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Sexual Harassment Panda 01-04-2006 02:13 PM

The so called "experts".
 
Quote:

Originally posted by Captain
You need to look at this in context. Even $388 billion can't buy you a half-way decent war.
You can if you leverage your allies' contributions and commit the needed forces at the outset. Otherwise, you're stuck hoping your invading forces are spontaneously greeted with flowers.

This I learned from numerous games of "Risk" when I was a lad.

Mmmm, Burger (C.J.) 01-04-2006 02:14 PM

Quote:

Originally posted by Spanky
Originally posted by Sidd Finch
So, where do I start? First, as I pointed out (and you gleefully ignored), 221 billion in 1985 dollars is about $388 billion today.

1985 dollars? 221 Billion dollars today may not buy as much as it did in 1985 but it still pays off a debt of 221 Billion even if it was incurred in 1985. You have to pay the 221 Billion plus interest. Is that what you mean by 1985 dollars?
How hard is this?

Look at Table 2

1985: Deficit, 5.1% of GDP, Debt 36.3%
2004: Deficit, 3.6% of GDP, Debt 37.2%

Sidd Finch 01-04-2006 03:09 PM

Quote:

Originally posted by Spanky
You have to pay the 221 Billion plus interest. Is that what you mean by 1985 dollars?

That would be another way of looking at the issue -- look at the principal plus the debt service costs. If you do that, though, then number is far higher than the simple inflation-adjusted number.

Either way, comparing the nominal deficit 20 years ago to today's total revenues and claiming that the former is "chump change" is silly.

Hell, even if your apples-to-oranges comparison had any validity, your conclusion would be wrong -- if you think $221 billion is chump change, would you be willing to have the government spend that on housing subsidies for the poor?

Shape Shifter 01-04-2006 03:16 PM

The so called "experts".
 
Quote:

Originally posted by Sidd Finch
Yes, thank you. Similarly, "Don't Walk" signals do not mean that I have no legal freedom of movement.
No, but the signals are an unnecessary intrusion by the Nanny State and a waste of tax dollars. They will be cut to balance the budget.

Mmmm, Burger (C.J.) 01-04-2006 03:20 PM

Quote:

Originally posted by Sidd Finch
That would be another way of looking at the issue -- look at the principal plus the debt service costs. If you do that, though, then number is far higher than the simple inflation-adjusted number.
How hard is this?

Budget (large pdf) check table 6.1, which has interest payments. They've been going down of late, primarily because the interest rate is lower.

That said, you ought to look at the actual outlay and the interest (or interest on interest). It's sobering when one takes out a mortgage adn realizes that the $500k mortgage will cost you $1.5m in payments over 30 years (or thereabouts).

Mmmm, Burger (C.J.) 01-04-2006 03:20 PM

The so called "experts".
 
Quote:

Originally posted by Shape Shifter
No, but the signals are an unnecessary intrusion by the Nanny State and a waste of tax dollars. They will be cut to balance the budget.
No, they solve a collective-action problem. That's legitimate government. Nothing else is.

Shape Shifter 01-04-2006 03:26 PM

The so called "experts".
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
No, they solve a collective-action problem. That's legitimate government. Nothing else is.
Bullshit. It's needless government interference. If people really needed help crossing the street, they could hire crossing guards supplied by the private sector. If people don't value their safety enough to pay for assistance, they don't deserve to cross the street safely. Let the Market work.

Sidd Finch 01-04-2006 03:31 PM

Quote:

Originally posted by Mmmm, Burger (C.J.)
How hard is this?

Budget (large pdf) check table 6.1, which has interest payments. They've been going down of late, primarily because the interest rate is lower.

That said, you ought to look at the actual outlay and the interest (or interest on interest). It's sobering when one takes out a mortgage adn realizes that the $500k mortgage will cost you $1.5m in payments over 30 years (or thereabouts).


And looked at that way, how much did the $221 billion in deficits in 1985 really amount to?

And is that number "chump change"?

Mmmm, Burger (C.J.) 01-04-2006 03:35 PM

The so called "experts".
 
Quote:

Originally posted by Shape Shifter
Bullshit. It's needless government interference. If people really needed help crossing the street, they could hire crossing guards supplied by the private sector. If people don't value their safety enough to pay for assistance, they don't deserve to cross the street safely. Let the Market work.
If they hire crossing guards, I just have to run more people over to get through the light. Still a collective action problem. After you, Alphonse?

Shape Shifter 01-04-2006 03:40 PM

The so called "experts".
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
If they hire crossing guards, I just have to run more people over to get through the light. Still a collective action problem. After you, Alphonse?
As long as they or their heirs are compensated fairly for any injury, who cares?

