# Do you ride/race uninsured? ie. Medical/Health Insurance?



## mike5krnr (Sep 14, 2004)

I got laid off in mid January, COBRA coverage was too expensive to carry so currently I am without health insurance.I still ride but, try to be careful and not take any chances to crash and break something..Anybody else in the same situation? btw, I am in N. California. Any "one day" or "race day" coverage you have found?


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## Mellow Yellow (Sep 5, 2003)

when I've been uninsured in my past, one of the first things that I cut back was the amount of mountain bike riding I did. I couldn't afford to miss out on what ever little bit of work I could find PLUS have medical bills; all from a bike accident. If I did ride, it was at some very vanilla/wheelchair friendly trails.


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## 007 (Jun 16, 2005)

No chance I would risk it. I would stick to the fireroads and be very very careful. If you crack your noggin' hard enough to get an actual brain injury, you are looking at possible HUNDREDS of thousands in medical bills.

I work in a hospital . . . I have seen people go bankrupt (literally) from medical bills due to lack of insurance.


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## Restricted (Jun 11, 2011)

I'm unemployed also. Ending up in the hospital with no way to pay for it crosses my mind. Scares the hell out of me.


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## pointerDixie214 (Feb 10, 2009)

No way would I ride if I wasn't insured. Completely NOT worth it at all IMO.


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## spsoon (Jul 28, 2008)

The #1 cause of personal bankruptcy in the US is medical bills.


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## bikepackingdude (Mar 25, 2010)

I don't have insurance and I ride the same as I did when I had it. I figure what the hell man you only live once!!!!


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## Daemon[CRO] (Jul 14, 2010)

Ah, USA, gotta love you guys 

Medical bills? What's that? 

With that said, I do have full life insurance covering small injuries, disabled states and death. Whatever happens to me, I get percentage of insured amount. Insured amount is approx 40.000$. In the event of "small" injury (fractured bone) I get about 5%. It climbs up depending on severity, disabled (cannot walk) is 100%, quadriplegic is 200%, death is 400% to my parents (still do not have wife). 

And since there are no medical bills, this is pure cash. 

God I love Europe.


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## sooner518 (Aug 1, 2007)

i went about 4 months without and didnt take as many chances when I had no insurance. not worth it to have tens of thousands of medical bills because you took a dumb chance without insurance.


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## 007 (Jun 16, 2005)

bikepackingdude said:


> I don't have insurance and I ride the same as I did when I had it. I figure what the hell man you only live once!!!!


Not trying to single you out in particular, but herein lies the problem . . . guess who gets to pay your medical bills? Everyone else. Through tax hikes, rising insurance premiums and skyrocketing medical costs.


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## nikojan (Jun 18, 2011)

OO7 said:


> Not trying to single you out in particular, but herein lies the problem . . . guess who gets to pay your medical bills? Everyone else. Through tax hikes, rising insurance premiums and skyrocketing medical costs.


Right, lets isolate that one case of a reckless young man and assume that it applies to everyone. It also covers children coming from poor families, yet you didn't bother to mention that scenario...

Anyways, I wouldn't take the risk even if I lived in the US. Every time I've gone out I've gotten hurt, not seriously but for the most part it's been luck that saved my ass and not skill.


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## jimbowho (Dec 16, 2009)

*No Ins.*

Looks like I'm going with BIKEPACKINGDUDE. I got old. My Insurance co Kieser! Now wanted 801.00 a month. They can suck the juice out of my riding socks.

Now if I wodd it up big! I will have to go to county in San Bernadino.

My Buddy Shawn got a cortizone shot in the shoulder ((10.000)) They said they had to put him under so he wouldn't move. PAAAleeeezzz. I got one in the knee, Dr. said hold still.

I don't believe the problem is from guys like Bikepack & Me! The problem is the greed, Lawyers, Moochers, Deadbeats, illegal people. The medical industry is corrupt IMO.

I'm not hiding under a bush! There's rattlers in there. Thanks to gross overcharging, I will be forced to roll the dice.

I haven't posted in months!! That felt good. Ride safe people


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## Anonymous (Mar 3, 2005)

I've never had insurance in my life. Manage your money wisely and you can afford to pay your own bills. I crashed and broke my hip a year ago. As soon as they found out I was paying cash, they cut my bill in half. It wasn't fun, but the bill got paid. Insurance is a scam.


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## mtbSmith (Jul 17, 2006)

I'm glad most of you recognize that riding without insurance is not a good idea but I think the OP was also asking if there's any "short term" insurance that would cover him for a race.

Not in the same boat, but was kinda curious myself.


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## formica (Jul 4, 2004)

I still remember being a race medic at a Nationals DH race. Guy wrecks, has to be back boarded off the course and then helicoptered off the mountain with a head injury. The girlfriend is sobbing, "but he doesn't have insurance" . I am surprised they'd let someone race DH without it but whatever.


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## WickedGood (Aug 19, 2008)

I'm riding the unemployment bandwagon ride now with no insurance and I still ride 3-4 days a week with no insurance. I ended up at the hospital a few weeks ago after a wreck and needed some stitches. I will be giving them 10 dollars a month for the rest of my life.

There are short term insurance plans out there. When I was fresh out of college I was uninsured for about a year and I took a week long horseback training camp down in FL. I had to have insurance for the week. It was basically a disaster plan and it set me back about 80 bucks for the week if I remember correctly.


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## scout (Jul 12, 2006)

Just picked up 30 days of short term for my entire family (wife, 2 kiddos), $150. Between jobs, worth the peace of mind while riding in my opinion


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## JSumner13 (Apr 26, 2006)

There was a 4 month period about 5 years ago that I was laid off and didn't have health insurance. I did continue to ride as usual but certainly thought twice about hitting anything I wasn't completely confident doing.


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## Adam_B. (Apr 7, 2011)

I'm in the Army so I am fully covered. However if an accident is severe enough they will have to make a decision as to whether it was in the line of duty or not. Which could be bad if they determined it was wrecklessness or negligence on my part. A friend of mine had an real bad accident on a 4wheeler and had to fight to have his medical bills covered. So that weighs on my mind a lot. Also being injured has a certain stigma and people tend to look at you like a dirtbag because of all the people that malinger and fake injuries to get out of stuff and sometimes out of the Army. I consider that as well. All that being said most of the time my competitiveness and need to progress in everything I do outweighs my best judgement and I go too hard.


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## rockerc (Nov 22, 2010)

When I started riding over here I took out a short term 6 month policy that had I think a 3500 buck deductible. The cost was around 260 per month. I am a 55 yr old in good health with no medical history. Now I have a more comprehensive policy that costs me just over 330 per month, with the same deductible. If I did not have that deductible, the premiums would be a bit silly. I would certainly not want to chance it without insurance here in the US, I am a brit and used to the imperfections of the National Health Service there. At least there you do not have to pay thru the nose for treatment. With all its imperfections, it makes sense to me, and the thought of people being bankrupted to pay medical bills is barbaric to my mind. As a previous poster said, there is much that is rotten in the medical and drug communities here.


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## IronTom (Jun 14, 2010)

jimbowho said:


> Looks like I'm going with BIKEPACKINGDUDE. I got old. My Insurance co Kieser! Now wanted 801.00 a month. They can suck the juice out of my riding socks.
> 
> Now if I wodd it up big! I will have to go to county in San Bernadino.
> 
> ...


Quoted for truth.

Putting my vote in a ballot box isn't going to change anything, but where I put my dollars will.

How many people here are paying for insurance, but don't wear any pads when they ride? I'm sure there are things about the industry I don't know, but could the reason insurance be so high is so many people are getting treated for things that could have been prevented or are flat out unnecessary?

Accidents happen, that's what I do with the money that I save not paying premiums. Bad accidents happen to, that's what death & dismemberment insurance is for.


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## techfersure (Dec 17, 2010)

Inevitably you will sustain an injury requiring medical attention,not having insurance can and will effect your confidence to step it up,not that you should be over confident because you do,but to be free from anxiety because you don't,look at it as back up to cover expenses and down time so when you do come back your not burdened by financial dept which can effect your confidence and the freedom to ride free!


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## monzie (Aug 5, 2009)

I ride uninsured. I can"t afford insurance and when I had a job my boss dicked me out of coverage. I haven't had insurance since I was too old to be on my biological father's military insurance at sixteen; I'm 26. I don't really think about it anymore. I have the mindset if something happens I'll deal with it then. Not the best way to go about things but that's how I roll.


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## richde (Jun 8, 2004)

jimbowho said:


> Looks like I'm going with BIKEPACKINGDUDE. I got old. My Insurance co Kieser! Now wanted 801.00 a month. They can suck the juice out of my riding socks.
> 
> Now if I wodd it up big! I will have to go to county in San Bernadino.
> 
> ...





IronTom said:


> Quoted for truth.
> 
> Putting my vote in a ballot box isn't going to change anything, but where I put my dollars will.
> 
> ...


You guys are both barking up the wrong tree.

Going without insurance in itself is a huge gamble...especially when you consider that anything that might happen while you're uninsured could be considered a pre-existing condition that will haunt you until you're old enough for Medicare.

Retired military over here, I can haz peice of mind?


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## JakeCB (Jul 11, 2011)

mike5krnr said:


> I got laid off in mid January, COBRA coverage was too expensive to carry so currently I am without health insurance.I still ride but, try to be careful and not take any chances to crash and break something..Anybody else in the same situation? btw, I am in N. California. Any "one day" or "race day" coverage you have found?


I know of no one day or race day coverage though I'm pretty sure if you are racing tri (Xterra) you are covered to a certain level with a USAT license.

My two cents, get yourself a high deductible insurance. Even if the deductible is 7.5K to 10K it is better then nothing at all.


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## JakeCB (Jul 11, 2011)

OO7 said:


> Not trying to single you out in particular, but herein lies the problem . . . guess who gets to pay your medical bills? Everyone else. Through tax hikes, rising insurance premiums and skyrocketing medical costs.


Or maybe people who have employer coverage are the problem. The reality is if most people were not covered by their employer but instead had to pay out of pocket themselves they wouldn't abuse the system by going to the doctor's office, or worse yet the emergency room when they get a headache. In many ways skyrocketing costs are due to American's being clueless as to what the true costs are.


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## IronTom (Jun 14, 2010)

richde said:


> You guys are both barking up the wrong tree.
> 
> Going without insurance in itself is a huge gamble...especially when you consider that anything that might happen while you're uninsured could be considered a pre-existing condition that will haunt you until you're old enough for Medicare.
> 
> Retired military over here, I can haz peice of mind?


That point has already come and gone. There has already been a lapse in my insurance coverage. Not of my doing, but my choice in not fixing it too.

I've seen too many peoples insurance companies not pay things that were definitely not pre-existing. The usual excuse is the persons chosen doctor (who was the only one near by and in the network) is charging to much for given procedure and will not be covered.

I hope I don't need Medicare either... Maybe I'm just "young and invincible" even though I"m mid 30's.

Back to the thread topic. I'm not insured, obviously. I also don't ride any shore style log bridges or do 8' drops either. My average speed is probably 8mph on a good day...


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## Mendosa (Jul 18, 2011)

Interesting question. I guess I just take my insurance for granted, it never crossed my mind for those that dont have it.


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## richde (Jun 8, 2004)

JakeCB said:


> Or maybe people who have employer coverage are the problem. The reality is if most people were not covered by their employer but instead had to pay out of pocket themselves they wouldn't abuse the system by going to the doctor's office, or worse yet the emergency room when they get a headache. In many ways skyrocketing costs are due to American's being clueless as to what the true costs are.


It's because people without insurance wait until they can't wait anymore and go to the emergency room for a very serious condition that could have been preventable. They can't pay, so the costs get shifted to people with insurance. Insurance rates go up so people lose/can't afford coverage, then they try to ignore a medical condition and wait until they can't wait anymore.....

Rinse and repeat.

But I'm sure that if we keep plugging away and not changing anything, we can get this whole private health insurance thing fixed.


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## SkaredShtles (May 13, 2007)

Look at catastrophic plans. And save some money for the non-catastrophic injuries.


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## DWill (Aug 24, 2010)

March 31st this year was the one day I didn't have insurance. I didn't have it that one day because I was a dumb ass and failed to read the calendar. 

Stopped my insurance on Mar. 30 by request to start a new policy with a different company on April 1. Failed to remember there are 31 days March. One day no insurance. 

March 31 I fell and ended up in a ambulance and in the ER with a very bad concussion. 

Total bill $15k. Took maybe 3 weeks for all the bills to come in. 
A few phone calls later the total bill was $7,500. I made arrangement to pay $5.00/month because that was all I could pay. 

Fast forward to July 5th. The bill is reduced to $3,500 (which is probably near what it should have been in the first place; insurance or not). 

I wrote the check this past Monday and paid it off.
Now I'm working on getting all the follow up care charges reduced, that's in addition to the $15k from Mar. 31. 

My new insurance decided that they didn't have to pay for the follow up care because it was a pre-existing (by less than 10 hours) condition. 

The medical and insurance industry is a rip off. The right hand steals from the left and each rewards the other for doing it. We pay for it. 

I've since canceled my new policy and put some money in a money market account that is now my own personal medical insurance plan.


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## jeffw-13 (Apr 30, 2008)

Ive read on here about people with insurance having claims denied because dangerous activities like mountain biking are not covered.

Read your policy, people


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## bikepackingdude (Mar 25, 2010)

Never said I didnt pay for my injurys. Because I do and the hostpital will usually offer a discounted amount and its only a couple hundred dollars more than what I would have paid if I had insurance.


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## PretendGentleman (May 24, 2011)

I have saved gobs of money by having my wilderness first responder certification training. My certification is expired, but I still remember all of the important stuff except for high altitude, which I will relearn if I go to high altitudes.

bmx dirt jump crash, fall from ~12' at ~25mph, feet blow out, ass hits ground. Instruct friend how to clear spine, save $3000 plus in ambulance, emergency, x-ray costs

long board crash at ~25mph, hit face, lose consciousness, skin up side of body, instruct friend how to clear spine, monitor for head injury complications, then wash and ice ice ice save: $3000....

cargo bike crash at ~35mph hit forehead but wearing helmet, skin up body, no loss of consciousness, deep deep road rash, know how to clean and prevent infection: save $1000 for not having to go to emergency room for antibiotic shot.

head injury, head injury, head injury....knowing how to monitor for complications, save:3x$1000 for a trip to emergency room and have them monitor me.

So a week long $500 course has saved me $13k+
and it was super fun too!

now I have health insurance, but I don't like doctors so I continue to treat myself when doing so seems reasonable.

oh yeah and never forget, ice is like magic. 20 minutes on, then 20 minutes off, repeat for as much as you can in 24 hrs, monitor for hypothermia (or stop earlier for less severe injuries)


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## fireball_jones (Mar 29, 2009)

jeffw-13 said:


> Ive read on here about people with insurance having claims denied because dangerous activities like mountain biking are not covered.
> 
> Read your policy, people


Yeah, if you ever get airlifted out of the woods, remember, you tripped on a bicycle while you were out for a hike.

I rode without insurance for two years. Having broken many bones doing silly things that one would not expect to break a bone doing, I figured that statistically I was no worse off riding my bike than I was walking down the street, so why not go for a ride.


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## Spinning Lizard (Nov 27, 2009)

I am in my 40's with no insurance and without for my kids. I want it but cannot afford it. Started out 2 years ago paying $175 per month ($10,000 deductible) last year it went to $275 and this year up to $410. never used it but the premuims just kept going up. Had to stop paying, lets see eat or have insurance. Not a tough choice, if i wreck, so be it.


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## nikojan (Jun 18, 2011)

PretendGentleman said:


> I have saved gobs of money by having my wilderness first responder certification training. My certification is expired, but I still remember all of the important stuff except for high altitude, which I will relearn if I go to high altitudes.
> 
> bmx dirt jump crash, fall from ~12' at ~25mph, feet blow out, ass hits ground. Instruct friend how to clear spine, save $3000 plus in ambulance, emergency, x-ray costs
> 
> ...


Thanks for that last little bit, I'll have to try it next time I wreck


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## crump582 (Apr 8, 2010)

JakeCB said:


> Or maybe people who have employer coverage are the problem. The reality is if most people were not covered by their employer but instead had to pay out of pocket themselves they wouldn't abuse the system by going to the doctor's office, or worse yet the emergency room when they get a headache. In many ways skyrocketing costs are due to American's being clueless as to what the true costs are.


Dude... I work for the state... if I go to the ER for a "headache" like you mentioned it's a $100 headache PLUS whatever my portion of the treatment is. $100 gets me through the door.

I had a kidney stone last year... the ER visit and treatment cost me $600 out of pocket. (I would have paid whatever they asked me to at that point BTW)

Don't blame the working man that pays for insurance for the problem... PLEASE.


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## krjr13 (May 2, 2010)

*whats insurance?*

I've had insurance for one day of my life! I was traveling and had to rent a bike so I got the insurance!


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## dirtdan (Jun 27, 2011)

Daemon[CRO] said:


> Ah, USA, gotta love you guys
> 
> Medical bills? What's that?
> 
> ...


I'm not a fan of countries going bankrupt, but hey, if that's what you're into it's great that you live in Europe. The US is working hard at getting there too though so we'll be right behind you.


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## dirtdan (Jun 27, 2011)

I quit riding altogether when I lost insurance. Now I'd still continue to ride if I lost it again, but I'd stick with very low risk rides. Biking is too healthy of an activity to cut out of the routine again, both mentally and physically.


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## B-Mac (Oct 2, 2008)

spsoon said:


> The #1 cause of personal bankruptcy in the US is medical bills.


Not trying to jump on you, but that statement is not true.

The number one cause of personal bankruptcy is credit card debt, by a HUGE margin.

How do I know? I'm a bankruptcy attorney (primarily). I've been doing bankruptcy cases for people and businesses since 2004. I've filed many thousands of bankruptcies. I've met with more clients seeking bankrutpcy representation than cases I've filed by a factor of 2(ish). In my time, I've seen less than 100 cases (guesstimation off the top of my head) which were purely medical. Less than 3% of the total number of cases I've filed were due to significant medical debt.

I think the statement you just repeated was manufactured during the recent political debate surrounding the health care bill. Allow me to assure you, as someone who does this for a living, it is pure, unadulterated BS manufactured out of thin air by politicians for solely political reasons and repeated by toady-esque figures in the media who routinely report "facts" whose truth they are too lazy to investigate.

Sorry for the brief hijack - I wouldn't ride without health insurance either. Nothing in the foregoing should be interpreted as implying that large medical debt won't cause you to file bankruptcy.


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## bamwa (Mar 15, 2010)

started riding maybe 24 months ago, learning curve, clipless, three xc race seasons, many six hours, syllamo's revenge and everything. My only health insurance is my helmet, $10 elbow and knee pads from play it again sports, and learning how to roll again.
American Indians didn't have no stinkin' health insurance.

(Insert jokes here,I'll start...)

American Indians didn't ride mtn bikes. or.
And you know what happened to them. or
You've got more kielbasa in your blood than any Indian I know.


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## trentpaulk (Jan 22, 2010)

SkaredShtles said:


> Look at catastrophic plans. And save some money for the non-catastrophic injuries.


That was a completely useless post.


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## pspwesty (Feb 27, 2006)

Look online for policies. When I was laid off years back I got a policy from a national company using one of the online insurance brokers. I picked a plan based on what I could afford. Cost was reasonable for the plan I picked.


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## 96p993 (May 21, 2011)

B-Mac said:


> Not trying to jump on you, but that statement is not true.
> 
> The number one cause of personal bankruptcy is credit card debt, by a HUGE margin.
> 
> ...


http://www.google.com/search?q=numb...s=org.mozilla:en-US:official&client=firefox-a

Google might just disagree with you...


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## Boyonabyke (Sep 5, 2007)

sooner518 said:


> i went about 4 months without and didnt take as many chances when I had no insurance. not worth it to have tens of thousands of medical bills because you took a dumb chance without insurance.


I don't understand, I don't take dumb chances with or without insurance... What is up with that? Does having insurance allow you to do dumb things?


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## onbelaydave (May 10, 2006)

I've been self employed since '84 and unemployed for the past 2 years.

Health insurance is not affordable to the common man, but that has never stopped me from MTB 'g, Rockclimbing, SCUBA diving , Hang Gliding to the extreme limit of my abilities for the past 38 yrs.

"If" I get hurt and need to go to the emergency room, at least it was because I was doing something I love, and not just sitting on a couch, 200lbs overweight, diabetic and a heart attack waiting to happen and whining that I don't have insurance.

Until the US joins 90% of the other modern countries on the planet and offers "free" health care, which should be a mandate, (except for the insurance lobbyists), I'm going to have to continue my activities "naked".


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## singlesprocket (Jun 9, 2004)

wow that's tough, in ontario i'm not to badly covered. works picks up the rest...


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## sayzawn (Jul 15, 2011)

I'm my own insurance company


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## bear (Feb 3, 2004)

Has anyone (that is an IMBA member) used their affiliated insurance?

http://www.adventureadvocates.com/imba/select-plan

I'm thinking about getting it as supplemental just for the reasons stated above - many of the standard insurance providers won't pay-up for "inherently dangerous" activities.

Like walking in the woods.


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## rockerc (Nov 22, 2010)

danhasdrums said:


> I'm not a fan of countries going bankrupt, but hey, if that's what you're into it's great that you live in Europe. The US is working hard at getting there too though so we'll be right behind you.


Bankruptcy is not just limited to European countries, take a look at the current financial crisis over here. As for the US working hard to get there too, unfortunately too many self-serving nut-buckets are actively working against these plans for there to be too much progress in that direction. It is a start though, and I really hope that sense prevails, and lessons are taken from other models to try and establish the fairest system that takes the good parts, and leaves greed and inefficiency behind... call me naive...


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## dirtdan (Jun 27, 2011)

rockerc said:


> Bankruptcy is not just limited to European countries, take a look at the current financial crisis over here. As for the US working hard to get there too, unfortunately too many self-serving nut-buckets are actively working against these plans for there to be too much progress in that direction. It is a start though, and I really hope that sense prevails, and lessons are taken from other models to try and establish the fairest system that takes the good parts, and leaves greed and inefficiency behind... call me naive...


Inefficiency is an absolute must as you will never live in the most efficient system. Eliminating greed is also an impossible task as it's a basic human emotion that you can't regulate away. In terms of sense prevailing, it all boils down to personal property and the protection of that. The more those lines are blurred and crossed, the easier it is for the greediest of people to put themselves in position to take advantage of that, and that's been happening for nearly a century now in the US.
What is your idea/model of the fairest and most common sense model? I lean towards the US constitution, minus the slavery (obviously).


