because (among other reasons) they force the public to underwrite their risks. When Federal regulators allowed companies such as AIG to grow that large it was a disaster waiting to happen.
Oh but private profit and public risk are the American way--apparently.
The filibuster isn't something only used by conservatives, it knows no ideology. It is a tool for the minority to stop legislation but doesn't mean that the minority "drives the legislative bus." Anyone who can get 41 votes in the Senate will use it to get concessions that they want.
As far as "7 years of total control" you are wrong and we went over this before. At best the Republicans had majorities in the house and Senate and the Presidency for 4 years. And keep in mind that the Senate majorities were not filibuster proof.
If you keep flacking this "total control for 7 years" garbage after you know it's not true then I must conclude that you are a lair.
-Sarah, bloginatrix
House 2000: R223/D242
House 2002: R229/D204
House 2004: R232/D201
House 2006: R233/D202
House 2008: R199/D235
Senate 2000: R50/D50
Senate 2002: R51/D48
Senate 2004: R55/D44
Senate 2006: R49/D49
Senate 2008: incomplete returns
Uhhhh. WTF are you talking about? Nancy Polosi - the Speaker of the House - in the 110th Congress is clearly not a R. The numbers you post are just amazingly incorrect.
Slightly less F'ed up as it is technically accurate, but the two independents caucus with the Dems giving the Dems control of the Senate beginning in 2006 as well.
I would string "apparently" from the entire post. Clearly you are just factually incorrect.
By the way, I did not call rick kennerly a lair, I simply said that if he keeps saying the same incorrect statement after he knows it is wrong then I would conclude he was a lair.
Yep, transcription error.
Face the facts, there is no way you can justify saying that the Republicans controlled the Congress for 7 years while Bush was in office. They controlled the House for 6 years and the Senate for just over 4.
As I noted previously, small government/ anti spending conservatives have the most complaints with Bush. Conservative government became big government for conservative interest groups, rather than small government. The biggest spending item of course was the war, which benefitted the military industrial complex, particularly contractors like Halliburton and Blackwater, as well as those who get a large dose of life's meaning out of military service. As has been pointed out, much of the military comes from rural areas, small towns and the south. And the war carried out the international policy goals of neoconservatives. Second big spending item was Medicare's prescription drug benefit which was a response to great need and demand but was written to benefit drug companies and insurance companies. The government could not aggregate its buying power to keep costs down, and insurance companies are subsidized to sell their confusing and constantly changing "advantage plans" resulting in the "doughnut hole" gaps in coverage. The third big spending item was probably the bailout where again the public was demanding that the government do something. The bailout was triggered by a number of deregulation related factors, and the immediate beneficiaries were banks and insurance companies, who were given money with out being required to free up credit markets. Nothing much wa sdone as yet to keep people from losing their homes. While the banking industry gives money to both parties, particularly committee chairs and representatives from the financial industry states like Delaware, Connecticut and New York, Republicans were clearly the leaders of deregulating lending, and most resistance came from Democrats like Sen. Sarbanes and to a lesser extent Rep. Frank, though not enough to make a difference. Republicans talk a lot about the Democrat friendly Fannie Mae (less about the Republican friendly Freddie Mac) but both of these were a relatively small part of the mortgage mess which developed primarily through private label securitizations done by investment banks rather than Fannie Mae and Freddie Mac. Republicans were in charge when the legislation reigning in Fannie Mae and Freddie Mac was proposed and chose not to push it in some kind of horese trade. The Federal government under Bush was the engine that protected predatory lending as the regulatory agencies like OTS and OCC competed to beat back state attempts at regulations, while Bush's HUD gave a boost to the corrupt practice of kickbacks from lenders to mortgage brokers for selling more expensive loans to their customers. Bush also gave an Ambassadorship to the owner of Ameriquest mortgage, one of the worst subprime lenders.
As far as filibusters are concerned, the Republicans used them to stonewall Clinton and then to stymie the narrow Democratic majorities we have occasionally had, at most one or two Senators, some of whom were often seriously ill. Since the Republicans stuck together on most everything, it only took 40 of them to sustain a filibuster, so issues rarely got to the floor for a vote.
I don't get called a religious fanatic very often, let alone a Democrat one.
On the GOP side, only McCain and Snowe regularly crossed the aisle.
Oh yeah, Bush was in the pocket of the drug companies. How about Medicare is a failing mess that is on the edge of financial collapse and Bush is trying to do something to help the growing elderly by coming up with a lame drug plan? A lame plan that is not unlike many other Medicare healthcare policies that want to hide the fact that they can no longer provide unlimited care and must use subversive rationing to keep the monster afloat. Hey Matt, if you ever read this stuff, why don't you take a look at Medicare as a government sponspored universal healthplan and see why transfering all of our healthcare management to the government is as good an idea and invading Iraq?
Finally, Freddie and Fannie were responsible for more than 50% of all mortgages filed. They bought and passed them on to companies that then securitized them. Our good-ole democrats, Carter, Clinton, Dodd, Frank all wanted to turn the mortgage business into a welfare institution and promoted this lunacy. The democrats put the candy into the store and the republicans unlocked the door and told the kids on Wallstreet to not go in and take any candy.
