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I was the billing manager.

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May 03, 2009 – Comments (8)

by Donna Smith;

One example of the terribly biased testimonies being taken is that of the testimony submitted by Richard Scott to the U.S. House of Representatives Energy and Commerce Committee, subcommittee on health, on March 24, 2009. Mr. Scott reports that he was asked to submit his testimony to the committee. On his website, Conservatives for Patient Rights, Scott touts his own experience in the delivery of healthcare in this nation as reason enough to consider him an expert. And Scott is also launching some very inaccurate advertising on behalf of his "organization" in the effort to keep himself and his closet allies in the insurance and private provider industry in a very preferred position in the U.S. healthcare system.

Here's a bit of this Congressional expert witness's biography: Scott founded the Columbia Hospital Corporation in 1987, but dumped by the company's board of directors in 1997 in the midst of the nation's biggest healthcare (Medicare and Medicaid) fraud scandal. In 2001, Scott co-founded the Solantic Corporation, which operates walk-in medical care centers.

We need to know more about who is influencing Congress and the media now in the discussion. So, here's more about witness Scott: In July 1997, when Scott was then the chairman and CEO of Columbia/Hospital Corporation of America and was forced out by the company's board of directors, he left with a $10 million severance deal and 10 million shares of stock. At that time, the shares were worth more than $300 million. Scott was replaced by Dr. Thomas Frist, Jr., the co-founder of HCA and the brother of Senator Bill Frist, then Majority Leader in the U.S. Senate.

It's all just a little incestuous, don't you think?

But wait, our 2009 expert witness on healthcare reform in the U.S. left a little more than history behind at his company that speaks to how he views what is most important to him: making a buck in this system.

In 2001, HCA reached a plea agreement to pay $95 million in fines to the federal government to avoid criminal charges against the company. In late 2002, HCA agreed to pay the government $631 million, plus interest, and paid another $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims. In all, civil law suits cost HCA more than $1.7 billion to settle, including more than $500 million paid in 2003 to two whistleblowers.

$1.7 billion with a great big "B" was paid by HCA to resolve the Medicare and Medicaid fraud mess orchestrated under Mr. Scott's watch who walked away with his own sweet deal. The largest Medicare and Medicaid fraud case in U.S. history, an investigation of over 10 years and he walks away with hundreds of millions of dollars only to return as one of our current expert witnesses on health reform? Whew. That's an epic award and an epic injustice.

I was the billing manager. I was asked to do some very creative bookkeeping and went to the Medicare law and read that I would be risking prosecution if "I knew or should have known" what I was doing was illegal under federal law. As I read the law, it broadly imposed appropriate sanctions upon those who might consider bilking the taxpayer-funded system....

....We must demand that our Congress and our president hear from experts that are not of this ilk. We are better people than this. And our healthcare system must reflect our values of justice, decency and compassion. Dr. David Himmelstein of Physicians for a National Health Program testified finally a couple of weeks ago - but so far he has been the only expert from outside the corporate fold allowed to utter a word on the Congressional record on behalf of single payer. The Senate has invited no witness who strays from the canned agenda that will force us all to buy the defective product that is for-profit health insurance.

Mr. Scott didn't care one bit about ripping off you and ripping off me and ripping off any other patient or taxpayer in this nation. He should not be an expert now advising Congress or anyone else on healthcare reform. His commercials and his organization's communications should have to carry a disclaimer fully disclosing his involvement in the Columbia/HCA fraud case.

 

Devoish:

I support H.R.676, the United States National Health Insurance Act. I would like to see section 211 line 6) removed. I would prefer to see it funded by a progressive income tax so each person could see exactly what it costs them, rather than have a portion of it funded by "instituting a small tax on  stock and bond transactions". Otherwise it is the best available option for healthcare.

I am unable to sort through the 17000 different plans currently available to select the plan best for me. Armed with my computerized health records and family history, for profit insurers will be able to offer a plan that satisfies their responsibility to their shareholders to maximize profit and minimize expenses. In the event I become sick and unable to work for longer than I can continue to make insurance payments, I need healthcare that will not be stopped or delayed. I want to be able to choose to buy private coverage for any treatments that are not covered by this Single Payer plan.

