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It's Not Just Healthcare That's Bankrupt - It's Our Legal System, Too

Tyler Durden's picture


Submitted by Charles Hugh-Smith of OfTwoMinds blog,

Yes, there is malpractice, but our current system is insane.

What can you say about a "healthcare" system in which 99% of all physicians will face a malpractice claim in their careers? According to Malpractice Risk According to Physician Specialty (The New England Journal of Medicine), "It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties."
Longtime correspondent Ishabaka (M.D.) provides some context:
"A little legal education is necessary to understand malpractice:For a malpractice suit to be successful, there are five necessary things:
1. A duty to treat - there has to be an established doctor - patient relationship. A typical example would be someone who corners me at a party and asks me what I think is causing their abdominal pain. I give them my card, ask them to make an appointment for a check-up, they never do, and the pain turns out to be fatal cancer - in that case I had no duty to treat.
2. Failure to practice the standard of care - note - this does not mean the BEST care in the world - it means the average, or median standard of care.
3. A physician in the same specialty willing to testify that the doctor practiced below the standard of care - all States require this.
4. Causation - the substandard care has to have caused the patient's problem - again, this requires expert physician testimony.
5. Damages - if the substandard care causes no damage, there is no basis for a suit.
Now, I ask you - how can 99% of obstetrician gynecologists, neurosurgeons, emergency physicians, neonatologists (pediatricians who take care of premature babies in the neonatal intensive care unit), and other high-risk specialists practice worse medicine than average? It's mathematically impossible.
By the way, in the back of law journals are ads for medical expert companies that promise they will get a doctor to testify to anything the lawyer wants.
Yes, there is malpractice, but our current system is insane."

I am not an attorney or a doctor, but it seems self-evident that our legal system enables "fishing expeditions" in search of a settlement by keeping the cost of "fishing" very low, the rewards high and no penalties for abuse of the law, by which I mean issuing unsubstantiated or fraudulent accusations in the hopes of triggering a nuisance settlement, i.e. it's cheaper and less stressful for the accused to pay the accuser a substantial sum to make him go away.

This practice is not unique to medicine. Anecdotally, I have heard from insiders in the insurance industry that there are people who make a good living claiming they were injured in department stores and retail outlets. The claims are bogus, but the grifters know our legal system encourages paying bribes to accusers to avoid the outrageous expense of a court trial.
Give me $10,000 and I'll go away. Do this ten times a year and it's a tidy income.
How can we defend a system where people are rewarded for spewing claims of damages in the hope that a few may stick or the falsely accused will pony up cash to avoid the horrendous expenses of defending oneself against baseless accusations in court?
Ishabaka (M.D.) has practiced medicine in both Canada and the U.S., and he reports that Canada's system for monitoring and dealing with malpractice is more effective at actually limiting incompetence in the system, and it does so without accusing essentially every physician of malpractice in an absurd "line up everyone for target practice" abuse of the legal system.
I do not have the expertise to validate this, and no doubt there are countless complexities to consider, but I find it difficult to believe that "ours is the best possible system," a blanket excuse issued in defense of both sickcare and our equally broken legal system.
I can anticipate that some within the legal profession will say that the low cost of making claims and accusations is worth the corrosive cost and stress of dealing with bogus claims and baseless accusations because it enables the poor and powerless to seek redress.
I find this argument mostly meritless based on two points:
1. How can anyone defend a system as fair, just and cost-effective when 99% of all physicians dealing with serious cases end up being accused of malpractice? It would take about 30 seconds to come up with a lower-cost, more just and effective system than what passes for "justice" in America.
2. The vast majority of poor people don't end up having their day in court because that day in court is as absurdly expensive as sickcare. "Justice" in America goes more or less to the highest bidder, outside of propaganda-type Hollywood films.Legal services are extremely expensive and mostly paid in cash, so only the wealthy can afford legal representation or advice.
We would be remiss not to mention the other factor in malpractice, which is unrealistic expectations of medical science and practitioners. Yes, there are some incompetent doctors who should no longer be allowed to practice medicine. But there are many other factors to consider, for example, those doctors who take on the most hopeless, difficult cases are the ones whose "track record" will appear less than stellar.
Yes, there are legitimate cases of malpractice, and legitimate claims that end up being argued in court. But any system that accuses 99% of its practitioners of gross incompetence is deeply flawed, rife with injustice and bloated by needless waste and stress.

It's not just our healthcare system that is bankrupt--so is our legal system.



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Tue, 08/12/2014 - 09:33 | 5081348 takeaction
takeaction's picture

When will this shit show just keeps escalating. 

Tue, 08/12/2014 - 09:39 | 5081385 CH1
CH1's picture

Maybe when people stop obeying their abusers?

Tue, 08/12/2014 - 09:41 | 5081398 Divided States ...
Divided States of America's picture

Oh so when our legal system goes BK, who should I go to sue for damages?? Rosenkratz, Weinberg and Friedman??

The legal system is already rotten to the core a long long time ago thanks to those fuckers.

Tue, 08/12/2014 - 09:53 | 5081445 Winston Churchill
Winston Churchill's picture

Sue,Grabbit, and Runn are very good.

Tue, 08/12/2014 - 10:05 | 5081504 LetThemEatRand
LetThemEatRand's picture

Did anyone read the actual study that this story is based on?  


Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants)."

It's a crisis!  This whole issue is insurance company propaganda.   Sad that even ZH'rs, who are usually good at spotting big corporation propaganda that urges individuals to give up their rights, are so rabidly in favor of same.

Tue, 08/12/2014 - 10:15 | 5081550 Anusocracy
Anusocracy's picture

Which rights are those?

Tue, 08/12/2014 - 10:26 | 5081614 LetThemEatRand
LetThemEatRand's picture

The right to make a claim for compensation and hire a lawyer who will take a contingency fee for those who cannot afford to pay a lawyer several hundred dollars an hour (which is most people).  Isn't taking away that right or at least curtailing it the point of this propaganda?

Tue, 08/12/2014 - 10:31 | 5081634 Citxmech
Citxmech's picture

"I am not an attorney or a doctor, but. . . "

Yeah - ask any personal injury attorney how "easy" med mal claims are.  Most I know won't even take them because they're such a gigantic pain in the ass.

Tue, 08/12/2014 - 10:41 | 5081701 eclectic syncretist
eclectic syncretist's picture

Cut the the chase and face facts CHS, our cultural morals are bankrupt, and that's the root problem here.  In fact, I'm not even sure what American culture is any more. 

Now get back to watching Ferguson residents destroy their own neighborhood just to show you how unhappy they are with their current circumstances.

Tue, 08/12/2014 - 10:46 | 5081725 negative rates
negative rates's picture

There are two things you can not compete with, insanity, and free.

Tue, 08/12/2014 - 10:49 | 5081746 negative rates
negative rates's picture

Oh yea, in case I forgot, FUCK ATNEA!*

Tue, 08/12/2014 - 11:59 | 5082134 Anusocracy
Anusocracy's picture

@ Citxmech

That may true but 7.4% of the doctors PER YEAR of the study were hit with a lawsuit.

That's a lot of lawyers doing something they don't like.

Tue, 08/12/2014 - 12:41 | 5082314 Citxmech
Citxmech's picture

OK - but how many of those suits were undeserved?  In my family alone I can think of at least two people who were basically killed due to incompetant health care and one of which who was put at extreme risk due to improper diagnosis (none of which were prosicuted btw).  

Also, when each doctor sees something like 32 patients per day (or about 8,000 per year), is it that hard to believe that 5-10% of them fuck-up pretty badly at least once per year?  

Being a doctor is a pretty tough job.

Tue, 08/12/2014 - 13:54 | 5082699 drdolittle
drdolittle's picture

One of the biggest fuckups is having 6-12 jurors with no medical education taking the word of two experts both paid for their opinion and trying to judge the case. Special judges and courts for bankruptcy law. Think medical cases are any more difficult than bk cases? Some countries cut out the lawyers. They have physicians pay into a patient damages fund. A team of medical experts hear the claimants case and decide if it has merit. Instead of Uniqwa and Billyjoe who think it's cool cause it's coming from a big insurers pocket. As in, I spill hot coffee on myself and the person who sold me the coffee owes me a couple mil.

Tue, 08/12/2014 - 15:04 | 5083089 Citxmech
Citxmech's picture

That McD's case was that high becasue of punitive damages - not becasue of the injuries suffered.

More likely than a liberal jury (in terms of throwing money the plaintiff's way) you're more likely to see corporate employees (who get paid for jury duty) and retirees - both of whom mostly believe that by stiffing the little guy, their own personal costs will go down.

The mere mention of insurance is kept from the jury out of fear that recoveries might be bigger.

Personally, I like the arbitration system better (usually reserved for smaller cases):  Try the case quickly and cheaply to an experienced lawyer with the right to appeal the decision with costs assessed for losers at that point.

Tue, 08/12/2014 - 16:49 | 5083698 MachoMan
MachoMan's picture

The mcdonalds case is quite a hilarious example of the misperception of the public...  you realize that the damage award was reduced, right?  Trade the headline...

Also, why do you presume that people are too stupid to decide a med mal case?  Do you need special training to determine that a patient shouldn't bleed out from his IV?  Or that if he has diabetes and his left leg is to be amputated, but they cut off the right, this might be a violation of the duty of care?  That a heart surgeon isn't supposed to cut the wrong veins and say "oh shit" and just walk out of the OR?

So you're advocating to make our legal procedures centered around the exception and not the rule?

Do the medical professionals also get to determine what a life is worth?  There's no wonder why this type of system works well in third world countries, where the lives of the poor simply aren't viewed as being worth as much as the rich.

It's been stated numerous times in this thread, but there are so many fucked up things with our legal system, I have no idea why this gets any attention...  it's like politicians arguing over abortion... 

Tue, 08/12/2014 - 13:47 | 5082668 drdolittle
drdolittle's picture

Most lawyers do personal injury cause that's how they pay the bills. Only have to have one or two big scores, as John Edwards

And, annually 7.4%. Over a thirty year career. Think that may lead to some defensive medicine? "Well, it's a slim chance but I don't want to get sued so I'll order a couple grand in tests just to cover my ass".

Tue, 08/12/2014 - 13:58 | 5082724 MachoMan
MachoMan's picture

The problem with that theory is that failure to diagnose cases are born losers.  A typical failure to diagnose case would be where a patient comes in with symptoms that could be numerous illnesses, but the doctor picks the most likely candidate and treats for that, ignoring others, which would most often require expensive and expansive testing to determine.  In these cases, the doctor typically does in fact treat the patient for something consistent with the patient's symptoms.  Compare this with a situation where a doctor saws off the wrong leg, see the difference?  Which one do you think an attorney is more likely to take?  Which one do you think a jury would find more appauling?  Further, what happens when the doctor gets the patient to sign a document stating that he has advised the patient to undergoe additional testing, but the patient has refused or, alternatively, that the nurse accompanying the doctor witnesses the doctor tell the patient this?  You think the patient comes out with anything?

Tue, 08/12/2014 - 17:09 | 5083909 OpenThePodBayDoorHAL
OpenThePodBayDoorHAL's picture

Most Anglo countries including Australia where I live have a simple rule that severely limits all of this: it's called "loser pays". Loser of a lawsuit pays the legal costs of the winner. It stops the worst fishing expeditions in their tracks, but real cases go forward as they should.

Fixing America is not that hard, in terms of the actual legal changes. Fixing the corruption of the politicians, and the apathy of the citizens, that's another story.

