80/20 RULE

[Juror#8]

Agree with capping non-economic damages. Let's face it...if a doctor's having a $100M punitive damage levied against him, it's probably the wrong punitive action.

 

Disagree with eliminating juries. I get your point...but there's a definite problem with non-expert citizen panels rendering judgement on technical matters that require a significant level of expertise to understand. Rather, I'd see something more akin to arbitration, where a doctor's conduct is judged by a board of professionals actually capable of judging his conduct. I'll compromise by suggesting civil juries for a penalty phase...deal?

 

That's actually a damn good compromise. Never thought about that (civil juries for penalty phase when a board of physician's has already rendered judgment on culpability). I'd definitely be in support of that.

 

And I see your point about the technical aspect. I'd have to say, though, that some of that should be mitigated during voir dire (but then again, that depends on your strategy).

 

As an aside, I was co-counsel on a products liablity case where I was representing a parts manufacturer against a defendent who was suing a toaster company for a design flaw (in the platiff's view - if you placed a bagel in the toaster, it wouldn't pop up enough for you to easily access it so the plantiff had to stick his finger in to retrieve it - causing burns). The plaintiff got the idiotic (but legally intelligent) idea to sue everyone in the chain of distibution - including my client, who just manufactured and supplied the perforated medal screens and coils used to circulate the heat. As we sat there listening to the expert on spring weight governance, the flippin dispositive issue in the case, one juror was asleep and two appeared to be playing tic tac toe on a single pad of paper.

 

It was pretty sad and made me wonder what information they were going to base their votes on.

[Doc]

Isn't this happening now?

 

And, in addition, the people who go to the emergency room for Advil, broken ankles, HBP, and other relatively routine matters because they're young, generally healthy, and haven't contemplated any manner of infirmity or health complication, end up raising the premiums for everyone else.

 

In large measure, they don't pay those exorbitant hospital bills. Those costs just get spread to the taxpayer.

It's happening far less now because there is no guaranteed issue at present. If you get sick now and then go to look for insurance, you may not get it OR you'll be hit with premiums well over 3X what the lowest premium is.

 

As for ER usage, it's not going to change unless EMTALA is repealed. Almost all of the visits to the ER are for true emergencies, psychosocial problems, or because people want to be seen quickly (and while you sometimes have to wait up to 6 hours to be seen, it's a lot sooner than weeks to months).

Don't want to take this thread too much off topic but if you'd allow me to address this question quickly....

 

Yes, some degree of tort reform would be helpful. However, I hope that tort reform never gets beyond capping non-economic damages.

 

Going to the English Rule, I believe, would only accomplish resticting access to the courts for those who are not financially advantaged. As it is, there are Rule 11s for issues of frivolity.

 

Eliminating juries as finder's of fact in certain civil actions is VERY strong medicine.

 

That's it.

Why not have any sort of tort reform in PPACA? They could "tweak it later." I think we all know why.

 

As for the English system, if you think your case has merit and a lawyer you consult does as well, then there is a good chance you could win and there's no problem.

 

And I agree with eliminating juries and having it be like arbitration, as Tom suggested. A jury is in no way capable of making informed decisions on these matters.

[B-Large]

So I am on record as being in support of much of the Affordable Care Act. I generally favor programs that help to sustain the less fortunate and abjectly impoverished so long is there is an aim, vision, goal, and it's sustainable, and it doesn't place an undue or unfair burden on the American taxpayer. Also, I tend to favor programs that profess to mitigate corruption amongst industries that deal in ensuring individual health and well being.

 

I'm also of the belief that people like the constituent parts of Obamacare. However body politic are largely dolts - so once a policy is demonized and becomes characterized as a pejorative, then it stays that way - even when, in essence, they agree with the sum if explained constituently. Or people just think "Dem - bad" even if the idea is novel and has potential to be improved upon.

 

There are a lot of cool little parts to Obamacare. I've conversed with folks who say that they hate Obamacare then later on in the conversation express delight that they can retain their 25 year old grad student daughter on their health plan. Weird huh? Isn't it a net positive that females can't be denied coverage any longer, or that pre-existing conditions cannot be the basis for a health coverage denial?