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## PretendGentleman (May 24, 2011)

nikojan said:


> Thanks for that last little bit, I'll have to try it next time I wreck


fantastic! and you don't need a barrier between the ice and your skin. a plastic bag to control moisture is the most you would want (unless you have broken skin, then you need a barrier for infection, though tap water tends to be reasonably clean unless you have a compromised immune system or live in a tiny town.

growing up whenever my mother would ice an injury, she would always wrap the ice in a towel. consquently it didn't shock me that much to have it up against my skin. also, it probably didn't do much good, as the towel insulated some of my body's heat loss.

I try to keep frozen fruit or veggies in my fridge for this purpose.


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## jimbowho (Dec 16, 2009)

trentpaulk said:


> That was a completely useless post.


Do you have Tourette's ?


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## spsoon (Jul 28, 2008)

B-Mac said:


> Not trying to jump on you, but that statement is not true.
> 
> The number one cause of personal bankruptcy is credit card debt, by a HUGE margin.
> 
> ...


I don't doubt your personal experience, but it may not be representative. I don't think it is just media hype. Here is a Harvard study for example:
http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm

Also worth noting that middle class chumps that did have insurance were only marginally better off, thanks to loopholes and myriad other ways insurance companies have to screw you over. The US healthcare system is really a mess


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## bear (Feb 3, 2004)

spsoon said:


> The US healthcare system is really a mess


Not from the perspective of the legistators or insurance companies, they seem to be doing just fine.

( disclaimer: I'm a MTB goober who is probably too desperately in need of riding to ever stop just for lack of insurance. Maybe stop going to Diablo though. )


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## mattjhz (Jan 4, 2011)

*opps*

so this is fitting that i sit here typing away with my 6th rib fractured and my rotator cuff completely demolished. at last glance at my gps i was doing a lil under 30 mph before i came to a complete and devastating stop. next thing i know my 5"2 girlfriend is saying" oh come on get up"( whom is a runner i recently converted to the dark side). so my ego got me up and back on my wheels.. i felt fine lil blood never hurt anyone and besides crusty scabs and pink flesh look awesome...right? hell no ..next morning (luckily i had 2 days off) i could barely get out of bed. so finally i roll out of bed and into the car with my 5"2 n of a girlfiend waiting and she takes me off to her work.. an mri xray imaging center(SCORE!!!) so i hop on the table and they give me the bad news... honestly i was scared like a studdering, shy 2 nd gradder in his first school play.. whose paying the child support? the mortage? my sour patch kids habbit? no one but me !! i have no health insurance but a decent job which ill show up too and make this 4-6 week injury probably last 6 months with the amount of lifting i do.. its been about a week since my wreck and i still have to duct tape my shoulder in place so it stops poping out and the same with the ribs. so moral of this story is that though its cool and feels awesome to ride the most gnarlyiest single tracks in north east pennsylvania.. be smart or keep your bike on the rack:madman:


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## PretendGentleman (May 24, 2011)

mattjhz said:


> so this is fitting that i sit here typing away with my 6th rib fractured and my rotator cuff completely demolished. at last glance at my gps i was doing a lil under 30 mph before i came to a complete and devastating stop. next thing i know my 5"2 girlfriend is saying" oh come on get up"( whom is a runner i recently converted to the dark side). so my ego got me up and back on my wheels.. i felt fine lil blood never hurt anyone and besides crusty scabs and pink flesh look awesome...right? hell no ..next morning (luckily i had 2 days off) i could barely get out of bed. so finally i roll out of bed and into the car with my 5"2 demon of a girlfiend waiting and she takes me off to her work.. an mri xray imaging center(SCORE!!!) so i hop on the table and they give me the bad news... honestly i was scared like a studdering, shy 2 nd gradder in his first school play.. whose paying the child support? the mortage? my sour patch kids habbit? no one but me !! i have no health insurance but a decent job which ill show up too and make this 4-6 week injury probably last 6 months with the amount of lifting i do.. its been about a week since my wreck and i still have to duct tape my shoulder in place so it stops poping out and the same with the ribs. so moral of this story is that though its cool and feels awesome to ride the most gnarlyiest single tracks in north east pennsylvania.. be smart or keep your bike on the rack:madman:


rotator cuff injuries suck. I'm luck enough just to just have both separated shoulders. Who would have thought that 5 severed ligaments are less of a problem than a few torn muscles?

good luck recovering.


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## Anonymous (Mar 3, 2005)

Insurance is a scam. If you buy insurance, you either are admitting that you can't manage your own money, or that it's ok for somebody else to pay your bills.
I just had a hip replacement. As soon as the hospital found out I was paying my own bill, they cut it in half. They didn't have to pay anyone to process mt claim, or to do the follow up with the insurance company. Also, I haggled with them about the $14 tylenol and the $1300 to have someone other than my doctor come in and look at my x-rays.
As far as I'm concerned, the health care system in this country is second to none. I love it. If I had a problem with it, I'd stand up on my own two legs, like a real human being and solve my own problem. I would rather die a long slow death, before I ever did anything as cowardly and pathetic as to use government to force you to solve my problem.

flame away


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## scmtbiker (Jan 11, 2007)

formica said:


> I still remember being a race medic at a Nationals DH race. Guy wrecks, has to be back boarded off the course and then helicoptered off the mountain with a head injury. The girlfriend is sobbing, "but he doesn't have insurance" . I am surprised they'd let someone race DH without it but whatever.


Do the races not carry insurance? I have never read the fine print for mtb races, but....when I raced bmx I ended up in the hosital with a pretty bad concussion and other injuries and the NBL's insurance paid most of my bill, all I had to do was fiile with their company.


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## PretendGentleman (May 24, 2011)

Anonymous said:


> Insurance is a scam. If you buy insurance, you either are admitting that you can't manage your own money, or that it's ok for somebody else to pay your bills.


clearly you have little understanding of risk management. For example, a risk adverse individual can dramatically increase her expected well-being by buying insurance. Its just like hedging a bet, and it makes gobs of sense. If you are interested in managing wealth, for example, you would be wise to include insurance as well as other risk spreading assets in your portfolio; this result holds under a wide variety of very reasonable assumptions.

The idea is that you are protecting yourself from incurring a gigantic loss by spending a little bit of money on insurance. pooling money with a group of people to buy a bunch of lottery tickets is a similar idea.

now this doesn't mean that all insurance purchases are reasonable for everyone or that no insurance companies are scamming their customers, but that your idea of why insurance is a bad idea is poorly thought out.

I hope I didn't disappoint you by not countering your point with flames.


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## wookie (Jan 24, 2007)

There's no such thing as free; if your not paying for it, someone else is.


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## wookie (Jan 24, 2007)

Delete.


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## nightops (Dec 17, 2004)

Anonymous said:


> Insurance is a scam. If you buy insurance, you either are admitting that you can't manage your own money, or that it's ok for somebody else to pay your bills.
> I just had a hip replacement. As soon as the hospital found out I was paying my own bill, they cut it in half. They didn't have to pay anyone to process mt claim, or to do the follow up with the insurance company. Also, I haggled with them about the $14 tylenol and the $1300 to have someone other than my doctor come in and look at my x-rays.
> As far as I'm concerned, the health care system in this country is second to none. I love it. If I had a problem with it, I'd stand up on my own two legs, like a real human being and solve my own problem. I would rather die a long slow death, before I ever did anything as cowardly and pathetic as to use government to force you to solve my problem.
> 
> flame away


I can see that you're trying to get a rise out of people so Ive taken the bait. The only thing that i will agree to in your post is that it is a scam. Insurance companies in this country exist to create profits and do not have the best interests of the patients or doctors in mind. We may have some of the best doctors and facilities in the world - but as i read this thread and see how many people dont have insurance and access to these facilities at a reasonable cost- it is pointless if the majority cant use them. In a practical sense- yes its true you can negotiate costs with the hospitals- but most wont even see you unless you have insurance or can prove you have the money in the bank to pay them. Now you may have negotiated a 25,000 bill to a third of that- great- but what about cancer treatment or some complicated procedure that is a 100,000 or more. most likely your not going to be able to pay that in cash and if you are, well your better off than most people. If you have dependents not having health insurance is not an option but they're not making that cheap anymore. for that i would do the high deductible major injury insurance and save money for the doctor visits-


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## sluggo69 (Sep 14, 2009)

*insurance*

well.... if you are single with no children or people depending on your financial support then you can your chances going uninsured.other than that everyone of age who can afford it should have health insurance of some kind. if not then your an idiot. this is coming from experience. i pay 700+ a month for my family health ins. i was injured racing a mc national enduro 2 yrs ago. i had to be airlifted to a trauma unit 4 hrs away,almost died,and spent several days in icu and a week in the hospital. then i had 6 months of pt.the helicopter transport alone was 35,000$. my total hospital bill was over 700,000$. even with insurance i am still paying medical bills to the sum of 20,000$ thank god i did have ins or i would have been bankrupted.


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## bear (Feb 3, 2004)

scmtbiker said:


> Do the races not carry insurance? I have never read the fine print for mtb races, but....when I raced bmx I ended up in the hosital with a pretty bad concussion and other injuries and the NBL's insurance paid most of my bill, all I had to do was fiile with their company.


Event insurance covers the _event_ and the people organizing the event. I've never actually heard of it covering the _participants_ of the event - this is why you have to sign a liability waiver (races, non-race events, land-use for private land, etc.).

and yes, an untold part of the fees we pay to do things in groups go to that insurance, it is just not for us. ;^(


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## Yogii (Jun 5, 2008)

Cobra is the best deal going. You should have found away to come up with the money. I your situation the only thing that you can do is ride/race in Canada.
If it is just you, then take the chance. You can declare bankruptcy if the worst happens. If you have a family, DO NOT RIDE!!!


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## formica (Jul 4, 2004)

??Every time I have looked at COBRA it's been hugely expensive. I've gone much better self insuring than extendeing any policy via COBRA. 

I have noted that self insurance really varies from state to state. A high deductible HSA plan in my state is very affordable compared to California for example.

We've never had any problems with our plans due to mtb accidents either, but we stick with top drawer companies. There's always the little form you fill out where they are looking to pin it on someone but we always say "accident" and have had no issues.


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## rockerc (Nov 22, 2010)

danhasdrums said:


> Inefficiency is an absolute must as you will never live in the most efficient system. Eliminating greed is also an impossible task as it's a basic human emotion that you can't regulate away. In terms of sense prevailing, it all boils down to personal property and the protection of that. The more those lines are blurred and crossed, the easier it is for the greediest of people to put themselves in position to take advantage of that, and that's been happening for nearly a century now in the US.
> What is your idea/model of the fairest and most common sense model? I lean towards the US constitution, minus the slavery (obviously).


 I really don't understand much of this. I do not agree that Inefficiency is an absolute must, and perhaps you meant to say you can never live in a perfectly efficient society? I agree in the latter, but you can strive to improve it. 
As for eliminating greed, I do not agree it is a basic human emotion, it is just greed, and a base part of human nature. We should do all we can to pillory the people that embrace it. That is not impossible, just difficult, and it would take a quantum shift in our value system to get anywhere close to achieving it. I am also not sure what you mean about blurring and crossing lines, what lines? Greed has been around for a lot more than a century, and in our present day culture that seems to reward the greedy, or at least to turn a blind eye to some of the excesses, we are rapidly losing the ability to even see any moral high ground any more. As for the US Constitution, it is indeed an admirable model to which to aspire, but sadly I believe a lot of the spirit in which it was conceived has been tainted and diluted since those days it was drawn up. I also do not remember anything about slavery being a part of the Constitution, That was a direct result of greed by early settlers and landowners. 
There is no perfect model of a society anywhere on this earth, there are good things about most, and bad things about all, but without people striving to educate themselves and others in basic principles of fairness and goodness, we are lost. 
As for Mr Anonymous who maintains that everyone should stand on their own 2 feet because he was lucky enough to be able to, it obviously sucks to be those people that unfortunately are facing dire consequences through no fault of their own. As long as the insurance option is the only realistic one to avoid the terrible and frightening consequences that might ensue from not being able to pay the exorbitant fees that this current health care system demands, then that is how it must be until some kind of nationalised health care system can be spurred into being. The model found in a lot of European countries is not perfect either, but at least almost all are able to get the care they might need. I never worried about getting injured while riding over there because I knew I would be able to get help if I did. Luckily I am in a position to be able to afford a policy over here because if something dreadful did happen to me, I would not want to be paying for it for the rest of my life, which would probably be somewhat shortened with the stress of worrying about my financial situation.


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## Eric Z (Sep 28, 2008)

the good thing about continuing your coverage via cobra is you are still able to part of a group plan. yes, paying 102% of the premium can get pricey since there is no subsidy from an employer. 

i work in benefits and see many people opt for a private plan instead- you can find more affordable plans that way but be careful if you use the insurance, premiums can increase or you can be dropped (similar if you were to get in a lot of car accidents with auto insurance).

i would be very leery to not have health insurance- riding or not riding. you never know what can happen! my wife found out she had a brain tumor and if we didn't have insurance, you're talking hundreds of thousands of dough!

at least look into an individual plan.

good luck and be careful!
ez


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## dirtdan (Jun 27, 2011)

I


rockerc said:


> I really don't understand much of this. I do not agree that Inefficiency is an absolute must, and perhaps you meant to say you can never live in a perfectly efficient society? I agree in the latter, but you can strive to improve it.
> As for eliminating greed, I do not agree it is a basic human emotion, it is just greed, and a base part of human nature.


If something is not perfectly efficient, then there are inefficient components, plain and simple.
I believe you probably used the right word when you said you might be naive. Entitlement systems that groups of people have teamed up together to put in existence are bankrupting countries. We are watching it all happen right now, yet so many still are in denial. It's a crappy part of the reality of life, but the only real right you have is to die. Everything else has been built up by people just like you and me, who have no special tools or devices that somehow make the formula of expense-income=balance work differently when employed by governments. The US health care system is already highly subsidized, something around 45% of all medical expenses incurred within the US health care system are paid for with public funds. The rule of, if it is subsidized, it will get more expensive holds true in so many markets that the argument is hard to ignore. The more subsidies have gone to health care, to college education, to energy, to home purchasing the more the average prices of those items have ballooned. Markets left untouched, such as technology, have seen prices drop over the past 2 decades. The problem being faced is public bankruptcy, it's people thinking they are entitled to more things than the system can numerically handle.
The idea that more regulators and paid government employees are necessary to implement systems that will somehow fix everything is a completely insane idea and the continued attempt at this failed ideology over the past several decades has brought us to the point that we are. Thinking a public health care system would be good for our country is just bad thinking. Combining those expenses with our costly militaristic prowess will put the nail in the coffin of our currency in the next 20 years. If our government could bring spending back to the levels of 2002, they could avoid raising the debt ceiling and still pay all of the interest on our debt. However, instead of making the rational choice to stop destroying the dollar, fear is used to get the public to rally behind those politicians that will increase the debt limit. We are continually answering the problem we're facing by applying more of the problematic solutions that have brought us to this point.
How this applies to the individual without health insurance and mountain biking is that the individual should measure their own risk levels and act accordingly. If they calculate wrong, well, they **** themselves over. I know in our society we've been trained to bail out people who make bad decisions, but it's not a sustainable model.


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## rockerc (Nov 22, 2010)

danhasdrums said:


> I
> If something is not perfectly efficient, then there are inefficient components, plain and simple.
> I believe you probably used the right word when you said you might be naive. .


Semantics... I am sure many will call me naive, but I know many historical figures that worked for a major shift in core values for the betterment of society were painted with the same brush. You gotta start somewhere!
The arguments you mention, the points you raise, the figures you point out, are indeed indicative of the core issues, but we go round and round in circles with no answers that anyone can seem to make work. Why? What is it that makes a just and fair society? Are those principles some which we want to live with? Are we happy to go through life and see the less fortunate or suffering and say to ourselves, "That's life," or "Lazy freeloading scum"... Undoubtedly some people are lazy and out to get what they can, but I believe that most of that sense of entitlement is a symptom of the nature of our corrupt value system. Until we make a real and major change in how we value individuals as part of the whole, we are basically f**ked as a healthy functioning society. In the meantime, and with the knowledge that I am forced to take out expensive insurance to gain some peace of mind, I am able to ride out into the desert here and open my eyes and mind to the harmonious wonderment that is life, I just wish **** sapiens would figure out how to stop destroying it.


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## rockerc (Nov 22, 2010)

Wow, I just saw my post above and realised that the built-in forum language police has replaced the word "****" in **** sapiens with little stars! Is that a dirty word??!? I guess if you were to use it in the sense of an insult: "You filthy ****!!!" 
I wonder if I can type ****...


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## rockerc (Nov 22, 2010)

...I guess not!


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## Wild Wassa (Jun 4, 2009)

Here in Oz our family has ambulance cover, which also includes helicopter medivac coverage.

The coverage is with NIB. We have family cover, for two adults and two kids and it costs $120AU per year. There isn't an excess to pay and the coverage started immediately when we took out the policy. The coverage is Australia wide.

Even in the case of a helicopter medical evacuation there is no excess or levi to pay.

I also have the bike and myself insured for theft and cycling accidents with Real Insurance, again $120 per year. There is an excess with this policy of $500 or $300 depending on the type of claim one might make.

It is a good comfort having coverage. A serious prang in a wilderness without it, could be the most expensive ride of my life. I've not ever made a claim ... fingers crossed.

Warren.


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## Glide the Clyde (Nov 12, 2009)

SkaredShtles said:


> Look at catastrophic plans. And save some money for the non-catastrophic injuries.


Ding Ding Ding


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## snowgypsy (Jun 5, 2011)

i didn't always think about insurance too much - I just went for it. Until...3 years ago purchased a tiny plan for accridental coverage only. Just cause. I was feeling saucy and had fallen for a really good sales pitch from anthem. 2 weeks later I shattered my ankle in a climbing accident. Between multiple hospital visits, xrays, mris, casts, and yes, medication, specialists, etc. it would have costed nearly 18K out of pocket. All in all, that insurance, though I cursed it later (couldn't do without it afterwards), was an absolute life saver. It wasn't great. But it saved me from bankrupcy. 
I also didn't care too much about it while single, but after I got hitched  I thought a bit more about what I do and how I do it - I couldn't imagine having something happen to me and burdening us with tens of thousands of dollars in medical bills or worse. 
I also couldn't imagine having that conversation - the one where you are in an intense (black out pain) amount of agony watching your foot swell up on the side of a distant trad climb, pitch 3 of 5, chewing on a stick, while discussing whether or not you can afford to call for help or if you should try and make it down and just deal with it and hope its not broken - yes I've had that conversation and it sucks. You can also lose your home to medical bankrupcy. 
Is insurance evil? In many ways, yes.
Would I ride without it? No. Primarily because I need to protect my family from that chaos, confusion, and fear.


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## wobbem (Jul 19, 2009)

I'm curious, what happens in the US if you are broke or jobless or bankrupt and crash badly, with no insurance? (living in the UK I would still be takin care of)


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## formica (Jul 4, 2004)

You go to the hospital, get treated, the hospital writes it off and everyone else's insurance goes up.


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## wobbem (Jul 19, 2009)

So whats the problem, surely if everyone did that things would change?


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## wobbem (Jul 19, 2009)

Sorry just clicked that wouldn't work unless everyone didn't have a job or owned a house.
Seems like poverty has some advantages.
Or your not born in the US.


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## rockerc (Nov 22, 2010)

formica said:


> You go to the hospital, get treated, the hospital writes it off and everyone else's insurance goes up.


Maybe, but they sew you up with blunt needles and string, knock you out with a mallet, and you wake up with most limbs amputated... that's if you wake up at all... then everyone's insurance goes up anyway.

Seriously, what? I would love to hear about any hospital 'writing it off'. I suspect that payment for the bills would be pursued in one way or another, and if sizeable enough and no way to pay, you might be forced into bankruptcy. 
Has anyone got any evidence of hospitals being so nice?


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## Yogii (Jun 5, 2008)

All hospital emergency rooms have to treat you under law. You will be taken care of. The problem is what happens after you leave the hospital. You will get a very large bill. Do they still have Debtor's Prison in the UK? We do not. In the Emergency Room, an x-ray might be charged at $500 an aspirin at $ 80, etc. In the US it is the most expensive way to treat patients.
You either pay the bill, negotiate a lower amount, declare bankruptcy, or submit it to your insurance company. But you will be treated!
They say that uninsured gunshot wounds increase emergency care cost by as much as 50%! The right to bear arms, blah, blah blah....


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## wobbem (Jul 19, 2009)

So declare yourself bankrupt and pay cash for eveything?


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## Yogii (Jun 5, 2008)

wobbem,

That works if you have a large pile of it and do not need to work to get more. They can and will garnish wages. Many employers will not hire people who have declared bankruptcy, many people will not rent housing to people who have declared bankruptcy.
Best thing to do is marry rich!


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## rjedoaks (Aug 10, 2009)

I'm 54 , I pay around 200.00 monthly/ 1000.00 deductible. Only emergencies are covered. I'll have to find out about high risk activities. With this type of insurance you only go to the doctor when needed. It definitely affects your decision making, weather to have an injury checked or just let it play out.


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## Yogii (Jun 5, 2008)

They definitely stick to us old guys. One doctor once told me for most people, they spend more money of healthcare the last year of their lives that all the other years put together! I guess the closer that we get to that year, the more it costs...Live well and then drop dead!


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## l0gjammin (May 29, 2011)

*No Insurance*

I don't know if they exist in all areas but where i live in Arkansas we have some small clinics that you can buy memberships to for $50 a month and if you have to make an actual visit it only cost you $30. They cover Xrays, IVs, stitches and several other things. One visit would more than pay for the membership in the savings over visiting the ER. I'm insured but I have a high deductible plan and this still seems appealing to me. I haven't been riding for long but all the accidents that my buddies and I had didn't require more that stitches or an Xray. Just a thought for those who don't have coverage


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## marzjennings (Jan 3, 2008)

This whole thread scares the pants off'a'me. As a Brit living in the US and even though I've been here 10 years, this whole need for health insurance still annoys me. The fact that people have to choose between having insurance or risking massive hospital bills and even bankruptcy is crazy. 

Imagine if education was managed the same way, our kids don't go to school unless we have education insurance.


