Generation Y and Z Debt

[ArgentCy]

I forgot to add to my list...

Defensive medicine is rampant in our system. It costs the hospitals and doctors nothing to over-prescribe and over-test (insurance is just going to pay for it) and, heck, might even make them more, and it is a backstop against malpractice lawsuits.

That "more is more, don't get sued" mentality drives up healthcare usage greatly.

Just the freaking cost of one lawsuit these days can easily bankrupt a small businesses. The E & O insurance costs for doctors and hospitals just has to be freaking insane because a jury can award almost limitless money for someone's "pain and suffering".

 

[Halincandenza]

Just the freaking cost of one lawsuit these days can easily bankrupt a small businesses. The E & O insurance costs for doctors and hospitals just has to be freaking insane because a jury can award almost limitless money for someone's "pain and suffering".

This is just false.

 

[Sigmapolis]

This is just false.

Malpractice insurance can vary between a few thousand to tens of thousands depending on your specialty and which state you are practicing in.

That is not exactly a cheap addition to the cost of care. It all adds up.

I think the "defensive medicine" mentality that a litigation-heavy environment creates is the far more damaging issue, and its costs do not show up as a line-item anywhere.

Every physician I have met complains about it, but nobody wants to be the one to try to do something about it given the individuals' downside risks.

 

[madguy30]

That's one aspect that I think is deceiving about health care performance studies. Many include obesity rates as an outcome of the health system rather than a condition that the health care system has to deal with. As most can imagine, the US is far and away the most obese OECD country. If you believe our health care system causes people to be fat, then yes, our performance is very poor and our health care system should be changed to about anything else. If you believe that causes outside of our health care system make people in the US obese, then that is not necessarily the case. Obesity and the lifestyles that lead to it destroy the US's performance in most metrics.

I think there are some aspects of health care systems that may help reduce obesity rates, but if you look at how different countries around the world rank, it seems there is no correlation between style of health care system and obesity. It appears to be driven by cultural and economic factors. In other words, obesity is something that each health care system around the world have to deal with at different levels.

How would Sweden or Denmark's health care system perform in terms of medical outcomes if they nearly doubled their obesity rate to match US levels?

My viewpoint on this type of stuff is likely far too simplistic and unachievable but I had some morning show on this morning and they were going over some huge 'summer spread' lunch or whatever. The whole thing made it look like you need to go buy X amount of ingredients for X amount of courses in the meal, and many of the ingredients looked like things that make the meal unhealthy and overall, expensive. This goes down the rabbit hole of making it look like you need to make enough money to eat the food, and then the meal is made unhealthy anyway.

There needs to be more campaigning for eating healthy, and providing the evidence that eating healthy doesn't have to cost a bunch. I.e. a bunch of bananas is going to cost like $1.50 or something which is cheaper or the same price as a bag of chips.

There's several other examples but just thoughts on taking real preventative measures to avoid future issues.

 

[Halincandenza]

Malpractice insurance can vary between a few thousand to tens of thousands depending on your specialty and which state you are practicing in.

That is not exactly a cheap addition to the cost of care. It all adds up.

I think the "defensive medicine" mentality that a litigation-heavy environment creates is the far more damaging issue, and its costs do not show up as a line-item anywhere.

Every physician I have met complains about it, but nobody wants to be the one to try to do something about it given the individuals' downside risks.

People complaining doesn’t mean much. As a percentage of cost of doing business, malpractice insurance is pretty small. In fact is that it is very difficult to win malpractice lawsuits and states have all enacted protections that cap damages awarded even if you do win.
If you are doing something out of fear of malpractice, then you probably aren’t good at your job.

 

[Sigmapolis]

People complaining doesn’t mean much. As a percentage of cost of doing business, malpractice insurance is pretty small. In fact is that it is very difficult to win malpractice lawsuits and states have all enacted protections that cap damages awarded even if you do win.
If you are doing something out of fear of malpractice, then you probably aren’t good at your job.

I do not disagree with you that malpractice insurance is not a huge cut of $$$ -- but again, I think the issue is fear of the same drives over-prescribing and over-testing of healthcare. Preserving your reputation as an institution and individual practitioner is valuable, too, as the accountants would call the "goodwill" of your practice, far beyond just the costs associated with insurance premiums or any payments you need to make. You need to look good to attract customers through those doors, which means avoiding lawsuits and negative publicity.

