Dick Armey, Big Shot
Delicious barbacoa tacos
Apparently Dick Armey is a jackass:
In one of our conversations about health care, Armey argued that tort reform would significantly cut costs because doctors, with less fear of huge malpractice judgments, would no longer order every possible test. I asked if it might not be patients who sometimes insisted on unneeded tests. As an example, I mentioned that I had recently suffered an athletic injury, a ruptured Achilles’ tendon, and underwent surgery after my orthopedist examined me clinically and said he was sure of his diagnosis. I didn’t ask for any further diagnostic exams, but I suspect that some patients, conditioned to accept the perceived scientific certainty of M.R.I.’s and other scans, would have insisted on more sophisticated measures. “I’d have gotten the M.R.I.,” Armey said. “I’m a big shot, and doctors sure as hell don’t want to be sued by a big shot. He would not even have dared ask. He would have just sent me for the test.”
Later, in North Carolina, we sat down to dinner, and he said: “You ever see that Danny DeVito movie, I think it was Danny DeVito, where he says big shots never order off the menu? They just say what they want.” We were at an On the Border, a Tex-Mex restaurant chain and not the type of place I imagine many big shots patronize, but he pushed the menu aside without reading it and told the waiter what he wanted the kitchen to cook up for him.
On the merits of the issue, no matter how large an impact you want to attribute to fear of lawsuits, changing this would be a one-time thing. What’s scary about health care isn’t that it costs a lot (though it does) but that the rate of growth is so high. Lawsuits don’t deal with that.
47 Responses to “Dick Armey, Big Shot”
Register
RSSLogin
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
November 5th, 2009 at 9:25 am
i keep thinking of the loudmouth Texan from The Simpsons.
doe Armey emphasize each sentence with a “WoooooHooo!” and a volley of pistol shots ?
November 5th, 2009 at 9:29 am
I think this was the more disturbing part of that piece:
The following day consisted of the three stops — rallies at the Harley dealership, the banquet hall and a barbecue joint. At each, Armey had a warm-up act, a somewhat bizarre one: Mason Weaver, a former San Diego radio personality and the author of the book “It’s O.K. to Leave the Plantation.” Weaver, in a gray suit, crisp white shirt and red tie, was dressed more formally than Armey, and his delivery had more heat to it. For those who believe that American politics has gone around the bend, Weaver could plausibly serve as Exhibit A. Speaking in a former Confederate state to almost entirely white crowds, Weaver, who is black, repeatedly referred to government as “master” and warned his audience that America’s first black president wants to enslave them. “You’ve got to decide what kind of country you live in,” he thundered at one stop. “You’ve got to decide if you’re free or you’re a slave. . . . They want you to be tolerant. Are you kidding me? They have broken into your home, folks. They are robbing you of your money. They have taken away your freedom.”
He went on to say: “You see, slavery was a choice. The master didn’t lock those slaves up at night. There was no ball and chain. They stayed because they thought like a slave.” Mocking one of Obama’s campaign themes, he added: “We don’t need hope and change. We are Americans. So therefore we are free. What the heck are we going to change to? Back to slavery?”
November 5th, 2009 at 9:29 am
We went through this with our daughter earlier in the year. We went through five different doctors who just kept ordering test after expensive test to try to determine what was wrong with her–it seemed more like a process of elimination. None of them wanted to hazard a diagnosis until every possible alternative was eliminated. Then we finally found a doctor who just spent a lot of time examining and talking to her, and figured it all out in one visit with no tests. And, because we have a very high deductible health plan, we had to fork out thousands of $$.
November 5th, 2009 at 9:31 am
Those tacos look great. I totally think thats lunch today.
November 5th, 2009 at 9:33 am
Wow, Dick Armey throwing his weight around at On the Border. That’s some serious Ricky Bobby action there. Fucking teabaggers don’t even know how to be jerks right.
November 5th, 2009 at 9:33 am
doctors, with less fear of huge malpractice judgments, would no longer order every possible test
Except they’re making money off the tests these days.
(Via referral kickbacks and even via ownership stake in the testing facilities. Surely Arney knows this.)