Replaced_Texan 01-04-2006 03:49 PM

Tort Reform!
 
Present for ya'll: Texas Monthly vs. Texans for Lawsuit Reform

Usually Texas Monthly keeps its stuff on the website for (paying) registered users, but I sorta kinda get the impression that the editors were rather pissed off about this and decided to open up the response to the general public.

Mmmm, Burger (C.J.) 01-04-2006 03:53 PM

The so called "experts".
 
Quote:

Originally posted by Shape Shifter
As long as they or their heirs are compensated fairly for any injury, who cares?
That's inefficient. We're both better off with traffic regulation devices.

Unless by "fairly" you're thinking like a defense lawyer, in which case: good point.

Shape Shifter 01-04-2006 04:00 PM

The so called "experts".
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
That's inefficient. We're both better off with traffic regulation devices.

Unless by "fairly" you're thinking like a defense lawyer, in which case: good point.
THE MARKET IS ALWAYS MORE EFFICIENT THAN GOVERNMENT INTERVENTION!!!

Stupid big-government liberals.

sebastian_dangerfield 01-04-2006 04:06 PM

The so called "experts".
 
Quote:

Originally posted by Southern Patriot
We'll take care of you with some of that there tort reform.

Yankee.
I'll quietly toast the day it passes. Ideologically, if coupled with reform of CEOs and corporate behavior, I'm all for tort reform.

Ideally, people should behave decently, and not require some noxious mouthpiece to fix their problems. Tort reform should include business torts as well...

ltl/fb 01-04-2006 04:06 PM

The so called "experts".
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
That's inefficient. We're both better off with traffic regulation devices.

Unless by "fairly" you're thinking like a defense lawyer, in which case: good point.
I'm a little curious what you see as unnecessary. It seems like it depends almost entirely on on how one defines and evaluates costs and benefits in the cost-benefit analysis.

Spanky 01-04-2006 04:12 PM

Quote:

Originally posted by Sidd Finch
That would be another way of looking at the issue -- look at the principal plus the debt service costs. If you do that, though, then number is far higher than the simple inflation-adjusted number.

Either way, comparing the nominal deficit 20 years ago to today's total revenues and claiming that the former is "chump change" is silly.

Hell, even if your apples-to-oranges comparison had any validity, your conclusion would be wrong -- if you think $221 billion is chump change, would you be willing to have the government spend that on housing subsidies for the poor?
It is a one time cost of $221. 221 Billion for the poor would have to be spent every year. If you are asking if I want to spend 221 Billion on the subsidized housing for the poor over the next one hundred years, no problem.

In 2030 our annual revenue will be 11 Trillion. That is a 11 Trillion per year. Even if our deficit went for another couple of years and then balances in 2010 and stay balanced until 2030 there would be no reason to pay off whole debt. By 2055 our annual budget will be like 40 Trillion and those numbers will seem even more insignificant.

In 1970 our entire national debt was 300 billion and I am sure some politician was saying that we are saddling our grandchildren with this debt. That 300 billion is still in the national debt, will never be paid, and it really is not a problem if it is never paid. It would be bad for the economy to pay off the entire national debt so it is just going to sit there forever.

Deficts are a problem. Recent deficits are a problem. But old debt is not a problem. The only time Old debt becomes a problem is if the economy is not growing or if you have deflation. But as long as the economy is growing and you balance the budget over time the old debt becomes insignificant. That is the advantage the US government has over you and anyone else, and that is why it has the highest credit rating of any organization in the world.

One you tame deficits, over time the national debt takes care of it self. It does not have to be paid back.

Mmmm, Burger (C.J.) 01-04-2006 04:19 PM

Quote:

Originally posted by Spanky
It is a one time cost of $221. 221 Billion for the poor would have to be spent every year. If you are asking if I want to spend 221 Billion on the subsidized housing for the poor over the next one hundred years, no problem.


One you tame deficits, over time the national debt takes care of it self. It does not have to be paid back.
So you're the reason for the bankruptcy reforms?

It's a recurring cost. You keep paying interest as long as there is debt. If you create a social welfare program costing X/year or if you carry debt costing X/year, it's the same--you keep paying it until you eliminate the source of the expense.

The problem is that the deficits have become as entrenched as many social programs. Even Keynes didn't recommend this--the idea was that in recessions you have deficits and in booms you have surplusses. But we have a structural, not cyclical deficit, which means that even in good times (these times are good, I'm told by my President), we have a massive deficit. What happens when tax revenues go south?

I hate to admit it, but Bush is the problem. He's shown no leadership at cutting spending in Congress, and Congress, run by republicans, has sent up more and more spending for Bush's signature. He has not vetoed a single bill, substantive or budget. He should be embarrassed.

ltl/fb 01-04-2006 04:20 PM

Neo-con vs. Neo-realist
 
Anyone want to help me out with distinguishing these? Thanks.