Tue, 08/12/2014 - 10:45 | 5081709 boattrash
boattrash's picture

LTER, to me, the point is also that one can lose everything they have, defending themselves against frivolous lawsuits. These can come from individuals, or worse, Govt Prosecutors.

Look up Arkansas Beauty Queen murder. It was covered in a 1 hour Doc. by 20/20, or some similar show. I've known this family all my life and it was really sad to see them spend their life savings (including the new business they had just completed building) to beat a charge pursued by a team of Bumble-fuck prosecutors, Cops, and expert witnesses. It happens every day.

Tue, 08/12/2014 - 12:00 | 5082140 Miffed Microbio...
Miffed Microbiologist's picture

After being in the medical field for 30 years I am shocked at the shambles malpractice claims have done to the field. Insane amount of testing done defensively resulting in diagnostic trees and lack of individually focused care. Clearly incompetent Drs not being sued because of great personas and hand holding skills that impress the unaware. I have even gone out of my way to talk to the family and suggest a better dr. " oh, but dr jones is soooo caring and nice! We have always gone to him."

I worked with one thorasic surgeon who accidentally slashed the aorta TWICE without losing privileges. He had great connections and his family had donated a lot to the hospital. Yep, this shit does happen I'm sad to say. Thank god not often.

Suits happen more for impressions there is a lack of care, not necessarily due to actual incompetence. Often great Drs get targeted unfairly. Not all bad outcomes are the results of bad care.


Tue, 08/12/2014 - 13:02 | 5082413 MachoMan
MachoMan's picture

There is a lot of truth here and some not so much...  First, you're absolutely right that the #1 reason for frivolous medmal claims is bad bedside manner (and also the #1 reason for good claims never being made), which is why you see all the guys giving boob jobs say that "everything went so well" or "you're so beautiful" yada yada...

Second, however, I cannot accept the notion of purely defensive medicine when the money for the testing goes straight into the medical practice's pocket.  The entire field is based upon trust, not only between the patient and the medical professional, but also between the latter and the patient's payer source.  Given that the decision to perform a test is typically not a clear issue, the medical professional has exceptional leeway (note: plausible deniability) to perform a myriad of tests.  In the end, the notion of defensive medicine is a convenient scapegoat given that if the truth were to emerge, then everyone has been fraudulently milking the system.  Which would you proclaim?  That you're a fraud or that someone else is responsible?

Further, there are incredibly simple ways to prevent the abuse of "defensive" medicine.  For example, hospitals have patients sign informed consent contracts for everything under the sun, among other things to limit liability.  In the event that a patient has been advised that he or she should have a procedure performed to rule out other possibilities, then why not get the patient to sign a standard form, stating the patient has been advised but doesn't want the procedure, and leave?  The hospital is then covered, albeit with less revenue.  [note: many practices already do this].

The reason why medical costs are out of control is because there is no policeman to curtail fraud...  Since a bonafide policeman is out of the question (too costly, easily corrupted, and tends to suck), the only solution is to give patients some skin in the game.  If this happens, I guarantee you that there will be more questions about the necessity of the procedures and "we're worried about getting sued" isn't going to cut it when it's get the procedure or eat cat food.  As it stands, most patients couldn't care less...  This is how medical costs get out of control, this is the wellspring from which everything else flows...  people who argue about expensive insurance or worry of lawsuit have cause and effect backwards, insurance companies and lawyers are just hangers on.

Tue, 08/12/2014 - 15:02 | 5083071 Miffed Microbio...
Miffed Microbiologist's picture

Today I ordered $81,000 worth of reagents for MRSA molecular testing for my hospital. This will last 3 weeks. Not one penny of this is reimbursable because a standard MRSA culture is 10X cheaper? We do this because I can discover if someone is a carrier of MRSA in 2 hrs vs 72. Therefore, we can prove a person is free of MRSA when they enter the hospital or if they do carry it, housed appropriately.

If a person contracts MRSA in a hospital in the state of CA, their medical care is not Medicare reimbursable. So, system wide it is cost effective. This is just one test the state by legislation has increased our costs. How do you propose we pay for this? Spread the costs over performing other procedures. People scream that a simple bag of saline costing 5 bucks is billed at $500, this is one of the reasons why.

I am not saying Drs are never padding their pockets with billing tricks but much of this is due to the hostile environment put on the system by lawyers, government and insurance companies changing the rules and demanding we jump thru hoops with no money to make it possible.

My father founded The Doctors Company. Google it if you like. Insurance worked well for many years before lawyers and government really fucked it up.


Tue, 08/12/2014 - 16:23 | 5083578 MachoMan
MachoMan's picture

You're complaining about the patients' payer source requiring you to perform additional tests on their insureds before you get payment for services?  This is a private matter between you and the insurance company.  If you do not want to jump through all the hoops imposed by the insurance provider, then I suggest you opt out or refuse to contract with them.  Good luck keeping up with your expenses, but this is your gambit.

After medical providers built monuments to the gods and made capital expenditures based upon ever increasing/endless insurance payouts, they are now impotent to reform (decreases in the cost of care).  The answer here is simple, but no one in the medical industry will allow it, due to self preservation, and no one in the remainder of our economy will allow it because virtually everyone is bootstrapped somehow.  This issue is no different than what has happened with student loans and tuition.  Albeit there are less convenient scapegoats for our education industry to blame.

PS, the number of lawsuits are simply a function of how many business transactions are conducted...  as the medical industry expands, so too do the lawsuits...  it's really this simple.

Tue, 08/12/2014 - 17:40 | 5084118 Miffed Microbio...
Miffed Microbiologist's picture

The government mandated the testing not Drs. They did not mandate the insurance companies to reimburse. I do not believe any private insurance would reimburse for this. However no Medicare reimbursement will be paid unless the hospitals prove a patient has not contracted MRSA while an impatient. Therefore Hospitals must perform the testing. The issue is with the government dictating requirements for reimbursement, not private insurance.

Obama care with its plethora of requirements will make this worse. Less and less reimbursement(which is now in many cases pennies on the dollar) coupled with a chronically ill population, will break the system. As with the student loans fiasco, if the government had never gotten involved, that trillion dollar disaster waiting to implode would not have occured either. I believe the government it ultimately responsible.


Tue, 08/12/2014 - 18:59 | 5084466 MachoMan
MachoMan's picture

Is medicare or medicaid private or state sponsored insurance?  You act like the legislature has just imposed some magical requirement, as if it is some island unto itself...  Ultimately, you are free to drop a payer source if you choose.  If the restrictions are such that you cannot turn a profit, then you have only one incredibly obvious alternative.

Again, you're complaining about reimbursement rates or the hoops you have to go through to bill a third-party payer source.  Let me put this a different way, if you had not built up a gigantic capital infrastructure and racked up debt in the process (just like academia), would you care as much about decreasing reimbursement rates?   Why are you entitled to continue to make profits in your business?  The fact that you can expect this ought to be a testament to why you should fail.  

This is part of the problem with america in general, no one wants to take any responsibility for having a hand in creating the present state.  No one can be honest enough and have humility enough to accept their role in the mess.  This is necessary before we can move forward with viable proposals.

PS, I'm guessing the legislative requirement was implemented to incentivize medical facilities to quit having rampant staph infection...  do you see any public policy reason for the new requirement or is it just another long list of incomprehensible bullshit the government has mandated to keep you down?  

Tue, 08/12/2014 - 23:42 | 5085647 Miffed Microbio...
Miffed Microbiologist's picture

My hospital is nonprofit. We operate under a very tight budget and are cost conscious. The " magical" requirement was a lawsuit claiming the death of a child due to MRSA was the hospitals fault due to lack of screening. No conclusive proof was presented that the infection was caused by the negligence of the hospital. The child ( who had multiple medical problems) died of MRSA during one of his visits.

You don't have to be patronizing to me. I am not unreasonable. But, I have watched regulatory increases massively increase costs. I have watched people die of infections normally not lethal. You would term this as medical negligence. I see it as a population mortally obese, chronically ill with glucoses regularly in the 500+ range that is the problem. Hospitals are just trying to survive in this environment. They did not create this. Guess what , under those conditions you will have rampant staph,MDRO GNR line infections and other opportunistic infections. Here is a frightening fact for you. Right now staph is living on your skin and in your body. Nosocomial infections do occur but the VAST majority are infections from opportunistic organisms found on the body.

So who is the guilty party not taking responsibility having a hand in creating this state? Or am I just too obtuse to see your point? I would love to hear your proposals that would solve these problems.


Wed, 08/13/2014 - 09:28 | 5086716 MachoMan
MachoMan's picture

So who is the guilty party not taking responsibility having a hand in creating this state? Or am I just too obtuse to see your point? I would love to hear your proposals that would solve these problems.

Well, I think your question begs a favorable answer.  I would pose the question a bit differently, so maybe we can get a different answer.  Regardless of who created fatass/shitty patients, who was responsible for building a business that cannot tolerate decreases in revenue (more specifically, who built a capital infrastructure around third party payments so large that the patients, i.e. real customers, couldn't possibly afford)?  I would hope that you could at least accept the fault in this business model or, alternatively, admit that the medical industry is simply a ward of the state.  [and I say this as someone who is actively helping medical professionals become independent again and get out of the way of the steamroller].  This is actually fairly similar to the situation the banks find themselves in due to too many years gaming the system and being dependent upon uncle sugar.

The solution to this problem is fairly simple: (1) declare the mandate to have health insurance as unconstitutional; (2) restrict health insurance to catastrophic illness and reduce/eliminate geographical insurance monopolies; and (3) expand consumers' ability to pull out pre-tax earnings to pay for medical expenses and/or increase the tax deductibility of medical services.  Obviously there are quite a few other measures that could help, but this ought to do a pretty good job of making a more direct connection between the patients receiving service and the payment of the service, which will have the additional effect of weeding out a significant amount of fraud.  Flushing malinvestment from the system is going to happen one way or the other, and everyone entrenched will fight it tooth and nail until the bitter end, but gravity always wins.



Wed, 08/13/2014 - 21:45 | 5090342 Miffed Microbio...
Miffed Microbiologist's picture

I could look favorably to item 2 and 3. Both of which had been used by myself for 20 years. We never carried health insurance until our catastrophic plan became so expensive ( our carrier was using it to fund other losing plans in the company. I personally would have premiums on the insolvent plan members but for some reason that was not done.) we would have relished a roll over HRA if we were allowed. We used our individual HRAs to pay for all of our basic medical expenses but unused monies were not able to be rolled over because we are employees and did not have a business. Had we have been able to have done this, we would have had almost 200k to use when we are older and more likely to need more care. The government, once again, has foiled our plans for seeing to our medical needs as well as retirement and, yes, I am resentful.

The malinvestment of which you speak would have no possibility of occurring without the obscene amount of money pouring in from government, via insurance or directly. This could not have any possibility of occurring in a fee for service scenario. Because we have reached an unsustainable situation where a chronically ill and aging population is demanding more technologically advanced, albeit more expensive care, the unwind will be painful. Believe me, where I sit, people are absolutely clueless how tenuous this system has become. Only recently have people become aware of national drug shortages in cancer therapies and surgery. I expect this to increase.

If everyone paid for their basic medical and used catastrophic insurance for those high cost medical events spread over a population, many of the problems would be solved. However, there are always those, especially now, who have no interest to taking responsibility for their own care. Here,IMHO, is a BIG problem that may be insurmountable unless draconian measures are imposed. This core issue no one will face and when it can be ignored no longer, it will be too late for an easy solution.