I have more confidence in physicians to recommend my treatment than I do insurers.

Support for Single Payer H.R 676 is widespread among physicians, nurses, unions, and many business's.

Single Payer has the support of over 90 Representatives.

The Capitol Switchboard to reach your congressman is 202-224-3121

Single Payers' supporters are having a diffiicult time even being allowed to present their case.

Please call today.

8 Comments – Post Your Own

#1) On May 04, 2009 at 1:16 AM, doctoraaron (< 20) wrote:

A really thoughtful posting.  Thanks.

Dr. Himmelstein's important testimony is here: http://www.pnhp.org/blog/2009/04/23/david-himmelsteins-testimony/

Everyone should read it.

A paraphrase would make an excellent letter to the editor or letter to one's Congressperson or Senator.

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#2) On May 04, 2009 at 2:19 AM, whereaminow (27.34) wrote:

Just for a second imagine a single payer grocery store. Everyone goes in and picks whatever they want, and someone else picks up the tab. How well do you think that would work? You think the shelves would remain well stocked for long? With high quality merchandise that the customers actually wanted?

Health care is no different. After all, while health care is critically important, so is food.

The reason people have come to expect better care from their grocery provider than their health care provider, is specifically because _they_pay_themselves. If the store sells shitty overpriced, products and make you wait for months in line to flatter some retarded progressive's idea of social organization, their customers simply go somewhere else. So the grocery stores that chose to do that are no longer there. And the ones left, are those who sell decent food at decent prices, with decent service. Of course some are better than others, and perhaps more expensive, but most are at least decent. Even at Wal-Mart people generally don't starve to death waiting in line at the checkout!

In health care, the customer does not pay. Currently an HMO does for most people, under strict regulation by the state. So, the provider spends it's resources keeping the HMO managers, and the state regulators, satisfied, not the customer/patient. If they can show some trumped up statistics that look cool in an election campaign, they get paid. Who cares about the sick guy. He's taxed broke anyway.

At least in the US, people can change HMO, although those are so regulated in what they can do that the difference is hardly worth the effort for most people. But with a single payer system, even this tiny sliver of ability to influence the system will be taken away. Then the providers can focus 100% of their effort on appeasing, coddling, wining and dining the bureaucrats, as well as providing well paying jobs for bureaucrats' friends and family, and funding their reelection campaigns. Then they'll get paid, and competitors will be kept away. Regardless of whether the patients get treated or not.

There has never been, in the history of humanity, a single instance of a single payer system of anything that actually worked decently, and there never will be. Even if, as Mises pointed out all those years ago, for some crazy reason, every bureaucrat in the system somehow happened to be completely altruistic and did his best. So why on earth should anyone not blatantly retarded fall for a scam as intellectually bankrupt as that, in an area as important to most as their own health?

These idiots in congress wanting to 'manage' other peoples lives and property needs to be told that freedom works. And that more freedom works better. And that most freedom works best of all. And then they can go run their own 'single payer' systems for their fellow congressional members, and leave the rest of us alone.

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#3) On May 04, 2009 at 12:18 PM, yournightmare (< 20) wrote:

Hey whereaminow:

About your "retarded" remark -- That's it? That's all you have?

Wow! For a self-described critical thinker you sure take the cake. I bet Mises Institute libercartoonians such as you really make a hit at the local John Gault and teabagging meetings.

What's next -- Are you going to use the descriptor mental midget morons next?

~YN~

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#4) On May 04, 2009 at 1:25 PM, devoish (97.26) wrote:

Dave, remember these words? I hope I can keep this debate lively, informative, and passionate while maintaining the thoughtful tone of your post. Or these? This post is a response to devoish's excellent post on Models for limited government.  devoish is a thoughtful and courteous debater as well as a skilled investor and I have nothing bad to say about him.

This idiotic, retarded, progressive senses a change in your sophisticated tone. Perhaps it is only imagined. However I would like to respond to your arguments, not your namecalling.

Just for a second imagine a single payer grocery store. Everyone goes in and picks whatever they want, and someone else picks up the tab. How well do you think that would work? You think the shelves would remain well stocked for long? With high quality merchandise that the customers actually wanted?

