It seems that we almost have a Patient's Bill Of Rights. What is holding it up is the question do lawsuits play in addressing grievances.
"That bill contains many of the same patient protections included in the Senate bill, but would not allow patients who believe they have been wronged by their insurers to sue unless their disputes have been thoroughly vetted by a review board."
Should there be a cap on awards? Would a $500,000 damage award affect a $50 Billion a year insurance company's attitude?
How many of you have been in an automobile accident and went to court with the insurance companies? Your own insurance company may be meaner towards you than the other person's insurance company. Having been through a portion of this myself, I can tell you that a mere $500,000 damage award won't change the behavior of an insurance company one bit. The reason being is that they make ten times more on their current policies than they pay out in small damage claims. By not threatening them with serious loss of revenue, they have no incentive to change the way that they treat people.
Worse, if you moderate who can even go to court in the first place by forcing complaints upon a review board, like a medical board, you can forget it. Politics play so heavily on review boards, even the most seemingly innoculous ones, and we've all seen what happens with politicians and Big Money.
Bush's stand is: F-YOU, Americans!
Is there any other way to interpret this very slanted in favor of corpoirations and their making money on the suffering and deaths of people? Without a strong BOR in favor of patients, all that will happen is that people who get hurt and killed by the money-making policies of the insurance companies won't have any recourse. That just boils down to plain MURDER in my reckoning. Isn't this just another way to kill people for more money?
posted on July 4, 2001 01:28:16 AM
Is there a precedent for legislating a "cap" on awards?
It seems like to do so is legally setting a dollar value on human life. If utterly botching someone's cancer surgery has a cap on it of $500,000, it doesn't seem unreasonable that there should be a $500,000 cap on my liability, when a neighbor's child drowns in my unfenced swimming pool.
I can sure understand concerns about health insurance costs -- and that's where the dollars come from to pay the settlement when a health care provider messes up -- but I can't agree with a "cap" on awards. It sure doesn't seem perfect, but we do have a system to review settlements of lawsuits -- and many are reduced upon appeal -- what happened with that $3 billion award for the dead smoker guy? Has the dust settled on that yet?
With a "cap" on awards, I can't help but think this would just become another equation to HMOs -- what will cost more? Paying the $500,000 cap? Or providing this expensive new treatment?
posted on July 4, 2001 03:07:54 AM
At the Kaiser Permanente hospital in Santa Clara, CA two men went in for surgery on the same morning. One, a diabetic, was to have his left foot amputated for gangrene from poor circulation. The other was there to have a gallstone removed. Mr. Gallstone went first and had his left leg amputated. Mr. Diabetic went later and had his right leg amputated. They discovered Mr. Diabetic's mixup while he was in recovery and took him back in to amputate his left leg before he woke up. Mr. Gallstone's new condition was discovered by his wife soon after he woke up as she and their children had been allowed into he recovery room to be there for him. He was rescheduled for the gallstone removal the next week.
So Mr. Gallstone finds himself with a leg missing and Mr. Diabetic has no legs at all.
The entire episode was laid to sloppy admissions recordkeeping and negligence on the part of the surgeons involved as they could be expected to know what procedure they were there to perform.
A cap on the liability for the destruction of these two people's lives? I don't think so. How could either of them be adequately compensated as it is? Why should there be protective mechanisms to preserve the already astronomic profits of these HMOs?
This scenario was one of the subjects of an extensive expose' by the San Jose Mercury News several years ago.
posted on July 4, 2001 03:23:19 AM
One of the issues was the ability for patients to sue their employer.
How many employers would want to offer health insurance when they could be sued?
Mississippi doesn't have a state lottery, but they do have a 'litigation lotto'. 40 insurance companies have stopped doing business in Mississippi recently because of the large settlements being given out in the state courts. The good news is that many lawyers have moved to Mississippi because of the healthy 'litigation lotto' climate.
You know what really sucks with 'litigation lotto'? You participate whether you like it or not, you're always buying a ticket. Most other state lotteries are much better, you have a choice on whether you participate, those are simply a tax for those poor at math.