Thu, 08/14/2014 - 10:10 | 5092018 MachoMan
MachoMan's picture

In all of that, I still don't see any acceptance of responsibility on the part of the medical industry (or you in particular).  Yes, our monetary policy has distorted pricing mechanisms and sent false signals to many market participants.  However, you don't get to eat your cake and have it too.  If you accept the profits during the monetary policy fueled boom, then how can you possibly demand to avoid the bust?  Further, how much can you blame monetary policy for distoring pricing when it is painfully obvious that for many, many years patients cannot afford the care they receive?  There are plenty of objective markers along the way to tell market participants where they are...

There are plenty of medical providers who have been able to navigate these waters and securely position themselves in an inhospitable environment.  I hope that they will be able to reap the rewards if the government will allow malinvestment to be flushed.

As far as state sponsored insurance taking care of people who refuse to lead healthy lifestyles, that era will be coming to an end as well.  One thing we have learned is that if the government pays your way through life, it will expect to be able to dictate your lifestyle.  This coincides with the will of taxpayers...  if you steal money out of my pocket to pay for your healthcare, then the least you can do is quit smoking a couple packs a day, stop eating cheesy poofs, and get off your ass once and a while.  The remibursement rates are declining for these folks and the paperwork only increasing when you see them...  with the added risk of clawbacks from audits due to procedural nonsense.  The state is working towards dramatically reducing its obligations.

PS, have you gone to a few professionals to determine your ability to utilize the $200k as you see fit?  That's enough money to even get a second opinion...  my guess is that if you throw some money at it, you'll be able to find a way to get done what you want.  However, you'll need to find someone incredibly specialized to give you an answer.  In my experience, there is virtually always a solution.

Thu, 08/14/2014 - 20:12 | 5094986 Miffed Microbio...
Miffed Microbiologist's picture

We have seen several professionals over the 200k. No, living in CA there is no way for us to set up a roll over HRA unless we had a business. We had contemplated forming a bogus business to do this but the costs and time needed to keep it running were prohibitive seeing I work full time and my husband puts in 12-14 hr days. Yes we are unfortunately wage slaves professionals with relatively high incomes but are taxed to death. I have talked to a friend in Texas and he has told me what we wish to do could be easily done there. More reasons to move.

Personal responsibility? Where am I lacking this? I am paid a wage which is considered at the mean of the local going rate. My take home pay is well below the average wage of San Diego gross wages. When I first was licensed I made $9.48/ hr. At that time I could pay my bills comfortably. Now I struggle to do so even though I make 4X as much. So how have I benefited by this inflationary environment? Clearly those higher up have reaped more reward especially in administration and medical specialists. This is not my doing.I am not personally subsidized though my employer most certainly is considering I work for a non profit. This is no fault of mine. I did not authorize this nor voted for its implementation. My job description has changed to include more supervisory work. If I refuse to do it, my pay will be docked 8%. This work must be completed during work hrs and no overtime will be payed. So, I am actually being paid less.

If the medical field imploded and I were to be paid a fraction of what I made now, I would have no problem inherently with this scenario. However, because my salary in relation to the inflated society of which we find ourselves at the moment would not pay basic expenses such as gas to and fro from work, I would have to quit. Where have I indicated I would be against a bust? This is pure sophistry. A bust is assured and unavoidable, only the timing is an unknown. That you claim I am reaping awards of this system and pathetically wishing for its continuance is simply untrue. How am I to blame when others have far more motivation to keep the status quo?

What we have today is simply socialized medicine. Insurance works properly if it covers only catastrophic care, not routine health care. This worked well for us carrying a $7500 family deductible and using $6000/ year untaxed dollars for care. Now we have the cheesy poof crowd who use the ER for basic care and are on an average of 15 different meds to keep them alive. They probably constitute 75% of my work. Unlike any business, they cannot be turned away. Their care is mandated by the government. So if reimbursements drop are we then allowed to turn them away unless they have cash? No ticky no washy? This is how it is done in the Philippines. However, it is only fair if I pay the cost of care for myself and am not subsidizing Mr Cheesy Poof's or illegal alien's free care. I would expect this would be considerably less cost than what I pay currently.


Fri, 08/15/2014 - 11:49 | 5097943 MachoMan
MachoMan's picture

First, you keep talking about a non profit medical provider like it's some panacea.  I help create these types of entities, so I have a pretty decent ground level view of what goes on...  Practically speaking, there is not a shred of difference between for profit and not for profit entities.  Other than the latter are essentially free from scrutiny from virtually any regulatory oversight.  Yes, you file a 990, but other than that, you're pretty much left to do as you please until someone politically connected enough gets the regulators off their asses to investiate you.  Further, you often get immunity from suit to boot!  At any rate, the only legal difference is that a the residual profits from the nonprofit are not just outright distributed to shareholders (which is asinine considering for profit corporations do their best to hold onto profits anyway in tax avoidance schemes).  What ends up happening as a result?  The nonprofit just pays out administrators more on the front end...  same shit, different entity type.

Second, you're tap dancing around the issue and have done so for numerous posts.  Essentially, you began complaining that your patients' insurance demands that you pay for certain tests which, ultimately, leads to decreased profit margin (through an inability to pass on this cost to patients).  My point was that you (in this case, complaining about the issue from the side of a medical practitioner/medical industry) refuse to accept any responsibility for placing your business in a position that makes it difficult, if not impossible, to weather a financial downturn.  This was done despite an objective acknowledgment that the patient is patently unable to pay for the services at the price levels demanded from medical practitioners. 

During the boom years, medical facilities expanded to capture as much of the loot as possible, and thus expanded their legacy/fixed costs.  This is the same argument made by people whose houses decreased in value.  While housing (and the medical field) was going gangbusters [and medical still is for the most part], everyone enjoyed the spoils.  Those enterprising souls bought bigger and bigger and bigger.  However, now that the gravy train is coming to a halt, no one wants to face the music.

PS, you're telling me that you don't have enough time to keep up a bogus business, but you could probably pay someone less than $100/mo. to keep it up...  is there an hour requirement that you're dealing with?  I don't know any such requirement...  again, there is a way...  if you choose not to jump through the hoops, then that's on you, but there is a way.  You're telling me that you don't have enough time to run a shell organization, but that does not require any time.  Quit complaining and get the job done.  I promise you that there is a professional out there cashing in on what you're trying to do and has a playbook for you...  if he screws it up, then sue him to make yourself whole.  You agreed to deal with complicated legal nonsense when you contributed to the account and now don't want to face up to a complicated legal nonsense solution...  once they get your money, no one wants you to be able to withdraw it.  My suggestion is to protect your money.

Tue, 08/19/2014 - 12:57 | 5115057 Miffed Microbio...
Miffed Microbiologist's picture

I guess I'm going to have to tap out on this one. Not that I don't wish to continue this discussion because it is an interest of mine and I do look for real solutions out of the medical morass we find ourself in today. The issue is multifaceted and complex with many components.

However, giving out my email on line has resulted in many contacts regarding Ebola and I am inundated by the response. At this point, I wish to focus on this because of its relevance at this time but I didn't want to just not respond to you considering the amount of time you spent on this interaction I am sorry.

I certainly hope Ebola will not make our discussion moot. If not, perhaps we shall continue some time again.


Tue, 08/12/2014 - 11:49 | 5082077 Anusocracy
Anusocracy's picture

You mean a made up right that allows you to do something to someone else in a government run system that no one has a right to establish in the first place.

Oh, that kind of imaginary right.

Tue, 08/12/2014 - 10:26 | 5081618 tmaynardr
tmaynardr's picture

And the study uses outdated data, as most of it is pre-tort reform.  For example, in Ohio, the number of claims post tort reform has been reduced by 54%.  Why haven’t premiums gone down by a proportional amount?

Tue, 08/12/2014 - 10:33 | 5081640 LetThemEatRand
LetThemEatRand's picture

Yes, funny how the tort reform push over the last decade or so has done absolutely jack shit to reduce insurance premiums even though claims have dropped substantially (meaning fewer people are able to seek compensation if they believe they were wronged).  But doctors and especially hospitals never screw up or design their practices as profit centers at the expense of patients, and insurance companies need more money so it's okay.

Tue, 08/12/2014 - 12:10 | 5082176 MachoMan
MachoMan's picture

Bingo.  Tort reform is actually just a push for tort immunity.  If you put tort reform into a historical context, the debate has been waging for centuries (millennia) and has changed dramatically over that time period, from one extreme to the other.  People act as though they're the first to suggest changes to the system, but they probably don't have the historical understanding to remotely understand what they're suggesting...  and why it's failed in the past.  Much the same as monetary policy...

In the end, with all its faults, the civil side of the legal system is the last meaningful, legal form of redress available for the average person.  People don't want to talk about this aspect of our society, but there is nothing the average person can do for redress against entrenched power other than fill a jury box of his peers and pass judgment on a multinational, local super star professional, governmental worker, or politician.  Whenever you pick up the torch to limit the availability of legal means of redress, ask yourself whose water you're carrying. 

Tue, 08/12/2014 - 13:20 | 5082327 Citxmech
Citxmech's picture

"Tort reform" is the propaganda arm of the insurance lobby.  They've been very successful too.  "Frivolous" lawsuits are least of our legal system's problems.

Oh yeah - and all those insurance premium savings we were promised ended up in the pockets of the boards of directors.

Tue, 08/12/2014 - 14:02 | 5082745 MachoMan
MachoMan's picture

Bingo.  A fair question for our state legislatures is why, in a highly regulated industry such as insurance, did they not mandate decreases in premiums along with providing decreases in tort liability?

Tue, 08/12/2014 - 14:20 | 5082831 Citxmech
Citxmech's picture


My guess is because the insurance lobby wouldn't have contributed to any campaigns that signed-on to legislation with that kind of language!

Tue, 08/12/2014 - 16:43 | 5083745 MachoMan
MachoMan's picture

Bingo.  Now we're getting to the meat of the coconut.  This is what our society is...  people don't want to actually utilize the process of political debate to determine the best course of action, rather it is simply a procedural necessity prior to counting up the money of opposing sides.  Needless to say, it seems like all who demand tort reform are either ignorant of the fact that tort reform is a constant in our system and has been happening for centuries, or are ignorant of how limiting citizens' ability to redress grievances against the politically entrenched might not be the best course of action, in other words, they simply don't understand the philosophies underpinning torts in the first place and the role tort suits have played over the centuries...

Tue, 08/12/2014 - 18:25 | 5084325 Citxmech
Citxmech's picture

What I don't understand is where are all the libertarians on this site who supposedly support the right of legal regress as the primarly enforcement mechanism for individual rights as opposed to big govt?

Tue, 08/12/2014 - 19:04 | 5084487 MachoMan
MachoMan's picture

If you could get the majority of people to have consistent political beliefs (or any beliefs for that matter), then you could die the most accomplished man in history.