Why is it you people on the right always offer the Hobson's choice of either what we've got--a fatally flawed system--or turning it all over to the government?
Perhaps you can explain to me why allowing corporations to suck all the profit out of the health system, tolerating their Toady Blankley style-lawyerly dicing of policy details to discourage or prohibit care, discouraging new family practice Dr.s and RNs from entering the field because it pays so little, and allowing tax breaks for charity hospitals associated with religious order that stopped treating charity cases long ago while our county ERs are filled with chronic and expensive indigent care, is in the best interest of our nation.
There's a lot we could fix about our healthcare system that doesn't mean turing it over to the government.
Here is info on Matt's forthcoming book, THE TYRANNY OF DEAD IDEAS:
The Tyranny of Dead Ideas Letting Go of the Old Ways of Thinking to Unleash a New Prosperity
America is at a crossroads. In the face of global competition and rapid technological change, our economy is about to face its most severe test in nearly a century - one that will make the recent turmoil in the financial system look like a modest setback by comparison. Yet our leaders have failed to prepare us for what lies ahead because they are in the grip of a set of "dead ideas" about how a modern economy should work. They wrongly believe that:
* Our kids will earn more than we do
* Free trade is always good, no matter who gets hurt
* Employers should be responsible for health coverage
* Taxes hurt the economy
* Schools are a local matter
* Money follows merit
These ways of thinking—dubious at best and often dead wrong—are on a collision course with economic developments that are irreversible.
In The Tyranny of Dead Ideas, Matt Miller offers a unique blend of insights from history, psychology, and economics to illuminate where today’s destructive conventional wisdom came from and how it holds our country back. He also introduces us to a new way of thinking - what he calls "tomorrow's destined ideas" - that can reinvigorate our economy, our politics, and our day-to-day lives. These destined ideas may seem counterintuitive now, but they will coalesce in the coming years in ways that will transform America.
A strikingly original assessment of our current dilemma and an indispensable guide to our future, Miller's provocative and path-breaking book reveals why it is urgent that we break the tyranny of dead ideas, for it is only by doing so that we can move beyond the limits of today's obsolete debates and reinvent American capitalism and democracy for the twenty-first century.
-Sarah, bloginatrix
It's good for America it's good for the economy to buy a flat screen TV, a ticket to a ball game, a sack of tomatoes, a car, or a Big Mac.
Why is it, then, that when we discuss healthcare costs in this country, we talk about healthcare like a plague or disease itself?
After all, millions of people are employed by healthcare, buildings are bought or rented, tons of supplies are bought, delivered, used and disposed of, people remain healthier longer staying on the tax rolls and buying more stuff themselves. Basic research, equipment and drugs all employ millions and generate profits.
So why is it Boeing is a net good for the nation and the economy, healthcare is not. Very odd.
Sarah
I agree with some of Matt's healthcare comments during the show, especially those concerning the link between job and healthcare benefits. I also get a sense that he feels if we have government sponsored, universal healthcare all will be fine in the world. Also, Center for American Progress healthcare reports are a bit too partisan in their assessments for me to feel comfortable.
I guess I'll have to get his book to understand his opinion.
--Your favorite bloginatrix
I cannot imagine better or more prompt service or more highly skilled practitioners. We get full blood and urine screenings every six month to keep tabs on our internal health to nip any problems in the bud, we've never waited for care in an emergency, and we've always had access to any specialist our conditions required. The system actually nag my wife about pap smears and mammograms and stays on her until she gets in. The longest I had to wait for anything was 4 weeks to MRI my rotator cuff and 6 weeks for elective repair surgery--which wasn't excessive since I'd been putting off the surgery for years. We've never paid for a drug or treatment--except through our taxes. The sole exception was for lasisk eye surgery, which was cosmetic (they said. I say nothing improves the quality of life for a chronically nearsighted 20/800 guy like having my eye's done).
Once we turn 65 well be dropped off on medicare's doorstep, but with a very affordable subsidized supplemental policy.
There is a lot to be said for a well run universal healthcare system.
Blankley's occasional, illogical rant against electric cars (both during the end-of-show, official "rant" and occasionally in the middle of the show) is annoying me to death.
First and worst, Blankley includes hybrids in his claim that ostensibly green cars in fact merely pollute by burning coal as opposed to gasoline. Hybrids run on gas, obviously, only using electricity (generated by that same gasoline) to render the entire motor more fuel-efficient. There is no coal involved, meaning a hybrid is very much indeed a greener option.
Second, although he is correct that a plug-in car is merely a coal (or nuclear or hydroelectric) car, Who has a plug-in car? It's not part of the market in any meaningful way. Natural gas, ethanol, bio-diesel... these are the alternatives out there. Criticize them (there are legitimate critiques out there to be made), instead of shrilly and erroneously attacking green option just becaus they're green.
But something to think about: It takes days to shut down a coal fired plant and restart it, so they idle all night long producing energy that is mostly wasted. Coal is bad, but wasted energy from coal is worse.
Plug-in electric vehicles charge overnight and would store what would have been wasted energy from the coal fired plant and use it during the day.