November 5th, 2009 at 9:38 am
Disclaimer: Tort costs and the response to torts represent a small part of the total health care bill.
As a physician, I commonly see other physicians ordering tests to confirm the initial diagnosis and the diagnostic test. There is misperception that more information is better. For non-physicians, let me ask it this way: how many of you would do work on your roof without multiple opinions? More information is better, right? I know this is wrong (Malcolm Gladwell speaks to this nicely in Blink) and that more information actually confuses more than clarifies, but this concept is lost among what everyone “knows.” Like they know that fewer work hours for an intern will lead to better doctors or that greater attending physician presence will make better doctors in the long run. These are all “accepted” because they seem to make sense…without any proof at all.
November 5th, 2009 at 9:38 am
Every time he said “I’m a big shot,” did he follow it with the word “see”?
November 5th, 2009 at 9:38 am
By arguing for restrictions on gratuitous malpractice lawsuits which he admits he’d readily partake in, Dick Armey is achieving new heights in jackassery.
“We should put a law up to protect the medical world from… me!”
November 5th, 2009 at 9:44 am
Differential diagnostic medicine essentially is process of elimination. (Of course, not all diagnoses need be differential). That generally means tests. Maybe down the road we will know more about the human body and be able to do it some other way, but reliance on tests is likely here to stay for the forseeable future. The question is – who gets the tests, and who doesn’t?
November 5th, 2009 at 9:46 am
. . . a dick army of one. . .
November 5th, 2009 at 9:47 am
btw, the movie to which Armey is referring is actually Get Shorty. it is Danny DeVito who is the “big shot,” but it’s actually Rene Russo who explains the restaurant dynamic. underrated film, actually.
November 5th, 2009 at 9:55 am
Like they know that fewer work hours for an intern will lead to better doctors or that greater attending physician presence will make better doctors in the long run. These are all “accepted” because they seem to make sense…without any proof at all.
Josh, Malcolm Gladwell’s reasoning in Blink is completely specious, and so is yours. Knee-jerk contesting-every-premise is a tactic that intellectually honest people discard after adolescence.
November 5th, 2009 at 9:56 am
I’m beginning to think I underestimate how much of the world is ruled by this kind of banal jackass, & that it’s not a trivial error. What but Divine Providence could keep a world run by this kind of people from having ruined itself long ago?
November 5th, 2009 at 9:56 am
And the scene is straight out of the Elmore Leonard book — the movie is one of the most faithful adaptations on record.
November 5th, 2009 at 10:06 am
I have done malpractice defense work, and here in WA state at least, 70-80% of the total amount of plaintiff’s financial claims are the costs of previous or future medical care to correct the claimed injury.
Plaintiffs attorneys work on contingency fees, usually 1/3 of the total award.
If plaintiffs did not have to pay out of pocket for medical care (I know not currently on the table) 70-80% of the amount plaintiffs claim would disapear.
Plaintiffs attorneys can not make a living on 1/3 of the 20-30% of the money that would be left without claims for additional medical treatment.
Universal coverage would end the medical malpractice industry as we know it. Tort reform QED.
This is why there are not many med-mal claims in England etc.
(I wonder is this why single payer was immediately off the table for the democrats, mindful of protecting the trial lawyers?)
November 5th, 2009 at 10:11 am
What’s scary about health care isn’t that it costs a lot (though it does) but that the rate of growth is so high. Lawsuits don’t deal with that.
Huh? This doesn’t make much sense to me. Seems to me that the rate of growth in malpractice awards should be about the same as the rate of growth in health care costs overall.
November 5th, 2009 at 10:19 am
Texas has all the things Republicans are proposing in tort reform–it’s really difficult to file a lawsuit, there’s caps…and Texas has one of the highest ratesof uninsured in the nation, as well as enormous costs.
In California, they passed caps and the affect on healthcare spending was un-noticeable. That’s been true of every state these have been done in.
The malpractice system is terrible. But it’s not what’s driving up costs.