My wife and every one of her colleagues I have talked to reports it as very real. That is anecdotal, of course, so how about we see what the literature has to say about it...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728884/

The kind of stuff we are discussing is absolutely rampant...

Generally, the physician's aim is to reduce chances of litigation. In some cases, it may be medically justified, but in some, it will be medically inept. In a study conducted by Studdert, et al. in Pennsylvania among 800 physicians to determine the prevalence of defensive medicine revealed that 92% of physicians were found to be ordering imaging tests and diagnostic measures for assurance and 42% were eliminating high risk procedures and avoiding patients with complications.[3] Gallup and Jackson Healthcare in 2010 found 73% and 92% of private sector physicians, respectively, admitted practicing defensive medicine, which was high compared to 48% of government physicians.[4] The above studies highlight how prevalent defensive medicine is due to fear of litigation. Another study conducted by Harvard Medical School concluded that majority of physicians across various specialties tends to adopt a defensive professional culture.[2] Rodriguez, et al., study in 2007 demonstrated that 50% of the doctors operating in emergency departments in California between 2001 and 2005 were concerned with matter of malpractice litigation.[5] Similar results emerged from a study conducted in Japan in 2006 with a group of 131 gastroenterologists.[6]

Well, you just said basically every doctor in this country is bad at their job. Anywhere from 50% to 90% based on that broad review of the literature there.

It is bad medicine and wastes a lot of money. I think we agree there.

Sounds like our healthcare system in general, no?

 

[Halincandenza]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728884/

Well, you just said basically every doctor in this country is bad at their job.

The kind of stuff we are discussing is absolutely rampant...

Generally, the physician's aim is to reduce chances of litigation. In some cases, it may be medically justified, but in some, it will be medically inept. In a study conducted by Studdert, et al. in Pennsylvania among 800 physicians to determine the prevalence of defensive medicine revealed that 92% of physicians were found to be ordering imaging tests and diagnostic measures for assurance and 42% were eliminating high risk procedures and avoiding patients with complications.[3] Gallup and Jackson Healthcare in 2010 found 73% and 92% of private sector physicians, respectively, admitted practicing defensive medicine, which was high compared to 48% of government physicians.[4] The above studies highlight how prevalent defensive medicine is due to fear of litigation. Another study conducted by Harvard Medical School concluded that majority of physicians across various specialties tends to adopt a defensive professional culture.[2] Rodriguez, et al., study in 2007 demonstrated that 50% of the doctors operating in emergency departments in California between 2001 and 2005 were concerned with matter of malpractice litigation.[5] Similar results emerged from a study conducted in Japan in 2006 with a group of 131 gastroenterologists.[6]

Anywhere from 50% to 90% based on that broad review of the literature there.

It is bad medicine and wastes a lot of money.

Sounds like our healthcare system in general, no?

Well, if they are ordering testing out of fear of litigation. Then yes, they are bad at their job. And what you cited does not say that fear of litigation is the main factor for defensive medicine. There is also a built in assumption with this line of thinking that all defensive medicine is bad medicine. When in fact, doctors do miss things and misdiagnose. So getting a doctor to do an additional test or explore an alternate diagnosis is not always a bad thing for the doctor or the patient.

The right along with right wing special interests groups have been pushing this malpractice fallacy for years. This magic pill of tort reform.

https://cardozo.yu.edu/fallacies-medical-malpractice-tort-reform


But the disingenuity of this claim has been exposed a decade ago. In 2003, the Government Accountability Office (GAO) found: “[T]he overall prevalence and costs of [defensive medicine] have not been reliably measured. Studies designed to measure physicians’ defensive medicine practices examined physician behavior in specific clinical situations, such as treating elderly Medicare patients with certain heart conditions. Given their limited scope, the study results cannot be generalized to estimate the extent and cost of defensive medicine practices across the health care system.”6

The Congressional Office of Technology Assessment (OTA) found that less than 8% of all diagnostic procedures were likely to be caused primarily by liability concerns.7 The OTA found that most physicians who “order aggressive diagnostic procedures...do so primarily because they believe such procedures are medically indicated, not primarily because of concerns about liability.”

https://www.cato.org/publications/commentary/case-against-national-medical-malpractice-reform
A 2014 study reported in JAMA, the journal of the American Medical Association, by Michael Rothberg and others concluded, “although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform.”