There are actually a lot more plug-in electrics out there than you know. Mostly homebuilt conversions, but then there's the Telsa. China just started producing a PEV and expects to be in the US market by 2011. I think BoingBoing did a round-up of PEVs on the drawing boards, there were 7 or 8 scheduled for the next 3 years. Toyota says the next Prius will be PEV but VW, Saab, Suzuki, and Honda were all working on designs and showing prototypes.
The Chinese manufacturer who builds most of the batteries in laptops and cellphones in the world claims a major breakthrough in battery technology. It hasn't been thoroughly assessed but he's hooked up with the PEV builder in China, so there might be something to it.
These are exciting times to live in, if we could just get the Toady Blakely's of the world out of the way.
-Sarah, bloginatrix
-sal
Of course, TB's willful ignorance and his over reliance on lawyerly parsing of arguments do invites parody and ridicule. Two years ago I never believed it would be easier at this point to take RS more seriously than TB.
Well Trix,
Where do you stand on my use of the Bickersonians? I'm thinking about having that trademarked (t).
The close follow-up for PAP smear and mammograms are markers required to grade large institutional care. You could rot out on the inside, but the healtcare provide will still get a high grade if you had your PAP smear. The average healthcare consumer in an HMO feels its a great product as long as their colds are treated, their minor surgeries get done, and the patient doesn't have to pay. Trouble is, the bury their mistakes and the patient is none the wiser. Believe me, I know, I served on the Medical Review Board in my state for 20 years.
Take Medicare and Medicaid as examples. They have outstripped their overhead costs, so the only manner to deal with things is to ration care. There's not a single politician in Washington who has the guts to utter the word "ration," so what have they done. They cut reimbursements to healthcare providers while demanding the same care...net result, I can't find a good internist who will still take Medicare for my parents. The government promoted HMOs and herded Medicare and Medicaid recipients into this healthcare model...net result, third party healthcare rationing where the HMOs take the blame away from the politicians. So now the bad guys are the HMOs the not the politicians who put them their in the first place.
No, it's completely government run.
MM's always flogging the blog on the show, so it must have value added for the show. So we're all over here providing our content for free. How come we're the only people connected with promoting the LRC who are not getting paid?
Why ration healthcare at all? We don't ration M1 Abrams tanks, FA18s, $3 billion aircraft carriers, or billion dollar submarines (5 will be produced here in the next decade).
Why not put healthcare for all Americans on equal footing with the defense industry?We've got 4k miles of ocean on one side and 3k miles on the other side. We can probably handle Mexico and the Canadians of they get rowdy. Who's actually developing plans to militarily confront the USA?
Your euphemism of pounding swords into scalpels sounds wonderful, but in a real world, Medicare/Medicaid spending cost 400 billion in 2007, or 14% of national spending. You could build 100 aircraft carriers and throw in a few M1s to make change every single year. Medicare/Medicaid covers a fraction of the entire populace...and the government can't seem to afford that much. Sure, we should cut our defense budget and probably will. The fact remains that the government is a piss-poor business manager. They would do much better through regulation of the current healthcare insurance industry than from creating their own new version of healthcare bureacracy.
Americans are already paying outrageous premiums for the lowest standard of care in the developed world. Certainly some combination of those premiums and regulation can be put to building a better system.
As I said, I'm thrilled with my government run universal plan.
Pretty soon we're going to stop talking about astronomical figures and just refer to them as economic figures.
Sounds like RightGuy is a participant in the health care business, (Dare I say the health industrial complex?) maybe an MD if you are on a Medical Review Board. You have some points about there being some limits to the health care we can provide, particularly the high tech stuff for people with critical or chronic illnesses. So what do you think should happen?
Our present system operates by having insurers compete to insure healthy people and kick sick ones off the books. We discriminate royally against people who are not connected to an insurer. We tell people to go to the emergency room, which is supposed to be for emergencies, charge them huge bills, sue and garnish them or force them into bankruptcy. Then we beat them up for abusing the system. Insurers deny claims right and left, and make some of them stick. We waste all kinds of money on these complex competing private bureaucracies. You would have to ration care less if you spent that money on care. Medicare looks great by comparison, even though it only covers part (a sick part to be sure) of the population. Preventive care is sloughed off, particularly for the poor under Medicaid where EPSDT is ignored. We compete to manufacture and promote Viagra (some of the most dignified and good looking grey haired people on the planet appear in their commercials) but not flu vaccines that would save lives.
You admit HMOs as gatekeepers are a bad idea. You admit tht Medicare D is a lame plan, although you dispute that Bush was in the pocket of drug and insurance companies.
Bush and conservatives also like privatization, so they push for private savings accounts, like they want private retirement accounts. I liken them to sending people swimming across the ocean with individual tanks of oxygen and see how far they get. Who can afford this? Privatizers also like the idea of consumers choosing their own health care, like they are supposed to know what we send people to medical school etc for years to learn. Look how badly consumers did choosing their exotic mortgage products. I ask people to think about what would happen if we sold brain surgery the way we sold mortgages, that is some brain surgery broker got a few thousand dollars if he talked people into brain surgery, regardless of whether they needed it, and with deregulation without any unbiased expert saying you need it or any consequences if you sell an unsuitable surgery. The purpose is to show how bad the incentives were in the mortgage business, but you could actually have a health care system like that. Why do drug companies do all these ads promoting pills and telling people to ask their doctors for them. Sometimes they don't even tell you what disease the stuff is supposed to cure. One on tv yesterday is full of smiling happy people while the disclaimers mentioned death twice as possible side effect. Sure you can say consumers should know better but advertisers do this because they know they work on some people.