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## B-Mac (Oct 2, 2008)

spsoon said:


> I don't doubt your personal experience, but it may not be representative. I don't think it is just media hype. Here is a Harvard study for example:
> Study Links Medical Costs and Personal Bankruptcy - BusinessWeek
> 
> Also worth noting that middle class chumps that did have insurance were only marginally better off, thanks to loopholes and myriad other ways insurance companies have to screw you over. The US healthcare system is really a mess


That study could be correct & I could certainly be wrong (I AM wrong frequently after all LOL), but I really doubt it.

Most cases I file have at least some medical debt. Hard to tell what standard the researchers used to determine what "caused" the bankruptcy filing. If the debtor has $75k in credit card debt & $10k in medical, would the researchers conclude that the medical debt "caused" the bankruptcy? Could probably discover this fact by reading the study & all but I guess it's not that important.

Totally agree that the health care system is effed all up. It's a difficult problem.

I think the credit system in this country is just as bad. Creditors design the system to enslave you - having problems making your credit card payments? Lets jack the interest rates up the 30% - did that help?? Absolutely crazy! I recently filed for an 80 year old man who recently lost a leg to diabetes. Medical debt was not the cause of the bankruptcy BTW. Three years before I filed the case, a creditor lent him $180k to refi his house, which included $50k to pay off credit cards. It was a 30 year loan. That creditor DESERVED to have its debt discharged.

Sorry, thread hijack now TRULY over.


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## ridingaddict (Feb 17, 2011)

marzjennings said:


> This whole thread scares the pants off'a'me. As a Brit living in the US and even though I've been here 10 years, this whole need for health insurance still annoys me. The fact that people have to choose between having insurance or risking massive hospital bills and even bankruptcy is crazy.
> 
> *Imagine if education was managed the same way, our kids don't go to school unless we have education insurance.*


Shhhh... Don't give the insurance companies any ideas. I've been unemployed 2 months now so I ride without insurance. I know that I'm taking a risk whenever I'm out there but it wasn't until this thread that I'm starting to get a little worried. After all, I'm still recovering from my last crash 3 weeks ago.


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## milehi (Nov 2, 1997)

I have insurance, top tier actually. But, unless I get injured while on the road, the nice lady at the vet sews me up, and my chiropractor friend takes the x rays. I love Bartertown.


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## mrbigisbudgood (Apr 4, 2011)

I live in a socialist country, I am always insured.


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## wv_bob (Sep 12, 2005)

rockerc said:


> Has anyone got any evidence of hospitals being so nice?


Perhaps so different to not apply, but when my Grandfather died many years ago, he was flat broke with no insurance because he'd been out of work for 5 years fighting cancer. He died in a Catholic hospital here, and the day of the passing a nun came to talk to my grandmother and they wrote the balance off right there and Granny never received any bills. She had nothing to take and only social security for income, but if they had sent bills she would've paid what she could.


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## Haligan78 (Jun 13, 2011)

I have great insurance through my work place. But I spent a good 7 or 8 years without insurance. As an avid motocross rider I spent plenty of time in the ER during those years.....I always paid my bill even if it took a year or two to get it done. Hospitals take payments for a reason.
I just don't do anything half way....I go balls out or nothing and worry about the details later but I have ALWAYS paid my own damn bills.


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## nOOky (May 13, 2008)

I don't adjust my riding based on whether I have insurance or not, as I have always had insurance. If I didn't have insurance I would probably be more conscious of my lifestyle decisions, especially if the bill would come out of my pocket.
I figure I have paid so many thousands to the insurance company over the years that I am due a large bill. Insurance companies love people like me, single, no claims ever. If I had to guesstimate I'd say I paid in well over $25,000 in insurance fees during my adult working life, the employer portion has to be quite a bit more than that. 
I am more than happy to help pay the medical bills of the unemployed who go over the handlebars and hurt themselves, but please try and become a better rider in the future and not wreck so much mkay?


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## apfs (Oct 19, 2011)

Check out adventureadvocates.com/imba. It was created to promote responsible outdoor recreation and membership includes accident medical insurance.


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## pattongb (Jun 5, 2011)

trentpaulk said:


> That was a completely useless post.


Actually NO that was the best post on this thread.

My parents both in their 60's have Catastrophic insurance and they put aside money for everything else.

Their so called Catastrophic insurance has a 5k deductible. This year my Mom had to have a heart Catheter done and it cost 20k when it was all said and done. They paid 5k.

Thats the problem today, people think healthcare should be free, or cheap.

I consider 2k of my savings account to be available for future car repairs should my car break down. Why? Because my car is a very important part of my life. But im not supposed to do the same for my health?? Stupid.


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## EclipseRoadie (Oct 7, 2007)

I'm not working right now (decided to go back to engineering school full time) but my wife has a yob. I think we pay about 350 bucks a month for insurance for all three of us, and it's been a lifesaver. I've got medical problems from the Army, VA is a joke and disability puts gas in my car every month. As long as I'm managing my weight, staying in shape, and doing my PT stuff the back injury stays at bay for the most part, but I'd be nuts to even consider living without insurance. 

To the dude who says "People who pay for insurance are just poor at managing money..." you're full of ****, as usual I suspect.. People who make 8 bucks an hour will never be able to "manage" enough money to pay for a major surgery (or 3). Most people around here are doing well enough to pay the bills and contribute regularly to their retirement fund. 

The medical industry is the only industry that doesn't set prices based on the consumers ability to pay, that is the problem.


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## dr.lee.g (Oct 10, 2011)

EclipseRoadie said:


> The medical industry is the only industry that doesn't set prices based on the consumers ability to pay, that is the problem.


AMEN. I'm a chiropractor and LOVE it, and I'll be the first to tell you the health care system is all kinds of jacked up. Health care has always been a little more expensive than other things, and rightfully so. You have skilled practitioners working to restore health or intervene in life or death situations, and it's only appropriate to pay for that skill. In reality, insurance (in addition to a plethora of other variables) has driven up the cost of healthcare dramatically beyond what is an appropriate cost.

Chiropractic is covered by most insurance plans, but that wasn't always the case. Before chiropractic was covered by medicare, few insurance plans would pay for it. If you wanted to go to a chiropractor, you paid out of your pocket every time. When this was the case, you could get adjusted for $5-$15 a pop. Now that most insurance plans will pay for chiropractic, you have chiropractors charging $35-$50 for an adjustment. I don't even bill insurance anymore because it's such a hassle to try to get paid. Instead, I charge an affordable fee that everyone pays whether they have insurance or not.

I really feel that the best fix is HSA's/Flex accounts coupled with high-deductible catastrophic coverage. You can pay for your minor stuff with your HSA and your catastrophic plan is there to bridge the gap. Most catastrophic coverage plans are very affordable.


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## Eckstream1 (Jul 27, 2011)

dr.lee.g said:


> AMEN. I'm a chiropractor and LOVE it, and I'll be the first to tell you the health care system is all kinds of jacked up


I've never been to a Chiropractor... Ever.
Is it odd that I can crack my neck and back on my own?

In response to the OP...

I've been uninsured and unemployed for the past 6mos... And I still ride 3 times per week.
I don't ride as hard as I did when I had insurance... But couldn't imagine not riding for fear of injury!

Even with insurance my last knee injury cost me just a bit over $5,000! Out of pocket...
The MRI alone cost me over $2,500 out of pocket after insurance...
And I even had Blue Cross through a union!

Usually if you are uninsured and have a hospital visit they will bill you for the services directly... If you don't pay they will send your info to a collection agency and they will hound you for money. All the while screwing up your credit...


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## dr.lee.g (Oct 10, 2011)

Eckstream1 said:


> I've never been to a Chiropractor... Ever.
> Is it odd that I can crack my neck and back on my own?


It's not odd at all. That cracking sound is little air bubbles in the joints that get released when the joint opens up a little. The difference between doing it on your own and having a chiro do it is the chiro will isolate and move only the joints that need to move. When you do it yourself, you can't isolate only the joints that need to move. Just don't force anything. You can stretch ligaments and joint capsules, which creates instability.

I also meant to say that I don't worry too much about not having insurance. I'm a card carrying Cherokee, so my health care is covered. :thumbsup:


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## Eckstream1 (Jul 27, 2011)

dr.lee.g said:


> Just don't force anything. You can stretch ligaments and joint capsules, which creates instability.


I crack my neck hands free... Just rotate a bit and POP POP POP!
Everyone looks at me funny when I do it in public... 

No force needed :thumbsup:


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## High Side (Apr 16, 2010)

Daemon[CRO] said:


> Ah, USA, gotta love you guys
> 
> Medical bills? What's that?
> 
> ...


You have medical bills. it's called taxes....a lot of them......


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## High Side (Apr 16, 2010)

To answer the OP, I am self employed and have been for years, but I have my own health insurance. BCBS. Costs me a whopping $120 a month.


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## RideMore56 (Jun 27, 2011)

bear said:


> Has anyone (that is an IMBA member) used their affiliated insurance?
> 
> IMBA
> 
> ...


I have it and I have used it. Was a bit of trouble getting the hospital to send the right info to the secondary insurance company but once they got the right papers they paid no problem. I have regular health insurance but it has a 2500/5000 deductible.

Broke my wrist in a race, the medics on site wrapped it up. I went the hospital, they x-rayed said there might be a bone chip in there and I should go to the bone doc on Monday. They rewrapped it the same as it was when I walked in there. So basically all the money spent at the hospital was a huge waste. Should have just waited till Mon and gone to the real doctor, who said it was fractured.

There was some coverage provided by the race promoters but I think it was only for costs over $5000.00 so I didn't file a claim with them.


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## AnthemRider (Feb 7, 2007)

dr.lee.g said:


> In reality, insurance (in addition to a plethora of other variables) has driven up the cost of healthcare dramatically beyond what is an appropriate cost.


I believe that the insurance has a lot to do with healthcare costs, simply because for many people (especially those with group plans with their employers) do not care about being "good consumers" when it comes to healthcare.

If, under their plan, they are only responsible for a $20.00 co-pay when they go in to see a physician there is really no concern over whether the doc is charging $50.00 or $150.00 for that visit because they still only pay $20.00.

Likewise, with insurance, many people want "gold standard plus" care. Got the sniffles? Let's run ALL of the tests just to make sure it's not cancer (yes, I know that's an exaggeration, it's meant to illustrate a point) and because they are going to make money off it many docs will be happy to oblige in ordering the tests even if they aren't really indicated or within the standard of care.


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## RideMore56 (Jun 27, 2011)

I think doctors are the ones that are too quick to order the cat scans and MRI's I have refused both since my deductible got so high.


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## 0010 0110 (Sep 20, 2011)

ridemore56 said:


> i think doctors are the ones that are too quick to order the cat scans and mri's i have refused both since my deductible got so high.


amen


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## cleon (Oct 30, 2010)

Insurance won't approve certain procedures unless specific scan have been completed. And let's not forget liability my friend. Try being an Ob/Gyn these days that did not complete a test that later developed into a health issue.

Random political interjection but you can find multiple examples of this kind of information all over the place, Health Care Spending

Has very little to do with doctors themselves. It's much more systemic and mostly to do with policies we've developed over a long long time.


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## pattongb (Jun 5, 2011)

Do you save up for car repairs? Most smart people do. So why wouldnt you save up for a few possible emergency room or Doctor visits?

Flex Spending Account for minor bills and major medical for large problems (very affordable). So whats the issue?

Unemployed and low income people should have access to free care. In that I will agree.


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## AnthemRider (Feb 7, 2007)

RideMore56 said:


> I think doctors are the ones that are too quick to order the cat scans and MRI's I have refused both since my deductible got so high.


True. They make money off it, many times they also forget to mention that they also have an ownership interest in the facility they are sending you to.

At the same time, the consumer would be more leery of being so eager (and expecting) to undergo a plethora of tests "just to be thorough."

I don't have any sources handy, so take it for what it's worth, but most of materials I've seen indicate that the effect of potential malpractice liability on healthcare costs (and malpractice insurance premiums themselves) is overblown by a substantial degree.

With that said, there are quite a few factors in the U.S. that result in high healthcare costs.


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## EclipseRoadie (Oct 7, 2007)

dr.lee.g said:


> AMEN. I'm a chiropractor and LOVE it, and I'll be the first to tell you the health care system is all kinds of jacked up. Health care has always been a little more expensive than other things, and rightfully so. You have skilled practitioners working to restore health or intervene in life or death situations, and it's only appropriate to pay for that skill. In reality, insurance (in addition to a plethora of other variables) has driven up the cost of healthcare dramatically beyond what is an appropriate cost.
> 
> Chiropractic is covered by most insurance plans, but that wasn't always the case. Before chiropractic was covered by medicare, few insurance plans would pay for it. If you wanted to go to a chiropractor, you paid out of your pocket every time. When this was the case, you could get adjusted for $5-$15 a pop. Now that most insurance plans will pay for chiropractic, you have chiropractors charging $35-$50 for an adjustment. I don't even bill insurance anymore because it's such a hassle to try to get paid. Instead, I charge an affordable fee that everyone pays whether they have insurance or not.
> 
> I really feel that the best fix is HSA's/Flex accounts coupled with high-deductible catastrophic coverage. You can pay for your minor stuff with your HSA and your catastrophic plan is there to bridge the gap. Most catastrophic coverage plans are very affordable.


Interestingly enough, I've had far better luck at my Chiro's office than any " specialist" has been able to figure out. Got tired of hearing "Take this (narcotic) every three hours and let me know when you want us to operate on your back."
I spent two weeks last year lying on my living room floor, unable to stand or roll over, and I made my first visit to a Chiro Doc. in desperation, and have been going ever since. My insurance will pay for back surgery, but not for decompression treatment... go figure.


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## EclipseRoadie (Oct 7, 2007)

pattongb said:


> Do you save up for car repairs? Most smart people do. So why wouldnt you save up for a few possible emergency room or Doctor visits?
> 
> Flex Spending Account for minor bills and major medical for large problems (very affordable). So whats the issue?
> 
> Unemployed and low income people should have access to free care. In that I will agree.


No argument. You're views are pretty much exactly the same as mine. Keep catastrophic coverage, manage your routine stuff, and (as a government) provide for those who cannot provide for themselves.


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## terrasmak (Jun 14, 2011)

I'm lucky to have the best health care the government provides for its lowest employees.


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## nightops (Dec 17, 2004)

thats because theres no money in chiro and preventative medicine. more profit to be made having anesthesioligists, nurses, expensive operating rooms, and selling pharmaceuticals than training the body to heal itself. i learned that when i got a sciatica and they offered an injection. the injection wore off in several days but physical therapy/chiro trained me how to help myself and to prevent further injury-that is the state of healthcare in the US.


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## desnaephoto (Jun 11, 2009)

OP asked about insurance for races. If the race is USA Cycling sanctioned, then there is insurance to cover you for anything during the race. Training accident, you are on your own.

I have the Adventure Advocate supplemental. At $35 per month, I have my $4000 max co-pay (whatever term Blue Cross uses) covered. Would take me over 10 years to save that amount (since I will only have the AA package when I'm training outside - 10 months a year).


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## Ailuropoda (Dec 15, 2010)

I'm an Emergency Physician. It's not the occasional otherwise healthy mountain-biker with an acute injury who is bankrupting the system. I had an otherwise very healthy fifty-year-old rider who broke his femur missing a turn the other day and both the surgeon and I marveled at his fitness, his excellent prognosis, and his likely short hospital stay with no rehab and no complications.

It's the thirty-year-old obese, drug-addicted, non-compliant slug on disability for self-inflicted lifestyle choices who has congestive heart failure, diabetes, kidney failure, and heart disease who comes to the ER for narcotics every week or the millions of idiot parents bringing their medicaid-insured children in because they'd rather sit in the waiting room with crack whores and derelicts than drop a few bucks for Tylenol who are killing us. Not to mention the supremely entitled elderly running through your children's future prosperity who come in for every little ache or pain "just to get checked out" because "it's better safe than sorry."

American Medicine is a big ****ing scam and a fraud. Hugely wasteful, a bureaucratic nightmare, and so irrational as to be completely ridiculous at almost every level.

PANDA BEAR, MD

My old blog that I stopped writing because is made me bitter. With respect, why don't you all shut up about health care unless you know something about it and you uninsured riders, it's my pleasure to treat you and if I could I wouldn't bill you...at least you're doing something basically healthy instead of shoveling crap in your mouth and sitting on your buts.


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## Ailuropoda (Dec 15, 2010)

nightops said:


> thats because theres no money in chiro and preventative medicine. more profit to be made having anesthesioligists, nurses, expensive operating rooms, and selling pharmaceuticals than training the body to heal itself. i learned that when i got a sciatica and they offered an injection. the injection wore off in several days but physical therapy/chiro trained me how to help myself and to prevent further injury-that is the state of healthcare in the US.


Preventative medicine does not save money. It costs money and it identifies costly medical problems that require extensive therapy leading to higher costs. Regular doctor visits for "checkups" do not save money either.

Chiropractic is snake oil and I weep that my insurance premiums, $17,000 a year, and tax dollars, are used to pay for it.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> True. They make money off it, many times they also forget to mention that they also have an ownership interest in the facility they are sending you to.
> 
> At the same time, the consumer would be more leery of being so eager (and expecting) to undergo a plethora of tests "just to be thorough."
> 
> ...


Bull. I make no money by ordering tests. And, it is against the law to self-refer.

We order tests mostly so we don't get sued. Malpractice is out of control.


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## lowcountryredneck (Oct 11, 2011)

LoL seriously not ride because of no insurance. Then no sex u could hurt ur back no walking u could miss judge a curb break ur ankle. Why live if you have no life.


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## beerrun (Jul 31, 2007)

interesting thread. can anyone chime in on what resource is available to summarize what types of coverage there are, i.e. what particulars to ask for? 
anyone self-employed and do the tax credit thingie that the feds came up with?
cheers.


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## rockerc (Nov 22, 2010)

Ailuropoda said:


> I'm an Emergency Physician. It's not the occasional otherwise healthy mountain-biker with an acute injury who is bankrupting the system. I had an otherwise very healthy fifty-year-old rider who broke his femur missing a turn the other day and both the surgeon and I marveled at his fitness, his excellent prognosis, and his likely short hospital stay with no rehab and no complications.
> 
> It's the thirty-year-old obese, drug-addicted, non-compliant slug on disability for self-inflicted lifestyle choices who has congestive heart failure, diabetes, kidney failure, and heart disease who comes to the ER for narcotics every week or the millions of idiot parents bringing their medicaid-insured children in because they'd rather sit in the waiting room with crack whores and derelicts than drop a few bucks for Tylenol who are killing us. Not to mention the supremely entitled elderly running through your children's future prosperity who come in for every little ache or pain "just to get checked out" because "it's better safe than sorry."
> 
> ...


Good for you! A voice of reason.


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## formica (Jul 4, 2004)

beerrun said:


> interesting thread. can anyone chime in on what resource is available to summarize what types of coverage there are, i.e. what particulars to ask for?
> anyone self-employed and do the tax credit thingie that the feds came up with?
> cheers.


What is available and costs are going to vary extremely state by state in the USA. We are self employed. We use a high deductible HSA plan, plus by nature of the structure of our corporation, the premiums are also fully deductible on the federal form. We worked with a broker that specializes in small business and self insured, and went with a well known plan, not a fly by nighter that advertises on late night TV. I've actually been using HSA plans for about 12 years, since they first came out.

For those unfamiliar with HSAs you are allowed to take an amount equal to or a little more than your plan deductible, and put it into a separate account specifically for health care expenses: co-pays, things not covered by your plan and a whole list specified that included alternative treatments, visions, dental, certain over the counter stuff etc. Then the amount you put into your HSA is funded with pre-tax dollars. You have to keep records but it's been fine for us. I don't use the investment aspect of the HSA for two reasons. One is we typically maxi it out every years, and two they ding you really good on investment transactions.

For some good information on how health care works in various countries around the world, and a comparison to the US plans, this is a very informative documentary, Frontline from several years ago
Sick Around The World | FRONTLINE | PBS


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## Ailuropoda (Dec 15, 2010)

By the way, Emergency Departments do not have to treat you. By law we only have to do a medical screening exam and if no emergency medicial complaint exists I can send you out to see your own or a private doctor. Generally I take care of everybody and I don't care if they can pay but the time is coming when we are going to have to start enforcing EMTALA (look it up) rigorously. 

Additionally, the law does not require you be treated for free and you are responsible for the bill even if most people don't pay. Only suckers pay their ER bill by the way. Most people, even if they come in for minor things, ignore the bill and after ineffectual attempts to collect it goes away. Naturally this raises the cost for everyone but in our lazy, entitled, apathetic, lard-ass nation nobody cares and everybody wants to suck on the government mammary anyway.


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## Ailuropoda (Dec 15, 2010)

dr.lee.g said:


> It's not odd at all. That cracking sound is little air bubbles in the joints that get released when the joint opens up a little. The difference between doing it on your own and having a chiro do it is the chiro will isolate and move only the joints that need to move. When you do it yourself, you can't isolate only the joints that need to move. Just don't force anything. You can stretch ligaments and joint capsules, which creates instability.
> 
> I also meant to say that I don't worry too much about not having insurance. I'm a card carrying Cherokee, so my health care is covered. :thumbsup:


Dude, that is just ridiculous and bogus science at its worst. Chiropractic is no better than a massage at best and a ridiculous scam in actuality. Air bubbles in joints? Absolutely stupid and vivid testimony to the shoddy education you received in your chiropractic diploma mill.


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## beerrun (Jul 31, 2007)

thx formica. HSA?


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## SilkMoneyLove (Nov 1, 2010)

> a ridiculous scam in actuality.


Giant Panda - FYI I have seen people feel much better after massage and chiro. As an example, I have also seen people feel no better after visiting a doctor for a problem, so it could be argued who is really a scam in actuality. Does the Massage Therapist tell you to take two of these and call in the morning if still feeling bad?

I am sure you are a physician with good intentions (by your posts), please know that there are good massage therapists and chiros out there that do actually help people. Do not begrudge a person their legal profession.

BTW - I am not a massage therapist or chiropractor. I work in an office and am fortunate enough not to have any health problems. I also only see the doctor if I have a real problem. Last time, two years ago, I had scarletina and needed a shot. That was it for the last five years. I consider myself fortunate in regard to health. That can change at any minute for all of us.

Also - I think for the amount of premium I pay, I should get a sponge bath by a HOT nurse whenever I visit the dr office. Just my opinion ;-) YMMV


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## MikeyLXT (Aug 8, 2011)

AnthemRider said:


> True. They make money off it, many times they also forget to mention that they also have an ownership interest in the facility they are sending you to.
> 
> At the same time, the consumer would be more leery of being so eager (and expecting) to undergo a plethora of tests "just to be thorough."
> 
> ...


