There are real problems in Florida caused by the fact that there are limits on recovery from some physicians and no limits as to others. In my experience, this issue has not arisin with ED docs, only with physicians who are employees of state agencies and therefore have a sovereign immunity cap of $100,000. The statutory change requiring that med mal liability be apportioned on the basis of relative fault may alleviate this problem.

Interesting discussion - I’ll be back to read more of your blog.

As for ED docs not knowing everything, Florida recognizes this fact and limits their liability, while denying any such protection to a physician who can’t examine the patient and is relying on someone “who doesn’t know everything” for information.

And another disincentive is ED docs who are reflexively defensive and anxious to point fingers at their consultants. I am grateful that I don’t have to deal with such attitudes in the matter I’m handling.

If you weren’t intending to bust on ED physicians, then I apologize that I got the wrong vibe from your post.
I agree that the current system creates disincentives to care. If the specialists took a stand and refused call due to liability concerns, policy would quickly change. ED physicians don’t have that luxury.
I also have seen first hand that the ED physicians aren’t the only ones who jump to point fingers at other physicians. It works in reverse, just as often. Having a good attorney to nip actions like that in the bud helps a lot.

It just does not seem right that for all practical purposes unless you are independently wealthy or permanently employed, you cannot have affordable health coverage in this country. And there’s really only one reason for that, which is the profit-making of health insurers and providers.

Once upon a time, before the advent of for-profit insurance providers, the purpose of all insurance was to spread risk of loss among a large heterogeneous population, making the insurance affordable to all and reducing (not eliminating) the risk of massive losses to any individual. Somewhere along the line when insurers figured out there was all kinds of money to be made, they decided to weed out the high risks by refusing to cover them for many different reasons, the most common being the so-called “pre-existing condition”, so while they continued to collect premiums from most of the subscribers, those who were most likely to cause payouts were prevented from participating at all.

This was and is a great deal if you happened to be employed or independently wealthy but pretty much sucked if you weren’t. So maybe what I’m saying is not necessarily that medical insurance for profit is the problem, but rather their ability to pick and choose their customers is. If anyone in this country in any physical condition could go to any medical coverage provider and bind coverage at the same per-subscriber rate as anyone else, then I would be fine with them pulling any profits they could, because the ones who send their insureds home 2 days after major surgery would soon be out of business.

Sure, I know what you’re thinking and probably getting ready to post: that’s communism; that’s not free markets; that’s not what made America great.

You’re probably right. But the health care industry is in my opinion the best example among many that prove, the collapse of world-wide communism notwithstanding, that free markets are not perfect markets. As long as there is profit motive in health insurance there will be victims of the health care industry, those who treated unfairly and those who are unable to participate.

I’ve already done more than a little reading about medical lawsuits and the odds of getting sued - after all, I used to work for a medical insurer. Actually, the cost and the odds of getting sued are relatively small with respect to the enormous amounts of money being made in the for-profit insurance business. If there wasn’t so much money to be made and if the for-profit medical insurers weren’t already making gobs of money, wouldn’t they have abandoned the business? Absolutely they would have. But they haven’t, so I’m forced to conclude that the cost and the odds of getting sued are simply a business cost to the for-profit medical insurer, something to be risk-managed, and something which contributes to the fact that while we in the US spend more than any other country in the world on health expense, we have something like the 30th or 40th worst resulting health and longevity. Take the massive profit-taking out of the picture and we might have a fighting chance and righting that imbalance.

Sure there are now more services to be had - that’s what is to be expected from and what inevitably happens with a “free-market”, profit-driven approach to this sector. But don’t confuse that with better services or better resulting health. And, finally, maybe if the driver wasn’t profit, which leads to “cost-cutting”, which leads to cost-cutting, which leads to mistakes, there wouldn’t be so many lawsuits.

True example - a member of our church recently went in for prostate cancer surgery and was sent home 2 days after surgery, which is a ridiculously short amount of time and would never have been contemplated if the motive for the insurer wasn’t profit. Of course, he went home, had complications and had to be re-admitted a few days later to deal with it. Now if he winds up dying, the doc and the insurer absolutely deserve to be sued. Maybe when they get sued enough times for that kind of slipshod, slapdash, profit-driven “medicine”, when it finally starts hitting them hard enough in the only place it seems to have an effect - the pocketbook - they might start thinking about providing quality care instead of high profits.

Do you understand how modern-day health insurance works? It doesn’t really seem like it.

Your idea has already been tried AND FAILED. There are significantly large chunks of this country (at least one whole state, for instance) whose ONLY med-mal insurance providers are non-profits (most of them doctor-self-insurance groups), because the private firms have all left (because there’s no profit to be had). Go look at how those gruops are doing, and you’ll see that insurance greediness plays an insignificant part in this mess.

Go do a little reading on what a single lawsuit costs, both in money and in emotional distress, and then do a little more reading about the odds of getting sued (essentially, all doctors get sued, and the relationship betwen lawsuits and bad care by the doctor is almost non-existant).

Much of the cost of medicine is actually driven by MORE medicine; that is, we consume more services that we used to, because there are more services to be had (classic example: when you have a heard attack, dying is much cheaper than being treated - 50 years ago, well, you just died and saved a lot of money).

Shortage of doctors willing to cover the ER, etc, is driven prrimarily by fear of litigation.

What is wrong with you liberals anyway? Do you really think that the doctors will be so happy to have these conditions placed on them - work once a month or else you won’t be able to practice - that everything will be hunkydory? There is such a shortage of doctors any more, as you know, and your solution is to make it even less attractive to practice medicine? Amazing.

And yes, the best way to counter an argument is to demand that your critics come up with their own suggestions because, after all, we can’t question your suggestions unless we come up with grand plans of our own.

Take away the increasing demand and prices will stabilize. Demand will drop off if insurers are no longer making enormous profits and if the consumer is responsible for a greater share of the cost.

The idea that stopping lawsuits will appreciably reduce costs is hogwash. The idea that forcing providers to provide services when they wouldn’t normally will improve service or reduce cost is hogwash.

The entire health care “crisis” in access would go away if doctors, like EVERY OTHER business, could write bad debt off on their taxes. I.e. if patients have no ability to pay, the govt. writes off the cost at Medicare rates on the physicians taxes. Voila, every physician in the country would at least be willing to do 35% free care (i.e. to eliminate their tax burden). Add on some sort of limited liability for emergency care and the ED coverage imbroglio would be gone too.

I choose to practice where I operate on a lot of indigent patients and I do about 35% charity care by choice (e.g. last case this PM was a homeless, hep C cirrhotic with an incarcerated umbilical hernia) but I’ll only comply with FORCED clinic days when they make the trial lawyers give away a similar amount of time (and legal representation IS an actual enumerated right — unlike medical care). I’ll give up medicine first.