The US, partly because of history, partly because of conservative ideology and partly because competing businesses of providers, employers and insurers haven't agreed on a system that they all do as well under, is the only industrial country that runs our type of dismal health care system. And it is neither cheap nor healthy.
So, RightGuy, what do you want to see happen? Get the government out totally? Keep this competition to insure the profitable? Have everyone pay for health care out of pocket?
Tony Blankley said a few weeks ago that people were just going to have to get sick and die. Do you want that? The problem is that when diseases get going they don't respect class, income and political boundaries, so you can't be sure that only the people who should get sick and die do. Health is actually a social state of well being, in which we all have a stake. Sounds like an argument for universal health care even if it sounds like that liberal if perjorative colloquialism, "socialized medicine." Actually government involvement in health care can cover a vast array of systems, some of them pretty bureaucratic, penny pinching, discriminatory and user unfriendly. The trick is to design good ones that relfect human needs, are set up to treat people fairly and allow navigating the system, while promoting and advancing quality care.
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence -- economic, political, even spiritual -- is felt in every city, every State house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the militaryindustrial complex. The potential for the disastrous rise of misplaced power exists and will persist. " President Dwight D. Eisenhower's Farewell Address, 1961.
"The only acceptable strategy is one that eliminates the possibility that Iraq will be able to use or threaten to use weapons of mass destruction. In the near term, this means a willingness to undertake military action as diplomacy is clearly failing. In the long term, it means removing Saddam Hussein and his regime from power. That now needs to become the aim of American foreign policy." 1998 letter from the Project for a New American Century, a neoconservative think tank. Members signing this and similar documents advocating "a Reaganite policy of military strength and moral clarity" included Dick Cheney, Donald Rumsfeld, Paul Wolfowitz, and Jeb Bush.
the current Consumer Reports has an article about converting a Prius to PEV. It also lists the PEVs on the horizon and the year they're expected:
Aptera 2010
Chevrolet 2010
Fisker 2010
Ford 2008
Nissan 2010
Saturn 2010
Tesla 2011
Prius 2010
Second, we have the best healthcare in the world. When you say we have the worse, it's based on things like infant mortality and life expectancy, which are measured differently between countries (it's like comparing apples to oranges) and are better measures of our social environment than of the healthcare system. Glorious France's universal healthcare system is currently going broke. The originator of Canada's healthcare system feels it was a mistake and now says they should return to system similar to the US.
Third, the ER fiasco was created by the government, who passed laws to compel treatment of the uninsured instead of dealing with the problem of the uninsured directly. Consequently, hospitals could not afford their ERs and shut them down and uninsured people are forced into the few remaining ERs as a means of obtaining healthcare.
Talk to your congressman about those stupid drug company commercials. They have recently stopped drug companies from leaving pens with their logos at physician's offices for fear that the staff may be inappropriately influenced, yet they allow drug companies to sandbag doctors by influencing the patietns directly.
Yes, everyone should pay for healthcare out of pocket. Wouldn't it be better if you were negotiating for your healthcare coverage directly than to have your employer do it for you, when their only incentive is to get the cheapest plan. People should know the costs of their healthcare, so they spend it wisely. If healthcare was "free" its costs would skyrocket out of control, which would bring you back to rationing care. You have to understand that you ARE paying out of pocket for your healthcare now, it either comes as a benefit in your employment or out of your taxes or as a higher healthcare premium the cost of every uninsured person is passed along to you.
Lawsuits are the reason your flu vaccines are not competitive and your medications are so expensive. Special mandates are provided to the few companies manufacturing vaccines because of the low profitability related to the litigation exposure. There are potential complications to every vaccine and the lawyer exploit them so now your drug companies don't want to make them any longer.
Hillary's plan wasn't so bad this time. There should be a mandate that everyone have healthcare and everyone become a consumer of that healthcare. Spreading the cost across everyone will reduce the costs to everyone.
Hello Stan, Thank you for your articulate, comprehensive posts. Your quietly presented, thoughtful ideas have a way of overriding the irrational noise that, at time, pervades this space.
First quote is from Eisenhower's farewell address.
Second is from the Project for a New American Century's letter to President Clinton in 1998 urging the overthrow of Saddam.
We badmouth the EU systems, but they have done a much better job of protecting the general health of their populations than we have, mostly by good policy integration. In the US, you can put an unregulated product on the market unless it is proven hazardous. In the EU--because they know they have to pay for the health care--you've got to prove a product safe before it goes on the market. You don't see melimine fed fish from China flooding their markets. And they are not having--epidemilogically speaking--near the incidece of childhood kidney stone and bile duct disease we do in the US. The suspicioin right now, is that melimine tainted dry milk products have been in our system for 5-6 years, at very low dosage rates and not in the EU's.
Hillary's plan wasn't so bad this time. There should be a mandate that everyone have healthcare and everyone become a consumer of that healthcare. Spreading the cost across everyone will reduce the costs to everyone.