I think it is BS that people expect the patients to offer advice to the doctors upon which test or scans they need. I go to an expert to get the expert advice that is gained from years of education and experience. I trust my doctor and if they tell me I should get an additional test then I do it. I am far from an expert on medical care and doing a google search is not a substitute for an expert opinion.

I trust my doctors and make decisions based on the information they give me.


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## dr.lee.g (Oct 10, 2011)

AnthemRider said:


> I believe that the insurance has a lot to do with healthcare costs, simply because for many people (especially those with group plans with their employers) do not care about being "good consumers" when it comes to healthcare.
> 
> If, under their plan, they are only responsible for a $20.00 co-pay when they go in to see a physician there is really no concern over whether the doc is charging $50.00 or $150.00 for that visit because they still only pay $20.00.
> 
> Likewise, with insurance, many people want "gold standard plus" care. Got the sniffles? Let's run ALL of the tests just to make sure it's not cancer (yes, I know that's an exaggeration, it's meant to illustrate a point) and because they are going to make money off it many docs will be happy to oblige in ordering the tests even if they aren't really indicated or within the standard of care.


There was the nail, and you hit it on the head.


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## dr.lee.g (Oct 10, 2011)

Ailuropoda said:


> Dude, that is just ridiculous and bogus science at its worst. Chiropractic is no better than a massage at best and a ridiculous scam in actuality. Air bubbles in joints? Absolutely stupid and vivid testimony to the shoddy education you received in your chiropractic diploma mill.


No need to flame on, buddy. There are some chiros out there who give the profession a bad name, but there are plenty of us that wanna help folks and do a fine job of it.

Cavitation phenomena is something that is pretty well demonstrated and researched in osteopathic circles as well. The 'air bubble' explanation is an easy way to explain what actually happens when you introduce a sudden external force that reduces pressure within the synovial vacuum. Most folks won't understand that terminology, so we say there are air bubbles that pop when you get adjusted. Simplistic? Yes, but it gets the point accross.

The Department of Biomechanics of Michigan State University published an article on cavitation associated with joint manipulation. It's on pubmed if you wanna check it out.

We can be friends, man. No need for harsh words.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Bull. I make no money by ordering tests. And, it is against the law to self-refer.
> 
> We order tests mostly so we don't get sued. Malpractice is out of control.


Bull pucky on both.

Your carrier has told you it is out of control, politicians have told you it is out of control. That doesn't mean it's out of control.


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## AnthemRider (Feb 7, 2007)

MikeyLXT said:


> I think it is BS that people expect the patients to offer advice to the doctors upon which test or scans they need. I go to an expert to get the expert advice that is gained from years of education and experience. I trust my doctor and if they tell me I should get an additional test then I do it. I am far from an expert on medical care and doing a google search is not a substitute for an expert opinion.
> 
> I trust my doctors and make decisions based on the information they give me.


Who said that people expect patients to offer advice to their physicians or that a Google search is a substitute?

You should go to an expert to get an expert opinion, and you should be able to trust that opinion. But that doesn't mean that just because someone has an M.D. that they are all wonderful doctors and never act in their own best interests -- nor does it mean that if a doctor says we could run some additional tests (regardless of whether or not ordering the tests would be within the standard of care) that the consumer is not going to say "do it," or tell their physician that Aunt Bessie got such and such test, I want it -- and if the doc doesn't order it they change physicians to one who will.

There is the practice of medicine, and then there is the business of medicine.


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## formica (Jul 4, 2004)

beerrun said:


> thx formica. HSA?


Heath Savings Account explained.
Health savings accounts (HSAs) explained

example of what benefits etc might look like for a HSA plan
Health Coverage Plans, Group Health Cooperative and Group Health Options, Inc.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Bull pucky on both.
> 
> Your carrier has told you it is out of control, politicians have told you it is out of control. That doesn't mean it's out of control.


No. I make no money for ordering tests. Period. I am an ER doctor. Because all of my patients are undifferentiated (I've never seen them and they self-select generally for more serious conditions and could have anything) and a lot of what do is high risk, I order more tests than five regular doctors.

Defensive medicine is the single biggest factor driving up costs. If I miss something the hospital can face a potentially devastating lawsuit and I can be ruined. My malpractice insurance is close to $200,000 per year so if you don't think malpractice litigation is a problem you are mistaken.

It is out of control. You have no idea. Read my blog.

PANDA BEAR, MD


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## Ailuropoda (Dec 15, 2010)

formica said:


> Heath Savings Account explained.
> Health savings accounts (HSAs) explained
> 
> example of what benefits etc might look like for a HSA plan
> Health Coverage Plans, Group Health Cooperative and Group Health Options, Inc.


This is true.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Defensive medicine is the single biggest factor driving up costs. If I miss something the hospital can face a potentially devastating lawsuit and I can be ruined. My malpractice insurance is close to $200,000 per year so if you don't think malpractice litigation is a problem you are mistaken.
> 
> It is out of control. You have no idea. Read my blog.
> 
> PANDA BEAR, MD


With all due respect, that is what many think until they are on the other side of the fence, especially in regards to medical malpractice. A perceived problem is not necessarily a real problem. I take it you don't see medical malpractice as a problem?

Although jurisdictions admittedly differ, medical malpractice claims are expensive to pursue and tough to win.

A medical malpractice claim is not going to be successful only because you missed something, that "miss" has to be because you fell below the standard of care -- in other words not because you didn't give gold standard care and ran extra tests just in case, but because you didn't meet the minimum care that a doctor would (and in some jurisdictions, didn't do as much as a poor ol' dumb country doc would have).


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## Ailuropoda (Dec 15, 2010)

dr.lee.g said:


> No need to flame on, buddy. There are some chiros out there who give the profession a bad name, but there are plenty of us that wanna help folks and do a fine job of it.
> 
> Cavitation phenomena is something that is pretty well demonstrated and researched in osteopathic circles as well. The 'air bubble' explanation is an easy way to explain what actually happens when you introduce a sudden external force that reduces pressure within the synovial vacuum. Most folks won't understand that terminology, so we say there are air bubbles that pop when you get adjusted. Simplistic? Yes, but it gets the point accross.
> 
> ...


Ah...so you've abandoned "subluxation." Chiropractic is perpetually looking for a scientific basis for their essentially irrational treatment modality and this is obviously the latest. "Cavitation." Har. That's rich. More mumbo jumbo. You're basically saying that the pressure in joint drops so low when you crack a back that the synovial fluid vaporizes temporarily providing therapeutic effect....how exactly? The same cavitation that destroys valves and screws on ships?

The philosophical basis of chiropractic and osteopathy is that the manipulation of the spine effects the function of organs and can cure disease. I did my residency at Michigan State with DOs and even most of them were embarrassed to be associated with this kind of thing and viewed having to sit through the 700 hours or so of "manipulation" as a necessary evil required to get a more-or-less equivalent medical degree to the traditional "MD."

Chiropractic is mostly placebo. That's fine. Free country. But we already spend to much money on real medicine without having to dump more into this kind of thing.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> With all due respect, that is what many think until they are on the other side of the fence, especially in regards to medical malpractice. A perceived problem is not necessarily a real problem. I take it you don't see medical malpractice as a problem?
> 
> Although jurisdictions admittedly differ, medical malpractice claims are expensive to pursue and tough to win.
> 
> A medical malpractice claim is not going to be successful only because you missed something, that "miss" has to be because you fell below the standard of care -- in other words not because you didn't give gold standard care and ran extra tests just in case, but because you didn't meet the minimum care that a doctor would (and in some jurisdictions, didn't do as much as a poor ol' dumb country doc would have).


It's not the actual lawsuits that are expensive. They are tough to win and the cost of settlements is a small fraction of medical costs. It is rather the cost of defensive medicine, the ordering of excessive tests and consults to avoid the lawsuit in the first place that is eating us alive. I assure you that the majority of all tests ordered are absolutely unnecessary but only ordered for CYA.

Suppose for example, I have a patient with abdominal pain and an equivocal exam meaning that he might have something going on but the findings are so vague it's hard to localize anything. This is actually a fairly standard patient in our entitled, soft nation. In a rational world without lawyers I would send the patient home with instructions to return in 24 hours if not better or sooner if they become acutely worse. This would eliminate the roughly 80 percent (by my estimation) of normal CT scans of the abdomen that are ordered because the fact is that if you miss one appendicitis, even if no harm comes to the patient, you have a very good chance of being sued because the standard of care is to not let anything settle out.

True, you would win the case in the end but it would be a Pyrrhic victory because just to defend a suit is an expensive ordeal. And grueling. I have been sued and it is so unpleasant that I'll spend all of your money to avoid it happening again. I was sued for something incredibly ridiculous but the lawyer doesn't care. Patients are encouraged to sue, it costs them nothing, it costs the plaintiff's attorney nothing, and if you throw enough mud, some will stick.

The United States has 98 percent of the worlds lawyers. They make money defending and prosecuting. They don't care. Their income depends on stirring up **** and they do it marvelously. Again, with respect, you have no idea.


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## Ailuropoda (Dec 15, 2010)

Once again, with feeling, you have no idea how unpleasant it is to be sued. 

I repeat. You have no idea how unpleasant it is to be sued.

If I practiced good, sound clinical medicine without concern for litigation I would last about a year. No hospital or group would ever hire me and I might as well hang it up. They could not afford to defend me even if I won every single case.

Burn this into your brain: Nobody cares if you win or lose the malpractice case. They only care about the aggregate cost to defend and the subsequent effect on their malpractice rates. I would rapidly become uninsurable and unemployable.

Note also that my yearly premiums are $200,000. That's two-hundred thousand dollars. I am an good doctor and have never been sued for a serious clinical error. If you don't think we have a huge problem....

Incidentally, while I do very well, I'm not rolling in dough. After alimony and child support, (the sequela of sacrificing almost ten years and my entire life, fortune, family, and health to train for this job) and taxes I'm not exactly thirsting for that BMW. I live in a cabin and I drive an inexpensive car. True, I have some nice bikes but this is an indulgence I think I've earned. I happen to live right behind one of the best trails in Louisiana so that's cool and i'm not complaining.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Patients are encouraged to sue, it costs them nothing, it costs the plaintiff's attorney nothing, and if you throw enough mud, some will stick.
> 
> The United States has 98 percent of the worlds lawyers. They make money defending and prosecuting. They don't care. Their income depends on stirring up **** and they do it marvelously. Again, with respect, you have no idea.


Wrong. It is quite expensive to bring a medical malpractice lawsuit, and because few patients have the resources to fund the suit all of those costs are advanced by the lawyer -- who will be out a lot of out of pocket money as well as a great many hours spent working on the case so no, they do not encourage people to sue just to see if something sticks. Yes, it sucks to be sued but you have just shown your ignorance of how things work, and your perceptions on based more on emotion -- just as the patient that has serious problems caused by malpractice will say that the physicians and hospitals just don't care about their patients because they're just out to make money and go to the golf courses.

And the stats on the U.S. having the most lawyers is misleading, because that is also based on societal factors. Do you not think that a capitalist society is going to need more contract lawyers that a communist country? What about a society with a low divorce rate -- think they might not need as many divorce attorneys? We also have stricter requirements on who can perform legal services and what constitutes unauthorized practice of law.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Burn this into your brain: Nobody cares if you win or lose the malpractice case. They only care about the aggregate cost to defend and the subsequent effect on their malpractice rates. I would rapidly become uninsurable and unemployable.
> 
> Note also that my yearly premiums are $200,000. That's two-hundred thousand dollars. I am an good doctor and have never been sued for a serious clinical error. If you don't think we have a huge problem....


You say you are a good doctor and have never been sued for a serious clinical error. That's good! That's the way it's supposed to work.

And do you really think that premiums are based solely on the costs of defending and paying out judgments? If that were the case, there are some docs (thankfully the minority) who would never be able to get malpractice insurance who are still going strong.

The insurance company is not some benevolent organization existing solely to protect you. They are there to make money for their shareholders. If the market will bear a $200,000.00 premium, that's what they'll charge and take that money and invest it somewhere else -- and on that subject, you do realize, don't you, that the insurance company will instruct its lawyers to not settle a case that has been filed against you, even though it could be settled for less than what a judgment would likely be? The insurance carrier will often prefer it to be drug on as long as possible so they can have the benefit of that money for a longer period of time.


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## desrcr (Feb 8, 2004)

IronTom said:


> Quoted for truth.
> 
> Putting my vote in a ballot box isn't going to change anything, but where I put my dollars will.
> 
> ...


Under you premise, mtnbiking is not neccesary. We should instead be at a spinning class.


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## TheMachinist (Feb 24, 2007)

Not riding is riskier than riding. Ride carefully, but keep the heart pumping.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> You say you are a good doctor and have never been sued for a serious clinical error. That's good! That's the way it's supposed to work.
> 
> And do you really think that premiums are based solely on the costs of defending and paying out judgments? If that were the case, there are some docs (thankfully the minority) who would never be able to get malpractice insurance who are still going strong.
> 
> The insurance company is not some benevolent organization existing solely to protect you. They are there to make money for their shareholders. If the market will bear a $200,000.00 premium, that's what they'll charge and take that money and invest it somewhere else -- and on that subject, you do realize, don't you, that the insurance company will instruct its lawyers to not settle a case that has been filed against you, even though it could be settled for less than what a judgment would likely be? The insurance carrier will often prefer it to be drug on as long as possible so they can have the benefit of that money for a longer period of time.


Wrong again. The insurance company and the hospital want to settle as quickly as possible for as cheaply as possible. The aggregate cost of the hospital's insurance is not effected adversely by settling a "nuisance suit" because they are a large corporate entity and can soak it up easily. In fact, when you're sued you sometimes need to get your own lawyer (if the hospital is paying your premiums) because the hospital and their insurance carrier will "throw you to the wolves" and settle even if you could win the case. The effect of this on an individual doctor is devastating.

An insurance carrier, generally, will infinitely prefer to pay a $50,000 out-of-court settlement than spend $200,000 defending. This is why patients are encouraged by a barrage of television ads and billboards (surely you've seen them?) to sue on "speculation" with no money of theirs at risk unless the case is won. It costs essentially nothing to sue except some filing fees. The country is full of low-level attorneys who do nothing but bring countless small suits...sure, a typical lawsuit in my state takes five years to resolve but if you have a lot of things cooking, you only have to get lucky a few times a year to make a living.

To reiterate, the nuisance suit is nothing to the hospital or carrier, devastating to the individual doctor who, never-the-less, is the only one in the medical system who can order tests and make medical decisions and, on medical matters, operates with complete autonomy. Note that we are not talking about legitimate lawsuits for obvious negligence or incompetence. These are a tiny fraction of cases and if that's all I had to worry about I wouldn't worry about it.

The insurance company is not, repeat not a benevolent organization. Who said it was? It is part of a huge legal-bureucratic-government complex that permeates every aspect of American medicine and adds huge costs to you, As for not being able to insure, many malpractice carriers abandon certain areas and markets, not because the doctors are of any lesser quality but because some states and specialties, Pennsylvania...Obstetrics, are so hard to insure that they can't make any money.


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## Ailuropoda (Dec 15, 2010)

Incidentally, at least half of my job involves paperwork, forms, forms to verify forms, reams of pointless boilerplate notes, more forms, check boxes, more paperwork, and paperwork to document paperwork almost all of it driven by the perceived need of the hospital to cover its ass legally and shift blame for any mistake to the doctor or nurse. The wait time in my ER can stretch to four or five hours and people get very irate....in the old days when a note could fit on an index card and the discharge instructions could be given verbally we could see many more patients. Now, as everything involves reams of paperwork a simple sore throat at my hospital generates literally 25 pages of paperwork you are just going to have to stew.

I reiterate: If you don't think the malignant legal environment of out country adds cost to the system (and not just medicine) I invite you to spend a shift with me and see it in action.

You all have no idea. None whatsoever. If we had no lawyers our health care costs would be cut in half overnight. Literally.


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## Ailuropoda (Dec 15, 2010)

desrcr said:


> Under you premise, mtnbiking is not neccesary. We should instead be at a spinning class.


I would much rather treat a healthy mountain-biker who will make a swift recovery, is likely a regular guy who is not sue-happy, and as he is not symbiotically grafted to the hospital like so many of our patients are, will be grateful for his care and respectful to his physician than the typical lard-ass frequent-flier drug addicts that I typically see.

I have seen several injured mountain bikers and without exception they've been nothing but righteous patients, easygoing, and fun to have in the ER (once we get their pain under control). One guy even brought in his S-Works Epic and we commiserated at his cracked frame.

That's a five-thousand dollar frame I believe. I have seven mountain bikes currently. A 2011 Specialized Enduro, a Surly Pugsley, a Trek Sawyer, a 2010 Specialized Stumpjumper Carbon Hardtail, a Niner One 9 SS, a 2009 Specialized FSR XC Expert...and a Cannondale Bad Boy I use infrequently when I decide to do some road riding.

I love bikes and mountain biking and at least my job lets me afford pretty much anything I want...although I'd balk at an S-works anything. Way to much bike for me.

Favorite bike? The Sawyer. I ride the Enduro seventy percent of the time, though.


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## Ailuropoda (Dec 15, 2010)

Obviously you mother****ers have hit a sore spot for me. I don't mean to offend.


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## wottiv (Oct 4, 2011)

I'm going to put my LIFE on hold... sit at a computer and do NOTHING that I enjoy. I will live vicariously through people I do not know on some MTB forum..... for fear that I might get scratched up a bit.
I had cancer- without insurance- after my treatment I looked into getting insurance... they wanted me to pay in for 13months before I could use my insurance, and with insane monthly payments... I decided to keep myself healthy, and mountain biking is part of that. If you ride your bike worried that you are going to crash and live in the hospital for the rest of your life, then you are more probable to live out that reality.

Put "puppy sabotage" into your google search.

result was a helmet broken in 3 places a ton of trail rash on the side I was sliding on, and a badly bruised rib/ribs. (my dog walked away without a scratch)


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Wrong again. The insurance company and the hospital want to settle as quickly as possible for as cheaply as possible. The aggregate cost of the hospital's insurance is not effected adversely by settling a "nuisance suit" because they are a large corporate entity and can soak it up easily. In fact, when you're sued you sometimes need to get your own lawyer (if the hospital is paying your premiums) because the hospital and their insurance carrier will "throw you to the wolves" and settle even if you could win the case. The effect of this on an individual doctor is devastating.
> 
> An insurance carrier, generally, will infinitely prefer to pay a $50,000 out-of-court settlement than spend $200,000 defending. This is why patients are encouraged by a barrage of television ads and billboards (surely you've seen them?) to sue on "speculation" with no money of theirs at risk unless the case is won. It costs essentially nothing to sue except some filing fees. The country is full of low-level attorneys who do nothing but bring countless small suits...sure, a typical lawsuit in my state takes five years to resolve but if you have a lot of things cooking, you only have to get lucky a few times a year to make a living.
> 
> ...


Sorry, but once again you are mistaken and basing your conclusions on only small bits of information. If a patient came to you and cited one symptom would you then make a diagnosis and prescribed a course of treatment? If they came in and said they had a tummy-ache would you immediately call to prep for surgery, or would you realize that maybe you need a little more information first?

The fact that you stated that a lawsuit only costs filing fees again shows that you have no idea what is involved. Kind of like someone saying that surgeons have a racket for taking out an appendix - shoot, all you have to do is make a cut, snip out the appendix and then sew 'em back up. 10 minutes tops --- and then they charge thousands of dollars for it.

These suits are not filed on speculation. It's entirely possible that you have had a number of patients that have sought out an attorney to sue you for malpractice that you have never known about because all of the lawyers the patient talked to either didn't think there was malpractice, or that there was negligence but the costs of the lawsuit would be too high in relation to the amount of damages likely to be awarded. How often do you throw out tens of thousands of dollars and spend countless nights coming home well after your family has gone to bed working on something that is frivolous and unlikely to have any return simply because there is that very slim chance that you'll get lucky? If so, you must have a lot more money and a lot less things to do with your time than most attorneys.

Put it another way, you cited the carrier spending $200,000.00 to defend a $50,000.00 claim. The patient's lawyer has to spend their money and time as well as the defense. Do you really think they are going to put in $200,000.00 of time and money in order to earn a fee of less than $17,000.00 (1/3 of the settlement)?

You are right that carriers can settle a lot of cases more cheaply than defending them, and that they are large enough to handle the payout. But, if they delay paying it out they use that money to make more than what they are paying to litigate.

While keeping a record so you can go back and so what occurred in case there is a claim is certainly a part of it, there are many more reasons why you have all the paperwork you do -- including the health insurance companies.

Remember that your malpractice carrier is a business. Which approach do you think works better when they want you to pay high premiums: Tell you that they have to charge so much because lawsuits are out of control, or tell you they need to charge so much because their investments didn't work out as well as they had hoped and they need to show good revenue for their shareholders and make a few multimillion dollar bonuses?

Again, a lot of people who griped about paying high premiums because of the "out of control legal system" get a rude awakening when they find themselves on the other side of the fence.

You haven't made me mad, but (like a lot of things in U.S. society) many people don't understand how the system works, so they hear a quick spiel about how it's all the fault of somebody else and they believe it -- it's certainly easier to just accept it instead of learning about the system. Quite frankly, people want to believe the Stella stories because it makes for a quick and easy scapegoat.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Sorry, but once again you are mistaken and basing your conclusions on only small bits of information. If a patient came to you and cited one symptom would you then make a diagnosis and prescribed a course of treatment? If they came in and said they had a tummy-ache would you immediately call to prep for surgery, or would you realize that maybe you need a little more information first?
> 
> The fact that you stated that a lawsuit only costs filing fees again shows that you have no idea what is involved. Kind of like someone saying that surgeons have a racket for taking out an appendix - shoot, all you have to do is make a cut, snip out the appendix and then sew 'em back up. 10 minutes tops --- and then they charge thousands of dollars for it.
> 
> ...


Here's what you don't understand. The insurance carrier has to hire a lawyer and pay him huge fees to defend a case. The Plaintiff's attorney spends no money because he is working on speculation and he has no out of pocket costs. This is why changing the law to make the loser pay all litigation costs would probably solve the problem. Then the Plaintiff's attorney would actually have a risk...some "skin in the game."