Furthermore, even after tort reform in states including capping of economic damages, medical malpractice insurance has not gone down. Nor has all the tort reform resulted in lower health care costs for individuals. If anything it is hurt patients because of how difficult it is for someone who has suffered as the result of doctor error to be able to made whole.


There are many more articles I could link to.
https://www.montlick.com/montlick-b...ng-common-fallacies-about-medical-malpractice
https://michiganjustice.wordpress.c...tort-reform-the-juice-isnt-worth-the-squeeze/

Then the fact is that people have a right to be made whole if there was malpractice and all tort reform has done is increase insurance profits and make it more difficult for those that have been wronged to get compensation for the damage that was done.

 

[Clonefan32]

All true -- but the general path is to learn under others while progressively garnering more authority and/or independence before maybe breaking out on your own.

Much like other professionals, actually... doctors, accountants, etc., all that.

Some other fields have more structured versions of this, especially doctors, but the basic process in the same. But throwing some numbers into this...

https://data.lawschooltransparency.com/enrollment/all/

According to that, there are roughly 40,000 law school enrollments each year. You probably know graduation rates better than me, but I will keep the larger number.

https://nces.ed.gov/programs/digest/d17/tables/dt17_322.10.asp?current=yes

There are 1.9 million undergraduate degrees awarded each year.

So roughly 2% of those graduates go on to law school.

-- So even if law is the perfect example where schooling prepares you to be an attorney, you are talking about a really slim subset of the undergraduate population.

-- I think you want to talk about law school because it is a better example, and it is, than undergraduate training. But how much do you really need a politics or history or whatever it might be degree before going to law school? Why do they need a BA? Why not take bright high school seniors, AAs, or those who worked a few years, perhaps even a law office?

As someone with a law degree I can tell you I never look back to my undergraduate degree, and very rarely look back to my law school education.

I actually think law school is a good indicator of Sigmapolis's general concept. At least where I went to law school, you did not learn anything state specific. We learned the "common law" approach to most legal issues. So we were reviewing laws and cases from jurisdictions we would never practice in that were illustrative of some larger legal issue.

Fast-forward to actually practicing, the "common law" approach means nothing. Everything is specific to your jurisdiction's Code, cases, etc. So you learn a general approach to several different legal issues, but then you have to go back through the process of seeing if your state applies the general approach. It's all very inefficient. The vast majority of what I use in my day-to-day practice was picked up through independent research and mentoring from other attorneys.

 

[Sigmapolis]

Well, if they are ordering testing out of fear of litigation. Then yes, they are bad at their job. And what you cited does not say that fear of litigation is the main factor for defensive medicine. There is also a built in assumption with this line of thinking that all defensive medicine is bad medicine. When in fact, doctors do miss things and misdiagnose. So getting a doctor to do an additional test or explore an alternate diagnosis is not always a bad thing for the doctor or the patient.

The right along with right wing special interests groups have been pushing this malpractice fallacy for years. This magic pill of tort reform.

https://cardozo.yu.edu/fallacies-medical-malpractice-tort-reform


But the disingenuity of this claim has been exposed a decade ago. In 2003, the Government Accountability Office (GAO) found: “[T]he overall prevalence and costs of [defensive medicine] have not been reliably measured. Studies designed to measure physicians’ defensive medicine practices examined physician behavior in specific clinical situations, such as treating elderly Medicare patients with certain heart conditions. Given their limited scope, the study results cannot be generalized to estimate the extent and cost of defensive medicine practices across the health care system.”6

The Congressional Office of Technology Assessment (OTA) found that less than 8% of all diagnostic procedures were likely to be caused primarily by liability concerns.7 The OTA found that most physicians who “order aggressive diagnostic procedures...do so primarily because they believe such procedures are medically indicated, not primarily because of concerns about liability.”

https://www.cato.org/publications/commentary/case-against-national-medical-malpractice-reform
A 2014 study reported in JAMA, the journal of the American Medical Association, by Michael Rothberg and others concluded, “although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform.”