Indeed, a good start. But we've also got to offer healthcare to any citizen, regardless of conditions, particularly for preexisting chronic diseases.
We also need to change either the bankruptcy laws to include medical bills or enact catastrophic medical coverage for all citizens.
And I understand that, a kind of chicken-egg thing. But I am extremely agitated right now about religious affiliated hospitals who get enormous tax breaks shutting down their indigent care programs and ERs. So we taxpayers pay twice, once on the tax breaks Methodist hospital gets for no longer treating charity cases and on the extra taxes we pay because of the County Hospital ER load. Our local paper did a FOIA request to get public records of our six religious affiliated "charity" hospitals in Hampton Roads. Indigent care had dropped by an average of 70%, yet they still took the big writeoffs.
but two paragraphs above you were blaming direct to consumer advertising.
The only part of our healthcare system that is unregulated are the holistic medications and treatments. All that crap from the healthfood and vitamin stores are sold outside the scrutiny of the FDA. While they are not supposed to say they treat any condition, they often infer it. While people cannot afford medication, they often spends huge amounts of their cash on these snake oil products. The consumers are being let down. There was an effort get FDA regulation of these products, but a huge lobby bought their way out of it in the congress a few years ago. To obtain FDA approval any medication or medical device must go through multi-stage testing costing untold millions. They don't just put untested medications or medical devices on the market.
Rick, you're mixing up healthcare delivery with personal responsibility. People can be educated and they can be offered the appropriate care, but you can't make a horse drink once it's at the trough. This is the flawed philosophy behind the universal healthcare mantra, "let the government be your daddy and provide all your healthcare needs and everything will be great," but people will be people and they will continue to abuse themselves, regardless of all the advise you can give. For instance, I dont' see the populace of the EU giving up cigarettes, most of them smoke like chimneys.
FDA/D of Ag cannot impound and destroy this honey, they can only not let it off the ship. So the tainted honey was sent back to sea where it was transshipped through Germany and arrived some months later in an east coast port. Inspectors caught it that time because Germany does not export honey. It's all a shell game being played with the American food supply at risk.
Well, here we are again. Below is a fascinating investigative report on Honey Laundering. First it was melamine from China poisoning our animals. Now it's found in most of the dry milk in the US and in small amounts in infant formula. Now this...again.
It's really quite disturbing that the FDA and D of Ag can't defend our food supply better. I guess my takeaway is that if you're a honey fan, think about getting it at the farmers market.
____________________________________________________
Oh, and why do the Chinese use Chloramphenicol on their bees? The same reason feed lots and chicken farms use antibiotics in our meat: not to protect us, but because the animals are packed in so tightly that one diseased animal can kill the entire lot (and because animals being fed antibiotics put on weight more quickly).
____________________________________________________
Anyway, wish me happy birthday (tonight, Dad really sweated for that tax deduction) and I'll wish you all a safe and happy New Year.
Rick & Gayle Kennerly
Cairn Terriers--Sydney, Baxter and Zeke, the girls in the hive
http://tinyurl.com/797ewr
Country of origin no guarantee on cheap imports
Certainly works with my plan.
And you'd better start thinking about the repercussions on the future of this nation & our tax base if today's children live shorter and more unhealthy lives than their aging parents.
All I'm saying is that we need to rethink how we regulate. D of Ag is a near captured agency of Cargill and Monsanto. Farm policy is designed to flood the market with cheap grains and corn syrup not because it's good for the nation but it's good for Cargill's.
The FDA comes out one day and says no level of melimine is safe. Two days latter they come out saying that trace amounts are fine, but there is no proven scientific maximum amount one can digest without doing harm. FDA another captured agency of the baby formula and powdered milk businesses, despite the fact the CDC is detecting unusual renal problems in toddlers (btw, those powdered coffee creamers have trace amounts of melamine in them, too).
Do you know it is actually illegal for the FDA to make policy based on long-term longitudinal health studies? There baliwick is limited to studies of acute exposure levels only--immediate risks.
Isn't it about time that we begin regulating for the long term public good of America, the stability and health of our society, and not the bottom line of corporations at public expense?
Maybe we get what we deserve. You know, the German govenment, the French government, the Spanish government even the British government are all considerably more afraid of their population than the American government. You see it in their policies.
Where you see the nanny state I see the American public taking back control of the destiny of this nation from the Wall Street brokers, Cargills, and Exxons and their enablers on Capitol Hill. A nation where regulation is actually in the public good because our leaders are actually a bit more afraid of us than they are tempted by the lobbyist dollars and cushy job waiting for them on K Street.
Do you even know if EU checks their food for Melamine?
but people will be people and they will continue to abuse themselves, regardless of all the advise you can give. For instance, I dont' see the populace of the EU giving up cigarettes, most of them smoke like chimneys.
People can be educated and they can be offered the appropriate care, but you can't make a horse drink once it's at the trough.
the flawed philosophy behind the universal healthcare mantra…
I have never read such smug, superior drivel in my life. On what are you basing these nonsensical, arrogant statements?
You would be amazed Mr. Rightguy, but many countries get along just fine without interference and advice from the great and magnificent U.S.A.