 

So that leads me to the thrust of this Friday night diatribe - the 80/20 rule. Basically:

 

"Health insurers must spend at least 80 percent of the money they collect in premiums on medical claims or improvements in health care quality and no more than 20 percent on everything else — administration, marketing, advertising, profits to investors, executive bonuses, etc."

 

AND

 

"If mandatory reports to state and federal monitoring agencies show a health insurer is spending too little on health care, the insurer is required to rebate the difference to health plan enrollees, either in the form of a check or as a discount on future premiums. Rebates to group health plans go to the sponsoring employer, with the expectation that the cost savings will be passed on to employees."

 

The 80/20 Rule took effect on January 1, 2011 and the first rebates are due by August 1, 2012.

 

With the rebate, will include this letter: http://cciio.cms.gov/resources/files/mlr-notice-1-to-subscribers-in-individual-market.pdf

 

Obviously note the timing of those letters. It will impact the election in some way.

 

More reading:

 

http://thepage.time.com/2012/05/11/sebelius-forthcoming-blog-post/

 

http://www.registerguard.com/web/opinion/28003760-47/health-rebates-care-insurance-insurers.html.csp

 

this is a really good post #8, and I agree that there are many pieces of the ACA that are really solid legislation..... staying on parents inssurance, the 80/20, the pre-exisitng guildelines, etc. Did it need to be 2,600 pages and growing, I am pretty certain it did not. But I do feel like this had to start somewhere, and this bill will be changed and bettered as we see how it changes the healthcare markets and related outcomes.... I am saddened that Republican leadership has taken the path of repeal, rather than diving into this bills and better the legislation that is in place.... I am not even mad about the challenge in the courts, our representatives are supposed to challnge the legalility of legislation, etc- my hope is this stays in place.

 

Selfishly, I would like to leave my current job, basically I don't really need to be here... I am here because my wife cannot get health insurance on the individual level- we are glad to pay for it, but we simple cannot get it because of her health history..... to me, more than anything, the ACA creates a market for honest Americans where one did not previously exist.... Do repeal this would be devestating for us, we would be stuck in a job instead of our following our dreams and passions.

[Rob's House]

It's happening far less now because there is no guaranteed issue at present. If you get sick now and then go to look for insurance, you may not get it OR you'll be hit with premiums well over 3X what the lowest premium is.

 

As for ER usage, it's not going to change unless EMTALA is repealed. Almost all of the visits to the ER are for true emergencies, psychosocial problems, or because people want to be seen quickly (and while you sometimes have to wait up to 6 hours to be seen, it's a lot sooner than weeks to months).

 

Why not have any sort of tort reform in PPACA? They could "tweak it later." I think we all know why.

 

As for the English system, if you think your case has merit and a lawyer you consult does as well, then there is a good chance you could win and there's no problem.

 

And I agree with eliminating juries and having it be like arbitration, as Tom suggested. A jury is in no way capable of making informed decisions on these matters.

Here's the real problem with juries. The median IQ in the country (and thus presumably of those called for jury duty) is 100. However, those on the + side are disproportionately adept at getting out of jury duty. The result: The average juror has an IQ in the double digits.

Edited May 15, 2012 by Rob's House

[Doc]

Here's the real problem with juries. The median IQ in the country (and thus presumably of those called for jury duty) is 100. However, those on the + side are disproportionately adept at getting out of jury duty. The result: The average juror has an IQ in the double digits.

Bingo.

[3rdnlng]

Here's the real problem with juries. The median IQ in the country (and thus presumably of those called for jury duty) is 100. However, those on the + side are disproportionately adept at getting out of jury duty. The result: The average juror has an IQ in the double digits.

 

 

I can see the points made here that there are times when the issues are so complicated that guys like Juror #8 will be at a loss (hehe) but scrapping the jury system is no way to go. Maybe a combination between expert witnesses and neutral panels to give the Juror#'s 1-12 some advice would be the way to go. I would hate to start down the slippery slope of taking cases out of a jury of our peer's hands. Then again, just so I don't leave myself open to you guys, I guess if what you say about the IQ thing is true, they wouldn't really be my peers.

[Rob's House]

Don't want to take this thread too much off topic but if you'd allow me to address this question quickly....