Tue, 08/12/2014 - 11:01 | 5081813 teslaberry
teslaberry's picture

what are you fucking joking me?the fact that you say THE WHOLE ISSUE INSURANCE COMPANY PROPOGANDA-------SHOWS HOW MUCH OF A FUCKING MORON YOU ARE. 




however; to addresss your point, and to begin demolishing your argument. 

as a lawyer who has a family friend who is a neo-natologist, you have no fucking clue waht you are talking about when you say there is no crisis.  there is indeed a crisis. a crisis that ratchets up the inevitable full institutionalization of an entire industry ( medicince) to the private benefit of NONindustry profiteers including-----malpractice insurance , MEDICAL insurance, wall street , and other financial profiteers that have little to zero to do with the actual practice of medicine.

if there is any problem with this article's point about the malpractice crisis---it is that the article does not give even close to a holistic over-view of WHY THERE IS A CRISIS. I'm not going to bother going into it. 

however, i will point out that the article is pretty simpleton bullshit obvious truth. yes, there is a crisis. there has been a crisis getting worse for some time now. and it's particularly bad in medicine, but the crisis is eating away at the heart of american in many other places. 

the cost of insurance drives up the cost of PROVIDING WORK. so employers either compensate employees more ( driving up the costs of the products or services they sell, and or employees slowly go broke.---BOTH OF WHICH ARE ACTUALLY HAPPENING TO DOCTORS THROUGHOUT THE MEDICAL 'INDUSTRY')

insurance kills everything it touches very slowly like a python, slowly ratcheting up the suffocating costs of the over-head of doing business. the insurance industries are a complete and utter scam that are OPENLY BAILED OUT AND TAX SUBSIDIZED . IT IS A RAQUET INSIDE ANOTHER RAQUET .

the medical industry has had such an accute crisis with this, that there are no longer new doctors practicing independently in the united states. new doctors out of med school are herded into their institutional jobs like cattle to a cattle car. they know not the original history of medicine as an independent profession where a man could make a living by saving lives and treating patients. 

if you think this isn't a crisis, the lack of INDEPENDENT DOCTORS. then i'm sure you also believe that unionizing lawyers is a good thing to. i'm a lawyer. lawyer pay in new york is so low and job security so shitty that i frequently hear lawyers talking about 'unionizing'. it is some serously outrageous shit. and yet, some people in fact do take it seriously. unionizing for what? lawyers and doctors already have guilds to protect their independent interests as professional independent practitioners. what happens when there is no more economic or political room for them to practice indpedently and they are forced into large institutions such as massive hospitals and huge ass coglomerates of small lawfirms that provide services for people with 'lawsuit insurance' -----you eventually get what you get in the soviet union. a fully beauracratized society. 

many of the former beauracrats of the soviet union literrrally die or become homeless with the collapse. but doctors, WELL DOCTORS ARE ACTUALLY USEFUL , AND THIS IS WHY YOU SAW SO MANY RUSSIAN DOCTORS DRIVING CABS IN NEW YORK CITY IN THE 80s and 90's. 


this is indeed a crisis for our civlization and your petty remark about a 1% claims rate is like republican propoganda ( an i'm republican) --------about how the rich pay all the taxes. it is lies lies lies lies and half truths meant to decieve. but in your case. youre probably just dumb and have no clue about how the system actually works and are spouting off someone else's propoganda. i only say this because your reading comprehension skills are so poor. 


Tue, 08/12/2014 - 11:31 | 5081983 Dr_Dazed
Dr_Dazed's picture

Wow - that was an incoherent rant.  Having a bad day?  What law school did you say you attended?

Tue, 08/12/2014 - 11:31 | 5081984 Dr_Dazed
Dr_Dazed's picture

Wow - that was an incoherent rant.  Having a bad day?  What law school did you say you attended?

Tue, 08/12/2014 - 11:13 | 5081850 Dingleberry
Dingleberry's picture


You forgot to mention the 15-20% of the entire medical bill that is related to practicing defensive medicine.

Everyone bitches when the doc makes you get a bunch of lab tests/scans, etc and it costs a bunch of money.

That's because litigious liberal fuckers (like you) want something for free.

The rest of the world (you know, the ones who you want to emulate with socialized medicine) does not have lotto-style lawsuits.

Why do we?

Oh, and if 80% + of lawsuits are thrown out...what does that tell you about the system? I's unfair. Maybe if we got "loser pays" (again, like some other socialist paradise you seem to revere) then this bullshit would stop. 

But I guess we should pay to keep legions of lawyers on retainer for bullshit lawsuits.  It doesn't cost much, right? 

Tue, 08/12/2014 - 13:46 | 5082659 Citxmech
Citxmech's picture

Where are you coming up with this "80% of lawsuits are thrown-out" statistic?

Tue, 08/12/2014 - 14:04 | 5082757 MachoMan
MachoMan's picture

Further, where is he coming up with the legal lottery notion?  I'm guessing he doesn't actually see what the vast majority of these cases are actually worth...

Tue, 08/12/2014 - 12:42 | 5082310 Trogdor
Trogdor's picture

This isn't just an "individual-sues-the-big-guys" situation, it happens the other way around, too.  Movie producers, directors, the MPAA, and RIAA, have been using the SAME disgusting techniques to soak tens of thousands of people for what is essentially "protection" money - i.e. pay us $1500-3000 and we'll go away - or we'll drag you through the court system at a cost of hundreds of thousands.  The scam works like this: they will collect IP addresses of people who *supposedly* downloaded some kind of content (it's impossible for them to tell if the IPs were spoofed, or, if the individual actually downloaded all the content, or the ID of the computer that supposedly did it, or if someone's wifi was hijacked, etc), then they will find a compliant scummy judge whom they can pay a few thousand to that will allow them to put upwards of 4000 individuals on a single subpoena - to avoid the $30/per subpoena charge, of course.  Then, the typically Jewish law firm will mail out mass "threat letters" all across the country.  What they do is make sure that the "payoff" amount is *slightly less* than it would cost for a person to go through the bullshit to prove themselves innocent - i.e. forensic analysis of their computer, court time, hiring a lawyer to speak to the filth making the charges, etc.  Most people just have to pay - which is of course what they want.  Millions in profits for just sending out a letter.  My neighbor is an older gentleman - he barely uses his computer, but that didn't stop a slimy DC Lawfirm from threatening him and managing to extort money he really didn't have. Nearest I can figure is that his wifi was hijacked - but that didn't matter to the greedy POS lawyers or the slimebag judge who allowed them to break the law.

The "legal" system is an obscene, sick joke - it's just as black-slimy-rotten inside as our political, corporate, and banking systems ... which really shouldn't surprise anyone at this point.

Tue, 08/12/2014 - 14:07 | 5082775 MachoMan
MachoMan's picture

It's probably important to distinguish between the legal system and the bullshit laws (in your example, copyright statutes) that the legal system has to hold its nose and deal with...

Sun, 08/24/2014 - 20:09 | 5138552 New World Chaos
New World Chaos's picture

Nobody "has" to hold their nose and deal with anything.  What is someone going to do, impeach a judge for improperly throwing out or ignoring a bunch of bullshit infringement cases?  Even if there are consequences, people are still morally responsible for their actions even if "it's the LAW".  That's no excuse for robbery.  So don't be a party to bullshit.  God gave us a soul but so many people willfully throw it away and become zombies.

Tue, 08/12/2014 - 10:06 | 5081513 max2205
max2205's picture

Moar cameras everywhere will solve this problem

Tue, 08/12/2014 - 10:09 | 5081530 Ms. Erable
Ms. Erable's picture

S&W, Glock, and Sig come to mind...

Tue, 08/12/2014 - 10:12 | 5081540 Anusocracy
Anusocracy's picture

Government, which is kleptocratic by nature, will influence society to become more kleptocratic.

Government exist through theft and will surround itself with underlings who exist through theft.

Tue, 08/12/2014 - 09:41 | 5081406 NotApplicable
NotApplicable's picture

You mean when people stop identifying with their abusers. The idea that this is "our" legal system is ludicrous.

Tue, 08/12/2014 - 09:47 | 5081425 Keyser
Keyser's picture

When you voluntarily live within the jurisdiction of a corrupt system, then guess what, it is system under which YOU have chosen to live, whether you characterize it as "OUR" system or not... The only option is to remove yourself from the rogue state... 

Tue, 08/12/2014 - 09:53 | 5081447 NotApplicable
NotApplicable's picture

There is no physical state to remove oneself from. Regardless of location, there always exists a criminal cabal imposing force upon me against my wishes.

Besides, I don't recall ever deciding to live. Birth was not an option under my control.

Also, I removed myself from all rogue states the instant I realized they are but abstractions that do not exist in reality. The instant I stopped supporting them, they ceased having legitimacy in my world-view. They are nothing more than gang colors.

Tue, 08/12/2014 - 10:00 | 5081482 CH1
CH1's picture

When you voluntarily live within the jurisdiction of a corrupt system...

Ah, so it's okay for them to rob me if I sleep on their turf?

You gonna allow the mafia to say the same thing? Or the drug lords? Do they also have the right to enslave?

And sleeping somewhere is my consent to slavery?

Tue, 08/12/2014 - 11:56 | 5082114 TruthHunter
TruthHunter's picture

It looks like its easy to get a doctor to testify

against a doctor...Its probably a lot harder to find a lawyer

to testify against another lawyer.   

Tue, 08/12/2014 - 14:07 | 5082779 MachoMan
MachoMan's picture

Same as anyone, if you put money on the line, then you'll get some nibbles.

Tue, 08/12/2014 - 09:39 | 5081394 Vampyroteuthis ...
Vampyroteuthis infernalis's picture

What is a thousand lawyers at bottom of the ocean? The beginning.

Tue, 08/12/2014 - 12:53 | 5082371 N2OJoe
N2OJoe's picture

A good start.

Tue, 08/12/2014 - 09:43 | 5081409 Stackers
Stackers's picture

europeans have a better control on this. If you bring a law suit to court and lose, you pay everyone's attorney fees and we need to stop attorney's from working on contingency fee as well. That will cut 75% of the nonsense out.

Tue, 08/12/2014 - 13:05 | 5082444 Citxmech
Citxmech's picture

JFC - Why don't you just fucking immunize corporations from suit while you're at it. . .

Contingency arraingments are the only equalizer the little guy has at his/her disposal when getting fucked by entities with deep pockets.

Tue, 08/12/2014 - 14:09 | 5082786 MachoMan
MachoMan's picture

Exactly.  We really need to eliminate the last vestiges of aspects of our society that actually work and provide checks and balances...  again, it just blows my mind people talk about these things as if this exact debate hasn't been waged for centuries...  they're often unaware for which side they're carrying the water.

Tue, 08/12/2014 - 14:15 | 5082809 Bay of Pigs
Bay of Pigs's picture

Checks and balances? What are those?


Tue, 08/12/2014 - 09:55 | 5081458 bpj
bpj's picture

One of the mantras at our bar association meetings was "innocent until proven broke".

Tue, 08/12/2014 - 18:12 | 5084263 mkkby
mkkby's picture

CHS just proved himself to be a complete idiot.  It is 99% of physicians IN THEIR LIFETIMES.  That doesn't mean more than half are practicing below the average.  It means once in a while they all make mistakes that hurts someone.

That is very easy to believe when you consider each doctor probably sees 30 patients a day, for no more than a few minutes each.  It's an assembly line.  If you come to work tired or not feeling well yourself, your standard of care will go down considerably.

Tue, 08/12/2014 - 18:17 | 5084287 mkkby
mkkby's picture

And another thing.  Hospitals are charging thousands of dollars for someone who walks in the door and right back out with no work performed.  That has nothing to do with tort reform or defensive medicine.  It's fraud, plain and simple.

They've got the power and you don't.  If you tried to sell bottled water for $100 you'd get arrested.  Hospitals can do that because they are yet another industry that is above the law.  They need to be strung up like all the other leeches that are literally bankrupting and killing people for profit.

Tue, 08/12/2014 - 09:56 | 5081459 boattrash
boattrash's picture

Just call 362-4360,, I lead a life of crime, (AC/DC)...The shit-show will slow down, at least, whenever enough people realize that it's cheaper to neutralize a damn fraudulent crook than to hire legal teams or pay undue settlements.