A lawyer who is suing on speculation incurs no costs except the filing fee. It's true that he has fixed costs, such as office expenses, but his time is essentially valueless if he has no work and except that working on one case over another might incur an opportunity cost, he is quite happy to work on speculation, deferring his compensation for as long as it takes because he has many such cases in the pipeline. He may incur some small fees for depositions and other legal mechanics but this is a cost of doing business and in no way deters him from pursuing his case.

I reiterate, the majority of cases in our legal system are frivolous. I see at least ten patients a week who "slipped on a puddle" at Wal Mart who are sent to the ER by their attorneys in the hope that I will document some injury with which they can leverage a small settlement. Nothing big, mind you, but a couple thousand here or there and you can stay in business. The roads of my town are full of billboards advertising personal injury lawyers or enjoining the public to join class-action suits against drug manufacturers.

Chiropractors are notorious for working hand-in-hand with personal injury lawyers to validate shady claims. Chiropractors have no real medical training but are viewed as doctors by the typical layman on a jury. Worse still, many medical doctors "sell out" and for a fee will validate bogus disability claims and serve as expert witnesses for the Plaintiff.

For your information, $17,000 is a lot of money and most low-level attorneys will gladly put a couple of weeks of their time to land this kind of fee. Most attorneys are not pulling in, nor do they expect, to make high profile hourly fees. Basically a lawsuit involves a lot of work at the front end, then the case idles for a few years, and then both parties frequently decide to settle to make it go away. Or it's so ridiculous that it never goes to trial and it goes away on its own but that's an occupational hazard.

I happen to be intimately familiar with the whole process, both because I was sued and because I have served on several medical review panels.

To bring it to a mountain biking level, what's the major factor that keeps landowners from letting you ride on their property? Naturally, the fear of liability. Liability is a huge industry and has replaced personal responsibility as the dominant cultural force in our society. Dude, I have patients drawing disability because they are drug addicts.

You have no idea.

The lawyer who is suing me, on behalf of a patient who is essentially a welfare basket case and has never paid a dime in her life for her food, her rent, her medical care or any of her numerous children, is suing every doctor who even looked at the patient in the six months before the minor in-hospital incident that was a normal complication and of which she made a complete recovery. In other words, I wasn't even involved in that hospitalization yet I am still being dragged through the mud. If you don't think the system is out of control you are insane.


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## Ailuropoda (Dec 15, 2010)

By the way, everything about American public life...medicine, education, government, the courts...is corrupt, backwards, and horrifically ridiculous.

Surely you must sense this? I happen to work on the front lines of society and see these problems first hand every ****ing day.

One more time, wade through my blog, PANDA BEAR, MD , to get a real-life view of American medicine from the burger-and-fries level.

That's why I enjoy mountain biking and crave my daily ride. My big mountain bike problem today? I broke a spoke. Easy and fun to fix and I can't wait to come home tomorrow morning and fix it.

I put in close to 4000 miles over the last year according to my Garmin.


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## milehi (Nov 2, 1997)

.

The lawyer who is suing me, on behalf of a patient who is essentially a welfare basket case and has never paid a dime in her life for her food, her rent, her medical care or any of her numerous children, is suing every doctor who even looked at the patient in the six months before the minor in-hospital incident that was a normal complication and of which she made a complete recovery. In other words, I wasn't even involved in that hospitalization yet I am still being dragged through the mud. If you don't think the system is out of control you are insane.[/QUOTE]

This discussion has taken an interesting turn as I recently have been named in a medical malpractice suit. Without getting into too much detail, the patient broke a titanium screw and is suing the hospital, the two orthopedic surgeons, the anesthesiologist, and the implant distributor(me). I decided to hire my insurances' lawyers to the tune of $5K. It may end up being more. My insurance is $250K a year.


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## Ailuropoda (Dec 15, 2010)

Vader said:


> .
> 
> The lawyer who is suing me, on behalf of a patient who is essentially a welfare basket case and has never paid a dime in her life for her food, her rent, her medical care or any of her numerous children, is suing every doctor who even looked at the patient in the six months before the minor in-hospital incident that was a normal complication and of which she made a complete recovery. In other words, I wasn't even involved in that hospitalization yet I am still being dragged through the mud. If you don't think the system is out of control you are insane.


This discussion has taken an interesting turn as I recently have been named in a medical malpractice suit. Without getting into too much detail, the patient broke a titanium screw and is suing the hospital, the two orthopedic surgeons, the anesthesiologist, and the implant distributor(me). I decided to hire my insurances' lawyers to the tune of $5K. It may end up being more. My insurance is $250K a year.[/QUOTE]

Naturally, I can't go into the details of my case but it's incredibly minor and I even saw the same patient a few months later looking fit, healthy, and pregnant with her fifth baby.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Here's what you don't understand. The insurance carrier has to hire a lawyer and pay him huge fees to defend a case. The Plaintiff's attorney spends no money because he is working on speculation and he has no out of pocket costs. This is why changing the law to make the loser pay all litigation costs would probably solve the problem. Then the Plaintiff's attorney would actually have a risk...some "skin in the game."
> 
> A lawyer who is suing on speculation incurs no costs except the filing fee. It's true that he has fixed costs, such as office expenses, but his time is essentially valueless if he has no work and except that working on one case over another might incur an opportunity cost, he is quite happy to work on speculation, deferring his compensation for as long as it takes because he has many such cases in the pipeline. He may incur some small fees for depositions and other legal mechanics but this is a cost of doing business and in no way deters him from pursuing his case.
> 
> ...


$17,000.00 is a lot of money, but $20,000.00 is more. Do you really think they're going to stay in business very long that way? No other costs than a filing fee and staff? Even in a case of outrageous negligence, it's going to be pretty darn difficult to find one of your brother physicians that is going to spend the time (and ill will in the medical community) to review medical records, swear out affidavits, give depositions and testify at trial all for free. Just because you don't know about the costs involved, doesn't mean they don't exist. And that work on the front end is the easy part -- again just because you don't see the work that is going on, doesn't mean that it isn't there. That is like me saying that you are B.S. when you talk about all that paperwork. I didn't see you do it, so it must not involve very much time.

Just because you were named in a suit does not mean that you are intimately involved in the whole process. You saw what you saw, you did not see everything else that was going on.

That's not to mention that when an attorney files the complaint he has to certify that it is well grounded in law and fact. There is a bit of leeway inasmuch as sometimes a lawsuit must be filed in order to get all of the facts. People aren't really quick to hand over reams of information to someone they fear will file a claim against them (if a doc is pulled into a suit when he wasn't involved in the care, then it very well may be because somewhere along the line someone or something indicated they were and once it gets sorted out the suit will be dismissed as against that doc.

Chiropractors are notorious for working hand in hand with attorneys? Hate to break this to you, but there is a perception among a large number of people that M.D.s are shady, and plaintiffs are referred to the M.D. so the M.D. can make it look good and get a kick-back from the settlement money.

Jurisdictions are different, but in many high chiro bills will kill a case unless there are even higher bills from a traditional physician. Rightly or wrongly, most juries will accept some chiropractor bills, but will take what seems to be your view that if there are high chiropractor bills but little medical bills then it's a scam.

You mentioned landowners not allowing mountain biking because of fear of liability:

Why do you think a lot of 5 year-old kids hide under the covers at night? Naturally it's the fear of monsters in the closet. If you don't think the problem of monsters in the closet is out of control in this country, you are insane.

Do you realize that there are statutes have protections against liability for landowners in order to encourage the landowners to allow others to use their property for recreation (the caveat is when it goes beyond merely allowing onto the property - such as if I were to build some "North Shore" type stunts, charged a fee to come ride, etc. and someone got hurt because of my negligence).


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## Ailuropoda (Dec 15, 2010)

Do you actually know anything or are you speaking ex rectum? There are plenty of doctors who will gladly serve as expert witnesses for the Plaintiff's attorney. In fact, many doctors make a career out of testifying in this capacity in malpractice trials.

Did I not say every aspect of American public life is corrupt and rotten to it's ridiculous core? 

Did you read what I wrote? I am being sued for a case in which I was not involved. This happens all the time. The Plaintiff's attorney does not have to carefully construct a case before he sues. Basically the standard practice is to shoot first and ask questions much later. Sure, I'll likely be dropped from the suit eventually but it has cost me many hours of my time and no end


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Do you actually know anything or are you speaking ex rectum? There are plenty of doctors who will gladly serve as expert witnesses for the Plaintiff's attorney. In fact, many doctors make a career out of testifying in this capacity in malpractice trials.
> 
> Did you read what I wrote? I am being sued for a case in which I was not involved. This happens all the time. The Plaintiff's attorney does not have to carefully construct a case before he sues. Basically the standard practice is to shoot first and ask questions much later. Sure, I'll likely be dropped from the suit eventually but it has cost me many hours of my time and no end


Doctors who testify as a career are testifying for the defense. A "professional witness" for the plaintiff is a death knell for the plaintiff. It is accepted and expected that the defense will have doctors who regularly testify, one who regularly testifies for plaintiffs will be quickly labeled as a shill. You can sure bet that your attorney will look into that (though he will likely already know the reputation of that doc) and make that fact known.

If the Plaintiff's attorney shot first and asked questions later, ask that the attorney receives sanctions for violating Rule 11.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Did I not say every aspect of American public life is corrupt and rotten to it's ridiculous core?


And so, by your logic, the problem of corrupt doctors in this country is getting out of control?


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## 007 (Jun 16, 2005)

Holy crap . . . I need to start reading this thread again! Where's my popcorn?!

For my own education, I know that Ailuropoda is an ER doc . . . AnthemRider, what is your professional background?


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> And so, by your logic, the problem of corrupt doctors in this country is getting out of control?


Dude. Everything is corrupt. Including medicine. Didn't I say that? At least doctors provide a valuable service, however, and for the most part most doctors are honorable and doing the best they can in the system in which they work.

American medicine is an insane goat however. Read my blog.

I am not corrupt and to the extent I blow through money it is only to protect myself from lawyers and bureaucrats.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Doctors who testify as a career are testifying for the defense. A "professional witness" for the plaintiff is a death knell for the plaintiff. It is accepted and expected that the defense will have doctors who regularly testify, one who regularly testifies for plaintiffs will be quickly labeled as a shill. You can sure bet that your attorney will look into that (though he will likely already know the reputation of that doc) and make that fact known.
> 
> .


Not at all. If this were the case expert witnesses would never be used...however almost every suit involves expert witnesses, many of them who regularly provide testimony to the high bidder. This is a fact. Many cases that make it to trial become contests between opposing expert witnesses.

Many doctors leave clinical medicine and become expert witnesses, and insurance company doctors or open low risk boutique clinics like weight loss, low testosterone, and skin care clinics precisely because they are sick of dealing with lawyers, administrators, the government, and entitled, non-compliant patients who think it's an affront on their human dignity to pay one thin dime for their medical care.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Not at all. If this were the case expert witnesses would never be used...however almost every suit involves expert witnesses, many of them who regularly provide testimony to the high bidder. This is a fact.
> 
> Many doctors leave clinical medicine and become expert witnesses, and insurance company doctors or open low risk boutique clinics like weight loss, low testosterone, and skin care clinics precisely because they are sick of dealing with lawyers, administrators, the government, and entitled, non-compliant patients who think it's an affront on their human dignity to pay one thin dime for their medical care.


No, that's not a fact. Again, it's expected to have a "regular" for the defense but not for a plaintiff. You've already shown that either you don't realize what is involved (or you just chose to close your eyes to it). You are married to a position that is based on misinformation and emotion.

The point is not whether your patients are compliant or want to pay for their medical care. The point was your contention that the high costs of medical care are due to the high number of lawsuits because it doesn't cost lawyers anything to file a malpractice suit and so they file a multitude just in case they get lucky. And it's not "most" malpractice suits involve experts, it's "all." If your carrier settles without the plaintiff having an expert, it means you screwed up unbelievably bad.

Then you went to just a few hundred dollars for a filing fee. Then acknowledged fixed costs (which I'll give you that in most cases don't come into much of factor for an individual case until it is one in which extra paraprofessionals are needed to assist on that individual case), then you move on to hiring experts, then to experts testifying on behalf of the highest bidder. You are quickly speeding towards the conclusion that someone is not going to spend tens of thousands of dollars and countless hours working on a case that has a one in a million chance

Are there "bad" attorneys? Sure, just like there are "bad" doctors. But, quite frankly your position seems to be an emotional one -- whether or not you have patients that don't want to pay for medical care is irrelevant to whether or not medical malpractice lawsuits are out of control or have this great impact on your insurance premiums (and being in an ER you are likely being exposed to a higher than average number of patients who feel this entitlement -- sort of like the prosecutor who came to the conclusion that, based on his experience coming into contact with the poor as a prosecutor, that most poor people were lazy and criminals).

Before you argue that they are filing malpractice suits to avoid paying for the services, a patient like that may go speak with an attorney but the attorney will likely send them away in less than a half-hour. Sometimes even when it may appear on the surface that there may have been malpractice, the attorney will turn them away simply because there aren't enough damages to justify the costs of pursuing a claim.

A medical malpractice claim is not a claim that you are a bad person, or necessarily even a bad physician. It's a claim that a mistake was made that fell below the standard of care -- and everyone makes mistakes and we just hope it's not a big one. Every profession has to worry about making a mistake, because part of being a member of that profession is holding yourself out as having superior knowledge and skill in a certain area. If something involves having superior knowledge and skill, sometimes a mistake will be made. Unfortunately, in your position a big mistake can have major consequences for someone else.

That's why the rally cry of abolishing/reforming tort law because of "personal responsibility" that has been advanced by the insurance industry the last few years is so interesting. People should not make claims because they should have personal responsibility? What happened to personal responsibility meaning that I made a mistake that caused harm to someone else, and so I'll try to make it right the best I can?

If a driver didn't notice a red light and crashes into your car, and you are so injured that you can no longer work as a physician --- are you going to say that you shouldn't make a claim against the other driver because you should have personal responsibility? Maybe instead that driver should take some personal responsibility for their mistake of not paying enough attention to the traffic signals by being responsible for the costs of your care, lost income, etc.?


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Dude. Everything is corrupt. Including medicine. Didn't I say that? At least doctors provide a valuable service, however, and for the most part most doctors are honorable and doing the best they can in the system in which they work.
> 
> American medicine is an insane goat however. Read my blog.
> 
> I am not corrupt and to the extent I blow through money it is only to protect myself from lawyers and bureaucrats.


But, the idea was that just because there may be some corrupt doctors/lawyers does not mean that the medical/legal profession is corrupt and out of control.

And, whether people want to acknowledge it or not, most lawyers are honorable and doing the best they can in the system we have (which, believe it or not, is a good system developed over hundreds of years and works best when not trying to be hog tied by politicians trying to make political points by capitalizing on people not understanding the system and/or "returning favors").

Regardless, we're both guilty of letting this get away from the original premise that malpractice lawsuits do not have the great impact on the costs of healthcare and your malpractice premiums that many believe.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> No, that's not a fact. Again, it's expected to have a "regular" for the defense but not for a plaintiff. You've already shown that either you don't realize what is involved (or you just chose to close your eyes to it). You are married to a position that is based on misinformation and emotion.
> 
> The point is not whether your patients are compliant or want to pay for their medical care. The point was your contention that the high costs of medical care are due to the high number of lawsuits because it doesn't cost lawyers anything to file a malpractice suit and so they file a multitude just in case they get lucky. And it's not "most" malpractice suits involve experts, it's "all." If your carrier settles without the plaintiff having an expert, it means you screwed up unbelievably bad.
> 
> ...


Dude, When did I say people file suits to avoid paying their bills? Most people file lawsuits to make some easy money and statistically, in my specialty anyway, since we have a high proportion of freeloaders, most of out suits are brought on the behalf of freeloaders.

In fact, one of the biggest problems we face as Emergency Physicians is wholesale abandonment of the ER by consultants strictly because they no longer want to accept the liability of being obliged to work on non-compliant, irresponsible, and litigation-happy patients. It is for example, hard to get orthopedic surgery coverage because many surgeons would rather work out of their own surgical centers doing routine knees, hips, and the like on paying, insured patients than come in to fix the shattered femur of a methadone addict. Remember that even if they don't pay, the surgeon is medically responsible for the complete course of the patient's care and these are patients with poor compliance who are at a higher risk for a bad outcome...or even an outcome that is unavoidable (when you break your pelvis in thirty places you will likely have a limp the rest of your life even under the care of the best surgeon in the country) and they are often sued for things like this.

I have to, for example, fly my vascular surgery emergencies to a different state because our vascular surgeons have decided it's safer to do routine vein-stripping and endarterectomies than risk their livelihoods repairing dissecting aneurysms.

Also, go back and read what I wrote. It's not the cost of the actual lawsuits and settlements driving up the cost of medical care but rather the cost incurred in avoiding the possibility of being sued in the first place, the so-called "defensive medicine." The attorney and patient who are suing me may only realize a relatively insignificant amount for their suit but...and internalize this...since I am in complete control of all medical decisions and act with total and complete autonomy I will spend millions of unnecessary dollars every year to avoid getting sued. It may be a trivial thing to you but to me getting sued is like World War II. I was a Marine many years ago and even a small non-war firefight in a brief operation is a huge deal if you're the one taking fire.

Naturally the government and insurance companies justifiably want to limit what doctors order and on one level I am all for rationality and good clinical medicine. Unfortunately there is no concurrent drive to protect us from legal predation so their is very little incentive currently for doctors to act "rationally."


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> But, the idea was that just because there may be some corrupt doctors/lawyers does not mean that the medical/legal profession is corrupt and out of control.
> 
> And, whether people want to acknowledge it or not, most lawyers are honorable and doing the best they can in the system we have (which, believe it or not, is a good system developed over hundreds of years and works best when not trying to be hog tied by politicians trying to make political points by capitalizing on people not understanding the system and/or "returning favors").
> 
> Regardless, we're both guilty of letting this get away from the original premise that malpractice lawsuits do not have the great impact on the costs of healthcare and your malpractice premiums that many believe.


Dude. My premiums are about a third of what I actually make. Right off the bat every patient is paying a third more than he should to see me to cover this cost. SInce doctor fees are a significant part of medical costs the cost of malpractice insurance drives up the cost of healthcare a significant amount. Every cost in the system is passed on to the patients and taxpayers.

But once more with feeling...it is the cost of DEFENSIVE MEDICINE that is the real issue. Another significant cost of Medicine is tests and consults. Most of these are unnecessary, especially in my specialty except that as it cost me nothing to order a test and a potentially expensive and time consuming lawsuit if I act below the accepted standard of care, I'll order the test even if it's not medically necessary. The standard of care now is "Better Safe than Sorry" strictly because of the fear of litigation.

Again, I am telling you how it is. You can stick your head in the sand but while I am by no means omniscient, I have seen something like 60,000 patients in the last ten years so I think I know a little about American Medicine and how it operates.

Essentially, American Medicine is expensive in part because it is expected to be "Zero Defect." People think that's a good thing but by the law of diminishing marginal returns, the last small, unobtainable increment of "perfection" is astronomically expensive.

Don't Just Do Something, Stand There: Part Two : PANDA BEAR, MD

How I Am Learning to Throw Money Away With Both Hands and a Big Shovel : PANDA BEAR, MD

Putting Granny Down and Other Health Care Conundrums : PANDA BEAR, MD


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## Ailuropoda (Dec 15, 2010)

Here's an example. Consider Europe. In europe, if you are a cardiopath with fixed cardiac lesions (stable heart disease) and have your typical chest pain that resolves with nitroglycerine (the so-called "Stable Angina) that's the end of it. If you go to the ER in italy they will look at you in a perplexed manner and say, more or less, "What do you want us to do about it?" Maybe they'll do an EKG and if it is stable from a previous EKG and you symptoms are resolved home you go. The odds of you dying from a heart attack are very small at that point and although eventually you are probably going to have the big one, it's not going to be under these circumstances.

In America you rush to the ER by ambulance even if you have no symptoms, and we admit you to the hospital for an expensive usually only one night stay where we confirm what we knew when you rolled in, basically that you have stable angina. I have admitted literally thousands of patients like this and not one has been shown to be anything but stable angina. Worse yet, we usually consult a cardiologist and even though there is no evidence that angioplasty decreases mortality in patients with stable angina, you may get an expensive TUHC (or a Totally Unnecessary Heart Catheterization). 

We're talking stable angina here, not new symptoms, persistent pain, new EKG findings, or other factors that make a patient more likely to have an Acute Myocardial Infarction or an impending one. 

The cost of this is immense and it has gotten to the point where even young people come in for every faint twinge of pain in their chest (of course I'm a daredevil so I send otherwise healthy young people with no risk factors home with a minimal workup). The cost to the doctor of missing that one in 10,000 random event is immense, however, and we literally pay billions of dollars avoiding it.

A typical ER visit for chest pain costs around $2000 if I send you home. A one-day admission runs about $3000. The sums are immense. Purely defensive medicine.


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## AnthemRider (Feb 7, 2007)

Okay. There is a good chance that in your undergraduate studies you took at least a freshman level logic course. Go back and review some of the formal and syllogistic fallacies. Your arguments are full of them.

Just because you have a fear of something, it doesn't mean that "something" is real no matter how much you fear it or what you do to avoid it. Just because you hire 12 mercenaries to protect you from Stella, that monster in your closet, does not mean there really is a monster in the closet. There is no liability in not ordering a totally unnecessary procedure. Keep in mind, too, that most juries are going to walk into that courtroom being very skeptical about the plaintiff. The insurance industry has been very effective in spreading the idea that most claims are frivolous and the legal system is out of control.

Medical school and treating 60,000 patients gives you expertise in medicine, it does not give you expertise in law (and you've already demonstrated that you either do not know what all is involved in a malpractice lawsuit - or are being dishonest about it). Having an M.D. doesn't qualify you as a J.D., just as a J.D. doesn't qualify one as an M.D.

People rushing to the hospital in an ambulance with any little chest pain has nothing to do with the legal system. It is the way U.S. society views healthcare and has more to do with the attitude of taking a pill to fix everything and the morning show doctors/PSAs telling people not to delay getting to the hospital if they have any signs of heart attack or stroke. In other words, those costs you just cited about a needless trip to the ER has nothing to do with a doc protecting himself from a malpractice claim it is from people making needless trips to the ER.

You say you're a "daredevil" ER doc that sends healthy people home with a minimal workup, and you've probably treated 60,000 patients? How many times have you been sued?

Another question, if I charge you a third of your income as insurance against our sun going Supernova this year, does that mean unequivocally that the sun is getting ready to go supernova? Trust me, I'm not charging you that high premium just because you'll paying it, I'm only doing it because those supernovas are out of control.