Just for reality, in America, when you went shopping on Friday, have a look around at what you see on the shelves. Was there more high quality orange juice or more inexpensive soda and a selection of even less expensive “store brand” soda?

Health care is no different. After all, while health care is critically important, so is food.

The reason people have come to expect better care from their grocery provider than their health care provider, is specifically because _they_pay_themselves. In an imaginary world things like advertising can easily be forgotten. In an imaginary world it is possible to ignore the connection between low prices and low quality. If the reason you do not buy certified organic produce is the expense then you probably have not come to expect better care from your grocery. If you do not buy certified organic because you do not trust that it is actually organic then you probably have not come to expect better care from your grocery. If you do not buy certified organic because you trust the agriculture industry to spray pesticides within the manufacturer’s guidelines and the manufacturer to set safety guidelines that restrict spraying and sales, or that no amount of pesticides constitutes an overdose or a health risk then “small” Government is for you. If the store sells shitty overpriced, products and make you wait for months in line to flatter some retarded progressive's idea of social organization, their customers simply go somewhere else. So the grocery stores that chose to do that are no longer there. And the ones left, are those who sell decent food at decent prices, with decent service. Of course some are better than others, and perhaps more expensive, but most are at least decent. Even at Wal-Mart people generally don't starve to death waiting in line at the checkout! There are no Doctors at Wal-Mart yet. People with health problems drop dead elsewhere. Your argument presupposes that there is a large enough supply of Doctors for people to easily go somewhere else. That is not the case in an unregulated supply and demand sytem. Shortages are ok for “widgets” but in healthcare it means you have screaming babies and permanent disabilities.

In health care, the customer does not pay. In healthcare the customer has prepaid. Currently one of the biggest issues people have is that after having pre-paid they find the salesman’s promises do not match the delivered service. HMO’s refer to that as being underinsured and suggest that the solution is to buy more adequate, higher priced coverage. In order to expect quality the private HMO’s suggest we should pay higher prices, than the highest prices in the world.   Currently an HMO does for most people, under strict regulation by the state. So, the provider spends it's resources keeping the HMO managers, and the state regulators, satisfied, not the customer/patient. If they can show some trumped up statistics that look cool in an election campaign, they get paid. The doctors of www.pnhp.org say the problem is inadequate regulation, surrendered by the regulators, to the private insurance industry, who have succeeded in putting themselves in the position of being the regulator, and who are now siphoning off one third of the money being spent on healthcare while forcing additional and unnecessary expenses onto the Doctors.

Who cares about the sick guy. He's taxed broke anyway. Excellent question, I think it is more often the Doctors and Nurses and volunteers and family of the sick guy who see him every day, and offer free services inside and outside America’s borders. Not the CEO of United Health Care who needs $37mil in compensation to be motivated to work. Or an previous CEO who needed over $100mil. By comparison the Director of the Government run CDC works for $200,000/ year.

At least in the US, people can change HMO, although those are so regulated in what they can do that the difference is hardly worth the effort for most people.

The “free market” solution to an inadequate healthcare provider is to select another. Let’s offer a real world example of how that system works. First you sit down with Human Resources at work and they tell you who the provider is and what plans they have selected for you to choose from. Of course that is not truly “free market” so in our example you do not get healthcare from your employer, instead your employer just transfers the entire amount that he would have spent upon your healthcare into your paycheck. Being a healthy single guy you find you have $400/month more and have decided that you will budget the entire amount toward getting healthcare. You ask your friends and coworkers who they have selected, you narrow your choices to three providers and go and have a look at their plans. Unfortunately you have a family history of diabetes and even though you are fine, eat right and may never get diabetes, your insurer has a responsibility to its share holders and cannot take that risk. One of the providers you chose decides they will not offer you a plan, the other two have plans that will cover you but the cost is higher. In order to get your costs back down you select a plan that only provides coverage if you use their selected Doctors. Last time you were in for a check-up your Doctor had seemed rushed and you were planning to switch anyway. The plan provider gives you a list of Doctors and you see many that are rated AAA including your Doctor, and some that are lower rated. You also choose a plan that has a 15% copay to get back within budget. That is no different then what you were getting through work anyway. You actually come in under the $4800. /year your employer was spending. You write the salesman a check for the first payment and fill out the paperwork so they can deduct a monthly payment directly from your checking account.