PS: Another bad thing about 'litigation lotto' is you have to give 40% of your winnings to some creature that crawls out from under a rock.
posted on July 4, 2001 04:11:30 AM
Accountability. Should hospitals and insurance companies be held accountable in a court of law for the decisions they make to cut costs?
DRGs came about in the 80s. Limit hospital stays based on diagnosis. Complications be damned. Patients who would have previously been in ICU out on the floors.
Acuity rising, staffing dropping.
Do away with staffing by patient acuity. Staff strictly by the numbers.
Your post CCu floor is short? Here's a neonatal nurse (aka a body). That nurse doesn't have the certifications and experience that your floor requires? Don't worry about it. Need more bodies? When X Ray isn't busy, they can ambulate patients and help out. Housekeeping too.
LVNs? Call them Patient Care Assistants and pay them less.
Experimental treatment?
Get thee to a university hospital.
And don't expect us to pay.
posted on July 4, 2001 04:39:29 AM
I am against a cap.
I have a niece, her son was 2 when he had to have his eshaphagus(sp?) strecthed. He had to have this done every so often due to a problem with it. When he had this procedure done, they always told her they started off with a very small balloon, and went up a couple of sizes when they were doing it. His eshaphagus was very thin, and they didn't want to rupture it.
One time he had to have the procedure done, a different doctor did it. After it was done, he came out very proud of himself and said, I used a size ###. That will take care of him for awhile longer. Well, the size that he said he started with, was larger than the size the other doctors ended up using at the end of the other procedures.
Very shortly after it was done...my niece noticed something wrong with her son. She called the nurses in, and they called the doctor. He said everything was ok, nothing was wrong. She Kept after them, bugging them, telling them to please do a test on him to make sure that he was OK. She was worried about how large the balloon was that the doctor used.
They treated her like she was stupid. She wouldn't give up though, she knew something was wrong. They finally gave in and did the test...said very thing was fine, and sent him home.
It was not long after she got him home, he just kept crying. So she called the doctor. He said give him this and that. His crying wouldn't stop, She called the doctor a few more times, then picked up her son, and they drove him to the hospital. To wait for an ambulance as far out as they were, would have taken to long.
Well, on the way to the hospital...he died in her arms.
She found out during the law suit against the doctor, that the TEST that they gave him...was just to shut HER up! They were supposed to use some sort of dye or something, it has been awhile so I'm not quite sure, but the fact is, that the test the way they did it, would not have revealed the big hole in his eshaphagus! And that all of the fluids going into his stomach, was going into his lungs.
The doctor, at the deposition...still being a real jerk! Kept giving her this look to try to shake her up. A look of like he was some great being or something. It didn't work, it just made her mad!
Do I think that there should be a cap? NO.
Some, not all, doctors think that they can get away with anything now. What would happen if there was a cap?
edited for spelling
[ edited by ashadowdancer on Jul 4, 2001 04:46 AM ]
[ edited by ashadowdancer on Jul 4, 2001 04:47 AM ]
posted on July 4, 2001 05:54:08 AM
What about this? Everyone, shelter your assets and drop your health insurance. Now no one's covered under an HMO, and they can go begging like the people they've maimed and killed. Some employers have reimbursements so that if you opt out of a benefit, they give you the cash. If yours does, buy the old fashioned kind of insurance, 80/20 or 70/30 with a deductible and a $5000 cap on your expenses.
And don't forget the power of your vote. A letter to your rep and Senators in DC saying you'll watch how this goes and vote accordingly next time they run can do wonders.
posted on July 4, 2001 06:06:00 AM
I am in awe of your niece's restraint from physically assaulting the murderer of her child.
I'm not sure that I could be so controlled.
You should hear some of the horror stories we military have about our "doctors" who are protected via the Ferres Doctrine.
A 1998 Pulitzer Prize-winning series of articles by the Dayton Daily News reports that a growing number of military medical malpractice claims are emerging in a health care system that enables military doctors to work under lower standards than their non-service counterparts. The examination found doctors who failed several state medical board exams, doctors who had medical licenses revoked or suspended, doctors who lost their malpractice insurance - even doctors convicted of crimes. Military doctors are not required to have malpractice insurance, they do not have to be licensed in states where they practice and they are virtually immune from being sued by their patients.