November 5th, 2009 at 10:20 am
The habits of the small town elite like Armey are quite amusing to behold. Here in the world of the actual elite professional class, we are content merely to make lots of money and achieve professional accolades for our work, rather than trying to convince everyone in earshot how important we are.
November 5th, 2009 at 10:26 am
feckless,
from what I remember, it does not work that way. Evidence of plaintiffs’ insurance is not admissible in determining their damages so the award would still be for the full cost, subject to their medical insurer seeking indemnity from the doctors liability insurer. Of course this also means plaintiff’s lawyers get to calculate their fee on the larger amount.
November 5th, 2009 at 10:29 am
Here in the world of the actual elite professional class, we are content merely to make lots of money and achieve professional accolades for our work, rather than trying to convince everyone in earshot how important we are.
Depends. If you are a absolutely white-shoe corporate M&A lawyer, you are pretty much in the banking world. I have often observed how litigators are much more concerned with accolades.
November 5th, 2009 at 10:33 am
CBO says tort reform big cost saver:
FROM: http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.html
“Congressional budget analysts said Friday that lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits — 10 times more than previously estimated……The federal government would reap a substantial portion of those savings, the CBO said, primarily through reduced Medicare costs.”
But don’t worry. Tort reform won’t happen. Here’s why:
FROM: https://www.opensecrets.org/industries/indus.php?ind=K01
2008 election cycle contributions by lawyers & law firms:
Democrats = $178,719,935
GOP = $54,500,270
November 5th, 2009 at 10:34 am
Differential diagnostic medicine essentially is process of elimination. (Of course, not all diagnoses need be differential). That generally means tests. Maybe down the road we will know more about the human body and be able to do it some other way, but reliance on tests is likely here to stay for the forseeable future. The question is – who gets the tests, and who doesn’t?
Except one big problem is that so many tests are unnecessary and are conducted “just in case,” because there is no reason not to.
There are *two* ways to address malpractice insurance rates. The first is to cap payments, which screws over the patients who are injured by doctors. The second way is to indemnify doctors from lawsuits who follow established evidence-based guidelines. In such an instance, a doctor pays lower malpractice rates when he follows standard practices. This, in turn, saves money for insurers and will reduce the number of patients who are injured by poor medical practices.
So, we have two choices. We can either save money by refusing to compensate injured patients, or we can save money by saving lives and providing better care to everyone else. So why is it that Dick Armey and his Republicans prefer the former?
November 5th, 2009 at 10:35 am
I gotta say, Al beat me to it, and I think he’s right.
Matt’s claim that tort reform would be a one-time impact with no continuing impact on cost growth would appear to be wrong on its face.
November 5th, 2009 at 10:36 am
Universal coverage would end the medical malpractice industry as we know it.
How do you figure? Rather than individual insurance companies coming after the guilty party for indemnification the state would come after the provider in question.
November 5th, 2009 at 10:36 am
The movie was Get Shorty, with Travolta, and it was De Vito who said that line, in the role of Martin Weir, a movie star. He not only made the restaurant cook something special, off the menu. But he doesn’t say anything about being a big shot, he just acts like the world revolves around him.
Armey is one of those high flyers who is so insulated from reality he doesn’t even care if he sounds like an self-centered asshole.
November 5th, 2009 at 10:39 am
kafka, that is 5.4 billion/year. Democrats have consistently point out that the cost of malpractice amounted to just 2 % of health care costs and was not significant in cutting cost. That study proves it– contra Republican assertions that it would result in a sea change of cost cutting– of the CBO is once again exposing right wingers as clueless ignoramuses and liars, why do we even bother to consider their worthless ideas?
And in any case, as we see from the experiences of Texas, it does not even do that.
November 5th, 2009 at 10:44 am
he doesn’t say anything about being a big shot, he just acts like the world revolves around him.
which is what makes the contrast so funny– Danny DeVito’s character basically doesn’t know any better– in his life he has always been catered to and never has been told “no.” Dick Armey is just a guy trying to act in a way he thinks important people act and adopting affectations he thinks he should have. Kind of like MylesG in his vocalized poseurness.
November 5th, 2009 at 10:46 am
Let me help with the mathematics.