You'll face


> a potentially expensive and time consuming lawsuit if [you] act below the accepted standard of care . . .


 Those are the keys words, just as I am sure that if you hire an attorney, and they perform their obligations below the standard of care and you suffer damages because of it, you will probably feel they have a liability to you as well.



> Unfortunately there is no concurrent drive to protect us from legal predation so their is very little incentive currently for doctors to act "rationally."


 Except, of course, those hundreds of years of development of the law and all of the political and legal pushes to limit someone's liability for making a mistake that causes someone to die.


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## Ailuropoda (Dec 15, 2010)

Did you read what I wrote? The "Standard of Care" is irrational nowadays and has become doing complete workups for anything and everything. In the legal world, it has very little to do with the inexpensive part of medicine, that is, a good history, review of systems, physical exam, and clinical judgment. 

Remember, I can be right 10,000 times about a patient but if I'm wrong just one time and send a patient home with a "zebra" I'm screwed, especially because even if directed to seek outpatient follow-up, many patients do not. Many doctors, for example, order abdominal xrays on every patient with belly pain even though in the Emergency Medicine textbook, it clearly says that the diagnostic yield of a plain film on a patient with a soft abdomen is essentially zero (meaning that the films are diagnostically useless). A colleague of mine was sued and one of the issues was not ordering an xray of the belly of a patient who had abdominal pain but no tenderness and no other abdominal exam findings who was later diagnosed with gallstones. The patient developed an inflamed gallbladder two months after the ER visit, was admitted, and had her gallbladder removed without complication and made a complete recovery.

In Rational World, we know that a plain film of the belly does not show gallstones with enough sensitivity to rule them out (hardly ever), lots of people have gallstones, gallbladder pain (colic) without inflammation is not an emergency and a patient with no exam findings (no tenderness, no fever, no jaundice, normal vital signs) and a normal "white count" and "liver functions" is appropriate for outpatient consultation with a surgeon without any imaging in the Emergency Department (which would by ultrasound anyway).

In Europe where lawsuits are relatively rare this is how they operate.

So you see, the standard of careis to "Miss Nothing" even if there is no danger from missing something. My colleague who was sued even told the patient and wrote in the discharge instructions, "Likely Billiary Colic from Gallstones." He was practicing rational medicine, used good clinical judgment, arranged appropriate follow up, and discharged a young, healthy, presumably intelligent and responsible patient with no symptoms at the time of discharge.

Not to mention even if he had obtained an ultrasound and found stones, the disposition for this kind of patient is...wait for it...discharge home with surgical referral as an outpatient.

Amazing.

Consider this as well. I have been sued twice out of 60,000 patients, both of them for minor things, one of which was dropped. Why then is my malpractice insurance $200,000 a year? I'm not the one driving this cost. The insurance company calculates the risk and arrived at this for the cost to insure an ER doctor in the area where I live, the hospital pays it without demur. Supernova or not, the people who pay the bills and who clutch dimes like they were children and weep at every dollar spent pay this amount every year as reasonable cost of doing business.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Except, of course, those hundreds of years of development of the law and all of the political and legal pushes to limit someone's liability for making a mistake that causes someone to die.


Sure. We probably agree that a doctor or hospital that is guilty of gross negligence should be sued as a means to protect the interests of the public and I have no problem with that at all. That's a reasonable check on the medical profession to keep us honest. But most lawsuits are for trivial things and many are for bad outcomes that are beyond the ability of the doctor to prevent.

Another example, one of my friends sent a ten-year-old patient home who had cut the tendons of the last joint of his index finger on the sharp edge of a can. Before discharge, he called an orthopedic surgeon and arranged a follow-up appointment for the patient to have the laceration re-evaluated and for surgical repair of the tendon. Routine stuff. See it every day, and no orthopedic surgeon is going to come in at 3AM to repair a simple tendon laceration of a finger.

The patient's mother forgot to go to her follow-up appointment and a month later noticed that her son couldn't bend the tip of his finger for which my friend and the orthopedic surgeon are now being sued.

Pretty ridiculous, huh?

The plaintiff's contention is that the Standard of Care is immediate repair in the Emergency Department. They will lose the case if it goes to trial but in the meantime it has sucked up hours of time, thousands of dollars, and generated huge amounts of ill-will. Maybe my friend will start insisting the surgeon come in to see the patient at a huge cost to you, the taxpayer who pays for Medicaid.


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## AnthemRider (Feb 7, 2007)

A daredevil doctor that gives minimal workup is sued twice out of 60,000 patients, and one of those was dropped? How many years have you been paying high insurance premiums? I never said that you were the one who was driving up the cost of malpractice insurance, but do you (the one who took the position that it costs nothing to pursue a malpractice claim - which a case like that would be quick work for the defense attorney to get dismissed before the answer to the complaint was even filed) think that those two cases really causes health care costs to be as high as they are?

Or, could it be other inefficiencies in the system and the fact that your malpractice carrier wants to make huge profits by telling you it has to charge that much because of all of the monsters in closets are feeding off your premiums?

If a patient fails to follow instructions or acts against medical advice, you know that that will vindicate the physician unless the mistake was one that the patient would have suffered from the negligence even if they followed instructions (and the claim would probably be reduced due to contributory/comparative negligence).

I bet politicians of the [party of your choice] never tell lies or serve special interests, either. They're just statesmen looking out for the best of the country. And communist and Muslim countries are the only ones that ever use propaganda or spin facts.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> A daredevil doctor that gives minimal workup is sued twice out of 60,000 patients, and one of those was dropped? How many years have you been paying high insurance premiums? I never said that you were the one who was driving up the cost of malpractice insurance, but do you (the one who took the position that it costs nothing to pursue a malpractice claim - which a case like that would be quick work for the defense attorney to get dismissed before the answer to the complaint was even filed) think that those two cases really causes health care costs to be as high as they are?
> 
> Or, could it be other inefficiencies in the system and the fact that your malpractice carrier wants to make huge profits by telling you it has to charge that much because of all of the monsters in closets are feeding off your premiums?
> 
> ...


The first one was dropped only after a year of wrangling, stagnation, and a "thumbs down" by our state's medical review panel. It soaked up a lot of my time and many, many hours of the lawyer's time who was paid to represent the hospital, me, and a separate lawyer for the insurance company. There is no simple way to get a case dismissed. There is no such thing as "quick work" when the law is involved.

The second is still pending but continues to generate fees for the defense attorney. Again, you missed my point. It is the cost of "defensive medicine," not the cost of the suits themselves, that drives up costs. Every doctor has his threshold beyond which he decides never to be sued again and starts to spend your money like crazy to avoid even the remotest possibility. It is that big a deal getting sued. Trust me.

I never said this was the sole factor driving up costs. But this, combined with byzantine rules and a true labyrinth of regulations and red tape, paperwork, overuse, criminal abuse of Medicaid, Medicare and Disability, and even outright fraud by doctors and hospitals all plays a part. Curtailing frivolous suits would save some real portion of the total cost. Ten Percent? Twenty? I happen to know that most of what I order is ultimately useless so I'd go for a higher number.

The secret of the Goat Rodeo? That most of what we spend is either futile, redundant, ineffectual, or completely unnecessary. The few healthy mountain bikers who occasionally need some treatment, recover completely, and are never seen again are not the problem.

As to patient compliance, you missed my point. The outcome of the suit is irrelevant. Even a victory is a Phyrric one at best because it is the cost to defend that defines the problem as well as the pressure to settle to avoid this cost. It is impossible to guarantee the patient will get follow up and all the plaintiff has to show is that the physician did not make clear the gravity of the need for follow up. Remember, many cases end up in front of a jury that is reflexively sympathetic to the plaintiff so upon this hope are many ridiculous suits advanced. In this respect, my specialty is becoming untenable because it is getting hard to send anyone home with any possibility of a bad outcome. You might think this is a good thing but the costs are immense.

The other thing you need to realize, and take this to the bank, is that with the exception of a few people like me in medicine, business, engineering, and the like, personal responsibility had been bred out of society.

The easiest way to get free health care, food stamps, section eight housing, and free college tuition for your kids in my state?

Get addicted to drugs, draw disability because of it, and reap the rewards. They'll even get you into a Methadone clinic. I see it every day.


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## AnthemRider (Feb 7, 2007)

> It soaked up a lot of my time and many, many hours of the lawyer's time who was paid to represent the hospital, me, and a separate lawyer for the insurance company. There is no simple way to get a case dismissed. There is no such thing as "quick work" when the law is involved.


If the Plaintiff did not have an expert, it would have been quick work and the attorney would likely have been sanctioned by the Court.



> Again, you missed my point. It is the cost of "defensive medicine," not the cost of the suits themselves, that drives up costs.


Again, you have missed the point. It is not the likelihood of a suit being filed, but rather an unfounded fear that a suit will be filed. Just because I build a fortress around my bed to protect me from the monster in the closet does not mean that the monster is the closet is real -- no matter how much the "anti-closet monster bed fortress" salesman tells me it is.



> As to patient compliance, you missed my point.


And again, you've missed the point. The point is the likely outcome of a suit. Do you invest tens of thousands of dollars and hundreds of hours in something that has only a very slight, if any, chance of you even breaking even?



> The easiest way to get free health care, food stamps, section eight housing, and free college tuition for your kids in my state? Get addicted to drugs, draw disability because of it, and reap the rewards. They'll even get you into a Methadone clinic. I see it every day.


Again, that has nothing to do with the topic at hand, it only show an emotional attachment to your position.


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## giantbikeboy (Dec 3, 2004)

I have insurance, so I can ride...right?


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> If the Plaintiff did not have an expert, it would have been quick work and the attorney would likely have been sanctioned by the Court.
> 
> Again, you have missed the point. It is not the likelihood of a suit being filed, but rather an unfounded fear that a suit will be filed. Just because I build a fortress around my bed to protect me from the monster in the closet does not mean that the monster is the closet is real -- no matter how much the "anti-closet monster bed fortress" salesman tells me it is.
> 
> ...


"Sanctioned by the Court?" Doesn't happen. No matter how sloppy the case. In other words, there is no penalty for filing a suit no matter how ignorant. The standard procedure is to name every doctor remotely connected with the case (and I mean remotely) and the hospital and all who sail in her. You do not have to have an "expert" to file a suit. You need no medical knowledge. In fact, at the request of my attorney I wrote a long letter explaining the condition about which the suit revolved...breaking it down to layman terms. Lawyers are generally pretty smart but they have limited medical knowledge, even those involved in medical malpractice. Repeat, attorney are not "sanctioned by the court" for frivolous suits. Lawyers on both sides and judges make their money by stirring up ****...the more the better. This is a fact of life.

The fear of a suit is not unfounded. On average, an ER doctor is sued once every two years. Every suit is a major ordeal. Here is the take-home point that you are missing: It Costs Me Nothing To Order Tests, Images, and Consults. Nothing. In fact, the hospital rather likes huge workups on insured patients because they need to stay in business and their profit margins are a lot smaller than you think. Therefore given the choice of practicing rational, cost-effective medicine and risking the inevitable lawsuit that will be _costly and inconvenient to me_ or spending your money like a drunken sailor to avoid this, it is very difficult not to spend your money and it gets more difficult every year and with every suit. You need to also know that every time I apply for a job I have to list every lawsuit in which I am named. A few too many and it seriously impairs your ability to find a job...which is why "settling out of court" is so disastrous for doctors. Those cases stay on your record.

And once more, with feeling. It costs nothing but the plaintiff's attorneys time to file a suit. He does not invest tens of thousands of dollars and hundreds of hours of his time. In fact, the MO of the bottom-feeding attorney is volume; kind of like baiting a trot line with a hundred hooks and leaving it in the river overnight. There are very few "high-profile" cases like you see in the movies.

Maybe you are young and naive but I think you have no idea how the world works, that money drives everything, and that corruption is the norm, not the exception. This extends, like I said, to all aspects of American public life and we are ruled by an entrenched elite of bureaucrats and lawyers.

The topic is "riding uninsured" and I'm also pointing out that mountain bikers and other injured healthy athletes are not the problem.


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## jimbowho (Dec 16, 2009)

Lawyers. Why are they considered respectable? They sucked the country into hell. That's right I said it.


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## Ailuropoda (Dec 15, 2010)

And I have to say, as much as I despise socialized medicine and the very notion that medical care is a right; essentially that a bunch of lazy freeloaders can steal my labor with impunity, I would enjoy one thing about being a government employee working for relative peanuts: With no fear of being sued I could do things the right way...of course the government always goes too far and we'd have trouble getting things we actually need for our patients but, oh the joy, of working an eight hour day, taking frequent breaks, looking at a full waiting room with indifference, and finally being able to practice "minimilist" medicine.


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## Ailuropoda (Dec 15, 2010)

jimbowho said:


> Lawyers. Why are they considered respectable? They sucked the country into hell. That's right I said it.


I kind of like my attorney. He's pretty sharp and a decent guy. But I cringe when I see another law school being built. Do we really need more lawyers?


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## Haggis (Jan 21, 2004)

"Socialized medicine" - the American fear factory at work: name it, bag it and call it evil. 

Other countries just call it health care and get on with delivering it at the best bang-for-taxpayers-buck possible. If you don't like public waiting lists etc you can always pay for private insurance... and there's free accident cover for all.


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## Ailuropoda (Dec 15, 2010)

Haggis said:


> "Socialized medicine" - the American fear factory at work: name it, bag it and call it evil.
> 
> Other countries just call it health care and get on with delivering it at the best bang-for-taxpayers-buck possible. If you don't like public waiting lists etc you can always pay for private insurance... and there's free accident cover for all.


It's not free. You pay for it with public debt, economic stagnation, and decline . The economic decline of our nation is being driven largely by out-of-control spending for "free" health care (and other rights) as it is in most of Europe. Greece is collapsing because of the inability of the public sector, the producers of wealth, to keep up with the cost of maintaining the dependent sector.

Medical care is not a public utility like running water.

Incidentally, I worked two major traumas last night and neither of the patients had insurance, will ever pay their bill, or even intend to pay even a token amount but they received world-class-no-expense-spared care.

But, it should be noted that the Europeans spend half of what we spend with no real difference in outcomes. They are still going bankrupt.

As an aside, the Welfare-Medicaid-Disability triangle in out country is deeply corrupt. Why feed it more money?

Additionally, it is very difficult to sue for malpractice in socialized systems and impossible, for example, in Greece (I was raised there, my mother still lives there) to sue public doctors and hospitals which by the way offer care so shabby that you need to hire a private nurse to watch over your relatives if they are admitted or they may go unattended. At least according to my friends in Greece who are doctors, there is no defensive medicine practiced. It does not drive costs. This is good and bad. Good because doctors are free to use sound clinical judgement but bad because things that I order like burritos for my poorest patients are virtually impossible to obtain over there...sometimes you do need expensive therapies, consults, and procedures. Kind of sucks to need one and be put on a two-year waiting list.

Until lawyers are brought to heel (which will require a revolution) our medical system will be confused and inefficient.


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## RigLS (Nov 6, 2009)

My wife went into labor 5 weeks early, spent 3 days in the hospital. My son spent 19 days in the NICU. I think the grand total without insurance is $120000. I have insurance and will pay a max of $4000. 

You guys that dont have insurance and dont want it must not have anything other than mountain biking to worry about.


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## Ailuropoda (Dec 15, 2010)

RigLS said:


> My wife went into labor 5 weeks early, spent 3 days in the hospital. My son spent 19 days in the NICU. I think the grand total without insurance is $120000. I have insurance and will pay a max of $4000.
> 
> You guys that dont have insurance and dont want it must not have anything other than mountain biking to worry about.


,

I hate to keep this thread going but...

The bill might have been $120,000 but the hospital and the doctors will not get anything close to that. Medical billing is incredibly byzantine and nobody really knows how much things cost or how much they will get paid. This is the "billed" amount but the collected amount depends on the contract with the insurer and their willingness to pay even what they have agreed to (because both the government and insurance companies throw up many obstacles to having to pay what they owe), what the patient can pay, and a hundred other factors.

The government, for example, cries "fraud" if they audit a chart and find an unsigned order. I give maybe twenty phone (verbal) orders a day and the hospital has a small platoon of expensive clerks who's only job is wading through mountains of charts making sure everything is signed and dated. Every day I have a stack of charts that need signatures. This contributes nothing to medical care but sucks up huge amounts of your money.

The point is that medical care in America is expensive because it is terrifically over-regulated, over-administered, and over-litigated, massively bureaucratic, insanely over-utiilized, and completely and utterly irrational on many, many levels.

It must be experienced to be believed.


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## 007 (Jun 16, 2005)

Ailuropoda said:


> The point is that medical care in America is expensive because it is terrifically over-regulated, over-administered, and over-litigated, massively bureaucratic, insanely over-utilized, and completely and utterly irrational on many, many levels.


This is 100% pure, unadulterated truth . . . sad, but true. There are so, so many problems on so many levels that I truly believe it will never be fixed.


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## TX_Shifter (Aug 14, 2007)

sooner518 said:


> i went about 4 months without and didnt take as many chances when I had no insurance. not worth it to have tens of thousands of medical bills because you took a dumb chance without insurance.


You answer is right on!!

Even though I pay for health insurance, I don't like taking advantage of using it (CO - PAYs sux!!). So I ride as if I don't have own health insurance.

Basically while I am riding I follow what my "signature" says below :thumbsup:

No one is paying me to go down the 6' + drop and at the end if I crash or not, I go on with my day w/o pay. 

Sincerely,

When in doubt, Bail out!!:thumbsup:


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## B-Mac (Oct 2, 2008)

Ailuropoda said:


> It's not free. You pay for it with public debt, economic stagnation, and decline . The economic decline of our nation is being driven largely by out-of-control spending for "free" health care (and other rights) as it is in most of Europe. Greece is collapsing because of the inability of the public sector, the producers of wealth, to keep up with the cost of maintaining the dependent sector.
> 
> Medical care is not a public utility like running water.
> 
> ...


A - you've made many excellent comments on this thread, appreciate your insight. Some of the arguments you've been dealing with are pretty ignorant, admire your patience & tenacity there. I'd have told the guy to eff off & unsubscribed from the thread a long time ago. Much positive rep for you.

For those of you who doubt his comment that a lawsuit only costs the filing fee - you're right, he's wrong. The attorney will usually cover that for the plaintiff. It doesn't even cost that much. Most med/mal attorney take cases on a contingency fee - in other words, the fee is deferred and is dependant upon recovery. After discovery, an expert witness is hired. That's the expensive part. If the expert's report won't substantiate the case (rare) the case is voluntarily dismissed. But the lawyer's firm sucks up those costs, not the plaintiff.

Ya know I'm a lawyer & I'm proud of what I do (which is NOT medmal, btw - bankruptcy, non-fdcpa collections, consumer rights, etc), but lawyers have screwed up the medical industry through malpractice lawsuits. Kinda like narcotics, there's so much money to be had there that there will always be someone willing to do what it takes to get it.

Agree strongly that "single payer" is not the answer. It'll create 10x more problems than it solves. People who think that putting the government in charge of something will make that something better anger me with their stupidity. I think health care should be free when rent, groceries, gas,, transportation, and heat for doctors is free. Healthcare is an economic good - nobody has a "right" to any economic good that they have not paid for.

I think it's a difficult problem. On one had, there ARE bad doctors out there - how do you cut the fraud without denying court access to someone who's been legitimately the victim of medical malpractice? Hopefully we can solve it without a revolution LOL. Believe I'll be hanging from a tree if that revolution happens.

It might interest you to know that I've been involved in the bankruptcies of 4 different doctors in the past 12 months, 2 of which were caused by student loans.

A - I thought my job had embittered me. You, my friend, need more time on the back of a bike & away from the ER. Seeing the worst people at their worst will do that to ya though.

BTW: I have insurance, but I'd ride without it. I'm an addict. I can also file my own bankruptcy for free if I need to (uuh, yay?).

Cheers!!
b-mac.


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## AnthemRider (Feb 7, 2007)

> For those of you who doubt his comment that a lawsuit only costs the filing fee - you're right, he's wrong. The attorney will usually cover that for the plaintiff. It doesn't even cost that much. Most med/mal attorney take cases on a contingency fee - in other words, the fee is deferred and is dependant upon recovery. After discovery, an expert witness is hired. That's the expensive part. If the expert's report won't substantiate the case (rare) the case is voluntarily dismissed. But the lawyer's firm sucks up those costs, not the plaintiff.


Just because the lawyer sucks up the fees and expenses, does not mean the expenses are cheap. Malpractice cases are a whole different animal from a car wreck case.

The premises was that healthcare is expenses because lawsuits are being filed without any good faith basis because it doesn't costs anything. That is wrong, it's a heck of a lot more expenses than a bankruptcy. And the firms don't throw that money away just because there's a one in million chance they might get lucky.

You do not hire an expert after discovery, you need the expert prior to filing suit so that you have that good faith basis.

Looks like Ailuropoda is in LA, which is different in many ways because it is based on Napoleonic Law instead of the Common Law, and I don't have quick access to much material to do real research on it - but a quick search makes it look as though you need a panel of 3 docs (not lawyers or judges) who practice in the same specialty as the respondent physician review to see if there was a breach in the standard of care before a suit can even be filed (from the little I got just from a quick search, it looks like this procedure was probably set in place as part of compromise legislation to institute liability caps).

Many jurisdiction you have to have the affidavit requirement:

NC:

(A) Prior to filing or initiating a civil action alleging injury or death as a result of medical malpractice, the plaintiff shall contemporaneously file a Notice of Intent to File Suit *and an affidavit of an expert witness, subject to the affidavit requirements established in Section 15-36-100*,

AR:

(a) If any action for medical injury is filed without reasonable cause, the party or attorney who signed the complaint
shall thereafter, as determined by the court, be subject to:
(1) The payment of reasonable costs, including attorney's fees, incurred by the other party by reason of the
pleading; and
(2) Appropriate sanctions.
(b) (1) In all cases where expert testimony is required under § 16-114-206, reasonable cause for filing any action
for medical injury due to negligence shall be established only by the filing of an affidavit that shall be signed by an
expert engaged in the same type of medical care as is each medical care provider defendant.
(2) The affidavit shall be executed under oath and shall state with particularity:
(A) The expert's familiarity with the applicable standard of care in issue;
(B) The expert's qualifications;
(C) The expert's opinion as to how the applicable standard of care has been breached; and
(D) The expert's opinion as to how the breach of the applicable standard of care resulted in injury or death.
(3) (A) The plaintiff shall have thirty (30) days after the complaint is filed with the clerk to file the affidavit
Page 1
before the provisions of subsection (a) of this section apply.
(B) If the affidavit is not filed within thirty (30) days after the complaint is filed with the clerk, the complaint
shall be dismissed by the court.