At least 77 physicians practiced in the armed services with "special" licenses issued only to doctors at military bases, Indian reservations, mental hospitals, prisons and labs handling organs for transplants. Nearly all the doctors either failed the state licensing exam or had no evidence in their files they took it. One failed 30 times.
The PBR will do nothing for the military. They continue to be denied any sort of say in their own care, often uninformed as to their own treatment or options, underserved by pseudo-doctors (which includes students, assistants and other non-doctors working as doctors), aging outdated understaffed facilities, underbudgeted even for basic supplies, denied any sort of redress, and held hostage to the whims of the legislature for basic rights enjoyed by civilians.
posted on July 4, 2001 07:08:38 AM
Insurance is the most rotten, cold, heartless industry in America. And now, we have the "compassionate conservatives" right in their lap, leaving ordinary Americans to
struggle with illness and the extraordinary cost of being sick.
Patients should be able to sue H.M.O's and other plans in state court or federal court with no limit on liability. All doors should be open to law suits and eligible awards should not be limited.
posted on July 4, 2001 07:12:22 AM
From what I understand, there is a clause which enables a person to sue their employer from which they've received their insurance. Stupidity. Obviously that needs to be struck (who thinks of these things?) or else the inevitable consequence will be that no employers will give insurance in the first place.
posted on July 4, 2001 07:13:59 AM
How would premiums be affected by having no cap on damages? Here in Kentucky they enacted healthcare "reform" several years ago. As a result, 75% of the providers left the state and our premiums have doubled.
posted on July 4, 2001 08:03:28 AM
This is just one illustration of their unscrupulous practices. Federal regulations should be established to maintain a uniform national standard of conduct for the insurance industry.
posted on July 4, 2001 08:13:28 AM
I'm in agreement with James and uaru about the employer clause. IMO, that would cause many employers to drop insurance coverage for their employees. I don't understand the reasons the writers of this legislation included the employer in the first place. Anyone know?
On the caps.....I think there should be caps, but with a much higher limit than the $500,000 now proposed. Maybe 1 to 2 Million. My concern (with having no cap) would be that the more the insurance rates go up, the fewer people will be able to afford even basic medical coverage.
posted on July 4, 2001 09:30:38 AM"I'm in agreement with James and uaru about the employer clause. IMO, that would cause many employers to drop insurance coverage for their employees. I don't understand the reasons the writers of this legislation included the employer in the first place. Anyone know?
"On the caps.....I think there should be caps, but with a much higher limit than the $500,000 now proposed. Maybe 1 to 2 Million. My concern (with having no cap) would be that the more the insurance rates go up, the fewer people will be able to afford even basic medical coverage".
Golly! You don't suppose that the clause protects employers and the caps protect insurers so that the entire health care financial load will be placed squarely on the user in an uncontrolled cost escalating melee?
posted on July 4, 2001 10:06:11 AM
This whole thing is so...disturbing....Not long ago, a man was awarded the largest, EVER, settlement from a tobacco company (who is appealing, of course) because,
never having read the warnings which have been on the side of cig packs for zillions of years, he did NOT know he could get sick....BTW: I dislke Tobacco Companies....
So, here we have that man winning gross millions...when that poor man ending up with NO LEGS, and one with ONE LEG OFF, thru no fault of either, should have a cap on their "Recovery" amount?????? I don't think so!
Fot 2 months, I waited for Kaiser Permanente to call me with appointments anxiously awaited for...Hearing nothing from Kaiser, I CALLED...and found out I was not in the system....[b]because my brand new (8 months in practice) doctor wrote the WRONG patient's name on MY tests request forms...
In order to CUT COST, Kaiser has been eliminating most established Doctors,
only keeping a handful of Specialists, and replacing them with truckloads of new, very young, very in-experienced ones from everywhere on the Globe, for VERY CHEAP. I was then informed that I could only see my
Doctor of 15 years, once a year.....
As I told my Oncologist, I could have gone to surgery to remove a tumor and come out with a Penis Implant.....We laughed, because it is just too ludicrous to even cry!