Tue, 08/12/2014 - 09:55 | 5081463 photonsoflight
photonsoflight's picture

Soon, very soon. Hehehehehe.

Tue, 08/12/2014 - 10:18 | 5081578 failure to perform
failure to perform's picture

It won't.  Over 400,000 are killed in hospitals just from medical errors. That's not negligence and medication overdoses that take place outside of hospitals. Medical errors are now our countries third (3rd) leading cause of death. I actually advocate for others after they tried killing off my 4 year old instead of treating her for their negligence. We filed suit on a Thursday and on Monday they were contacting my attorney to settle. We did settle and I have a nice 10 page "gag" order that they forced me to sign. How so? They were going to file a motion to enforce settlement if I didn't sign. The team of doctors teach in a well accredited university and most have received promotions. The lawyer who did next to nothing received $456,000.00 Happens all the time.

Tue, 08/12/2014 - 14:06 | 5082770 drdolittle
drdolittle's picture

Wonder how they come up with that number/ Seems awful high out of 2.5 million deaths annually. 1/6 medical errors?

Sorry about your kid, I do realize errors happen but the stats are bs. Is there a list compiled after cases have been reviewed and determined to be caused by errors or is this just some made up number?

Tue, 08/12/2014 - 14:25 | 5082852 MachoMan
MachoMan's picture

I'd say it seems a bit high, but it could be in the ballpark.  The reason why there is such a push for tort immunity is that many medical providers are having to staff themselves with the cheapest labor possible and errors (albeit not necessarily serious) are rampant.  The problem is that many of these folks don't have much skin in the game are not as careful or skilled as more trained people.  The medical provider has a duty of care, regardless of whether it's a doctor or a minimum wage orderly.  Between that many hands touching a patient, and expected to see so many patients, someone is likely to drop the ball.  If you're dealing with elderly patients, then it doesn't take much to create a chain of events that eventually leads to their death, whether it's placing an IV incorrectly, dropping them and breaking a hip, staph infection, letting them choke while feeding them, etc.  Some places have their shit together, others not so much...

Tue, 08/12/2014 - 09:34 | 5081364 Seasmoke
Seasmoke's picture

And you didn't even touch on the theft of FRAUDCLOSURE. 

Tue, 08/12/2014 - 09:39 | 5081387 Renfield
Renfield's picture

I would like to see a Hedge article on this alone.

I have heard a thousand (it seems) anecdotes of banksters foreclosing on properties that a) have no lien on them; b) have never had a lien on them; c) were paid off; or d) lien is in dispute and payments in escrow.

Anecdotes are smoke without fire, but it is chilling to think of how unclear title has become in the United States. I have to assume the problem is the same in Canada but I have no good information.

Waddayasay, Tyler?

Tue, 08/12/2014 - 09:45 | 5081416 NotApplicable
NotApplicable's picture

This is well-worn territory (see Dr. Housing Bubble).

Once the State AG herd lined up with their hands out for a cut of MERS profits, chain-of-title effectively died. All they had to do was to divert attention to DocX for a while.

Tue, 08/12/2014 - 10:01 | 5081485 sleepingbeauty
sleepingbeauty's picture

Not really a problem that I know of in Canada. My hubby is a mortgage broker and he has never seen a problem buying a property because of unclear title. Plus there is title insurance, that most lenders insist the landowner buy in order to protect their investment.


I think in the states the reason that there is confusion is that a bank will package all of their liar-loans and sell them to another institution who in turn will sell it to someone else. And no one really knows who has the hot potato, because the documents were forged and unclear.

Tue, 08/12/2014 - 10:03 | 5081499 photonsoflight
photonsoflight's picture

As long as you have to pay property taxes your just renting from the government. Eminent domain gives them the ability to confiscate your property for whatever they wish to pay you for it. We are all just serfs at this point of time.

Tue, 08/12/2014 - 10:19 | 5081581 sleigher
sleigher's picture

They don't call it a "grant deed" for nothing.  

Tue, 08/12/2014 - 14:28 | 5082876 MachoMan
MachoMan's picture

I have heard a thousand (it seems) anecdotes of banksters foreclosing on properties that a) have no lien on them; b) have never had a lien on them; c) were paid off; or d) lien is in dispute and payments in escrow.

If it's a, b, or c, then you're talking about a lawyer's wet dream...  maybe 1 out of 10,000 foreclosures?  Now, each time it happens, it will get local media scrutiny, but it's incredibly rare.

PS, title isn't screwed up...  everyone knows the owner of record by just going down to the local courthouse.  The issue is whether there are any liens on that title...  and that situation is completely crazy.

Tue, 08/12/2014 - 09:38 | 5081368 souljaboy
souljaboy's picture

There are only two questions a plaintiff's attorney needs yes answers to before he takes any case: 1) Are you hurt? 2) Do you need money? The facts nor the law matter.

Tue, 08/12/2014 - 10:43 | 5081718 Kickaha
Kickaha's picture

You are an idiot.


“Some critics have suggested that the malpractice system is inundated with groundless lawsuits, and that whether a plaintiff recovers money is like a random ‘lottery,’ virtually unrelated to whether the claim has merit,” said lead author David Studdert, associate professor of law and public health at HSPH. “These findings cast doubt on that view by showing that most malpractice claims involve medical error and serious injury, and that claims with merit are far more likely to be paid than claims without merit.” 

"The authors reviewed 1,452 closed claims from five malpractice insurance companies across the country. They focused on four clinical categories: surgery, obstetrics, medication and missed or delayed diagnosis, areas that collectively account for about 80% of all malpractice claims filed in the U.S. Specialist physicians in each of these clinical areas reviewed the claims and the associated medical records to determine whether the plaintiff had sustained an injury from care. If an injury had occurred, the physicians judged how likely it was to have been due to medical error.

"The reviewers found that almost all of the claims involved a treatment-related injury. More than 90% involved a physical injury, which was generally severe (80% resulted in significant or major disability and 26% resulted in death). The reviewers judged that 63% of the injuries were due to error. The remaining 37% lacked evidence of error, although some were close calls."



Tue, 08/12/2014 - 09:36 | 5081370 philipat
philipat's picture

Be careful. 20% of the top 1% are physicians....

Tue, 08/12/2014 - 09:40 | 5081396 venturen
venturen's picture

They are pikers compared to the massive theft that is called our financial system of wall street manipulators and shisters! A system of regulatory and tax loopholes bigger than Kim K's ASS and as dysfunctional as her pathetic family! 

Tue, 08/12/2014 - 09:48 | 5081427 Keyser
Keyser's picture

It's not the 1% we have to be concerned with, it's the top 1% of the 1% that control the world... 

Tue, 08/12/2014 - 10:04 | 5081496 CH1
CH1's picture

Being in the 1% is not evidence of a crime. Some are criminals, some are not.

Envy is poison.

Tue, 08/12/2014 - 09:37 | 5081379 venturen
venturen's picture

Roman wasn't destroyed in a day!

Tue, 08/12/2014 - 09:48 | 5081430 Keyser
Keyser's picture

Perhaps, but TPTB are much more efficient these days... 

Tue, 08/12/2014 - 09:49 | 5081380 Sudden Debt
Sudden Debt's picture

I recently saw this article about a guy who cut his finger... 9000 bucks...


That's so fucked up :)

And than there was this question, how much should it cost to put a band aid on his finger? A 1000 WOULD BE OKAY!!!

That was just crazy :)

Over here they do that for free :)


But I wonder why people don't start a bizz where they put on band aids for only 500 dollars per finger?

I mean... somehow between the costs and expenses there must be room for some profit right?

Tue, 08/12/2014 - 18:57 | 5081827 messymerry
messymerry's picture

Yo Domo,

It will cost you 5 million dollars to get a permit to adminsiter that band-aid.  You can thank the ginormous bloated glut that steals our productive labor under the threat of violence...

Of the three supposedly co-equal branches of government,  justice is the most worhy of contempt.

Tue, 08/12/2014 - 09:38 | 5081382 Dr. Engali
Dr. Engali's picture

Right now, I can't name one institution in this country that isn't broken.

Tue, 08/12/2014 - 10:21 | 5081592 Stuck on Zero
Stuck on Zero's picture

Most criminal institutions are prospering.

Tue, 08/12/2014 - 11:08 | 5081847 photonsoflight
photonsoflight's picture

I have tried to think of a way to rebuke you, but try as I might I can not. From religion to the law, medical to agriculture, automotive to energy production, you are absolutely right. I find that most people I know have no passion for what they do anymore. They are just going thru the motions of life until they retire ( die).  Oh how I wish I could rebuke you for being cynical.

Tue, 08/12/2014 - 09:40 | 5081393 Ghordius
Ghordius's picture

OK, today I really have no inkling in being diplomatic. WTF? The American Legal System is bankrupt?

Are we talking about that system that ensures that who has the money has the right? The system where the worse words you can hear is "I'll drag you to court and I have plenty of money for that"? The system that makes sure all private prisons are filled?

Isn't it "working as requested"? /S   Note that all of the above are prejudices. Plain stupid, uninformed european prejudices. Please dispel those silly notions

Tue, 08/12/2014 - 09:49 | 5081428 NotApplicable
NotApplicable's picture

Just once I'd like to see you make a post as a plain ole human, rather than a one of a European flavor.

Why do you constantly let criminal elements define you? Have you ever stopped to consider that there's no such thing as "citizens?" Like any abstraction, they only exist in your mind. That you rely upon them for your identity is scary to those of us who are peaceful in nature.

Tue, 08/12/2014 - 10:22 | 5081597 SmackDaddy
SmackDaddy's picture

oh gimmee a break.  everyone exists within a context and I find it helpful when others identify theirs.  just the fact that we are communicating in the english language has implications....

you are the one who seems to be identifying as a "global citizen"

Tue, 08/12/2014 - 10:33 | 5081653 Ghordius
Ghordius's picture

well, perhaps you don't note my other posts? I belong to a small minority in many, many ways which are - I'm sorry - very continental. And I seriously like ZH, where many articles are incredibly US-centric, like this one. And so I have to qualify my input, otherwise it's not understandable

I, for example, oppose in several EU countries the expansion of the current prison capacity. Because I'm of the opinion that if you build them, you'll fill them

you know what our average capacity is, on the continent? 1 prisoner out a population of 10'000. everything exceeding this level equates to an excessive criminalization of the people, which I equate with tyranny

meanwhile, I'm sorry, your "citizen is an abstraction" is utterly American. even our most intense anarchists would not pose it that way. a lot of things are abstractions, including the words we are exchanging. a lot of thing exist in the mind... and have real effects on the world. flags come to mind, or blueprints for a bomb

who are "those of us who are peaceful in nature"? is that a club that can be joined?

Tue, 08/12/2014 - 14:33 | 5082914 MachoMan
MachoMan's picture

@ Ghordius

Your premise of why the system behaves as it does is correct.  However, from the mules in the back of the pack train, many of the system's institutions are indeed broken.  Just a difference of perspective.

Tue, 08/12/2014 - 09:43 | 5081408 ugmug
ugmug's picture

Obama is the de facto legal system.

Obama is the de facto economic system.

Obama is the de facto government.

Obama is the de facto golf pro.

Obama is the de facto genius and the media are Obama's de facto worshipers.......


Tue, 08/12/2014 - 10:27 | 5081610 SmackDaddy
SmackDaddy's picture

jesus h christ, save it for the Yahoo! comments section

Tue, 08/12/2014 - 11:10 | 5081755 ugmug
ugmug's picture

That reminds me...