One month later you receive a package in the mail detailing your coverage. It is 117 pages long and the font is the same size as a phone book listing. Every line has three words you do not understand, but you buckle down and work through it anyway. It is difficult going and you get tired fast, and find you don’t remember what you read just two pages ago. You blame the difficulty on having just worked a ten hour day. Eventually you get through the whole thing, you learned that liver disease has a higher than 15% copay due to note aa in appendix c which talks about a higher percentage of liver problems in men over thirty with your genetic history, (you are black) and you learn that ambulance service is paid at 100% for the first $1500, 50% thereafter with a $7000 limit. You call the salesman to ask and yes he does have more complete coverage but not within the budget you had given him. Then he laughs and says the coverage would be even more expensive if you had marked yes for bungee jumping or diving. You pay dutifully for 6 years, and coverage has grown to 137 pages, and the ambulance service has gotten worse. You have been healthy and gotten regular check-ups. Unfortunately, today was your unlucky day, and you became sickened by a pesticide overspray from a farm near where you ate lunch. With every muscle in your body aching you drive yourself to the nearest hospital and throw up on the floor in front of their counter. Because no-one who does not have insurance is there they can see you immediately. You give them your insurance card, and they inform you there is a plan doctor on staff. You sign a form guaranteeing payment of any balance not covered by your insurer and they go to work. You are saved, hurrah. You stay overnight for monitoring and are released in the morning.

Three weeks later you receive notice from the hospital that you owe them $13,000. You call your insurer and are told to submit the bill to them. Four weeks pass and you are notified that they have already paid the full amount that you are covered for. The hospital resends the bill for $13,000. This time you call the billing department and learn that your insurer does not pay for the plan Doctor outside of his office. You learn that the hospital is not a plan hospital so only 30% of your bill is covered. You pay $7,000 from savings and put the $5000 on your mastercard, and the balance on Discover. Because you are carrying a large balance your card interest rate doubles from 13% to 26%.

Frustrated you curse, “Darn Government”.

But with a single payer system, even this tiny sliver of ability to influence the system will be taken away. Interesting concept in that people are turning to their Government to “influence the system” because they have less influence with their insurer.

Then the providers can focus 100% of their effort on appeasing, coddling, wining and dining the bureaucrats, as well as providing well paying jobs for bureaucrats' friends and family, and funding their reelection campaigns. Then they'll get paid, and competitors will be kept away. With H.R.676 there will be no private insurer to “wine, dine, and provide well paying jobs for bureaucrats’ friends and family or funding their reelection campaigns”. In fact that is a major improvement of H.R.676 over any reform that includes the private insurers and that is currently dominating the discussion. Regardless of whether the patients get treated or not.

There has never been, in the history of humanity, a single instance of a single payer system of anything that actually worked decently, and there never will be. And yet almost all single payer systems outperform the private insurer model. Here is a list of Countries by private expenditure on health as a percentage of total expenditure on healthcare. http://www.nationmaster.com/graph/hea_pri_exp_on_hea_as_of_tot_exp_on_hea-health-private-expenditure-total

Once again I suggest you pick a model of a country where you would like to live.

 Even if, as Mises pointed out all those years ago, for some crazy reason, every bureaucrat in the system somehow happened to be completely altruistic and did his best. Mises is a con-artist, who wants to sell me that peoples character in private enterprise is so much more altruistic. If you do not trust people, the best way to make sure they put your interests at heart is to make sure they get what you are getting. So why on earth should anyone not blatantly retarded fall for a scam as intellectually bankrupt as that, in an area as important to most as their own health? It has been falling for “free market” ideology that is intellectually bankrupt and blatantly retarded. The USA has been in steady decline since Reagan turned us down the path of trusting privatization and deregulation. It is long past time to turn back. It is a nice fantasy that success comes from relaxing and letting “free markets” work. The truth is that success will come from demanding that good government benefit the weakest Americans, not relinquishing our authority to the most selfish.