 

Yes, some degree of tort reform would be helpful. However, I hope that tort reform never gets beyond capping non-economic damages.

 

Going to the English Rule, I believe, would only accomplish resticting access to the courts for those who are not financially advantaged. As it is, there are Rule 11s for issues of frivolity.

 

Eliminating juries as finder's of fact in certain civil actions is VERY strong medicine.

 

That's it.

I pretty much agree with this, as well as Tom's suggestion. It's easy to call for tort reform, it's a bit more difficult to find appropriate reform measures.

[dayman]

I can see the points made here that there are times when the issues are so complicated that guys like Juror #8 will be at a loss (hehe) but scrapping the jury system is no way to go. Maybe a combination between expert witnesses and neutral panels to give the Juror#'s 1-12 some advice would be the way to go. I would hate to start down the slippery slope of taking cases out of a jury of our peer's hands.

 

wise words from 3rdlng of all posters

[3rdnlng]

wise words from 3rdlng of all posters

 

 

Nice edit of my post. You still can't slip one by me. Regardless, what's with all you whacked out libs coming over here en masse in the last couple of weeks? Do you think maybe you should have availed yourself of a little recon or search and probe before attacking?

[DC Tom]

I can see the points made here that there are times when the issues are so complicated that guys like Juror #8 will be at a loss (hehe) but scrapping the jury system is no way to go. Maybe a combination between expert witnesses and neutral panels to give the Juror#'s 1-12 some advice would be the way to go. I would hate to start down the slippery slope of taking cases out of a jury of our peer's hands. Then again, just so I don't leave myself open to you guys, I guess if what you say about the IQ thing is true, they wouldn't really be my peers.

 

I'll counter that with: if a doctor's being tried, by what grounds are his peers selected from the general population?

[3rdnlng]

I'll counter that with: if a doctor's being tried, by what grounds are his peers selected from the general population?

 

I understand where you are coming from and I don't disagree. My concern is going down the slippery slope of losing the democratic right of being judged by a jury of your peers. I regard that as sacred. Should the doctor be able to have 12 doctors judging him? Should the janitor have 12 janitors judging him? No, but I could see having an option of a professional advisory committee that is independent of plaintiff/defense, advising jurors on the technical questions. Now, if they both agree to arbitration, let it fall where it may.

[dayman]

Have good lawyers, pick a good jury, have an orderly presentation of evidence and clear experts. That's all you can do.

Edited May 15, 2012 by TheNewBills

[3rdnlng]

Have good lawyers, pick a good jury, have an orderly presentation of evidence and clear experts. That's all you can do.

 

 

So, I guess what you are saying is a fair trial is impossible? Criminal trial, you have a little better chance, civil trial, what a farce. Let's give this woman Multi-millions for spilling hot coffee down her kitty?

Edited May 15, 2012 by 3rdnlng

[dayman]

So, I guess what you are saying is a fair trial is impossible? Criminal trial, you have a little better chance, civil trial, what a farce. Let's give this woman Multi-millions for spilling hot coffee down her kitty?

 

Well what is so unfair about that? And that McDonald's case is basically the face of propaganda for tort-reform.

[Doc]

Well what is so unfair about that? And that McDonald's case is basically the face of propaganda for tort-reform.

LOL! The court system is littered with frivolous lawsuits, both for medical cases and non-medical cases. The fact of the matter is that tort reform would save billions, but Barry didn't want to include it because he's a lawyer. Among the other bull **** deals he made with the major players that drive medical costs.

[3rdnlng]

Well what is so unfair about that? And that McDonald's case is basically the face of propaganda for tort-reform.

 

WOW, so you think that someone buying "hot coffee" (as it is advertised) should get millions because she spilled hot coffee on her kitty? I know, if we could just get rid of all the corporations, and make them pay what they should, we would be somehow able to pay everyone NBA wages.

[dayman]

If you choose not to buy, you are penalized by getting locked out for a period of time. You cannot simply choose to stay out despite the mandate and then take advantage of the preexisting injury deal at your leisure. Insurance companies are not worried about what you describe bankrupting them. It's just not one of the issues that is concerning everyone.