Obama is the de facto healthcare system.

Obama is the de facto spy agency.

Obama is the de facto despot.

Obama is the de facto Harvard graduate who is so proud of his academic accomplishments that he still will not release his university transcripts.

Obama is the de facto drug addict like everyone in Hollywood .

And lest we forget....

Obama is the de facto executive order waitress....

Tue, 08/12/2014 - 09:52 | 5081439 ebworthen
ebworthen's picture

The entire society is morally and ethically bankrupt, this is just one symptom of the disease.

Decent people are punished while grifters of every type and stripe are rewarded.

Tue, 08/12/2014 - 10:55 | 5081772 dizzyfingers
dizzyfingers's picture

..." grifters of every type and stripe are rewarded"

And "the state" and lawyers see to it that grifters win, using your money to do so.

Tue, 08/12/2014 - 09:51 | 5081442 lincolnsteffens
lincolnsteffens's picture

Must support all those insurance companies. Also I've heard it said we have more lawyers per capita in the good ole USA than any other country so we must support all those Bar flies. Also we have a high number of lawyers in Congress. Makes perfect sense to me! It is just a way to provide more jobs for paper shufflers since so much labor need to produce real things have either been moved to the low priced producer elsewhere or modern techknowledgy has raised efficiency so much. 

Think of it as just another welfare type government program. After all what else is there for you to do other than help these poor unfortunates that would otherwise find no work to have rewarding employment.

Tue, 08/12/2014 - 14:35 | 5082927 MachoMan
MachoMan's picture

First, we have more lawyers because traditionally, we do more business...  more business = more lawyers...  however, it has been well documented that we are beyond saturation in the number of lawyers due to stagnation/decrease in business...

Second, don't get politicians confused with lawyers.  They might have attended law school, but they probably haven't practiced a day in their lives.

Tue, 08/12/2014 - 09:55 | 5081455 TrumpXVI
TrumpXVI's picture

I like CHS, but this particular argument (altough it has merit), doesn't hold up on the math (and I'm terrible at math).  But malpractice is case by case, one case at a time.  Soooo, CHS is arguing that because it's mathematically impossible for 99% of physicians to be below average in the care they provide on a daily basis, that therefore the majority of malpractice claims are unsupportable legally.  This is not logical, because it's definitely possible for 99% of physicians to, at one point in their career, provide below average care to ONE patient.

Tue, 08/12/2014 - 10:07 | 5081517 sleepingbeauty
sleepingbeauty's picture

Yes, and that is the point. If a person cannot always be at their best, then it is a stupid system that expects a doctor to be above average all of the time or they will get sued. Save the suing for the blokes who come to work drunk, high or are just plain idiots.

Tue, 08/12/2014 - 11:01 | 5081800 Kickaha
Kickaha's picture

At first I was inclined to ridicule your opinion, but upon reflection, the idea that the current legal requirement that a physician should always provide a standard of care at least equal to what is typically expected of him should be changed to a lower standard is perhaps worthy of some debate.  

Presently, those people who suffer when a generally good doctor has a bad day possess the right to sue and collect damages.  They can collect damages because there is an insurance policy in place.  The basic ideas behind insurance is that those who suffer a misfortune can be made whole from the pool of money built up through insurance premiums.  So, your options are to lower the required standard of care and perhaps keep more money in the insurance pool, and maybe (and history has shown this is a huge maybe) the insurance companies will lower premiums and make the practice of medicine more affordable and less stressful; this is actually cost-shifting on to the shoulders of patients who suffer harm on those "bad days".  The medical lobby would be all for this cost shifting.  It has, in fact, succeeded in obtaining the passage of many, many laws in many states across the USA which has made the litigation of medical malpractice cases exceedingly expensive, both in court costs and attorney time.  The average case costs the Plaintiff firm $40,000 in litigation expenses, with the result being that the firms will not accept a case unless it involves death or major disability of a wage earner.  People with damages less than that end up unrepresented and uncompensated.  The shifting of the social costs of their less disastrous injuries onto their own shoulders and those of the taxpayers is the real "medical malpractice crisis".

Tue, 08/12/2014 - 15:49 | 5083344 MachoMan
MachoMan's picture

Insurance companies do not reduce medical malpractice insurance premiums when tort reform gets passed...  so, that cow is out of the barn.

Tue, 08/12/2014 - 11:53 | 5082086 FrankDrakman
FrankDrakman's picture

Sigh. Doesn't anyone understand statistics? The "standard of care" is not average, it is not above average, it is not below average. It is a checklist (figuratively, if not literally) of all the things you would do if a patient with symptom "x" showed up in your office. For example (and I'm not a doctor, but let's play along..) patient says "I can't breathe!". You (dr.) first listen to his chest, then take a tongue depressor and look down his throat, then ask "Where have you been lately?" (exposure to allergens), "Are you allergic to anything?", "Does anyone in your family have asthma?", etc. I don't know how the long the list would be, and what would be on it, but you would follow the process until you were reasonably sure that your diagnosis was correct. (Note: "reasonably" not "perfectly"!) The doctor doesn't have to be above average, or even average, to deliver the 'standard of care'; it's expected of ALL doctors, even the ones who finished at the bottom of their class. (Just as, when you get a tire changed, whether you do it at Joe's Garage or Mr. Goodwrench, you expect the tire to be filled and all four lug nuts put back on the wheel.)

Thus, it's reasonable to expect that 100% of doctors would meet the standard of care in most normal situations. (A 737 crashed in your neighbourhood, and you're one of two docs who came to the scene? Different story, and a different 'standard of care' applies.) Doctors are human of course, and they get tired, are rushed, and sometimes distracted (like their wife just found out about their affair with nurse Jenny), and that's when mistakes get made. Ideally, malpractice fills two needs: compensation for victims and a warning for docs that they must apply a minimum of effort, but the current system in the US, where the lawyer can pocket up to 2/3rds of the award serves lawyers first, patients second, and doctors last.

Now, let's say you do a lot of high risk procedures where things don't always turn out as expected, and the doctor doesn't have time to consult with anyone. e.g. baby's coming out, and cord gets twisted around baby's neck. Doc has ten seconds before baby chokes to death, so he cuts the cord but with a struggling baby, the scalpel slips and also cuts a four-inch long non-life threatening wound on new mommy's belly. So she sues him for malpractice because she can't wear a bikini anymore with a faint scar showing. If some mishap happens once every 10,000 births (which is phenomenonly good - just over 100 years ago, DEATH was the outcome in about 2% or more of cases), then a doctor who does 500 births per year (about 1.5 per day) has a 5% chance of this happening every year, and 63% chance after 20 years, and a 77% chance after 30 years. And that's with a 1 in ten thousand chance of things going wrong. If there's a 1 in 1000 chance, it's a virtual certainty that one of these events will occur after only 10 years.

So, depending on how big/small an error there needs to be for a malpractice suit to be filed, it's quite possible that 99% of the doctors will face one or more suits over their practiciing lives. That's not a failure of the law - that's just statistics. The question to be asked is "How do we make it easy for people who've been seriously harmed to get justice, while keeping frivolous suits out of the courts?". As others have noted above, trial lawyers are the WORST people to be making this decision.

Tue, 08/12/2014 - 13:02 | 5082421 hidingfromhelis
hidingfromhelis's picture

Pffft, statistics.  When I need medical care, I make sure to visit Lake Wobegon Hospital, where all the doctors are above average.

Tue, 08/12/2014 - 14:07 | 5082777 FrankDrakman
FrankDrakman's picture

Garrison Keilor had a recent sex-change operation, and unfortunately, died giving birth.

Tue, 08/12/2014 - 09:56 | 5081466 q99x2
q99x2's picture

You have to live within a small group of people that look closely to what you look like otherwise other tribal groups that all look different than you look will gang up on you. Bunch of savages out there in America. They act like people.

Tue, 08/12/2014 - 10:44 | 5081469 Comte d'herblay
Comte d'herblay's picture

That's because "due process"  was misunderstood.  What they meant to happen was  "Dual Process".  

There was supposed to be a two track legal system to take the courts out of the equation when "certain guilt" was at stake, as opposed to "reasonable doubt" guilt requiring trials, or settlements. 

In the case of murderers caught in the act there is no need for a trial. They're guilty, they did it, they were caught.  They either die themselves very quickly or be sent to LWOP, no nuancinfg LWOP to be interpreted as, "well, he's been good for 5 yrs let's let him back out among the next of his victims". 

In the case of robbers caught in the act, no trial is necessary; ditto with drugs, most of which are settled out of court anyway. The use of trials and juries is ancient practice and needs to be severely limited.  

Drugs of the recreational kind need to de-criminalized, and there goes a zillion hours saved, lives saved, and prison pops brought down to sufficient beds for all with no overcrowding. (don't tell contractors paying off state officials to build new prisons, which is another boondoggle at the expense of the taxpayers).

It's not so much that it's b/k, but that it is administered for the benefit of employment and career opportunities, and not for the administration of justice. Once the real reason for the system is made manifest, the CONgress can set about returning the donations from the ABA to keep the current system status quo.

Tue, 08/12/2014 - 10:02 | 5081497 Reaper
Reaper's picture

There is a lawyer/police/prosecutor/judge industrial complex. It exists to fill their troughs. In the second federal circuit, all the federal judges are approved by Schumer to insure their venal nature.
The inscription which should be inscribed over every courthouse is "Abandon all hope of justice, ye who enter here. Make sure your lawyer is well paid and well connected with the judge."

Tue, 08/12/2014 - 11:46 | 5082056 DullKnife
DullKnife's picture

My lawyer's wife was the Judge's daughter.

But doesn't help when the Judge is not interested in the merits of the case.

Incompetence trumps relations.


Tue, 08/12/2014 - 10:05 | 5081508 Creepy A. Cracker
Creepy A. Cracker's picture

"The first thing we do, let's kill all the lawyers." William Shakespeare's Henry The Sixth, Part 2 Act 4, scene 2.

Yes, it's a lawyer joke. Even then, lawyers were seen as scum of the earth.  Some things never change.

Tue, 08/12/2014 - 10:10 | 5081523 percyklein
percyklein's picture

ZH exaggerates the significance of the study. Amercian are litigeous. Lawyers encourage this to line their own pockets. Hospitals are not all so hot. Mistakes are made, some compensible. Nothing new here. 

Tue, 08/12/2014 - 10:16 | 5081558 SethDealer
SethDealer's picture

scumbag trail lawyers

Tue, 08/12/2014 - 10:20 | 5081586 ricky663
ricky663's picture

In Thailand, the courts act in a different modus operandi....

If you take someone to court, and you lose, you pay all legal fees, and a fine to the other side. This surely reduces frivolous lawsuits.

There are almost no lawyers here, and most of the legal posturing, and settlements occur in the local police station (between the two parties, on the day of the "infraction"). I have seen this with my own eyes, and it is very efficient and effective.

A huge amount of wealth is wasted (transmitted to legal "professionals") because of the US justice system.

Tue, 08/12/2014 - 10:27 | 5081617 Citxmech
Citxmech's picture

Loser pays (also in Alaska fwiw) also ensures that may smaller, justified, claims never see the light of day - especially if the aggrieved is poor. 

Tue, 08/12/2014 - 10:23 | 5081601 tmaynardr
tmaynardr's picture

This article is a great example of how a person can use statistics to prove an inaccurate position.  The article points to a study that relied upon data from 1991 until 2005.  Conveniently, a lot of states implemented tort reform in 2005 which renders the data completely useless, as the number of claims has drastically reduced since 2005.  It made filing a claim much more difficult, and also limits the amount of money a person can recover for damages.