GA:

9-11-9.1. Affidavit to accompany charge of professional malpractice

(a) In any action for damages alleging professional malpractice against:

(1) A professional licensed by the State of Georgia and listed in subsection (g) of this Code section;

(2) A domestic or foreign partnership, corporation, professional corporation, business trust, general partnership, limited partnership, limited liability company, limited liability partnership, association, or any other legal entity alleged to be liable based upon the action or inaction of a professional licensed by the State of Georgia and listed in subsection (g) of this Code section; or

(3) Any licensed health care facility alleged to be liable based upon the action or inaction of a health care professional licensed by the State of Georgia and listed in subsection (g) of this Code section, the plaintiff shall be required to file with the complaint an affidavit of an expert competent to testify, which affidavit shall set forth specifically at least one negligent act or omission claimed to exist and the factual basis for each such claim.

Do you want more examples, or are you ready to admit that you're wrong?


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## AnthemRider (Feb 7, 2007)

> I would enjoy one thing about being a government employee working for relative peanuts: With no fear of being sued I could do things the right way...of course the government always goes too far and we'd have trouble getting things we actually need for our patients but, oh the joy, of working an eight hour day, taking frequent breaks, looking at a full waiting room with indifference, and finally being able to practice "minimilist" medicine.


On behalf of others, I take exception to that. Maybe you look down on them because they make "relative peanuts," but I know a number of "government workers" that are damn fine docs (better than a number of private docs I've seen), that put in a lot of hard work, without frequent breaks -- especially when they see a waiting room fill up. They just have different reasons for doing what they do.

Of course they don't always order as many tests, but the facility can still have claims filed against them (State and Federal governments have sovereign immunity, but also have statutory provisions allowing for malpractice claims). If they get a number of claims against them, they don't have a job for very long and private facilities probably aren't going to be to eager to hire them either.



> Lawyers are generally pretty smart but they have limited medical knowledge


 Just as MDs are generally pretty smart but they have limited legal knowledge.

Almost every argument you have made are emotional arguments.


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## 007 (Jun 16, 2005)

AnthemRider, what do you do for a living and/or what is your educational background?


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## B-Mac (Oct 2, 2008)

AnthemRider said:


> Do you want more examples, or are you ready to admit that you're wrong?


Respectfully, I'm not wrong.

However, the spectacle of watching you clumsily try to school an ER doc on insurance and now a lawyer on the law is good stuff. Keep at it.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Just because the lawyer sucks up the fees and expenses, does not mean the expenses are cheap. Malpractice cases are a whole different animal from a car wreck case.
> 
> The premises was that healthcare is expenses because lawsuits are being filed without any good faith basis because it doesn't costs anything. That is wrong, it's a heck of a lot more expenses than a bankruptcy. And the firms don't throw that money away just because there's a one in million chance they might get lucky.
> 
> ...


Dude, I have told you. Every suit I know about is frivolous. It is not difficult to find an "expert" to testify to anything. Reasonable cause is the key. What's sounds reasonable to you in regard to medicine is often ludicrous to people who know about it.

In my state the suit goes to a Medical Review Panel consisting of three physicians who collectively draft a medical opinion on the validity of the case. I have been on several of these panels where we determine if the there was a doctor/patient relationship (important because many attorneys randomly name everyone in the chart), whether there was a breach in the standard of care, and whether harm resulted from it.

The review panel can give an opinion but the plaintiff's attorney is not obligated to drop the suit if the panel decides the case has no merit. As an example I refer you to my description of the child with the lacerated tendon. That case went to trial (and was dismissed) despite the obvious and common sense finding that the Emergency Physician acted appropriately and the mother was negligent in seeking follow-up as directed. It soaked up a huge amount of my colleagues time, cost him thousands of dollars of his own money to hire his own attorney rather than let the hospital settle, and was generally a source of grief for him until it was dismissed. The plaintiff and her attorney got nothing but were not sanctioned in any way although the review panel clearly stated their was no fault.

Once again, with feeling, and I'm not sure you yet understand this...win or lose...defensive medicine is directed against simply being sued. Because we're spending OPM (Other People's Money) at no cost to ourselves, we are going to be super cautious to prevent a lawsuit from happening in the first place. This is the same principle that motivates families of brain-dead patients to refuse to withdraw care. They're not paying for it so they don't care about costs. If they had to mortgage the house to pay for the $4000-per-day ICU bill they's pull that plug like they were starting a lawnmower.

There is no "loser pays" in our country although many people think it would be a good idea. You can counter-sue the plaintiff to recover your losses but by the time everything is settled legal exhaustion (for lack of a better term) sets in and it's best to let that dog lie. Besides, the plaintiff is usually a deadbeat anyway so there's the whole "blood from a stone" problem.

I have also never heard of a plaintiff's attorney being sued for "Legal Malpractice" although I think that would be a wonderful thing.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> On behalf of others, I take exception to that. Maybe you look down on them because they make "relative peanuts," but I know a number of "government workers" that are damn fine docs (better than a number of private docs I've seen), that put in a lot of hard work, without frequent breaks -- especially when they see a waiting room fill up. They just have different reasons for doing what they do.
> 
> Of course they don't always order as many tests, but the facility can still have claims filed against them (State and Federal governments have sovereign immunity, but also have statutory provisions allowing for malpractice claims). If they get a number of claims against them, they don't have a job for very long and private facilities probably aren't going to be to eager to hire them either.
> 
> ...


The VA is the perfect example of a Government Medicine. I have had many encounters with VA doctors and their system and there is a huge, "Not My Problem, It's Past 4PM" mentality that must be experienced to be believed. This is the perfect model for free medical care delivered on the cheap. Oh the horror stories I could tell you.

In fact, the VA is chock full of substandard physicians, many from shady overseas medical schools and programs, largely because they don't pay enough for quality physicians who still have other options. One of the benefits of working at the VA even if you are a good doctor is that you work regular hours and can be a "clock watcher" with impunity. Try getting anything from the VA after 3PM. Go ahead.

I do not look down on anybody making peanuts. I made peanuts as a resident for four years, something like three dollars an hour, even when I was the senior ICU resident essentially managing a 30 bed ICU at night all by my little self.

But they make peanuts because the government pays peanuts and in exchange, you get benefits...the most important being that it is almost impossible to get fired. It is a fact of life that you work harder if the wolves are prowling at your door. I see thirty-to-forty patients a shift because if I don't, the hospital will damn well find someone who will for the kind of money they're paying me. Thirty patients in a twelve-hour shift is, by the way, a lot of patients especially as they are all "undifferentiated" and some of them are quite sick.

I say again and take this to the bank: If you lowered my pay but in exchange made me a government employee who it would take an act of congress to fire, I'd slowly decide not to bust my ass and I'd generally work at a leisurely, non-stressful pace no matter how full the waiting room was.

I have done many rotations in VA hospitals as a resident, by the way. The good doctors there are generally academic attending physicians who are affiliated with the University or the Medical School and not the VA. I did my intern year at Duke and the Durham VA Hospital is quite good...because Duke University Medical Center is right across the street.


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## 007 (Jun 16, 2005)

B-Mac said:


> Respectfully, I'm not wrong.
> 
> However, the spectacle of watching you clumsily try to school an ER doc on insurance and now a lawyer on the law is good stuff. Keep at it.


And an ER doc who clearly has experience in the med-legal world at that.

Until I know what this person's background is though, I'll refrain from adding to the conversation. I've asked twice now . . . we'll see if I get an answer this time.


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## AnthemRider (Feb 7, 2007)

B-Mac said:


> Respectfully, I'm not wrong.
> 
> However, the spectacle of watching you clumsily try to school an ER doc on insurance and now a lawyer on the law is good stuff. Keep at it.


You're the one who stated that experts are only hired after discovery is done (forgetting that little part about how important experts are in the discovery process). Do I need to go through the statutes of all 51 jurisdictions?

Of course, I guess there is no Rule 11 in your jurisdiction. I'm sure your malpractice carrier would find comfort in knowing that you don't feel due diligence is an important part of pursuing a cause of action.

You might also want to brush up on those logical fallacies -- maybe even appeal to false authorities.


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## AnthemRider (Feb 7, 2007)

OO7 said:


> And an ER doc who clearly has experience in the med-legal world at that.
> 
> Until I know what this person's background is though, I'll refrain from adding to the conversation. I've asked twice now . . . we'll see if I get an answer this time.


Sorry, just saw your request. I have a J.D. and I'm an appellate attorney.


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## Ailuropoda (Dec 15, 2010)

OO7 said:


> And an ER doc who clearly has experience in the med-legal world at that.
> 
> Until I know what this person's background is though, I'll refrain from adding to the conversation. I've asked twice now . . . we'll see if I get an answer this time.


Unfortunately, my experience is at the business end of the medical-legal world...as in looking down the barrel.

I would also note that every hospital and many large practices devote a substantial amount of money to something called 'Risk Management." Naturally we want our patients to be safe but our risk managers even make recommendations related to the practice of medicine, many times in direct contradiction to the recommendations of the various medical colleges (specialty groups, I mean, like ACEP) for rational and evidence-based medicine. Why on Earth should any civilized society full of hard-working people who are doing the best that they can have to live in such fear of the legal profession that we have specialty devoted just to protecting us from it?

At my hospital they publish a large booklet detailing how to minimize getting sued. In its pages you will find the recommendation that we be "liberal" with antibiotics even if they are not indicated (and believe me, the majority of antibiotics are prescribed for no other reason than to placate the patients..."placebo."). They also recommend CT scans for every patient with a headache which, let's see, is roughly every patient I see.

In other words, the legal environment is so predatory that the hospital attorneys recommend I obtain twenty to thirty CT scans of the brain every shift, day in, day out which conservatively is around 4000 mostly unnecessary scans a year at a cost to you of about $700 a pop. The hospital accountants recoil at this because the radiologists are paid on a "piecework" basis so while its true that the scanner is just sitting there and there is no real cost to scan an uninsured patient, the interpretation costs them real money.

This is all part of the ongoing war between doctors, lawyers, and hospital administrators. Again, you have no idea. At this time, however, it is very difficult to control what doctors spend because no matter what the hospital say or promises, when you are sued you are on your own, thrown under the bus at the first sign of trouble...no honor among thieves if you know what I mean. We know it, they know it, so they tread lightly and I have never heard of any doctor being told he was ordering too many tests.

In fact, when I first finished residency and was full of idealism and chock-full of the Knowledge of How Things Should Be I tried very hard to only order tests that were medically necessary. I was "reprimanded" for this...meaning I was politely warned that I would be impossible to insure if I continued, essentially, to practice rational medicine.

You lawyers make me laugh. You are a huge part of what is wrong with not only medicine but our entire society. My office chair, the one that I'm sitting on right now, has no less than five separate warning labels stapled and glued under the seat all part of the efforts of the productive class to ward off your depredations.


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## Ailuropoda (Dec 15, 2010)

And you all got me so fired up i've restarted my blog.

PANDA BEAR, MD

My new Niner One 9. The latest bike, by the way, that I ride in security because I pay $17,000 a year for my family's insurance.


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## B-Mac (Oct 2, 2008)

AnthemRider said:


> You're the one who stated that experts are only hired after discovery is done (forgetting that little part about how important experts are in the discovery process). Do I need to go through the statutes of all 51 jurisdictions?
> 
> Of course, I guess there is no Rule 11 in your jurisdiction. I'm sure your malpractice carrier would find comfort in knowing that you don't feel due diligence is an important part of pursuing a cause of action.
> 
> You might also want to brush up on those logical fallacies -- maybe even appeal to false authorities.


Please feel free to do whatever makes your little rage-filled heart feel better, snookums.

The point I made was that the PI attorney will cover the cost of the expert & not the plaintiff, so that A's post that "the lawsuit only costs as much about the filing fee" was wrong, but in A's favor.

Do you see now? I can draw you a chart . . .


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## texasnavy05 (Sep 9, 2010)

Spinning Lizard said:


> I am in my 40's with no insurance and without for my kids. I want it but cannot afford it. Started out 2 years ago paying $175 per month ($10,000 deductible) last year it went to $275 and this year up to $410. never used it but the premuims just kept going up. Had to stop paying, lets see eat or have insurance. Not a tough choice, if i wreck, so be it.


"eating or having insurance" is an easy decision. But....looking back on some previous posts it looks like you spend quite a bit on cycling. You own a superfly and an anthem and have a scalpel on order and several wheelsets you mentioned riding that are pretty pricey. And you race which can add up in a hurry. Im not trying to tell you how to prioritize your expense accounts, but I think I would change the line "I want it but cannot afford it" to something like "I want it, but dont have enough money for everything and if i had to choose between cycling or insurance for my family and myself I would choose cycling."

Of course you could be sponsored and not have to pay for any of these things which would negate everything i just said.

Just out of curiosity, what do the guys without insurance plan on doing if they wreck and cant afford the medical bill?


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## Ailuropoda (Dec 15, 2010)

texasnavy05 said:


> "eating or having insurance" is an easy decision. But....looking back on some previous posts it looks like you spend quite a bit on cycling. You own a superfly and an anthem and have a scalpel on order and several wheelsets you mentioned riding that are pretty pricey. And you race which can add up in a hurry. Im not trying to tell you how to prioritize your expense accounts, but I think I would change the line "I want it but cannot afford it" to something like "I want it, but dont have enough money for everything and if i had to choose between cycling or insurance for my family and myself I would choose cycling."
> 
> Of course you could be sponsored and not have to pay for any of these things which would negate everything i just said.
> 
> Just out of curiosity, what do the guys without insurance plan on doing if they wreck and cant afford the medical bill?


Typical Scene at Emergency Department:

Baby's Daddy pulls up to ambulance entrance in his Lexus, momma gets out with well-looking baby, demands they be seen right away because L'il Booboo had a fever, get irate when I won't write them a prescription for Children's Tylenol which is three bucks at Wal Mart, and brandish their Medicaid Card yelling that they don't have to pay ****.

Happens a lot.


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## AnthemRider (Feb 7, 2007)

B-Mac said:


> Please feel free to do whatever makes your little rage-filled heart feel better, snookums.
> 
> The point I made was that the PI attorney will cover the cost of the expert & not the plaintiff, so that A's post that "the lawsuit only costs as much about the filing fee" was wrong, but in A's favor.
> 
> Do you see now? I can draw you a chart . . .


Perhaps I should draw you a chart, given that you do not seem to have very good reading comprehension skills -- specially given that you are the one arguing out of emotion my little sweat-pea.

If you read the thread, the point is that the fear that lawsuits are out of control because of all of the frivolous lawsuits that are filed on the "one in a million chance" that something will stick (and in that case it would have to survive an appeal or remittitur) is not based on reality.

Extremely few lay people will be able to even get a medical malpractice lawsuit filed without being quickly dismissed (and ordered to pay the defense's costs and fees).

That means the case has to be filtered through an attorney. Contrary to what you seem to believe, it's rather hard to find an attorney who is going to jump at the chance to put in that many hours and spend that much money on a case that has a 99.9999999999999% chance of losing. And that doesn't even account for the monetary sanctions placed upon them or referrals for negative action against their license to practice law.

That is why I told him earlier that while he has only had a couple of malpractice claims against him when he has treated some 60,0000 patients that there is a good chance that there have been other patients who thought they had a case but were turned down by every lawyer they went to (and some of these attorneys will even tell you that they have the same person call them multiple times because they have called so many attorneys - and told they don't have a case - that they forget who they have already called).

Tell you what. Next time I get an e-mail from that friendly gentleman from Nigeria, I'll forward it to you. You can then send him all of your life savings to him so he can arrange that bank transfer. After the bank transfer, I'll let you keep 30% of the proceeds and I'll keep the other 70%. You should jump at this opportunity! After all, it is no cost to me and you might get lucky and find out the e-mail was legit!


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> Unfortunately, my experience is at the business end of the medical-legal world...as in looking down the barrel.
> 
> I would also note that every hospital and many large practices devote a substantial amount of money to something called 'Risk Management." Naturally we want our patients to be safe but our risk managers even make recommendations related to the practice of medicine, many times in direct contradiction to the recommendations of the various medical colleges (specialty groups, I mean, like ACEP) for rational and evidence-based medicine. Why on Earth should any civilized society full of hard-working people who are doing the best that they can have to live in such fear of the legal profession that we have specialty devoted just to protecting us from it?
> 
> ...


Yes, I do have an idea.

You posted earlier that medical malpractice attorneys are not that knowledgeable in medicine -- and you are right. If they've been doing it for very long they have picked up quite a bit, but I wouldn't suggest going to one for medical care because they have, at best, learned just enough to be dangerous.

I also would not advise someone going to an ER doc for legal advice. Even if he has been involved in a number of legal proceedings he has, at best, learned just enough to be dangerous. Might not have learned enough yet to realize that there is a lot he doesn't know.

Again, you're not grasping that just because someone fears something, and goes to great lengths to avoid that which he is afraid of, means that it is a rational fear. If someone spends thousands of dollars in tin foil hats, does that mean the aliens are really reading his mind? It must be, because all of the people in the alien-protection chat rooms keep telling him about all the things that are going on (just covered up by the government).

Look at the sources you are getting your information from. Someone in risk management telling you how not to get sued? Think maybe they like their job enough to go to the extreme far end of caution? As you said, they're just spending other people's money so why shouldn't they be overly-cautious just to give themselves a wide margin of error.

20-30 brain scans a shift? Either that is a specific patient who apparent lives in imaging, or just (which I suspect) a general recommendation without any basis in the needs of a particular patient - so in other words is not based upon the standard of care for that patient but for considerations not related to that patient.

Your hospital is throwing you under the bus when you didn't make any error? That would be more of problem with the hospital administrators not having character than with the legal system. I obviously don't have access to your policy, but if your carrier is giving you an attorney who has a conflict of interest between you and the hospital, you should address that with both the attorney and your carrier.

And in response to one of your earlier statements. Yes, there is a reason why attorneys also carry malpractice insurance. Like a great many things, just because you haven't heard of it doesn't mean that it doesn't happen.

We can even use an extreme case (we'll take out the element of insurance for simplicity):

Suppose an ER doc has a malpractice lawsuit filed against him. Someone purporting to be a bankruptcy runs to his defense -- even though this attorney is unable to exercise the knowledge of a first year law student and distinguish between contract (insurance) and tort (negligence) law.

Even though it was pointed out to him that statutes require the affidavit of an expert prior to filing suit, and that he could have the plaintiff be ordered to pay the costs and legal fees if they fail to do so, the attorney doesn't get the case dismissed even though he could have with less than 5 hours of work.

Then, he not only doesn't realize that the plaintiff isn't able to develop effective discovery (and hence their case) because they still don't have an expert to work with them. Of course, that's probably takes too much to figure out, since it apparently still hasn't dawned on him that if he sent out a simple interrogatory asking "whose your expert?" he would learn the plaintiff still doesn't have one.

Now, the judge is remaining completely impartial and so is not giving legal advice to either side, and somehow this goes to trial and results in a large verdict against the doc (not surprising, given his attorney) and the doc is devastated.

Think when the doc learns everything could have been avoided with small expense that the other side would have had to reimburse him for anyway that he is going to just say "Oh, well. I lost a million bucks, but I don't want to be one of those people that sue in hopes of a jackpot."


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## B-Mac (Oct 2, 2008)

AnthemRider said:


> Perhaps I should draw you a chart, given that you do not seem to have very good reading comprehension skills -- specially given that you are the one arguing out of emotion my little sweat-pea.
> 
> If you read the thread, the point is that the fear that lawsuits are out of control because of all of the frivolous lawsuits that are filed on the "one in a million chance" that something will stick (and in that case it would have to survive an appeal or remittitur) is not based on reality.
> 
> ...


Feel better now? Tantrum over yet?


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Yes, I do have an idea.
> 
> You posted earlier that medical malpractice attorneys are not that knowledgeable in medicine -- and you are right. If they've been doing it for very long they have picked up quite a bit, but I wouldn't suggest going to one for medical care because they have, at best, learned just enough to be dangerous.
> 
> ...


Again, you are completely missing it.

We both agree that lawsuits are rare and you correctly note that I have seen thousands of patients and have only been sued twice. But the point you missed is that lawsuits, even if frivolous which both of mine are and were, are so onerous to a physician and cause so much trouble and expense to us even if they have no merit, are eventually dismissed, or go to trial and are found without merit that most doctors in high-risk specialties will go to extraordinary lengths to ward them off. This generally involves the ordering of excessive tests, imaging and consults because the new "Standard of Care" is "Zero Defect, Miss Nothing."

Now, you can say that this is a good thing but it is a very expensive way to practice medicine. If I order a million dollars worth of tests to catch one extremely unlikely condition if you're that one person in ten thousand you think the money was well spent but from an economic standpoint this is the road to financial ruin. That one guy doesn't care how much was spent just like the family of a brain dead, ventilator dependent patient don't care how much keeping his brainless body alive costs because it's Other People's Money.

See? Although doctors do find defensive medicine distasteful, it's Other People's Money and in the end they'll spend it to avoid the more distasteful possibility.

I also think you don't understand risk management. They are not recommending, for example, scanning everybody who has a headache to make money for the hospital but because the cost of a lawsuit for, let's say, sending a patient home with an undiagnosed brain tumor, can run in the millions and they'd rather spend medicaid, medicare, and insurance money (Other People's Money) than risk that.

Remember, they're asking for scans for every patient with a headache. Dude, every patient I see has a headache. That's the presenting complaint de jour if you're looking for a work note or narcotics. When risk management has it's way and doctors finally succumb, there will be no room for clinical judgement. I have ordered, for example, thousands of CTs of the brain and I have never been surprised by a positive finding. In other words, I know before I order it the real likelihood of a positive finding and am instead surprised to find nothing as I often do.

An older patient, for example, with first ever seizure that stared in his left arm...bang...brain tumor every time and I hardly need a scan at all to tell me this except the neurosurgeon needs to see what he's dealing with.

That's how CTs should be ordered. When there is a reasonable suspicion based on exam and history and the test is ordered to confirm or refute it. In other words, you should always have a good idea of the result of the test before you order it. It's okay if it's negative, you can just shrug your shoulders and say, "I was wrong but it was a legitimate test."