Mmmm, Burger (C.J.) 01-04-2006 04:20 PM

Neo-con vs. Neo-realist
 
Quote:

Originally posted by ltl/fb
Anyone want to help me out with distinguishing these? Thanks.
red pill/blue pill?

ltl/fb 01-04-2006 04:23 PM

Neo-con vs. Neo-realist
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
red pill/blue pill?
Neo-realists are blue state-y? Really?

A bit more detail would be helpful. Yes, I looked at wikipedia. I need it dumbed down more.

ltl/fb 01-04-2006 04:29 PM

Oh and I really liked this letter
 
re: CEO pay. From a CEO to the comp committee of his board.

http://www.nytimes.com/packages/pdf/business/17gret.pdf

Spanky 01-04-2006 04:36 PM

Tort Reform!
 
Quote:

Originally posted by Replaced_Texan
Present for ya'll: Texas Monthly vs. Texans for Lawsuit Reform

Usually Texas Monthly keeps its stuff on the website for (paying) registered users, but I sorta kinda get the impression that the editors were rather pissed off about this and decided to open up the response to the general public.

Don't let the messenger spoil the message. The message is an important one. Litigation costs have run amock in this country and are causing extensive damage to the economy. For example:

United States
Litigation and health care

Scalpel, scissors, lawyer
Dec 14th 2005 | ROCKVILLE, MARYLAND
From The Economist print edition

Health-care litigation costs America far too much


AS ANYONE thinking of having a baby in Maryland will know, it's not easy to find an obstetrician in the Old Line State. The main reason, says Debbie Redd, the head of Capital Women's Care (CWC), the largest group of obstetrician/gynaecologists in the Washington, DC, area, is that it costs $118,000 a year to insure just one of them against malpractice lawsuits. That is more than the total cost of employing a doctor in most countries.

Trial lawyers argue that malpractice lawsuits deter negligence. Craig Dickman, an obstetrician affiliated to CWC, says they mostly deter the kind of behaviour that might get you sued, which is not the same thing. To cover himself, he says, he orders excessive tests, monitoring and consultations with specialists. He guesses that 12%-15% of the procedures he bills for are unnecessary. If he fails to order every imaginable test, even if there is “no clinical evidence of efficacy”, he is exposed if something were to go wrong. A trial lawyer can scour the country for the one expert who thinks that his omission might have caused the patient's injury.

Dr Dickman has been sued five times in 21 years on what he (inevitably) describes as specious grounds. That is not unusual for an American obstetrician: 76% of them have been sued at least once. (They are more at risk than most doctors, since they typically operate on healthy patients, who may then blame them if they become ill.)

When doctors win cases, as they usually do, they still lose, because they have to pay their legal bills. And when they lose, they lose big. In jury trials, the average award of damages against a doctor is $4.7m. How much they have to pay to insure against these costs depends on where they practice. In St Clair County, Illinois, neurosurgeons paid an average premium of $228,396 in 2004, five times more than their colleagues in Wisconsin did. Inevitably, doctors (and insurers) flee the states that are friendliest to plaintiffs. Pennsylvania lost a third of its general surgeons between 1995 and 2002.

The cost of medical-malpractice lawsuits has risen more than 2,000% since 1975, to $26.5 billion in 2003, according to Tillinghast, an actuarial consultancy. And to what end? A study of malpractice suits in New York by the Harvard Medical Practice Group found that plaintiffs had actually been injured by doctors' negligence in only 17% of cases. Those patients with small claims often cannot find a lawyer to represent them, while those who win find their lawyers have swallowed half the payout from the doctors.

American health care is bedevilled by two problems that lawsuits do nothing to heal. First, health care costs too much. Americans pay twice as much per head for health care as people in other rich countries. Rising health-care costs threaten the solvency not just of private firms such as General Motors but ultimately also of the government itself. Second, some 46m Americans languish uninsured.

The problems of an industry that chews up 15% of GDP ($1.6 trillion in 2003) plainly cannot all be laid at the lawyers' door. But they do help push up prices (and thus increase the number of uninsured). For instance, in the 1990s, health-maintenance organisations cut costs by trying to cover only treatments that were proven to work. But patients who were denied experimental treatments, and the hospitals that wanted to be paid for providing them, started to sue. After being slapped with a few multi-million dollar verdicts, HMOs more or less gave up trying to ration treatment and just raised their premiums instead. The cost of covering a family soared 59% in the four years from 2000, and the proportion of small firms offering employees health insurance fell from 68% to 63%.