I recommend, for your reading pleasure, the below article concerning the current administration. This is the bunch of incompetent, ideologues that we selected to lead our country for the last 8 years. It will be like looking in a mirror.
http://www.vanityfair.com/politics/features/2009/02/bush-oral-history200902
Trix are for kids!
(;>)
-s
Prevalence of cigarette smoking in American men and women, repectively=35% and 22%. European men and women=46% and 26%.
The fact that anyone in America or Europe still uses tobacco nearly 40 years after the Surgeon General's statement is but one illustration of my statements. If you want to add drugs, alcohol, and obesity, you will find that a large portion of human illness is self-induced even though people know better.
Rick and I were discussing healthcare in America and comparing it to Europe. Perhaps you would be less smug, arrogant and accurate if you quit spending so much time hating Bush and America. The drivel you seek is in that trashy Vanity Fair article you referenced. Expand your reading a bit and perhaps you won't jump to judgment and condemn people with a different opinion.
Well, my fault. I knew I'd draw out the LCD on the list with some of that. Maybe it's time you go have another beer with Bush and let the adults handle things for awhile. I'm sorry if I just can't get past the conservative penchant for Private Profit and Public Risk, judging from their actions, at least.
As I've said before "No" is not a plan or even a workable strategy when things are failing. If you have suggestions, I'd be glad to hear them. How would you fix health care in the USA?
Where? I read an awful lot and do the kind of work now that allows me to download and listen to some 60 hours of quality podcasts a week. University lectures, TED Talks, Science, Medical, Engineering, and even some of that NPR stuff.
You raise what you call the "malpratice lotto" system. An interesting subject. The underlying issue is that when medical malpractice happens, it can do huge amounts of damage to people. Because we allow lawsuits and recovery for this, the economic cost of this is spread by insurance, and passed on as a cost of care. Malpractice suits also have the positive effects of giving the medical practitioners incentives to clean up problems and prevent future injuries, something that won't happen if they are immune. It makes prevention of harm intrude into the cost benefit analysis.
Also diseases caused by treatment are exceptionally common. They have a technical term for it, "iatrogenic," which can be discussed openly in professional settings away from ordinary people. Some of this is inherent in having sick and injured people in close proximity with treatment instruments and each other, so it takes a lot of work and cost for providers to avoid this harm. And in business cutting costs means increased profits.
Whatever the "standard of care" to avoid this harm should be, there is a lot of harm done when malpractice happens. Some say that is a tradeoff for all the good that is done, which is fine if you are not the one harmed. Others say we can not afford healthcare if we add the costs of dealing with large malpractice verdicts. In any case you have all the foibles of individual and organized humans with a high potential for doing harm as a result, much higher than what the rest of us face if we mess up in our jobs.
There have been decades of "malpractice reform" which have had the effect of raising barriers to relief or driving up the cost of litigation so that only people who are really really really harmed can bring a case. These reforms have done little to actually do some compensating for people who are really injured but not enough to support litigation. These cases become battles of experts and, realistically, questions of who the jury likes better, the injured person, the health professionals, and the expert witnesses they bring in. This seems certain to create the "lottery" effect described by Rightguy. A few people win a lot, most lose. When you think of the natural tendency of professionals to identify with each other, let alone be concerned about protecting mistakes they make, it is amazing that anyone wins. When a patient wins it is not before years of living with their situation, plus the anxiety of litigation, plus all the expense. Similarly lawyers who represent injured people have to invest in cases and hope they win enough contingent fees to keep going and they hope, do well financially.
Businesses do not like the prospect of being sued, because it gets power of them out of their community, perhaps to a jury of ordinary folks who are in many ways not their "peers". With our private system of funding political campaigns, donating to legislators in exchange for immunities from suit, or diversion into industry friendly "arbitration systems," has become a way of life. And it is the political message that you hear from businesses that lawsuits are terrible. However they are one of the few things that creates "accountability" which, whatever it means, people seem universally to believe in.
In any case, these malpractice reforms would have credibility if they wanted to deal with the problem, compensate similarly situated people in some fair way that does not also bring down the system, and be less "lottery like" than the present system. Unfortunately that does not happen. Instead they merely seem to erect barriers to relief.
So again to Rightguy, who is critical of the present system, how do you suggest we do better? (Your last reply to a question of this type certainly did a good job by the way).
I've known two families who have won sizable medical malpractice suits. One had to do with a medication error the other a forceps birth gone very bad.
Their newborns faced tens, no, hundreds of thousands in medical procedures, rehab care, and, after the parents eventually died, custodial care because of medical errors.
The family is faced with enormous lifetime care bills and aren't allowed to file bankruptcy for medical reasons. What choice, in a country without universal health insurance, does a family have but to sue and sue big? How else to protect one's disabled child?
How can we have tort reform without enacting some form of catastrophic care insurance first?
Does a lawsuit really do anything to improve healthcare by charging a bad doctor's malpractice insurance and then allowing them to practice after the payoff? Does a lawsuit, where up to 70% of the money goes into the lawyer's pocket, really help an injured patient? Does it help to threaten innocent practitioners with frivolous lawsuits?