There is no reason to fear letting Doctors set a standard for healthcare if the opportunity for outrageous wealth is removed for those setting the standard. There is no reason to fear a low standard if our elected Congressman get the same standard. There is every reason to rid ourselves of private insurers who are setting the standards and controlling our healthcare system. There is every reason to end a system whose motive is to charge the most and deliver the least.

These idiots in congress wanting to 'manage' other peoples lives and property needs to be told that freedom works. And that more freedom works better. And that most freedom works best of all. And then they can go run their own 'single payer' systems for their fellow congressional members, and leave the rest of us alone.

There are idiots outside of Congress too.

Under H.R.676 Doctors will be the highest paid people in healthcare, not insurance company executives. Under H.R. 676 if you are dissatisfied with coverage you will petition your elected Government for improvements. That is what you are doing now, but your Government has limited authority over free market insurers. It is the insurers who are underpaying Doctors, who are delaying payments to Doctors, and who are overcharging Doctors for malpractice. It is Americans who are finding their private insurance to be expensive and inadequate.

Under H.R.676 you will have the freedom to buy private coverage for any treatment you desire that is not included. You will have the freedom to travel to another country for a treatment that is not covered or you believe is better delivered outside the USA. If you think the best Doctor is in Houston, you have the freedom to move there.

Under H.R.676 there will be no private insurer with the “freedom” to pay off a corrupt politician. Report this comment
#5) On May 05, 2009 at 2:06 AM, whereaminow (27.34) wrote:

An honest man (HM) questions a dishonest man (DM) about Single Payer Health Care.

HM: Single Payer Health Care sounds great.  If a person receives a service, they should be the one to pay. 

DM: Well that's not exactly how it works.  The single payer is the government. 

HM: Oh, well the name of the bill implies an individual payer.  Single = One, Payer = Person Who Pays. 

DM: It is one payer: the government.

HM: Ok, but the money the government has comes either directly or indirectly from working Americans right, through inflation, taxation, and confiscation right?

DM: Yes, but in return the government provides necessary services like health care.

HM: So it's not a Single Payer Health Care bill then.  It's a Taxpayer Health Care bill. 

DM: In a way.

HM: So why do you call it Single Payer Health Care?

DM: Polling data showed a lukewarm response to names that directly represent the realities of the bill.

HM: But the name Single Payer Health Care is popular right?

DM: Very much so.

HM: Well, wouldn't that be because most people believe you should pay for what you consume?

DM: Yes, but the State must step in when necessary for the good of sociey.

HM: But I thought the point of representative government was that it represented the beliefs and views of the citizens from which it derives its power.

DM: The State is infinite.  The State knows best.

HM: I thought only God was infinite.  Either way, aren't you deliberating misrepresenting legislation in order to pass a law that is not supported?  Isn't that called fraud?

DM: We're just framing the debate.  The people don't know what is best for them.

HM: I'm long gold, silver, and guns. Have a nice day.

David in Qatar

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#6) On May 05, 2009 at 10:19 AM, devoish (97.26) wrote:

I usually win when I argue against myself too. So did Mises.

Could you settle the chicken/egg thing for us too?

Unfortunately, it would have been nice to live in your world, had it been real. Unfortunately relinquishing the authority of Representative Gov't to free market ideology only looked succesful for as long as the foundation of the new deal held it up.

The name Single Payer Health Care is popular because the plan behind it is excellent.

HM: Single Payer Health Care sounds great.  If a person receives a service, they should be the one to pay. 

Single Payer Supporter:  Single Payer refers to having one plan to pay Doctors. One goal is to reduce billing costs to Doctors and patients. The second goal is to eliminate the risk to patients of finding they are "underinsured" and all the money they have pre-paid to health insurers has failed them.

HM: Oh, well the name of the bill implies an individual payer.  Single = One, Payer = Person Who Pays. 

DM: It is one payer: the government.

HM: Ok, but the money the government has comes either directly or indirectly from working Americans right, through inflation, taxation, and confiscation right?

SPS: Correct, just as the money the insurance industry has comes directly from working Americans. But in return the government provides necessary services like health care, not an excess of unneccessary services like healthcare billing. The amount of money spent billing for healthcare has grown so large that many people are concerned it will significantly and adversely affect unemployment levels if it is improved to the level of Government Efficiency. Funding for retraining healthcare billing employees to be healthcare providers is included from the savings.