 

Really? Can you point out the specifics of this from the law? How long of a time are you locked out? When you are locked out, can you still go to the ER for help? Will they still treat you, or are you locked out of the ER, too? Are you telling me that the Democrats just passed a bill that will leave sick people banging on the locked doors of emergency rooms throughout the country because they could not afford whatever Obamacare was supposed to cost them?

 

This is even worse than I thought.

 

Of course that isn't what I'm saying.

 

Feel free to quote the section of the Act that describes that.

 

Ok well first off I haven't read the damn thing. But that was the way it was explained to me by someone who worked with the creation of it (directly with members of congress and the white house) and who I know is qualified to speak on it (although certainly is not the God of all things related to the Bill).

 

Anyway I did go ahead and tool around looking for somewhere in there I could reference. Obviously you can pick apart the specifics of what I said before but the idea is insurance companies still have some control over their enrollment.

 

‘‘SEC. 2702 ø42 U.S.C. 300gg–1¿. GUARANTEED AVAILABILITY OF COVERAGE.

‘‘(a) GUARANTEED ISSUANCE OF COVERAGE IN THE INDIVIDUAL

AND GROUP MARKET.—Subject to subsections (b) through (e), eachhealth insurance issuer that offers health insurance coverage in the

individual or group market in a State must accept every employer

and individual in the State that applies for such coverage.

‘‘(b) ENROLLMENT.—

‘‘(1) RESTRICTION.—A health insurance issuer described in

subsection (a) may restrict enrollment in coverage described in

such subsection to open or special enrollment periods.

‘‘(2) ESTABLISHMENT.—A health insurance issuer described

in subsection (a) shall, in accordance with the regulations promulgated

under paragraph (3), establish special enrollment periods

for qualifying events (under section 603 of the Employee

Retirement Income Security Act of 1974).

‘‘(3) REGULATIONS.—The Secretary shall promulgate regulations

with respect to enrollment periods under paragraphs

(1) and (2).

 

WOW, so you think that someone buying "hot coffee" (as it is advertised) should get millions because she spilled hot coffee on her kitty? I know, if we could just get rid of all the corporations, and make them pay what they should, we would be somehow able to pay everyone NBA wages.

 

The plaintiff and the spill incident. The plaintiff, a 79-year-old grandmother named Stella Liebeck, was not driving, nor was the vehicle moving when the injury occurred. While the car was stopped, Mrs. Liebeck, who was sitting in the passenger seat, tried to hold the coffee cup between her knees as she removed the lid. The cup tipped over, spilling the contents into her lap.

The injury. Mrs. Liebeck’s injury was anything but trivial. The scalding-hot coffee caused third-degree burns over 16% of her body, including her genital area. She had to be hospitalized for eight days. She required extensive skin grafts and was permanently scarred. She was disabled for a period of two years. During the ensuing trial, Mrs. Liebeck’s physician testified that her injury was one of the worst cases of scalding he’d ever seen.

 

The coffee. At the time, McDonalds’ corporate specifications explicitly called for coffee to be served at a temperature between 180 and 190 degrees Fahrenheit. An expert witness testified that liquids at this temperature will cause third degree burns of human skin in two to seven seconds. (Coffee served at home is typically 135 to 140 degrees.)

McDonalds’ culpability. During discovery, McDonald’s was required to produce corporate documents of similar cases. More than 700(!) claims had been made against McDonald’s, and many of the victims had suffered third-degree burns similar to Mrs. Liebeck’s. Yet the company had refused to change its policy, supposedly because a consultant had recommended the high temperature as a way to maintain optimum taste. Some have speculated that the real reason for the high temperature was to slow down consumption of the coffee, reducing the demand for free refills.

 

Greed? Despite the pain caused by her injury, and the lengthy and expensive treatments she required, Mrs. Liebeck originally offered to settle with McDonald’s for $20,000. The corporation offered her a mere $800, so the case went to trial.

 

The settlement. The jury awarded $200,000 in compensatory damages to Mrs. Liebeck, which was reduced to $160,000 because the jury felt that only 80% of the fault lay with McDonald’s, and 20% with her. They also awarded $2.7 million in punitive damages, essentially as punishment of McDonald’s for its callous treatment of Mrs. Liebeck, and its years of ignoring hundreds of similar injuries. This amount was held to be reasonable given that it represented only two days’ worth of McDonalds’ revenue from coffee sales alone. The trial judge reduced the punitive damages, however, to $480,000. After further negotiation, Mrs. Liebeck ultimately received $640,000.