A cure indeed
Can legal costs be curbed? You might imagine that the Democrats would be keen to change a system that leaves so many poor people uninsured, overcharged and uncompensated. But the party gets a lot of money from trial lawyers and even chose one, John Edwards, as its vice-presidential candidate last year. So it is left to the Republicans (who get even more money from insurers and hospitals) to be the keenest promoters of tort reform.

Earlier this year, Congress passed a bill forcing most big class-action suits to go through the federal courts, thus preventing lawyers from shopping around for the most plaintiff-friendly local courts. That may help drug firms, who complain that awards for faulty products are out of all proportion to the damage; and that the costs deter research by lowering the expected returns to it. Wyeth, a drug firm, has set aside $21 billion to settle lawsuits over Fen-Phen, a diet drug, while Merck, another drug firm, is expected to have to pay between $18 billion and $50 billion for having released a painkiller called Vioxx.

Both drugs were faulty—tests suggested that they caused heart problems in some patients. So the scope of the eventual settlements will give some clue as to whether the legal bandwagon has slowed down. Drug firms are not wildly optimistic that it has. Although the first federal prosecution against Merck collapsed this week, it is still facing 6,500 suits related to Vioxx, and was ordered by a jury in Texas to pay $253m to the family of just one victim.

Such awards are usually reduced on appeal, but the industry's chief complaint is that juries are unable to distinguish between good and bad science. Safe products, such as Norplant, a contraceptive device, have been hounded off the American market. Drug firms are especially reluctant to develop pills for people who are well, which is why no American drug firm has produced a new contraceptive since Norplant was withdrawn in 2002.

Class-action suits matter less to individual doctors and hospitals. The Republicans have made less progress when it comes to reforming straightforward medical malpractice. That is partly because most Americans want to be able to sue their doctor. But it is also because many of the costs of the current system are hidden. Studies have found that “defensive medicine”, of the sort Dr Dickman describes, more than doubles the costs that malpractice suits impose on health care, and sometimes prompts doctors to hack patients around more than is healthy.

For example, few clinicians think that babies get cerebral palsy because the obstetrician failed to deliver them by caesarean section. But smooth lawyers like Mr Edwards have made a fortune by convincing juries that this is the case. The fear of being sued prompts doctors to perform unnecessary C-sections—a risky and invasive procedure. But a five-fold increase in C-sections in rich countries in the past three decades has brought no decrease in the incidence of cerebral palsy.

James Copland of the Centre for Legal Policy at the conservative Manhattan Institute, author of a recent study called “Trial Lawyers Inc”, estimates that the total costs, direct and indirect, of health-care litigation (including suits against doctors, drug firms, HMOs, nursing homes and so on) could be as much as $200 billion—a Hurricane Katrina every year. This figure involves some heroic extrapolation, but even half that sum would seem a lot to pay for a system that is not even good at compensating patients who are injured.

So what can be done? Some “solutions” look bizarre. Maryland's state government, for example, pays a portion of doctors' insurance bills, thereby adding to the pot that lawyers feed on. (A 10th-century English king, Aethelred the Unready, tried something similar when he offered bloodthirsty invaders cash or “Danegeld” to go away; oddly, they kept coming back.)

A more sensible idea would be specialist medical courts, as proposed by Philip Howard of Common Good, a group that lobbies for legal reform. Cases could be decided by judges who heard only medical cases, rather than by juries. The court could call its own neutral expert witnesses, rather than relying solely on the partisans hired by the litigants. Non-economic compensation for pain and suffering would be according to a fixed schedule—so much for an arm, etc—rather than by having jurors pluck a number out of the air.

The idea is partly modelled on the specialist courts that deal with other complex technical issues, such as patent disputes and bankruptcy. It ought to make the system less capricious. The Centre for Justice and Democracy, a pro-lawyer group, calls it “horrific”, which suggests it is worth a try. A Senate bill to allow pilot medical courts (among other reforms) may begin hearings early next year.

Not Bob 01-04-2006 04:42 PM

The so called "experts".
 
Quote:

Originally posted by Shape Shifter
No, but the signals are an unnecessary intrusion by the Nanny State and a waste of tax dollars. They will be cut to balance the budget.
Exactly. Free citizens can see when cars are or are not coming. They need to take some personal responsibility for crossing the street.

Oh, and if enough people want a signal at a given crosswalk, the market will provide one. QED.

Not Bob 01-04-2006 04:43 PM

The so called "experts".
 
Quote:

Originally posted by Shape Shifter
Bullshit. It's needless government interference. If people really needed help crossing the street, they could hire crossing guards supplied by the private sector. If people don't value their safety enough to pay for assistance, they don't deserve to cross the street safely. Let the Market work.
Scroll, *then* post, Not Bob. Scroll, then post.

Shape Shifter 01-04-2006 04:59 PM

The so called "experts".
 