One of the basis of lawsuits is "the injury speaks for itself," i.e., if a person has an injury a physician or hospital has to prove they didn't cause it. The trouble is, by definition, patients often present with their injuries, such as someone with a ruptured cerebral aneurysm. When they are left with a residual deficit a patient can claim the doctor did not act in a proper manner and caused that deficit, even if there was no wrong doing. The doctor then has to prove their innocence. There is a shortage of obstetricians because they may be deemed liable for a learning deficit in a child up to the age of 18, just if a mother claims it so.
Aside from limitations on pain and suffering, there has been little malpractice reform. If you really want a legitimate method to police malpractice and improve the delivery of medicine, these cases should go through the Medical Board review. Unfortunately, the first step is a lawsuit to get money, revenge or both. Many of the Medical Board cases actually arrive after the fact when the lawsuit has been won. The case is automatically referred to the Medical Board by the courts, with little interest from the attorneys and patient after recompense has been determined in the courts.
The first step should be to the Medical Board, which doesn't cost patients anything and provides an impartial, expert review of the merits of the case. If the case has merit, let the courts decide any recompense for loss in arbitration and let the Medical Board issue appropriate measures to either retrain a physician or remove them from practice and protect the public.
Happy New Year!
The Medical Malpractice Myth discusses the evidence of the impact on the supply of doctors and the costs of defensive medicine, arguing ultimately that med-mal claims have little effect. Baker takes the normative position that medical-malpractice claims are good for the system and that the legal system adequately sifts out nonmeritorious claims. Further, Baker tries to gauge the overall costs of the tort system, arguing ultimately that med-mal victims are undercompensated (especially bearing in mind the large majority of potential plaintiffs that do not seek recompense).
Actually, only 40% of medical malpractice suits are groundless, says a Harvard study.
The complex nature of medical injury makes it very difficult to understand whether malpractice has taken place. It often takes a physician within the same specialty to understand whether the standard of care has been breached. An incompetent doctor with a good personality will get sued much less than a very competent doctor who pisses his patient off or doesn't speak to the family. Most good lawyers don't take frivolous suits, but there are sufficient attorneys who do in hopes of getting a quickie settlement. Assessing the true cost of malpractice suits requires the measurement of too many intangibles to get an accurate assessment of the costs. Imagine that every decision you make may cost you your home and family, even if you didn't do anything wrong. Think how that influences the decisions and practice of medicine.
Look at the "fourth" issue discussed on page 3 of the book you cited. He throws out the notion that frivolous claims have any effect because "most are thrown out before trial, most trials end in a verdict for the doctor, most doctors don't pay claims out of their own pockets, most insurance companies and hospitals refuse to pay claims unless there is good evidence of malpractice (imagine that!), and the settlement of these claims is often hugely discounted.
The author of your book is speaking about direct costs of claims. The average frivolous claim cost about 100 grand in legal fees and court cost before it is thrown out. And the claims for frivolous lawsuits are hugely discounted, but why should there be ANY payout on a frivolous claim? He completely ignores the psychological impact these suits have, as I discussed. He states that doctors don't pay any out of pocket expense for these claims, but these claims take a huge amount of time out of the doctor's practice, a doctor's malpractice premiums go up with multiple claims, a doctor can lose their malpractice insurance with too many claims (and thereby your ability to practice), and doctors already pay huge malpractice premiums every year that they practice.
Finally, your book is written by a lawyer. Of course he's going to defend his bread and butter.
As long as many of our citizens are forced to pay for their medical services and possibly go bankrupt doing so, malpractice suits will be a way of getting some of their hard earned money back.
Sounds irrational? Here’s something to think about.
“Of all the malpractice payment reports made world wide, over 80% of those payments were made by United States doctors with the whole rest of the world accounting for just 20% of all payments made for malpractice.”
I don’t know if this statistic is verifiable. However, my guess is that there is most likely something to it. This country has a way of assuming that everything we do is the best in the world. We refuse to consider other points of view or methodology. If the idea is not American, it can’t be good. We end up just tinkering with outmoded systems and institutions.
If you want to solve a problem, you need to go to the root cause – wherever that might lead you.
Let's be fair to the author, he's also an academic and a recognized social science researcher.
But why should doctors be exempt from law suits? Everyone else risk suits for far less remuneration. They used to kill doctors whose patients died. We don't have duels anymore. We don't have blood vendettas. We don't have blood feuds.I don't like it much, but this the system we've settled on in this country to right wrongs. And in that system we assign blame and take what is most precious to Americans: money.
In my system we are prohibited from suing the doctor or the institution. However, in return in findings of fault those injured are given guaranteed lifetime care for the mishap and any resulting complications, a monthly stipend, and in case of death, a generous payout in cash or over time. In cases where the person can no longer work or function, they also get full pay retirement.
As I've said before, we cannot have malpractice reform without some way of generously compensating those who have been harmed.
You should really switch to my plan.
I haven't read the book yet, but MM talked about it on the show a few weeks ago. After WWII he returning troops had gotten used to good health and dental care and there was great pressure to do something to make healthcare affordable and accessible. There was a pretty good push for a national healthcare system. But since the Reds had socialized their healthcare the government pushed industries--like the big three auto makers--to lead the way with employer paid healthcare as a different model.
Ironically, the auto worker unions wanted to run the healthcare system themselves, but the makers were afraid that would get out of hand so they insisted on keeping it on the company side.