And I should NOT BE ABLE TO SUE KAISER? or only get a CAPPED AMOUNT, decided upon by some Joe Shmo who has been giving a CHART to go by???? NOT!
********
Gosh Shosh! My "About Me" Page
[ edited by Shoshanah on Jul 4, 2001 10:10 AM ]
You don't suppose that the clause protects employers... Sure it protects employers. What I don't understand is why some feel they shouldn't be protected.
I don't feel employers should be included in any lawsuit that an injured party might bring against their doctor, hsp., etc. What would they (the employer) have done to be partially responsible for a doctors (etc.) malpractice or denial of care.
and the caps protect insurers so that the entire health care financial load will be placed squarely on the user in an uncontrolled cost escalating melee?
IMO, the caps don't only protect insurers, they protect the policy holders from the higher rates that will be passed on to the consumer when these high $$$ lawsuits are won. The more lawsuits filed (if there are no $$ limits) the higher everyone's premium is going to be.
Edited to add: And the higher the cap limit, or if there are no caps, the more lawsuits the attorneys will be filing....thus more cost to the consumer.
posted on July 4, 2001 10:26:48 AM"IMO, the caps don't only protect insurers, they protect the policy holders from the higher rates that will be passed on to the consumer when these high $$$ lawsuits are won. The more lawsuits filed (if there are no $$ limits) the higher everyone's premiun is going to be"
What utter nonsense!
To go slow: The employers are not being protected from the lawsuits, they are being given an out so as not to have to provide the insurance. THEN, as a coupled action, the caps limit the damage the insurer may suffer.
NEXT deregulate the insurance industry so that the providers can charge what the market will bear, AND the user, needing insurance to protect from the already usurious charges imposed by the health care providers WILL buy coverage at all cost. OH WAIT! That's already the case.
SO, the employer is protected by not bearing the increased cost of coverage, AND the insurer is protected by caps on awards.
SO the employer gets richer, the insurer gets richer, and the user gets the bone.
posted on July 4, 2001 10:32:43 AM
I do believe sincerely, if we all stopped going to doctors, except and unless it were absolutely necessary, supply and demand would take care of the high cost of medicine!
We also need to realize, medicine/doctoring really is not necessarily a guaranteed "right".
I am free to choose any healthcare provider I want as long as I can afford them. If I can't afford the provider of my choice....I have to take what I can get.
All the legislation in the world is NOT going to get me better care at lower cost.
I can't have my cake and eat it to. Wish I could. Yes, I want to be able to go to the best doctor in the country, be treated at the best medical facility in the country, have access to the best modern medicine has to offer AND I want it to only cost me $10 co-pay with a $250 deductible for major medical!!!!!
If I feel the best wasn't good enough, I want to be able to sue for a zillion dollars and I want to be able to include EVERYONE in that suit.
I want the government to pass a law and "make it so".....Does anyone really think that is going to happen?????
edited to remove most of my moronic drivel. I have a simple mind and I have to think along simple lines.....
[ edited by sulyn1950 on Jul 4, 2001 01:56 PM ]
posted on July 4, 2001 10:45:58 AM
For you Kaiser Permanente fans out there, 60 Minutes did a special on them a few years back. It seems that doctors who work for KP get a bonus each year based upon the test that they DON'T run! That's right.
My mother is having a serious bout of cancer right now. It's serious because KP is so incompetent that the disease progressed way beyond what it should have been if it had been caught early on. My mother is just recovering from stomach surgery where they removed a cancer tumor the size of a grapefruit. The next day, they made her get up and walk the halls - and she's 77 years old too. We tell her to not comply but to rest after such a serious surgery where they removed two-thirds of her stomach and a variety of attached parts "Just In Case".
For the last two months prior to this surgery, my mother had been going to KP's equivalent of Emergency. The last time that she was there, the doctor told her that since nothing was wrong with her that she was abusing the system! When it came time to talk surgery, she was sent to a REAL hospital and the surgeon took one look and did the operation the next day!