Now, one in ten thousand patients with a mild headache, normal neurological exam, normal vitals, no systemic symptoms, no history to suggest anything but a benign headache...no real reason not to wait a little and maybe scan in a week or two if the symptoms don't resolve....one in ten thousand may be sent home with and undiagnosed finding but you have to ask yourself if the millions spent to avoid this because of the fear of a lawsuit is well spent, especially if there is very little risk and the patient is instructed to follow up or even return to the emergency department if not better in a few days.

This is how things work and what motivates risk management.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> We can even use an extreme case (we'll take out the element of insurance for simplicity):
> 
> Suppose an ER doc has a malpractice lawsuit filed against him. Someone purporting to be a bankruptcy runs to his defense -- even though this attorney is unable to exercise the knowledge of a first year law student and distinguish between contract (insurance) and tort (negligence) law.
> 
> ...


Dude, are you saying that we are worried unnecessarily about being sued because most of our lawsuits can be easily dismissed with only five hours worth of work on the part of our defense attorney? Holy Fajita, Ghost Rider. In what alternate plane of reality do you practice law?

Your sticking point is that you believe it is impossible to get sued for something minor because it would be impossible to get an expert to swear that the standard of care was breached resulting in harm to the patient but this is not the case. There are many physicians who will review a case and provide whatever opinion the plaintiff's attorney desires. In fact, my "college," the American College of Emergency Physicians" (ACEP) regularly censures physicians who do this...ineffectually because it has neither regulatory or enforcement powers...in the hope that this will cary weight in lawsuits that do make it to trial.

But, as you can find a lawyer to do or say just about anything, you can find a medical expert to do the same and as I noted a while back, many cases that go to trial become duels between competing expert witnesses. This is part of the general corruption of our society that has been enabled by the huge amounts of money in play in large part because there is so much money in tort.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Yes, I do have an idea.
> 
> 20-30 brain scans a shift? Either that is a specific patient who apparent lives in imaging, or just (which I suspect) a general recommendation without any basis in the needs of a particular patient - so in other words is not based upon the standard of care for that patient but for considerations not related to that patient.


Exactly! This could be your Eureka moment...the recommendation to scan every patient with a headache, effectively making this the Standard of Care, is not, repeat not,based not on the rational practice of medicine and regard for the effective use of scarce medical resources.

See? You've got it.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Your hospital is throwing you under the bus when you didn't make any error? That would be more of problem with the hospital administrators not having character than with the legal system. I obviously don't have access to your policy, but if your carrier is giving you an attorney who has a conflict of interest between you and the hospital, you should address that with both the attorney and your carrier.


Dude....Dude...seriously?

Hospital administrators are spineless. Except that it requires twelve years of training to do my job and it is a little more difficult to replace me than the guy spooning pseudo-meat into my Chalupa, I am no different than anybody else and I will be canned at the slightest sign of trouble or expense. This is the way of the world. I don't object to it but I laugh when corporations, for example, send me a Christmas card as if we're one big, happy ****ing family.

SInce my malpractice insurance is covered by the hospital, the malpractice attorney they hire represents the interests of the hospital. Period. In my specialty, the hospital is always...always....named in the suit because they have the Deep Pockets. The hospital always acts exclusively for their own interest. If this means settling out of court to avoid an expensive trial even if the case could be won they will do it even though this can be professionally devastating to me. If it means having themselves dropped from the case and leaving me defenseless they will do it.

The insurance company does not..repeat does not...repeat does not....care about the merits of the case. Their only concern is their cost to defend. It's not like in the movies. They would rather lose or settle every case but have minimal expenses than bankrupt themselves fighting for truth and justice.

This is why I have to hire my own lawyer if I am sued...to protect myself from the hospital's attorney.


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## AnthemRider (Feb 7, 2007)

> Dude, are you saying that we are worried unnecessarily about being sued because most of our lawsuits can be easily dismissed with only five hours worth of work on the part of our defense attorney? Holy Fajita, Ghost Rider. In what alternate plane of reality do you practice law?


Go back and read the post. When a statute requires you to file an affidavit of your expert before or at the time of filing, and you never have an expert (which obviously means you don't have an affidavit), it doesn't take long to handle that -- with sanctions against the plaintiffs attorney thrown in.



> SInce my malpractice insurance is covered by the hospital, the malpractice attorney they hire represents the interests of the hospital. Period. In my specialty, the hospital is always...always....named in the suit because they have the Deep Pockets. The hospital always acts exclusively for their own interest. If this means settling out of court to avoid an expensive trial even if the case could be won they will do it even though this can be professionally devastating to me. If it means having themselves dropped from the case and leaving me defenseless they will do it.


But, again, that is a different problem. It is a problem with your hospital administrators and with the attorney your carrier is providing. If an attorney is going to represent you, he has to represent you without a conflict of interest (_i.e_., they can't throw you under the bus in favor of another client[the hospital]).



> The insurance company does not..repeat does not...repeat does not....care about the merits of the case. Their only concern is their cost to defend. It's not like in the movies. They would rather lose or settle every case but have minimal expenses than bankrupt themselves fighting for truth and justice.


I've already agreed that the carrier does not care about the merits of the case. They also do not care about you, nor do they care about "doing right." They care about making money.

The cost to defend is not as big of factor to them as you think it is. If they can settle for much less than what a settlement/verdict would normally be they will, but for the most part it is to their benefit to put up a fight.

Part of it is to make litigation more arduous for the plaintiff (again, even if you have a "sure fire" case for $5,000.00, an attorney isn't going to spend more than that, plus put in all of the work, just so he can collect a $1,600.00 fee); but much of it is to 1) hope that the defense will be able to prevail (contrary to popular belief, juries are skeptical of claims in most jurisdictions) and also to delay the payment of judgment.

I have had clients that have been in this situation. They were told by their carriers that the reason that they had to pay such high premiums was because of the ease in which plaintiffs can sue (and hit the jack pot). Then, when they or someone in their immediate family suffers they find out just what all they have to go through just to get to and through trial -- and then through appeals filed even though the defense knows they are almost certain to lose the appeal.

That's business. The carrier does not make its money by collecting your premiums - it makes it by using the money you pay in premiums. If you have $100.00, and you can invest that and make an additional $100 in six months (so you have a total of $200), but you'll probably have to pay the original $100 out to someone else next week -- don't you think it might be worth your while to spend $5.00 to delay that payment for seven months?

There are many more factors involved, but the bottom line is that the "out of control problem of frivolous lawsuits" does not have near the impact that you think it does, more they are convenient scapegoats to justify costs because it's easy for people to believe the stories.



> In fact, my "college," the American College of Emergency Physicians" (ACEP) regularly censures physicians who do this...ineffectually because it has neither regulatory or enforcement powers...in the hope that this will cary weight in lawsuits that do make it to trial.


And they will. Do you really think the testimony of an expert witness will carry any weight when they've been censured? That's already be discussed. The jury expects that the defense will have someone that regularly testifies, but a "professional witness" kills a plaintiff's case.



> Your sticking point is that you believe it is impossible to get sued for something minor because it would be impossible to get an expert to swear that the standard of care was breached resulting in harm to the patient but this is not the case.


No, theoretically, you can be sued for minor injuries -- and theoretically there isn't really any reason why you shouldn't be able to. If a physician makes a mistake (not a known risk, stuff happens type of things, but a mistake) that causes harm to a patient then the patient would be entitled to reasonable compensation. But to say that there is an avalanche of minor cases filed by plaintiff's attorneys hoping to get lucky is driving up your insurance costs is another matter because the attorneys are not going to be rushing out there to spend their money and their time on a case that is going to have a negative return.

Think of it this way. Say you're having a busy day (not hard to imagine for an ER doc), and so instead of taking a lunch hour you send someone on staff to go grab you a sandwich. The smallest bill you have is a $20.00 so you give to them to pay for the sandwich -- which costs $5.00. They bring you the sandwich, put stiff you on the change and won't give it back. We'll assume that you paying this staff member for their time anyway, so the change isn't to compensate them for their time in getting your lunch for you. Are you entitled to your $15.00? Of course --- but how much time and money are you going to spend to get that $15.00 back?



> I also think you don't understand risk management. They are not recommending, for example, scanning everybody who has a headache to make money for the hospital but because the cost of a lawsuit for, let's say, sending a patient home with an undiagnosed brain tumor, can run in the millions and they'd rather spend medicaid, medicare, and insurance money (Other People's Money) than risk that.


No, as I said, your risk management people would rather tell you to throw in everything including the kitchen sink, because they're just spending other people's money. Blaming frivolous lawsuits is much easier than drawing a demarcation line. It's certainly easier to tell someone to put on a tin hat and then say "no aliens controlled your brain today, so I did a good job by telling you to put on a tin hat!"



> That one guy doesn't care how much was spent just like the family of a brain dead, ventilator dependent patient don't care how much keeping his brainless body alive costs because it's Other People's Money.


That's true, and it's a problem, but it's a different problem. I think I brought that up before, and it was essentially dismissed. One of the reasons we spend so much on health care is that people don't see what they are spending -- whether it's public assistance or private insurance. While I believe it's a darn good idea to have health insurance, as a society we are not good consumers of health care because if a patient only has to pay a small co-pay they will demand that their doc give them a script for that drug they saw on t.v. or that test that they think they need. They are only looking at that co-pay, not the effect on health care/insurance costs as a whole -- and I'm sure that you would agree that there are some docs who will comply with those demands to either placate the patient or because if they don't then the patient will just start going to a doctor who will.



> We both agree that lawsuits are rare and you correctly note that I have seen thousands of patients and have only been sued twice. But the point you missed is that lawsuits, even if frivolous which both of mine are and were . . .


Thank you for agreeing as to that. I have absolutely no knowledge of your cases, and so I obviously can't say whether they are frivolous or not, but I can posit that 1) if they are, there are means available to remedy it and 2) sometimes (especially when it's personal to you) something seems frivolous to one isn't always so. Remember, malpractice is not equal to malfeasance and doesn't mean that you meant harm or did not care, and so it's easy to feel "I didn't do anything wrong" Everybody makes mistakes.

With that said, the premise that healthcare is so expensive because docs are being sued left and right for frivolous claims that are filed because the plaintiffs might get lucky (_extremely_ lucky, they'd do better playing the lottery) is propaganda and not reality.

Taking the easy way out and blaming everything on the closet monster only results in an avoidance of looking carefully at all of the problems - and hence they will never be corrected.



> Exactly! This could be your Eureka moment...the recommendation to scan every patient with a headache, effectively making this the Standard of Care, is not, repeat not,based not on the rational practice of medicine and regard for the effective use of scarce medical resources.


Taking your statement at face value, your hospital is saying that it wants X number of scans per shift, not caring what patient or symptoms are present. That is your hospital policy, not a plethora of lawsuits, that is driving that.


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## Ailuropoda (Dec 15, 2010)

[QUOTE}

Taking your statement at face value, your hospital is saying that it wants X number of scans per shift, not caring what patient or symptoms are present. That is your hospital policy, not a plethora of lawsuits, that is driving that.[/QUOTE]

But you see, the Standard of Care is defined as those actions that a typical physician, given the same circumstances, would take. SInce every hospital is open to legal depredation, and they all have risk management telling them pretty much the same thing, the standard of care has evolved to reflect this practically everywhere. In fact, the risk management handbook from my group says, "The Standard of Care has evolved to include the liberal use of CT scans for patients presenting with Headache."

It also advocates giving antibiotics to patients even if not indicated (and they usually aren't) just to keep the patients happy so they will be less likely to sue. This is not only pathetic but has been disastrous medically as we lose once mighty antibiotics to resistant strains.

Or, to look at it another way, if every doctor had testicles of iron and refused to practice defensive medicine instead only ordering studies and consults that were reasonable and medically indicated, the Standard of Care would reflect this and we'd spend a lot less money. Instead, the cowards, that is, those who have been sued past their tolerance threshold, drive the Standard of Care bus off the cliff....in other words we all devolve towards the lowest common denominator because all it hurts is our pride and costs us nothing.

Lawyers naturally deny the existence of defensive medicine and insist the cost of lawsuits is relatively small but I am telling you from my personal experience that if I wasn't concerned about 1) being sued and 2) being unemployable because made risk management nervous by not covering the hospital's ass I'd order about a third of the tests, images, and consults I currently do.

And I'm something of a daredevil.


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## pattongb (Jun 5, 2011)

If the last 2 posts have shown anything is how terribly messed up our health care SYSTEM is. Noticed I capitalized 'system' because our Health Care is excellent, its the 'system' that is extremely broken.


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## AnthemRider (Feb 7, 2007)

> But you see, the Standard of Care is defined as those actions that a typical physician, given the same circumstances, would take.


That is close, but not quite right. In order for a physician's care to be negligent, he would have to fall below the standard of what a _*reasonable *_physician (and in some cases, a physician in the same specialty) would provide -- not the _*typical *_physician. In some jurisdictions, a physician can also fall on the the "I'm just a ol' country doc, I can't be held to same standards as some city doc with all them fancy medical journals."

Also, for an actionable claim it is not enough that the care fell below this standard. The failure has to have been the cause some injury.

Think of running a stop light. If you're speeding and running a red light, you've fallen below the standard of the reasonably prudent driver. If there is a car traveling on the intersecting road - but not in the intersection -- he might yell a few words at you but because you didn't hit him he has no claim against you.

Same way, even if there is an injury ("bad outcome") doesn't mean there is a claim. Suppose someone needs a delicate operation in which paralysis is a known risk. The surgeon performs flawlessly but the patient suffers paralysis. No actionable claim because even if the surgeon exercises all due care that procedure unfortunately does not always have a good outcome.


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## RideMore56 (Jun 27, 2011)

_That's business. The carrier does not make its money by collecting your premiums - it makes it by using the money you pay in premiums._

Thats what has me scared, where are they investing it? With investments doing so poorly these days and interest rates being so low, how are insurance companies making any money? Seems like premiums for all kinds of insurance will be going way up.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> That is close, but not quite right. In order for a physician's care to be negligent, he would have to fall below the standard of what a _*reasonable *_physician (and in some cases, a physician in the same specialty) would provide -- not the _*typical *_physician. In some jurisdictions, a physician can also fall on the the "I'm just a ol' country doc, I can't be held to same standards as some city doc with all them fancy medical journals."
> 
> Also, for an actionable claim it is not enough that the care fell below this standard. The failure has to have been the cause some injury.
> 
> ...


See, you are clawing towards the light. We both agree that most suits are without merit and will either be lost by the plaintiff or settled out of court to avoid the cost of litigation. "Reasonable" and "Typical" physician means the same thing. All typical physicians are reasonable and are held to the same standard of care. But to bring a suit it is not necessary to prove a breach of the standard of care but only to allege that there was a breach. The level of proof required to make an allegation is much less than required to prove it.

In other words, we know most lawsuits are without real merit but they are pressed anyway because the cost to the Plaintiff is negligible and there is a very real possibility that the suit will be settled favorably out of court merely to avoid the substantial cost of defense. Additionally, even cases that appear to have merit but in reality do not are going to go in front of an emotional, non-medically-trained jury who can award large damages on a whim.

This is why lawsuits are brought for bad outcomes all the time even if there is no merit to the case. Here's a stunner: except that a few too many lawsuits can make you unemployable, the cost to the physician of winning a case is the same as losing it. The idea is, like I said, to avoid being sued in the first place. The damage to me is the same whether the case has merit or not and except for a little moral victory, the cost is the same if it goes to trial whether I win or lose.

The Cost To Me. The Cost To Me. Internalize this. Not the cost to the insurance company, the hospital, the country, or anyone else. Therefore, particularly in my specialty where I have in my Emergency Department access to more expensive tests and imaging than many small third-world nations, I will order tests, imaging, and consults out the wazoo in an attempt to miss nothing and protect myself, with your money, from losing any of mine. This is the essence of Defensive Medicine. It is a huge cost, like I said, and you are no position to refute this because you simply have no idea.

Additionally, the fear of lawsuits is not irrational. Physicians are sued all the time. Heck, we live in the most litigious society on earth and in the history of the world. We have more lawyers than there is legitimate work to keep them busy so they will stir up the ****, so to speak, at a tremendous cost not only to medicine but to every aspect of life in our truly ridiculous nation.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> ..In some jurisdictions, a physician can also fall on the the "I'm just a ol' country doc, I can't be held to same standards as some city doc with all them fancy medical journals."


You cannot be serious. This will not go over well with my lawyer when, at my deposition, I try to convince the plaintiff's attorney that I am a retard who doesn't know squat about modern medicine. You can claim that you don't have the facilities or specialists to adequately address the patient's problems but for any doctor to insist that he is an uneducated rube who doesn't keep up with his specialty is unthinkable.

However, you have accidentally hit on another practice driving up the cost of health care. Currently, and again because we live in such a predatory legal environment, the default advice when you call your doctor with any problem more serious than a cold is to "Go the the Emergency Room." This simple advice absolves your doctor of all responsibility for a bad outcome and transfers all of the risk in town to the ER doctor which is why my premiums are so high.

The problems is that even leaving aside the cost of defensive medicine, everything costs an order of magnitude more in the ER than it would if done at a clinic or outpatient lab. It's the nature of our specialty and the need to maintain a big staff for the real emergencies. This adds huge costs to you but you obviously don't know or care.


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## AnthemRider (Feb 7, 2007)

Ailuropoda said:


> You cannot be serious. This will not go over well with my lawyer when, at my deposition, I try to convince the plaintiff's attorney that I am a retard who doesn't know squat about modern medicine.


Yes, that is an actual defense in some jurisdictions, based not on that particular doctor but that the doctors in that jurisdiction just aren't up to date (apparently haven't learned about the Internet, air travel to attend training to update skills, mailing of journals, etc.).

You're also still confusing _fear _of being sued with actual _risk _of being sued.


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Yes, that is an actual defense in some jurisdictions, based not on that particular doctor but that the doctors in that jurisdiction just aren't up to date (apparently haven't learned about the Internet, air travel to attend training to update skills, mailing of journals, etc.).
> 
> You're also still confusing _fear _of being sued with actual _risk _of being sued.


I've been sued twice in the three years since I finished residency. The risk is as real as the fear considering what these suits cost me in time, money, aggravation, and paperwork and both of them are and were for, I assure you, nothing.

And it's not just in medicine. Business owners, engineers, private citizens...you name it...we all carry large liability policies to protect ourselves from legal predation. The money we spend on this amounts to a tax on economic activity, taking from the productive sector to at best give to the bureaucratic sector but at worst to enrich the huge freeloader class in whose bosom the legal class makes its home.


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## AnthemRider (Feb 7, 2007)

I'll just let this die, unless and until you want to use actual real life and rational thought to continue the discussion instead of just venting out of emotion.

I saw a quote that improved on an old cliche the other day (unfortunately I can't cite it because I don't remember where I saw it), but roughly it was "Everyone wants the protections and advantages provided to them by the law, they just don't want to have the responsibilities of the law applied to them."


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> I'll just let this die, unless and until you want to use actual real life and rational thought to continue the discussion instead of just venting out of emotion.
> 
> I saw a quote that improved on an old cliche the other day (unfortunately I can't cite it because I don't remember where I saw it), but roughly it was "Everyone wants the protections and advantages provided to them by the law, they just don't want to have the responsibilities of the law applied to them."


Good Lord. I am a pillar of the ****ing community. I was a Marine Infantryman for seven years. I was a Structural Engineer. I'm a physician now taking care of the sickest and the poorest members of our society. I obey the law, pay my taxes, respect authority, and have done everything asked of me and more as a highly productive member of our society. Your Law, sir, is a Beast and does nothing but harass the few of us left who contribute.


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## TCW (Mar 13, 2006)

Ailuropoda said:


> Good Lord. I am a pillar of the ****ing community. I was a Marine Infantryman for seven years. I was a Structural Engineer. I'm a physician now taking care of the sickest and the poorest members of our society. I obey the law, pay my taxes, respect authority, and have done everything asked of me and more as a highly productive member of our society. Your Law, sir, is a Beast and does nothing but harass the few of us left who contribute.


I'm enjoying your remarks and agree with most of them. I have a question, you say you were a Marine Infantryman. What's your opinion of the Marines in general?


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## Ailuropoda (Dec 15, 2010)

TCW said:


> I'm enjoying your remarks and agree with most of them. I have a question, you say you were a Marine Infantryman. What's your opinion of the Marines in general?


I got out in 1991. The current generation of Marines did a fantastic job in places like Fallujah and I believe they are tough and well-trained. I don't know any Marines currently and I don't really keep up. I'm a proud former Marine but I've moved on. My career was honorable but undistinguished and unremarkable.


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## TCW (Mar 13, 2006)

Ailuropoda said:


> I got out in 1991. The current generation of Marines did a fantastic job in places like Fallujah and I believe they are tough and well-trained. I don't know any Marines currently and I don't really keep up. I'm a proud former Marine but I've moved on. My career was honorable but undistinguished and unremarkable.


Appreciate your service. Marines are heroes and definitely the kind federal employees that I can respect and honor. Too bad the rest of them suck, especially VA employees (as you pointed out earlier). Again, thanks for your willingness to sacrifice life and limb for freedom.


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## AnthemRider (Feb 7, 2007)

Reviving an old argument, I know. But inasmuch as most everyone wanted to believe a non-attorney, I thought it would be interesting for people see how all of these greedy lawyers responded to someone's quest to bring a medical malpractice lawsuit:

No antibiotic prescription after surgery, got Infection, Could I sue doctor? - Avvo.com


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## Ailuropoda (Dec 15, 2010)

AnthemRider said:


> Reviving an old argument, I know. But inasmuch as most everyone wanted to believe a non-attorney, I thought it would be interesting for people see how all of these greedy lawyers responded to someone's quest to bring a medical malpractice lawsuit:
> 
> No antibiotic prescription after surgery, got Infection, Could I sue doctor? - Avvo.com


Interestingly enough, one of my lawsuits involves the same thing. I did an Incision and Drainage of an Abscess (surgery) and sent the patient home without antibiotics because they are not always indicated in an otherwise healthy patient after an Incision and Drainage of a simple abscess. The patient came back two days later and had to have the abscess drained again and repacked. No harm came to them, the discharge instructions clearly stated that sometimes this can happen and to return if that was the case.

The patient had Medicaid and didn't pay a dime for any of his treatment. This suit has cost me $3000 of my own money even and even though our state's medical review panel has decided it to be without merit it is still wending its ponderous way through the legal meat grinder; no doubt the bottom-feeding plaintiffs attorney hopes for an out-of-court settlement.


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