Quote:

Originally posted by Not Bob
Scroll, *then* post, Not Bob. Scroll, then post.
Where does the Constitution say anything about "Don't Walk" signs?

Sidd Finch 01-04-2006 05:08 PM

Quote:

Originally posted by Spanky
Deficts are a problem. Recent deficits are a problem. But old debt is not a problem. The only time Old debt becomes a problem is if the economy is not growing or if you have deflation. But as long as the economy is growing and you balance the budget over time the old debt becomes insignificant. That is the advantage the US government has over you and anyone else, and that is why it has the highest credit rating of any organization in the world.

One you tame deficits, over time the national debt takes care of it self. It does not have to be paid back.

This is all fine and dandy, and I agree with it. But there is one slight problem: We can't wait forever.

I agree with you that, if you maintain a balanced budget for 20 years, then old debts are likely not a problem (depending on how big they were and how big the remaining debt service obligation is).

I assume you would agree with me, however, that if you continue to run large deficits, such that you are continuing to add debt even as debt service has become a very substantial part of the budget, that this is, in fact, a problem.

The question, then, is how much time do you have to solve, or avoid, the problem. I think we may have very little -- that we are getting ever more vulnerable to fiscal shocks, ever more reliant on the willingness of China to buy unlimited amounts of US debt, and ever closer to huge increases in obligations for the retiring baby boomers.

You may think we have more time, but I assume you do not think that we have unlimited time.

It's fine to say "old deficits are not a problem", but only if those old deficits do not lie under a big -- and ever-expanding -- heap of newer deficits.

If the deficit disappears in 2010 and remains disappeared for two decades, then we'll be fine. But tell me -- how confident are you that this will happen? And on what do you base that confidence?

Mmmm, Burger (C.J.) 01-04-2006 05:13 PM

Oh and I really liked this letter
 
Quote:

Originally posted by ltl/fb
re: CEO pay. From a CEO to the comp committee of his board.

http://www.nytimes.com/packages/pdf/business/17gret.pdf
That's a joke, right?

ltl/fb 01-04-2006 05:14 PM

Oh and I really liked this letter
 
Quote:

Originally posted by Mmmm, Burger (C.J.)
That's a joke, right?
No.

Sexual Harassment Panda 01-04-2006 05:21 PM

Tort Reform!
 
Quote:

Originally posted by Spanky
Don't let the messenger spoil the message. The message is an important one. Litigation costs have run amock in this country and are causing extensive damage to the economy. For example:

United States
Litigation and health care

Scalpel, scissors, lawyer
Dec 14th 2005 | ROCKVILLE, MARYLAND
From The Economist print edition

The Economist is probably the best news publication out there. That said, they sometimes come out with utter crap. This article might as well have been written by the AMA. Not a mention of the 1999 Institute of Medicine report that found between 44,000 and 98,000 preventable deaths every year in US hospitals, or the 2002 Public Citizen report that 5% of doctors are responsible for 50% of malpractice awards. A 2005 study by Dartmouth College researchers suggested that increases in doctors' insurance premiums are not due to jury awards and financial settlements for injured patients, but are more likely due to insurance companies having raised doctors' premiums to compensate for falling investment returns.

Reregulate insurance companies, force the AMA to police its own, and mandate aggressive reductions in preventable errors in hospitals. Any or all of these will reduce malpractice awards - and the last two have the additional benefit of increasing the quality of health care.

Spanky 01-04-2006 05:23 PM

Quote:

Originally posted by Sidd Finch


If the deficit disappears in 2010 and remains disappeared for two decades, then we'll be fine. But tell me -- how confident are you that this will happen? And on what do you base that confidence?
Not very confident. I was just responding to the comment that Ty made about saddling our children with the debt. It is political hyperbole that is meanlingless. Big deficits cause problems now. They increase interest rates and reduce growth. Over time the damage of todays debt diminishes.

By having huge deficits today, we are not screwing our grandchildren by saddling them with debt, but providing them with an economy that is not as big as it could be.

Deficits are fine in a recession but highly irresponsible in a growing economy. The Bush deficists will be fine if he is able to balance the budget by the time he leaves because he inherited a recession. But I am not hopeful that will happen. I am afraid that the deficits will continue through the recovery. Not good.

Mmmm, Burger (C.J.) 01-04-2006 05:29 PM

Quote:

Originally posted by Spanky


By having huge deficits today, we are not screwing our grandchildren by saddling them with debt, but providing them with an economy that is not as big as it could be.

We are doing both. Every time someone dies, that is one less person who can share in paying off the debt they accumulated.

If one of your clients dies without paying his bill, and he leaves no estate, do you not consider yourself screwed?