For example, in Ohio, before the tort reform changes, a patient merely had to file a lawsuit against a doctor they felt committed malpractice.  To go to trial, a patient needed an independent physician to testify that the defendant-doctor failed to meet the appropriate standard of care and caused an injury to the patient.  However, by the time trial was reached, a defendant/insurance company could have spent $25,000+ to defend the lawsuit, only to leave the decision into the hands of a jury, which usually includes members of the public with a wide variance of intelligence, education, and experiences.  Thus, pre-trial settlement negotiations were common and payments were made without being presented to a jury.

However, after the tort reform act went into effect in 2003, a patient must now have the expert review the file *PRIOR* to making a claim.  A patient cannot file a lawsuit unless a reviewing physician writes an affidavit stating there is merit to the claim.  This has resulted in a significant reduction in medical malpractice claims in Ohio. For example, in the year 2012, Ohio had 2,733 claims, with only 576 claims resulting in payment.  Compare this to 2005, when there were 5,051 claims.

The real “malpractice” here is using irrelevant data to support a meritless position.  If the author analyzed post-2005 statistics correctly, he would find a great reduction in the number of claims made against physicians and hospitals.  Then, maybe, he could write an article about how insurance premiums remain high despite over a 50% reduction in the number of claims.  

Tue, 08/12/2014 - 10:24 | 5081608 flysofree
flysofree's picture

The basic premise of this article is wrong. Today's medical profession is not what it was in 1970s when doctors would order all sort of screening tests to cover themselves of potential liability claims. Medicine as practiced today is all about saving cost. Doctors are incentivized to limit access to health care!

ALL HMOs throw gate keepers at preventing patient access to specialists by requiring doctor referrals. Family doctors and General Practitioners along with nurses are dealing with medical issues they have no expertise in treating. This is the modern medical scandal and not frivolous malpractice suits.

Tue, 08/12/2014 - 10:35 | 5081654 SmackDaddy
SmackDaddy's picture

are you fucking kidding?  they have all these expensive instruments that are sunk costs.  the marginal cost of actually using them is comparitively nil.  so when you go they order every fucking test they can for and bill as much as they want.  im certainly not a fan of the additional costs imposed by the massive insurance bureaucracy, but i cant imagine going to the hospital and paying out of pocket without having a insurance company who normalizes the costs and rejects the bullshit...

Tue, 08/12/2014 - 11:20 | 5081922 dizzyfingers
dizzyfingers's picture

"...they order every fucking test they can for and bill as much as they want." 

 They order tests so that they won't land in court because they didn't order tests.

I'm not a fan of the US so-called-medical establishment, but rising costs of malpratice insurance in the 70s (costs of some policies rose 1000% or more--you can look that up), so the tests are additional "insurance"  for doctors.

Tue, 08/12/2014 - 11:04 | 5081829 boattrash
boattrash's picture

Do the math though. Now Dr. is covered by malpractice Insurance. A co-worker of mine w/ a dentist in the family said his Malp. Ins. was 220K per year. That's Aprx $1000 per day JUST for insurance, not building, equipment, staff Etc... 10 @ $100 per visit, just to pay Ins. This is a great example of the reason most Amaricans can't just walk in and pay for health care out of pocket. FFS, a common drill & fill would likely cost $20-40 if it wasn't for crap like this. Same w/medical costs.

Tue, 08/12/2014 - 15:53 | 5083379 MachoMan
MachoMan's picture

he needs to bid out his insurance and dramatically reduce his limits or quit coming in drunk to the job.  I get to see a lot of insurance costs for doctors across the practice spectrum and they're dramatically lower than you'd take away from a dinner party conversation.

Tue, 08/12/2014 - 18:03 | 5084230 boattrash
boattrash's picture

You may be right, I did not view any paperwork, or maybe he is in a state that mandates ass-raping, or maybe he chose to purchase insurance that would actually WORK if  it was ever needed.

I've had Healthcare Ins. that was bad enough, I'd have dragged an SOB across his desk and beaten him, had he been closer than the 24hr drive to do so.

You get what you pay for (sometimes)...and cheaper, isn't always better.

Tue, 08/12/2014 - 10:28 | 5081626 youngman
youngman's picture

This is one of th reasons I moved to Colombia...there are no lawyers fall down....its your fault....if you get in a car accident is settled in one hour.....who is at fault and who pays.....contracts here are simple and clean.....Lawyers have destroyed USA business....just look at any manual you get from some product you have just bought...its full of CYAs..dont do this or dont do that....yes there are millions of shyster lawyers out there that game the system..and that was not even looked at in Obamacare...not one tort reform in that law.....

Tue, 08/12/2014 - 10:35 | 5081666 RabbitOne
RabbitOne's picture

My best friend is a retired lawyer. He stated it best when he said (after a few beers) “…our problem is our legislatures. We allow lawyers to dominate the legal processes that produce lawyer biased legislation. So when a lawyer is done with the legislature they can practice with biased laws which favor the lawyers submitting fishing claims to garner fees. …A better way is to ban lawyers from public legislatures, except in an advisory capacity, to stop this corrupt practice of fishing claims. Instead layman legislators should be used to spot and eliminate the biases for lawyers fishing for claims…”


Tue, 08/12/2014 - 11:09 | 5081855 boattrash
boattrash's picture

Rabbit, sounds good. I don't think it'll work. The lawyers would just become lobbyists, buy the said legislators, and we would get the exact same result.

Tue, 08/12/2014 - 10:43 | 5081696 Toolshed
Toolshed's picture

"What can you say about a "healthcare" system in which 99% of all physicians will face a malpractice claim in their careers?"

Based on my experiences with "health care professionals" over the last few years, I am only surprised that the figure is not 100%. I am a big fan of 2 wheeled sports. Dirt bikes, street bikes, and mountain bikes have kept me in quite good condition for may age, however, the occasional off-bike excursion has benefitted the bank account of numerous medical entities. A recent incident that resulted in multiple broken ribs and a punctured lung nearly resulted in litigation between myself and a local hospital. After falling off my mountain bike, while riding alone in the woods, and quickly realizing, due to lots of personal experience, that I needed to get to an emergency room, I dragged my broken body to the closest ER. Now, I could have called for an ambulance, but I knew I could drive myself there faster, and save multiple thousands of dollars by doing so. When I arrived I was in excruciating pain, gasping for breath, and bleeding from numerous locations. I was also still wearing my bicycling attire. I immediately requested aid from the "reception guy" who was giving some people directions to a patient's room. He held up his hand to silence me and told me to wait my turn. He then finished giving directions and asked me what I wanted. I informed him of my accident and that I knew I had broken ribs and feared, based on my breathing difficulty, that I had punctured a lung. He was totally unconcerned, and requested ID and healthcare info. I was having trouble speaking by this time, and just handed him my wallet. He took my info and rolled me into a waiting area and said I would have to wait my turn to see someone. After a while, two people in scrubs walked by my wheelchair, and I pleaded with them to help me. They reponded by asking if I had "checked in". I told them I had, and they told me to wait my turn. This was in a ER on a Sunday afternoon. There was little activity and the only two others waiting were there to get presciptions filled, according to their conversation. I thought I would probably die in the wheelchair and make my heirs quite wealthy as a result. Fortunately, when they called the next patient, that kind woman said, "Take him, he is obviously severely injured". They took me in, pretty quickly recognized that I was indeed seriously injured and sprang into action.......finally. Pretty sad. If I had only spent $5,000.00 plus for the ambulance ride, I am sure things would have gone differently. Sue them everytime they screw up and eventually they will either go broke or provide better service. Pretty simple really. Or, give them unwarranted protection and watch healthcare costs continue to rise while healthcare service declines simultaneously, as it has for decades now.

Tue, 08/12/2014 - 11:42 | 5082012 I Write Code
I Write Code's picture

What you describe is just "da system", bad as it is that's barely even a candidate for malpractice.  A lot of that bad comes from being overloaded by freeloaders (including lots of illegal aliens).  Probably 50% or more of ER traffic should go to urgent care.  Probably 10% of it is people who aren't really sick.  I think every ER in the country loses money these days.

But I agree there is a TON of very real malpractice out there, and I cannot get too excited about needed *legal* reforms.   What is mostly needed is *medical* reform.  There *are* "death panels" out there and I watched them at work with both of my parents in their final days.  Yes Medicare reimbursements are cheap, but obviously the entire system is now constructed to be equally cheap, too cheap to provide good service.  And I could give a long list of borderline incompetence from my own contacts with the medical system.  If you observe closely I defy you to watch anyone in a hospital setting for twenty-four hours and NOT see actionable malpractice, and if anything less critical care doctors are probably worse.  Doctors bury most of their victims, but a few survive and have justified suits - and represent those who did not get to fight back.

In my father's last days I had a clear case of malpractice regarding his primary care physician - a guy that I had picked out, and who had been an excellent doctor - until his group merged with another.  Then the rules changed.  The whole office knew they'd screwed up royal, and multiple times.  I'm sure I could have picked up a quick $50k or more after contingency fees, but y'know, it wouldn't change anything and it wouldn't bring my father back.

Tue, 08/12/2014 - 15:57 | 5083405 MachoMan
MachoMan's picture

In my father's last days I had a clear case of malpractice regarding his primary care physician - a guy that I had picked out, and who had been an excellent doctor - until his group merged with another.  Then the rules changed.  The whole office knew they'd screwed up royal, and multiple times.  I'm sure I could have picked up a quick $50k or more after contingency fees, but y'know, it wouldn't change anything and it wouldn't bring my father back.

and the doctors thank you and will keep on fucking up.

Tue, 08/12/2014 - 10:50 | 5081752 youngman
youngman's picture

and the only two others waiting were there to get presciptions filled, according to their conversation


That says it all...going to the ER to get prescriptions can bet they did not have insurance..they should have been kicked more free healthcare....hard choices but it will work to bring costs down..

Tue, 08/12/2014 - 11:08 | 5081846 bg6666
bg6666's picture

Workman's Comp in Illinois is a big money maker for hospitals and some doctors, physical therapy etc. While most health insurance negotiate price for service, Worker's Comp in Illinois is full retail price. Of course, treatments include every test and therapy possible. Oops, then of course there's the lawyers looking for settlements. In Illinois if a pre-existing condition that is aggravated at the work place also counts as a workplace incident. A total fiasco.

Tue, 08/12/2014 - 11:24 | 5081941 FreeNewEnergy
FreeNewEnergy's picture

I have had no healthcare coverage for years and it's pretty weird. Well, life all around is weird these days.

I try to stay in pretty good shape - I'm 60 - ride my bike, work in the garden, lift occasionally and use a rowing machine to keep fit in the winter, but I figure I'm going to die of something sooner or later and any doctor is just going to prescribe pills, which I won't take, so flip them all off, they're worthless.

Point is, you live, you die. In between, you'll likely need some medical attention, but, it shouldn't cost you an arm and a leg (pun intended, see what I did there?). FICO scores are now going to exclude medical bills, which account for over 50% of all bankruptcies, IIRC, probably higher.

Nobody wants to die, but, surely, nobody wants ass-raping by doctors and lawyers, either. I'm old enough to remember when doctors made house calls and there wasn't an insurance company in between you and your physician. I say it was better that way, and we should just scrap all insurance, it's more of a nuisance than anything else. I don't have homeowner's on my primary residence, but unfortunately, I have to carry coverage on my car, but it's pretty cheap, primarily because I haven't had a claim, accident or ticket in almost 30 years.