Furthermore, even after tort reform in states including capping of economic damages, medical malpractice insurance has not gone down. Nor has all the tort reform resulted in lower health care costs for individuals. If anything it is hurt patients because of how difficult it is for someone who has suffered as the result of doctor error to be able to made whole.


There are many more articles I could link to.
https://www.montlick.com/montlick-b...ng-common-fallacies-about-medical-malpractice
https://michiganjustice.wordpress.c...tort-reform-the-juice-isnt-worth-the-squeeze/

Then the fact is that people have a right to be made whole if there was malpractice and all tort reform has done is increase insurance profits and make it more difficult for those that have been wronged to get compensation for the damage that was done.

Tying to synthesize this for both of us...

There is ample literature to document that there is *some* effect here from defensive medicine and defensive medicine undertaken with liability exposure in mind. The same is true of doctors avoiding certain patients because they are risky.

That number is not zero. That number is not "all of it" like some of the right-wing tort reformers would want to believe. I think it is a relatively small fish in the huge pond of the U.S. healthcare system. We can talk about if it is a minnow or a chub, but there are some Great Whites swimming around in the same water, so does it matter much really?

I am not one to blame trial lawyers or think tort reform is some sort of silver bullet. I do not think there is a "bad guy" here -- plenty of patients are seriously harmed by errors and malpractice, and they deserve good representation from well-meaning attorneys and fair compensation. Indeed, medical errors plague our system right now, and very few of them go detected or litigated. There are bad doctors out there who need punished or even run out of the field, but most of them are trying to do their best, doing good, and reasonably responding to the incentives that a lawsuit could create and expose them to some serious financial and reputational risks. It is one of the reasons our system is expensive, but far from the only one.

I just see it as one of many contributing factors.

As someone with a law degree I can tell you I never look back to my undergraduate degree, and very rarely look back to my law school education.

I actually think law school is a good indicator of Sigmapolis's general concept. At least where I went to law school, you did not learn anything state specific. We learned the "common law" approach to most legal issues. So we were reviewing laws and cases from jurisdictions we would never practice in that were illustrative of some larger legal issue.

Fast-forward to actually practicing, the "common law" approach means nothing. Everything is specific to your jurisdiction's Code, cases, etc. So you learn a general approach to several different legal issues, but then you have to go back through the process of seeing if your state applies the general approach. It's all very inefficient. The vast majority of what I use in my day-to-day practice was picked up through independent research and mentoring from other attorneys.

@Halincandenza is going to want to beat you with a hammer for posting this.

 

[SpokaneCY]

-- I think you want to talk about law school because it is a better example, and it is, than undergraduate training. But how much do you really need a politics or history or whatever it might be degree before going to law school? Why do they need a BA? Why not take bright high school seniors, AAs, or those who worked a few years, perhaps even a law office?

Maturity, experience, perspective, discipline, world-view, ability to complete a course of anything....

Hi - I'm Doogie Howser and I'll be your corporate attorney after I get home from prom.

 

[Halincandenza]

Tying to synthesize this for both of us...

There is ample literature to document that there is *some* effect here from defensive medicine and defensive medicine undertaken with liability exposure in mind. The same is true of doctors avoiding certain patients because they are risky.

That number is not zero. That number is not "all of it" like some of the right-wing tort reformers would want to believe. I think it is a relatively small fish in the huge pond of the U.S. healthcare system. We can talk about if it is a minnow or a chub, but there are some Great Whites swimming around in the same water, so does it matter much really?

I am not one to blame trial lawyers or think tort reform is some sort of silver bullet. I do not think there is a "bad guy" here -- plenty of patients are seriously harmed by errors and malpractice, and they deserve good representation from well-meaning attorneys and fair compensation. Indeed, medical errors plague our system right now, and very few of them go detected or litigated. There are bad doctors out there who need punished or even run out of the field, but most of them are trying to do their best, doing good, and reasonably responding to the incentives that a lawsuit could create and expose them to some serious financial and reputational risks. It is one of the reasons our system is expensive, but far from the only one.

I just see it as one of many contributing factors.



@Halincandenza is going to want to beat you with a hammer for posting this.