Spanky 01-04-2006 05:41 PM

Quote:

Originally posted by Mmmm, Burger (C.J.)
We are doing both. Every time someone dies, that is one less person who can share in paying off the debt they accumulated.

If one of your clients dies without paying his bill, and he leaves no estate, do you not consider yourself screwed?
The year my grandfather died the entire accumlated debt was 200 billion. With an annual budget of Two Trillion that is insignificant debt. Especially consdering we have an infinite number of years to pay it off.

ltl/fb 01-04-2006 05:46 PM

Quote:

Originally posted by Spanky
The year my grandfather died the entire accumlated debt was 200 billion. With an annual budget of Two Trillion that is insignificant debt. Especially consdering we have an infinite number of years to pay it off.
What does the year your grandfather died have to do with anything? And if the amounts are so insignificant, why can't we just pay it? Or increase the inflow of money by this "insignificant" amount, to cover the difference?

sebastian_dangerfield 01-04-2006 05:54 PM

Tort Reform!
 
Quote:

Originally posted by Spanky
Don't let the messenger spoil the message. The message is an important one. Litigation costs have run amock in this country and are causing extensive damage to the economy. For example:

United States
Litigation and health care

Scalpel, scissors, lawyer
Dec 14th 2005 | ROCKVILLE, MARYLAND
From The Economist print edition

Health-care litigation costs America far too much


AS ANYONE thinking of having a baby in Maryland will know, it's not easy to find an obstetrician in the Old Line State. The main reason, says Debbie Redd, the head of Capital Women's Care (CWC), the largest group of obstetrician/gynaecologists in the Washington, DC, area, is that it costs $118,000 a year to insure just one of them against malpractice lawsuits. That is more than the total cost of employing a doctor in most countries.

Trial lawyers argue that malpractice lawsuits deter negligence. Craig Dickman, an obstetrician affiliated to CWC, says they mostly deter the kind of behaviour that might get you sued, which is not the same thing. To cover himself, he says, he orders excessive tests, monitoring and consultations with specialists. He guesses that 12%-15% of the procedures he bills for are unnecessary. If he fails to order every imaginable test, even if there is “no clinical evidence of efficacy”, he is exposed if something were to go wrong. A trial lawyer can scour the country for the one expert who thinks that his omission might have caused the patient's injury.

Dr Dickman has been sued five times in 21 years on what he (inevitably) describes as specious grounds. That is not unusual for an American obstetrician: 76% of them have been sued at least once. (They are more at risk than most doctors, since they typically operate on healthy patients, who may then blame them if they become ill.)

When doctors win cases, as they usually do, they still lose, because they have to pay their legal bills. And when they lose, they lose big. In jury trials, the average award of damages against a doctor is $4.7m. How much they have to pay to insure against these costs depends on where they practice. In St Clair County, Illinois, neurosurgeons paid an average premium of $228,396 in 2004, five times more than their colleagues in Wisconsin did. Inevitably, doctors (and insurers) flee the states that are friendliest to plaintiffs. Pennsylvania lost a third of its general surgeons between 1995 and 2002.

The cost of medical-malpractice lawsuits has risen more than 2,000% since 1975, to $26.5 billion in 2003, according to Tillinghast, an actuarial consultancy. And to what end? A study of malpractice suits in New York by the Harvard Medical Practice Group found that plaintiffs had actually been injured by doctors' negligence in only 17% of cases. Those patients with small claims often cannot find a lawyer to represent them, while those who win find their lawyers have swallowed half the payout from the doctors.

American health care is bedevilled by two problems that lawsuits do nothing to heal. First, health care costs too much. Americans pay twice as much per head for health care as people in other rich countries. Rising health-care costs threaten the solvency not just of private firms such as General Motors but ultimately also of the government itself. Second, some 46m Americans languish uninsured.

The problems of an industry that chews up 15% of GDP ($1.6 trillion in 2003) plainly cannot all be laid at the lawyers' door. But they do help push up prices (and thus increase the number of uninsured). For instance, in the 1990s, health-maintenance organisations cut costs by trying to cover only treatments that were proven to work. But patients who were denied experimental treatments, and the hospitals that wanted to be paid for providing them, started to sue. After being slapped with a few multi-million dollar verdicts, HMOs more or less gave up trying to ration treatment and just raised their premiums instead. The cost of covering a family soared 59% in the four years from 2000, and the proportion of small firms offering employees health insurance fell from 68% to 63%.

A cure indeed
Can legal costs be curbed? You might imagine that the Democrats would be keen to change a system that leaves so many poor people uninsured, overcharged and uncompensated. But the party gets a lot of money from trial lawyers and even chose one, John Edwards, as its vice-presidential candidate last year. So it is left to the Republicans (who get even more money from insurers and hospitals) to be the keenest promoters of tort reform.