In some ways, culling of the herd makes sense to me. Killing off the useless eaters would include all the scum on welfare, plus all the people who are supported by that system, then the lawyers, bankers, wankers, politicians and anybody who basically doesn't produce something of value. I suppose that's why Robin Williams offed himself. Can't be funny anymore, see ya! Makes sense on many levels.

Tue, 08/12/2014 - 11:39 | 5082020 MedicalQuack
MedicalQuack's picture

Myself and others have been warning for years about the use of data and profit making with proprietary "scoring".  Here's what's happening to doctors that see Medicare Advantage patients, getting "scored" out.

By the way they are using predictive analytics to determine jail sentences now too.  Like I said, people don't work that way and the public is being way oversold on analytics and their degree of accuracy. 

Here's another example of money making with credit card data if you want see the middleman and what they do as they take your credit card records and spin some analytics on them.

CMS at it big too with insurer quants getting the best of them too, modeled around the "risk" factor and managed for 5 years to charge Medicare $70 billion more.  It's all an algorithmic process to adjust the risk factors up and down for profit, just like the banks do.

Tue, 08/12/2014 - 11:40 | 5082026 DullKnife
DullKnife's picture

Yes, the USA justice system is a mess.

Due to corruption and incompetence, but mostly corruption.

As one who spent large sums of money, was in the legal right, and still lost, I can strongly advise that you should do your best to avoid the USA judicial system.

In my case, despite having a vastly stronger case, being in the right, Judge WhatDoICare could not be persuaded to judge on the merits of the case and just awarded all to my opponent.  Our Living Trust instructions were tossed into the trash can because the Judge was not interested enough to examine them.  Our opponent was caught falsifying court evidence and the Judge showed no concern.  You can have right on your side, and a good$$$$ lawyer, but without a decent Judge, the whole thing (lasting years due to crowded Court calender) is a farce.  

And another issue.  Why are lawyers worth $300 to $500 per hour?

And should one ever have to defend from a Government suit, one can be bankrupted as the Govt has unlimited funds and can sue you, not expecting to win a case, but they still win by bankrupting you.

And doesn't it bother anyone that when one is prosecuted by the Govt, it is in their Court system, by their people...a great temptation for corrupting the Judicial process.

People and Companies spend millions in the bigger cases.

And political hacks are made Judges and so are not impartial...but rule not by law but by political views.

Justice-wise, the USA is a 3rd World tinpot mess.


Tue, 08/12/2014 - 13:10 | 5082466 MachoMan
MachoMan's picture

In the event you have been accused of a crime or the victim of a civil matter that touches on your civil rights (e.g. police brutality), then an attorney will be appointed for you free of charge.  If you feel like an attorney charges too much, then don't hire them...  I don't think virtually any attorney is worth that much, but if he's making you $1,000/hr, then it's pretty hard to argue against...  just depends on the kind of case you have.

You've also managed to leave out the virtual entirety of the facts of your case...  let us know the venue and case number and we'll judge for ourselves.

Tue, 08/12/2014 - 11:46 | 5082052 El Vaquero
El Vaquero's picture

Yes, the system is insane.  It wants people to settle, even when they shouldn't.  I've been through it without an attorney and have come out unscathed, against a bank no less.  If the system pushed towards more trials and making those who have frivolous claims pay the other side's legal fees, the system would be crushed by the volume for a few years.  But that is what would need to happen to fix it.  Making it less complex would help with those who cannot afford an attorney.  I was able to learn the rules and use the rules to my advantage.  Most think that they can just go in and tell a sob story without ever even understanding that there are rules, and they get hammered.  But go in and ask for help with the rules and you won't get shit, except a statement that there is such a thing as discovery, or your document *looks* good in its format.  To give such advice is practicing law without a license.  It's an adversarial system, which half way makes me want to be a lawyer so that I can go in and beat up on other lawyers.


State rules mirror federal rules when it comes to civil procedure:


(a) Making an Offer; Judgment on an Accepted Offer. At least 14 days before the date set for trial, a party defending against a claim may serve on an opposing party an offer to allow judgment on specified terms, with the costs then accrued. If, within 14 days after being served, the opposing party serves written notice accepting the offer, either party may then file the offer and notice of acceptance, plus proof of service. The clerk must then enter judgment.

(b) Unaccepted Offer. An unaccepted offer is considered withdrawn, but it does not preclude a later offer. Evidence of an unaccepted offer is not admissible except in a proceeding to determine costs.

(c) Offer After Liability is Determined. When one party's liability to another has been determined but the extent of liability remains to be determined by further proceedings, the party held liable may make an offer of judgment. It must be served within a reasonable time—but at least 14 days—before the date set for a hearing to determine the extent of liability.

(d) Paying Costs After an Unaccepted Offer. If the judgment that the offeree finally obtains is not more favorable than the unaccepted offer, the offeree must pay the costs incurred after the offer was made.

When I say the courts want people to settle, I mean it is in the rules.  Fuck that.  If you're going to have an adversarial system, have an outright adversarial system, and go to trial, BITCHEZ!  If people had to flop it all out for the world to see, a lot of the frivolous shit would go away.

Tue, 08/12/2014 - 12:14 | 5082188 KingFiat
KingFiat's picture

The best way to avoid legal fishing expeditions and other frivolous claims is to let the loosing side pay all court expenses and lawyer's fees, unless it can be shown that the loosing side had probable cause to expect he would prevail in court.

This is how it is done in Denmark, where I live, and we do not see all these frivolous claims here.

In civil cases the courts here also try to make the parties settle amicably, which I think is a good thing in civil cases (when both parties know the loosing side has to pay all court expenses and lawyer's fees). But not in criminal cases, where settlements are extremely rare. This avoids the many problems with plea bargains seen in the US criminal court system.


Tue, 08/12/2014 - 12:23 | 5082229 El Vaquero
El Vaquero's picture

Lacking probable cause is the same as a frivolous claim.  I would not initiate a lawsuit unless there was a chance that I could win at trial or via summary judgment without going through discovery.  That's not to say that I wouldn't use discovery, I just wouldn't rely on it 100%.  If you ever see me suing a cop for a civil rights violation, you can pretty much bet that I will have that shit on video.  

Tue, 08/12/2014 - 13:04 | 5082438 MachoMan
MachoMan's picture


We chose a different system than the English...  our philosophy is that we would rather deal with frivolous claims than to bar the poor from access to the courts or to negatively incentivize marginal cases...  Further, awarding attorneys' fees to the victor is the norm in contract cases and many other causes of action...  just not torts.

Tue, 08/12/2014 - 14:00 | 5082739 KingFiat
KingFiat's picture

You can have any system you want. I would not like to impose something upon you that you do not like. All I can do is to tell you how it is done elsewhere, so you can make more informed decisions.

As for barring the poor from access to the court system, I do not think it is happening here. Here are the two most important reasons: Even if you loose a court case and have all court and lawyer costs awarded against you, you don't have to pay if you do not have the money. Instead you owe it until you get the money, and an interest on the debt similar to the interest on most US credit cards. The second reason is what we call "free process". This means that if your income is less than about USD 60k, the state will pay you the cost of your lawyer, even if you loose the case.

Last time I was involved in a civil court case almost 20 years ago my income was low, so I got "free process". The court heard the case, and the judge said: "If I rule on this case, my ruling will be X, but I prefer you to settle, and give you 30 days to do so". X was what I initially proposed to the other side for an amicably settlement before both sides got involved with lawyers and went to court. We ended up settling the case on these terms. The other side knew that if he refused, he would be required to pay all court costs and the cost of my lawyer. Because of the settlement he only had to pay his own lawyer and the court costs (because he was the plaintiff).

Tue, 08/12/2014 - 16:03 | 5083436 MachoMan
MachoMan's picture

You can have any system you want. I would not like to impose something upon you that you do not like. All I can do is to tell you how it is done elsewhere, so you can make more informed decisions.

Yes, and what I'm saying is that we know and chose something different.  Each system has its own costs and benefits.  All things considered, we chose this one.  That is not to say that it should never be changed, but if it is to be changed, then we have to at least address the philosophies underpinning why we made the decision in the first place.  Instead, all we get is a high profile instance -> crisis -> solution mentality (or more accurately, a powerful lobby) that chips away at the system's foundation, until there is no longer any consistent philosophical underpinning, leading to a broken system.

Tue, 08/12/2014 - 12:13 | 5082187 FrankIvy
FrankIvy's picture

"how can 99% of . . . high-risk specialists practice worse medicine than average? It's mathematically impossible."

Mathing is hard, to be sure,  but if this Doc's idea of "mathematical impossibility" is representative of all doctors out there, it, by itself, explains why they keep getting sued.

For you english majors, the reason that this is such a stupid comment is because a doctor only has to have a bad day one time.

It's equivalent to saying, "it's matematically impossible that 99% of baseball players have a game where they bat below average."

It's assinine, and, frankly, as much as I believe that tort reform needs to happen ASAP, the quality of medicine in this country is garbage and, while many of these lawsuits are unsupportable, many are not, and are based on truly bad doctoring.

Tue, 08/12/2014 - 12:19 | 5082215 MachoMan
MachoMan's picture
I can anticipate that some within the legal profession will say that the low cost of making claims and accusations is worth the corrosive cost and stress of dealing with bogus claims and baseless accusations because it enables the poor and powerless to seek redress. I find this argument mostly meritless based on two points:
1. How can anyone defend a system as fair, just and cost-effective when 99% of all physicians dealing with serious cases end up being accused of malpractice? It would take about 30 seconds to come up with a lower-cost, more just and effective system than what passes for "justice" in America.   2. The vast majority of poor people don't end up having their day in court because that day in court is as absurdly expensive as sickcare. "Justice" in America goes more or less to the highest bidder, outside of propaganda-type Hollywood films.Legal services are extremely expensive and mostly paid in cash, so only the wealthy can afford legal representation or advice.
We would be remiss not to mention the other factor in malpractice, which is unrealistic expectations of medical science and practitioners. Yes, there are some incompetent doctors who should no longer be allowed to practice medicine. But there are many other factors to consider, for example, those doctors who take on the most hopeless, difficult cases are the ones whose "track record" will appear less than stellar.

Yes, there are legitimate cases of malpractice, and legitimate claims that end up being argued in court. But any system that accuses 99% of its practitioners of gross incompetence is deeply flawed, rife with injustice and bloated by needless waste and stress.

As to your first premise, you realize that the entirety of med mal claims (and torts in general) are taken on a contingency fee basis, right?  The vast majority of people never see a day in court (something like less than 3% of cases), but it's not because they're too poor to get a day in court.  I'm sorry, but if you had done even a rudimentary review of this issue, you would know that...

As to your second premise, you realize that practicing medicine is similar to a basketball player in that not every shot goes in the hoop, right?  If you practice for decades, under incredible stress from administrators to see an ungodly number of patients an hour or to be so productive, then isn't it reasonable to expect at some point along the way that you're going to screw up?  In that case, it's time to pay for your mistake.

Further, you act as though there is some objective way to determine the facts of the case prior to filing a lawsuit.  That's not how the process works...  Two people can each reasonably have different opinions as to how an event transpired.  You have a factual dispute.  Whether something is merely incompetence or gross incompetence is for the trier of fact, and if you bring a suit and you're wrong, then you've wasted a shit ton of money...  or, rather, your lawyer has.  This tends to weed out the trash by the way...

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