One may ask what did my mom's doctor do about the bleeding ulcers in her stomach for the year prior? Why did they not look for cancer? All the damned doctor did was to keep giving her stronger anti-heartburn stuff and some stuff for her nausea. It never occurred to any of the doctors at KP that it may be cancer causing this.
=========
Aside from that, I just wanted to point out two things:
1) I am not sure that the damage award cap is only $500,000. I couldn't remember exactly and that figure is what I think I remember hearing about. So please don't hold me to it, as I was using it figuratively in the thread post.
2) Suing the employers. You know, no one anywhere on any political show has mentioned why that proviso is in there. Since I have not heard on the reasons for it to be in there, I can only agree that it should not be in there for the reasons already stated.
posted on July 4, 2001 11:00:26 AM
Medical costs were/are rising faster than inflation. HMO's were supposed to help contain these costs. Denying coverage is the tool HMO's use to control costs - sometimes costing the patients their lives.
The main objectives should be to control costs and have as many people as possible covered. Allowing lawsuits without caps for fraudulent withholding of benefits contains the ability of HMO's to deny coverage. If a cap is placed on the penalty, HMO's can compute this cost into the price of their product, and lawsuits will have no reforming effect on the HMO's.
One thing to do is to lower the cost of medical education and STOP medical associations from limiting the number of doctors admitted to medical school.
While it was hugely unpopular due to mostly empty propaganda, universal medical insurance may be the only solution.
There are too many people uninsured in the US.
While the "failures" of Canada's system is often used as example, there is analysis to be done.
Many claim that you have to always wait for surgery and other care in Canada. Well the reason you have to wait is becasue everyone in Canada is insured and therefore in the "line".
The reason you don't have to wait for surgery in the US is because all those uninsured people in the US are not in the line.
So I guess that the question is whether it is better to wait 5 months for your open heart surgery, or not get the surgery at all because you have no insurance, and I suppose die.
I have very good employer paid medical insurance [through the Federal government no less], so why would I trade it for universal coverage and have to "wait" for medical care as one does in Canada ?
This is the selfish reason I and many others will not support universal coverage.
However, with present trends, I think universal coverage is not a question of "if", but only "when" it will have to come about. The issue will probably be raised by employers as premiums continue to rise faster than inflation. The alternative for large employers may be to reincarnate the old company doctor and company hospital.
I think Hillary Clinton was premature in raising the issue.
posted on July 4, 2001 11:03:34 AMBorillar....I am so sorry to hear about your Mother! and I hope with all my heart, that things will turn out for the best.
The problem lies in who one's Doctor is: They do NOT come with written guarantees, unfortunately. I must say, I am disturbed by the new Kaiser trend of importing this wet-behind-the-ear new "doctors"...But it was not always like that...
In defense of Kaiser, it is NOT only Kaiser who is distributing high Bonuses if a Doctor does NOT refer to a more expensive Specialist. I saw that 60 minutes also, and heard the debate on NPR News: it is in ALL Major Hospitals...In fact, Kaiser came out BETTER than most. I have been using Kaiser since 1965 and all of my Cancer Treatments were absolutely outstanding. But it varies from LOCATION to LOCATION.
My most recent problem, listed above, occured at a NEW location, which I quikly left to go back to my OLD, well seasoned one...
Even with all I have gone through with Kaiser over the past 35 + years, I still believe, that, compared to the huge expense I incurred PRIOR to being offered Kaiser, I am very well-off with them. No more 20% of Major Medical to pay...No more Deductibles...I wish Kaiser had been available when I had 5 vertebrae fused! Cost me a bundle....
******** Gosh Shosh! My "About Me" Page
posted on July 4, 2001 12:25:21 PM
okay krs, I guess "going slow" works both ways.....
While I haven't been able to find much information regarding the 'why' this bill wants to hold employers libel in lawsuits, from everything that I have read, this bill does allow employers to be sued.
http://www.appwp.org/ is the site of The American Benefits Council. They released a paper discussing how the Kennedy-McCain bill will leave employers wide open to new federal personal injury suits. I quote "Employers could be sued based on alleged errors in plan administration decisions covering a number of specific senarios." (end quote)
It's always been my impression that employers offer medical benefits to their employees as a 'benefit', and aren't involved in the 'plans' administration decisions. For a long time people have applied for jobs where the benefits the company offers are better than the one's offered by their previous employer.