Earlier this year, Congress passed a bill forcing most big class-action suits to go through the federal courts, thus preventing lawyers from shopping around for the most plaintiff-friendly local courts. That may help drug firms, who complain that awards for faulty products are out of all proportion to the damage; and that the costs deter research by lowering the expected returns to it. Wyeth, a drug firm, has set aside $21 billion to settle lawsuits over Fen-Phen, a diet drug, while Merck, another drug firm, is expected to have to pay between $18 billion and $50 billion for having released a painkiller called Vioxx.

Both drugs were faulty—tests suggested that they caused heart problems in some patients. So the scope of the eventual settlements will give some clue as to whether the legal bandwagon has slowed down. Drug firms are not wildly optimistic that it has. Although the first federal prosecution against Merck collapsed this week, it is still facing 6,500 suits related to Vioxx, and was ordered by a jury in Texas to pay $253m to the family of just one victim.

Such awards are usually reduced on appeal, but the industry's chief complaint is that juries are unable to distinguish between good and bad science. Safe products, such as Norplant, a contraceptive device, have been hounded off the American market. Drug firms are especially reluctant to develop pills for people who are well, which is why no American drug firm has produced a new contraceptive since Norplant was withdrawn in 2002.

Class-action suits matter less to individual doctors and hospitals. The Republicans have made less progress when it comes to reforming straightforward medical malpractice. That is partly because most Americans want to be able to sue their doctor. But it is also because many of the costs of the current system are hidden. Studies have found that “defensive medicine”, of the sort Dr Dickman describes, more than doubles the costs that malpractice suits impose on health care, and sometimes prompts doctors to hack patients around more than is healthy.

For example, few clinicians think that babies get cerebral palsy because the obstetrician failed to deliver them by caesarean section. But smooth lawyers like Mr Edwards have made a fortune by convincing juries that this is the case. The fear of being sued prompts doctors to perform unnecessary C-sections—a risky and invasive procedure. But a five-fold increase in C-sections in rich countries in the past three decades has brought no decrease in the incidence of cerebral palsy.

James Copland of the Centre for Legal Policy at the conservative Manhattan Institute, author of a recent study called “Trial Lawyers Inc”, estimates that the total costs, direct and indirect, of health-care litigation (including suits against doctors, drug firms, HMOs, nursing homes and so on) could be as much as $200 billion—a Hurricane Katrina every year. This figure involves some heroic extrapolation, but even half that sum would seem a lot to pay for a system that is not even good at compensating patients who are injured.

So what can be done? Some “solutions” look bizarre. Maryland's state government, for example, pays a portion of doctors' insurance bills, thereby adding to the pot that lawyers feed on. (A 10th-century English king, Aethelred the Unready, tried something similar when he offered bloodthirsty invaders cash or “Danegeld” to go away; oddly, they kept coming back.)

A more sensible idea would be specialist medical courts, as proposed by Philip Howard of Common Good, a group that lobbies for legal reform. Cases could be decided by judges who heard only medical cases, rather than by juries. The court could call its own neutral expert witnesses, rather than relying solely on the partisans hired by the litigants. Non-economic compensation for pain and suffering would be according to a fixed schedule—so much for an arm, etc—rather than by having jurors pluck a number out of the air.

The idea is partly modelled on the specialist courts that deal with other complex technical issues, such as patent disputes and bankruptcy. It ought to make the system less capricious. The Centre for Justice and Democracy, a pro-lawyer group, calls it “horrific”, which suggests it is worth a try. A Senate bill to allow pilot medical courts (among other reforms) may begin hearings early next year.
The damage is not limited to the arena of med mal litigation.

There's a great book out there (maybe still in print) called The Death of Common Sense. Its written by a lawyer, and details how all sorts of hyperregulation, do-gooderish legislation and general over-litigiousness are dragging on the economy. The author goes through a great, even-handed explanation of how the people who deal in writing laws, divining their meaning, and making money from administering them have created a massive shadow economy which doesn't do much but keep those people in jobs.

Of course, he never explains what these people in the shadow economy would do if their self-perpetuating system were shrunk or dismantled. I guess that's the real issue in any effort to make our lives less complicated - "Who will lose a job as a result?"... and "How hard will he fight to keep his job?" From what I see, pretty damned hard. The very suggestion on this board of stripping away any of the govt codes/rules/interference that keeps us in German sedans is treated as heresy.

Of course we need regs. Of course we need govt to act in our lives. Of course we need a hell of a lot less of it than we've been treated to, and paid for, for the past 50 years.