Hey! I don't want to beat anyone with a hammer, at least not literally.

 

[Cyched]

Hey! I don't want to beat anyone with a hammer, at least not literally.

Speak for yourself

 

[Sigmapolis]

Maturity, experience, perspective, discipline, world-view, ability to complete a course of anything....

Hi - I'm Doogie Howser and I'll be your corporate attorney after I get home from prom.

17 year olds used to fly Hellcats against the Japanese over the Pacific

The increasing length of adolescence and delaying of adulthood is a modern phenomenon and a particular culture one, not something inherent about teenagers.

Plus, knowing what I know about most undergraduate educations, I am not sure they are particularly good at installing any of those things in a young adult, especially if they did not already have a good head on their shoulders to start.

I think you are dodging the point, though. I am not exactly advocating an 18 year old be the lead attorney in some multi-billion dollar litigation or capital crime. But would they be served worse by working as a clerk in a law office to start (and making some money) before moving up than they would paying tends of thousands to go to a law school?

Or doing that instead of earning a BA in flute performance or whatever before going to law school? Going to be a long time until they have some real authority either way.

We complain about inequality and poverty, but then we put a college degree -- an incredibly expensive item -- up as the ticket to the middle-class. Why not try to have more ways up instead of just that one, singular, expensive, and nerdy way to do it?

 

[SimpsonClone]

My GF of 4 years falls into the teacher category, and I worked in a non-profit for 7 years after college before going private sector. I can confirm all this. Except my gf is still on the "put a baby in me" path.

I have worked with kids for five years and my wife has for four. It has bought me a good amount of time, but it appears that this form of contraception loses its effectiveness over time. My mom does daycare and my brothers both have two kids. Maybe a week long trip before school starts is in order. I might even volunteer to babysit so my brothers and their wives can go out for the evening.

 

[cowgirl836]

I have worked with kids for five years and my wife has for four. It has bought me a good amount of time, but it appears that this form of contraception loses its effectiveness over time. My mom does daycare and my brothers both have two kids. Maybe a week long trip before school starts is in order. I might even volunteer to babysit so my brothers and their wives can go out for the evening.

Set an alarm on her phone to go off in intervals overnight ranging from 45 minutes to 2 hours.

 

[SimpsonClone]

Set an alarm on her phone to go off in intervals overnight ranging from 45 minutes to 2 hours.

That's too risky. She already punches/kicks me when I get into bed and startle her.

 

[yowza]

I have to ask, do you actually understand the challenges that young adults face today? Yes, there may be similarities to what you may have faced in your life, but "similar" is not "the same". Time has moved forward and the world has changed. There are different caveats and wrinkles that may not have existed when you were younger.

I'm sure you had your tough times, as we all have to one degree or another. But don't write off the struggles that others face just because the the internet, or smart phones. Maybe try using a little empathy and try to relate, instead of trying to invalidate others with "back in my day" rhetoric.

I hope this is sarcasm. You get what you work for. educate yourself. make educated decisions. use available resources. Take some risks and don't do stupid ****. And if someone lives their life based on what they see on Facebook or message forums, they need to reevaluate.

 

[BCClone]

I hope this is sarcasm. You get what you work for. educate yourself. make educated decisions. use available resources. Take some risks and don't do stupid ****. And if someone lives their life based on what they see on Facebook or message forums, they need to reevaluate.

I definitely say my generation has it easier than my predecessors. I wasn’t shot at by people in a different country like them.

 

[3TrueFans]

I definitely say my generation has it easier than my predecessors. I wasn’t shot at by people in a different country like them.

I mean you could be if you really wanted to be.

 

[dualthreat]

In one of the richest countries in the world, no one should be forced to chose between not getting or getting a higher education or job training on the basis of lack of money to cover the tuition to cover the costs of said training.
Nor should companies or businesses be profiting off people wanting a better life for themselves or following their dreams of a college education.

THIS is a big reason prices are being driven up. How dare the federal government deny a loan to a student. Joe Schmo and his women and gender studies degree landed him a job making $100k a year so that justifies the other 99 people who applied for similar ridiculous loans that won't be able to find a job to pay back their loans.

So they demand the loans be paid off too. Rinse wash repeat.