 

You don't have enough cred to use the "you're an idiot" argument without backing it up with reasoned analysis. I'm interested to hear the flaws of his "idiotic" logic. Would you be so good as to indulge me?

 

 

 

 

When the first assertion is so broad and based w/ no "logic" of it's own how do you expect me to combat it with reasoned analysis? "The way the bill is written" will put insurance companies out of business? ok...

[IDBillzFan]

Ok well first off I haven't read the damn thing. But that was the way it was explained to me by someone who worked with the creation of it (directly with members of congress and the white house) and who I know is qualified to speak on it (although certainly is not the God of all things related to the Bill).

Here's an idea: since the total extent of your knowledge of the bill is the equivalent of someone saying they saw George Seifert at the Buffalo Airport, I would refrain from trying to point out the benefits of the bill until you actually know what the benefits really are. You can't simply say that the pre-existing clause doesn't work for people who purposely stay out of the insurance pool because they get locked out without having even the slightest idea of what in the holy hell you're talking about.

 

Check that: you CAN make that stuff up and you CAN say you heard it from a person who worked with the creation of the bill, but for all we know (and apparently all you know) the person you're referring to was responsible for the cover sheet...or the table of contents...or maybe they were responsible for keeping all the paper in the copier because, y'know, it's hard to make copies of 2700-page document without someone manning the paper feeder. I mean, if you're in charge of the copier, aren't you technically involved with "the creation of it?"

 

Get your facts and bring them back, or stop trying to push something when you clearly have no idea what you're actually talking about.

[dayman]

Here's an idea: since the total extent of your knowledge of the bill is the equivalent of someone saying they saw George Seifert at the Buffalo Airport, I would refrain from trying to point out the benefits of the bill until you actually know what the benefits really are. You can't simply say that the pre-existing clause doesn't work for people who purposely stay out of the insurance pool because they get locked out without having even the slightest idea of what in the holy hell you're talking about.

 

Check that: you CAN make that stuff up and you CAN say you heard it from a person who worked with the creation of the bill, but for all we know (and apparently all you know) the person you're referring to was responsible for the cover sheet...or the table of contents...or maybe they were responsible for keeping all the paper in the copier because, y'know, it's hard to make copies of 2700-page document without someone manning the paper feeder. I mean, if you're in charge of the copier, aren't you technically involved with "the creation of it?"

 

Get your facts and bring them back, or stop trying to push something when you clearly have no idea what you're actually talking about.

 

Actually shouldn't the burden first be on those who make baseless claims that certain obvious things are not given thought in the bill? Am I here to fact check you and just field wild questions and go do research for you? Am I here to educate you? There is a clause that references what will occur. Also the current crop of preexisting injuries we are dealing with are to be dealt with in a variety of ways including the creation of high-risk pools and all this has a 90-day after enactment to 2014ish window...the issue of the abuse you all fixate on is separate from dealing with the current crop...the hypothetical incidents of abuse (which can't occur for years..that's why they are hypothetical at this point) will have problems when they suffer medical bills w/ no insurance same as they do now.

Edited May 15, 2012 by TheNewBills

[IDBillzFan]

Actually shouldn't the burden first be on those who make baseless claims that certain obvious things are not given thought in the bill? Am I here to fact check you and just field wild questions and go do research for you? Am I here to educate you? There is a clause that references what will occur. Also the current crop of preexisting injuries we are dealing with are to be dealt with in a variety of ways including the creation of high-risk pools and all this has a 90-day after enactment to 2014ish window...the issue of the abuse you all fixate on is separate from dealing with the current crop...the hypothetical incidents of abuse (which can't occur for years..that's why they are hypothetical at this point) will have problems when they suffer medical bills w/ no insurance same as they do now.

Next time, just say "I just think ACA is a good idea so I point to a few items of unknown value to make it seem like the entire bill is worth the billions of dollars we're wasting on it."

 

That's all you have to say and it will save us both a lot of time.