Mitt Romney as Doll
Yes, Mitt's so slick of speech and slick of garb, he
Reminds us all of Ken, of Ken and Barbie--
So quick to shed his moderate regalia,
He may, like Ken, be lacking genitalia.
It's not that injured parties shouldn't have justified recompense, the problem is when you "generously compensate" someone you take healthcare money away from another. It has to come out of somewhere, so it come out as spiralling healthcare costs.
I agree that your plan is actually a good example of the benefit of insuring healthcare for everyone, if there is a injury, whether medical or general, the lion's share of lawsuits often arises from funding estimated future healthcare costs. If healthcare is already provided for then the size of future lawsuits will go down.
The family that had a CP baby after the forceps birth incident is a good case in point. A blind and brain damaged infant with a completely healthy body. How does one compute the lifetime costs of caring for that child? The stats are pretty good the child will not live a long life, but the family only has one shot at getting enough to cover every eventually, including their deaths and care for their disabled adult child.
BTW, you haven't asked buy the US Navy covers my healthcare. I retired after 28 years, but my wife is still active duty, a Captain in the Nurse Corps.
I have a hard time believing that 90% of malpratice claims are frivilous. Frivilous means, not just that a claim eventually loses, but that there are no grounds to support it. People who don't like lawsuits against people like them often editorialize by calling things frivilous, so that may be part of it.
Reasons for scepticism include that, as Rightguy notes, good attorneys don't file frivilous lawsuits, since they only get paid if they win and can get sanctioned if they do file frivilous cases. This is a highly specialized area of law practice and bad attorneys are not going to survive long filing frivilous cases. Since the waves of malpractice reforms began and the accompanying anti-litigation campaign by the general business community, insurers have not been settling many frivilous cases. Credible experts willing to take on another doctor are less available than they are to doctors. Furthermore juries have great respect for doctors, even ones with gruff or unfriendly demeanors, and a malpractice case is a tough sell to a jury.
In addition, the cure sought by the AMA and the insurance industry, caps on malpractice awards, has nothing to do with the number of frivilous cases there are and more on how big a hit the insurer takes in cases where malpractice does happen.
The Harvard Study cited by Kennerly, found that the number of malpractice cases that they would have ruled against was 40%. 3% involved no injury, most of the rest involved serious injuries and many involved really close calls or cases that needed to be developed. It also found that non-winning cases take up very little of the costs paid by insurers on claims.
Admittedly doctors like having their judgment questioned by courts even less than by HMOs, and admittedly malpractice claims are aggravating and distracting to doctors and take a long time to resolve, so many doctors try to avoid them by practicing cover your behind medicine. No doubt the line of the standard of care is something of a moving target given how much care-caused injury goes on. Obstetrics are a particular problem area because it is a vulnerable situation and can lead to a lifetime of damages. So I am sure Rightguy's posts reflect his feelings and views of him and others.
However, as the Harvard study shows, the claims of a malpractice crisis seems to be overblown, possible due to various political factors. One is a campaign by the general business community, particularly stockbrokers, lenders, and car dealers and manufacturers against litigation in general. This must be seen in view of the lawless business practices that they can otherwise do with impunity and externalize (put of the books) the costs of the harm they do. This is highlighted by the fact that businesses contribute mostly to the Republicans and the plaintiffs' trial lawyers contribute mostly to Democrats, and this creates high political stakes in a money driven political system. In addition, conservatives have attempted to blame much of the rising cost of health care on frivilous lawsuits, seeking to divert the demand for more universal health care reform. In addition insurance companies have sought ways to increase the bottom line as other investments have faltered, and limits on large damage awards not only increase profits but eliminate uncertainty, as small awards are a cost of doing business as usual.
So I would certainly question a claim that 90% of malpractice suits are frivilous. It reminds me some of claims by Christian conservatives that secular humanists and atheists are taking over the country even though 90% of Americans believe in God. On closer examination, neither sets of evidence holds up (Specifics where secular humanists and atheists are taking over the country are lacking, and whatever answers 90% of Americans give to polls about God, most don't agree with Christian conservatives), but Christian conservatives feelings and perceptions are that the statement is true. This essentially reflects a lot of feelings of mistrust and being disrespected, but not necessarily a picture of what is happening in society. It also may reflect an effort to win allies in a larger political debate over the cause of the feelings of unease many have about things that are happening in society, and who should be in charge to deal with them. Similar dynamics may be at work concerning cliams of enormous numbers of frivilous malpractice cases. Again we need a way to discourage malpractice, encourage better care, compensate injured people fairly and not burden the system of care unnecessarily in the process.
Anyway, interersting article in Salon.
http://tinyurl.com/9j8x66
It was the worst of times for ordinary Americans. And even worse times for deregulators and supply-siders. The bright side? Their party is over.
By Andrew Leonard in Salon
Jan. 2, 2009 | Of all the economic earthquakes that racked the global economy in 2008, one temblor ranks supreme. Alan Greenspan's declaration to Congress on Oct. 23: "I made a mistake."
Greetings from the deep south, by that I mean the really deep south as in Canberra (the Capital of Australia).
How's the great drought going?
--Sarah, the bloginatrix