ETA: I just googled Death of Common Sense and discovered that Phillip Howard, quoted in Spanky's post, is the author of the book.

sebastian_dangerfield 01-04-2006 05:56 PM

Quote:

Originally posted by Mmmm, Burger (C.J.)
We are doing both. Every time someone dies, that is one less person who can share in paying off the debt they accumulated.

If one of your clients dies without paying his bill, and he leaves no estate, do you not consider yourself screwed?
A little, but not as screwed as he is...

ltl/fb 01-04-2006 05:58 PM

Tort Reform!
 
Quote:

Originally posted by sebastian_dangerfield
The damage is not limited to the arena of med mal litigation.

There's a great book out there (maybe still in print) called The Death of Common Sense. Its written by a lawyer, and details how all sorts of hyperregulation, do-gooderish legislation and general over-litigiousness are dragging on the economy. The author goes through a great, even-handed explanation of how the people who deal in writing laws, divining their meaning, and making money from administering them have created a massive shadow economy which doesn't do much but keep those people in jobs.

Of course, he never explains what these people in the shadow economy would do if their self-perpetuating system were shrunk or dismantled. I guess that's the real issue in any effort to make our lives less complicated - "Who will lose a job as a result?"... and "How hard will he fight to keep his job?" From what I see, pretty damned hard. The very suggestion on this board of stripping away any of the govt codes/rules/interference that keeps us in German sedans is treated as heresy.

Of course we need regs. Of course we need govt to act in our lives. Of course we need a hell of a lot less of it than we've been treated to, and paid for, for the past 50 years.
Even over the past 10 or so. I was doing "professional reading" and looking at a chart showing legislation that has REQUIRED retirement plans to make amendments (not just given them the opportunity -- but changed the law so much that an amendment is absolutely necessary) since ERISA, and there weren't many until late 90s, but since then there's at least one act a year. Which is a huge pain in the ass. And a lot of it is just stupid.

ETA which is to say, they need to knock it the fuck off with all the stupid tweaking legislation.

Replaced_Texan 01-04-2006 05:58 PM

Tort Reform!
 
Quote:

Originally posted by Sexual Harassment Panda
The Economist is probably the best news publication out there. That said, they sometimes come out with utter crap. This article might as well have been written by the AMA. Not a mention of the 1999 Institute of Medicine report that found between 44,000 and 98,000 preventable deaths every year in US hospitals, or the 2002 Public Citizen report that 5% of doctors are responsible for 50% of malpractice awards. A 2005 study by Dartmouth College researchers suggested that increases in doctors' insurance premiums are not due to jury awards and financial settlements for injured patients, but are more likely due to insurance companies having raised doctors' premiums to compensate for falling investment returns.

Reregulate insurance companies, force the AMA to police its own, and mandate aggressive reductions in preventable errors in hospitals. Any or all of these will reduce malpractice awards - and the last two have the additional benefit of increasing the quality of health care.
2 on everything stated above, also noting the 2005 study at the University of Texas and the 2005 study from Columbia.

Southern Patriot 01-04-2006 06:09 PM

The so called "experts".
 
Quote:

Originally posted by Not Bob
Exactly. Free citizens can see when cars are or are not coming. They need to take some personal responsibility for crossing the street.

Oh, and if enough people want a signal at a given crosswalk, the market will provide one. QED.
What are these things, "cars"? They do not sound like a very good idea.

baltassoc 01-04-2006 06:13 PM

Tort Reform!
 
Quote:

Originally posted by Replaced_Texan
2 on everything stated above, also noting the 2005 study at the University of Texas and the 2005 study from Columbia.
What, you give us academics? Like those pointy-headed weenies can tell us anything.

sebastian_dangerfield 01-04-2006 06:18 PM

Tort Reform!
 
Quote:

Originally posted by ltl/fb
Even over the past 10 or so. I was doing "professional reading" and looking at a chart showing legislation that has REQUIRED retirement plans to make amendments (not just given them the opportunity -- but changed the law so much that an amendment is absolutely necessary) since ERISA, and there weren't many until late 90s, but since then there's at least one act a year. Which is a huge pain in the ass. And a lot of it is just stupid.

ETA which is to say, they need to knock it the fuck off with all the stupid tweaking legislation.
I think an excellent way to upgrade govt performance and cut down on busywork legislation is to run govt like a business. You do a killer job, you get a bonus and ability to move up. You clock-watch, you get fired. You can't have it exist as a safe haven for people. Nothing gets done without incentives. Govt workers should get market level pay. How can we afford that? I think you'd find two efficient workers could do what five average workers do.

But then we get back to my earlier question - "What will those inefficient people do if they don't have the govt to work for?" I don't have the answer to that one. But it seems awfully unfair that we cut programs for the poor while giving lavish benefits to a lot of people who aren't much more productive than the homeless.


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