HM: So it's not a Single Payer Health Care bill then.  It's a Taxpayer Health Care bill. 

DM: In a way. SPS. No, people who do not pay taxes will also be covered. Most Americans now realise that after paying for years for a healthcare plan, if they get sick and use up their savings, their plan drops them for non-payment onto the Gov't just when they need what they have been paying for. Most Americans now realise that if their healthcare costs were not double the nearest Gov't run plans, they would have more money saved for those rainy days. Most Americans now realise that even after years of college, they can struggle to save, or become suddenly unemployed despite having been a hard worker.

HM: So why do you call it Single Payer Health Care?

DM: Polling data showed a lukewarm response to names that directly represent the realities of the bill. SPS. Did you not want to hear the answer to your second question? I can repeat it for you; Single Payer refers to having one plan to pay Doctors. One goal is to reduce billing costs to Doctors and patients. The second goal is to eliminate the risk to patients of finding they are "underinsured" and all the money they have pre-paid to health insurers has failed them.

HM: But the name Single Payer Health Care is popular right?

DM: Very much so. SPS. So is actually eliminating the private healthcare insurance model.

HM: Well, wouldn't that be because most people believe you should pay for what you consume?

DM: Yes, but the State must step in when necessary for the good of sociey. SPS. Most people also believe they should get what they have paid for, and recognise that the private insurer model is not delivering.

HM: But I thought the point of representative government was that it represented the beliefs and views of the citizens from which it derives its power.

DM: The State is infinite.  The State knows best. SDS. Despite getting less press coverage than Ron Paul, support for H.R.676 is growing quickly wherever people hear about it. It has more support from Physicians and Nurses that any plan that includes the private insurers, It has devoish's support and he is not the Government. It has the support of over 90 Congressman and they are the Government. It has more public support than tea partys.

HM: I thought only God was infinite.  Either way, aren't you deliberating misrepresenting legislation in order to pass a law that is not supported?  Isn't that called fraud?

DM: We're just framing the debate.  The people don't know what is best for them. SPS. No, are you deliberately misrepresenting legislation by representing yourself as able to argue against yourself and misrepresenting the level of public support for H.R.676? Is that fraudulent?

HM: I'm long gold, silver, and guns. Have a nice day.

SDS. Please don't shoot yourself in the foot.

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#7) On May 05, 2009 at 11:01 AM, dbjella (< 20) wrote:

This is a very tough debate for sure, but after working in health insurance I find it very very hard to imagine that any "new" plans will do much of anything to the cost of health care.  They all sound and feel good, but there are three huge factors that the gov't hasn't been able to control (most likely will not be able to control):

1) Our population is getting older and demanding more health care and our older population does not pay taxes anymore.  

2) Our education system costs have continued to rise.  We do not build many new colleges and universities to train medicine.  (I know of quite a few doctors who went to South America, because it was too difficult to get into US colleges....they were very bright people).  Someone (you and I) has to pay for $100k bills to pay to become a doctor.

3) Litigation continues to plague the system.  Lawsuits have their time and place, but someone has to pay for mistakes the inevitably occur when humans interact with one another.  I wonder how much of your bill is attributed to malpractice insurance?

Sorry to be depressing, but there is no "right" solution at this point.  Dave in Qatar, I agree with your assertion, but we will never go back as the gov't is too deeply imbedded.  Devoish, you make some nice points, but this plan or any other plan will not contain costs...it will not without rationing health care. 

I don't have any answers that are palatable in a democracy.

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#8) On May 05, 2009 at 1:21 PM, blake303 (29.31) wrote:

our older population does not pay taxes anymore.

Not quite. They pay sales tax and any redemption of taxable 401k and IRA savings (their income) will be taxed as Roth accounts are a relatively new development. Also, the 65+ population is already on a single payer system.

Our education system costs have continued to rise. 

Irrelevant. This will not change whether the national healthcare system is single payer or not.  

Litigation continues to plague the system.

A significant portion of jury awards are for future medical costs. If the government is paying for these future costs, it drastically reduces the amount awarded to malpractice victims.

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