So, I can see why these employers might just make the decision that since they aren't involved in making the decisions of each plans administration to stop providing coverage at all. Thus they would eliminate their liability under this new bill (that has passed, but can be vetoed).
posted on July 4, 2001 12:48:14 PM
Linda K, your link is to a site which is also calling for employers to lobby to block this bill.
Employers Urged to Oppose Kennedy-McCain Bill in Senate
June 14: The Senate is expected to begin debate on a “Patients’ Bill of Rights” next week. Senators need to hear from employers today about their strong opposition to the Kennedy-McCain bill, which is the patient protection proposal (S. 872) sponsored by Senators Edward Kennedy (D-MA) and John McCain (R-AZ) and the bill that will be under consideration in the Senate.
The Council has released a new paper on the specific reasons why the Kennedy-McCain Patients' Bill of Rights fails to protect employers from liability, and a chart describing the key employer concerns with the various legislative proposals. Please use these resources in your lobbying on the Hill and distribute it widely.
In an Action Alert sent today to all Council members, employers are asked to call, write, e-mail and personally lobby Senators to urge them to vote “NO” on Kennedy-McCain. Send a letter or e-mail your Senators directly by using the Capitol Connection feature of the Council’s Web site. The main number for the U.S. Senate switchboard is (202) 224-3121 and the address is U.S. Senate, Washington, D.C. 20510.
posted on July 4, 2001 12:57:21 PM
And the Mission Statements of The American Benefits Council:
Shaping the World of Corporate Benefits Policy
The American Benefits Council (the Council) is recognized as the preeminent advocate of employer-sponsored benefit programs in Washington, D.C.
Our members either sponsor directly, administer or service retirement, health and stock compensation plans covering more than 100 million Americans.
We are major corporations sponsoringcomprehensive and diverse benefit plans.
We are professionals in the benefits field with expertise in investments, retirement, health insurance, accounting, actuarial science, banking, law, and benefits consulting who provide service and support to corporate benefit plan sponsors.
Our mission is to be the most effective advocate for voluntary private employee benefits.
The Council initiates and champions legislation and regulations favorable to our members' needs and interests, and influences policy development within Congress and the White House and executive branch agencies.
We fend off policy proposals that add burdens, liabilities and costs for the employer plan sponsor community.
We serve as a technical resource on benefits issues for lawmakers, the media and other industry trade associations. We also lead other public policy organizations in developing and communicating a collective business community position and forge alliances on benefits issues.
We are an active participant as a "friend of the court" in judicial cases affecting benefits.
posted on July 4, 2001 01:18:32 PM
Hi snowyegret - Yes, I know who the site belongs to. The only reason I posted it was to show krs that I have read (and heard debate on) the fact that this bill that has passed the Senate did speak to the issue (that I think krs is denying) that employers are open to lawsuits under this bill as it's written.
I know that business have a special interest in being sure this doesn't pass. It's so they can't be held liable in malpractice lawsuits. And should it not be vetoed, then we'll all pay for the additional costs or we'll pay by the companies not offering any insurance (so as not to be liable).
I'm not trying to argue corporate americans cause, I'm trying (and asked above) to find out what the reason was that the people who wrote this bill would want to hold employers liable for malpractice. No one here seems to know either.
This was the only search I found that addressed this issue.
And as I stated in my earlier post, I agree that $500,000.00 is too low.
[ edited by Linda_K on Jul 4, 2001 01:22 PM ]
posted on July 4, 2001 01:27:08 PMI'm trying (and asked above) to find out what the reason was that the people who wrote this bill would want to hold employers liable for malpractice.
To discourage employers from offering health insurance. That's my guess.
Now you'll probably ask, "why would they want to do that?"
posted on July 4, 2001 01:39:33 PM
Could it be hospitals are employers too? In some communities, hospitals are the largest employer. And HMOs sponsoring their own plans?
I'm not finding any *neutral* sites, but from what I know after 20 years in the hospitals, this bill sticks it to the patient.