If malpractice lawsuits are growing proportional to the overall growth of health care costs, reducing them or eliminating them altogether doesn’t do anything to the rate of growth.
Look at it this way. Suppose you have a mold/fungus population in your basement which is growing at an alarming rate. About 2% of the population is orange. The orange stuff grows about as fast as the green stuff. So, you kill off all the orange mold. Well, that’s slightly better than doing nothing. However, killing the orange mold won’t do anything to change how fast the green mold is growing each year.
And, if I may exit the easily-visualized analogy, that’s the big concern: how fast the remaining bulk of healthcare costs grows each year.
November 5th, 2009 at 10:58 am
Whether or not giving fewer hours to interns would make for better doctors, it would certainly make for fewer people killed by doctors in unnecessary car accidents.
November 5th, 2009 at 10:59 am
We were at an On the Border, a Tex-Mex restaurant chain and not the type of place I imagine many big shots patronize, but he pushed the menu aside without reading it and told the waiter what he wanted the kitchen to cook up for him.
I’ve never been a cook, but I’ve washed dishes and heard the cooks talk, and I can pretty much guarantee that Dick Armey’s meal came flavored with spit.
Spit if he was lucky.
November 5th, 2009 at 11:11 am
Members of the actual elite have neither the time nor the inclination to comment on every post.
November 5th, 2009 at 11:19 am
Seems like all the poiticians named Dick surre are dicks: Nixoon, Armey, Cheey. I know what name I’m never giving to my kid. Especially if it’s a girl.
Seriously, WTF? I’ve been living under national health for 6 years, and it’s great. Better, cheaper health care than I ever had in the US, even with my mother’s plan until I graduated university. Japan charges $30 for teeth cleaning, and that’s without any insurance. 15 for the top, 15 for the bottom and I’m good to go. Seriously. I got Lasik done here for roughly half of what it cost in the US when I had it done (3 yrs ago).
What the fuck is wrong with the idiots in our country.
November 5th, 2009 at 11:19 am
questions mark ?
November 5th, 2009 at 11:42 am
Dick Armey is just a guy trying to act in a way he thinks important people act and adopting affectations he thinks he should have.
A bit like the other Hickory Hillbillies of just beyond the Beltway.
Armey of Dicks might think he’s a big shot, but outside of Teabaggerland (prop. Koch Family Foundations) we pronounce it with an ‘i’.
November 5th, 2009 at 12:07 pm
Proposed tort reforms will have no significant effect on excessive testing and procedures.
About 1% of health care costs are malpractice awards and settlements. Punitive damages amount to 0.3 to 0.5% of total malpractice awards. Punitive damages amount to somewhere between 0.003% amd 0.005% of health care costs. That’s insignificant, particularly when you consider that some punitive action is certainly warranted.
Non-economic damages (pain and suffering) had been declining as a percentage of total malpractice awards even before the ridiculous wave of state tort reform laws which cap them. Those laws have had little effect except to deny people who are suffering severely from receiving just monetary compensation. They are now down to around 10-20% of all malpractice awards – or about 0.1%-0.2% of all health care costs.
Combining elimination of punitive damages with a cap of $250,000 on non-economic damages could, at most, save 0.04% of health care costs directly. Unnecessary procedures account for about 30% of health care costs. That is a factor of 750. There is no way doctors are doing $750 dollars worth of procedures to avoid $1 in lawsuits.
Economic damages are the biggest part of malpractice costs, and the only part of malpractice awards that is increasing as a percentage of the whole. The biggest cost increases in economic damages have been due to the rise in costs of health care. A big part of a malpractice award is payment for procedures necessary to remediate the damage caused by the error. Since the cost of health care has risen, the part of the settlement for remediation has gone up. Performing tests or similar procedures so as to reduce the total amount of medical costs incurred is the right thing to do. This segment of defensive medicine is certainly desireable and should be encouraged. If doctors want lower malpractice premiums, they’ll have to stop padding their bills.
November 5th, 2009 at 12:24 pm
In 1985 the American Society of Anesthesiologists published a study of analysis of malpractice claims and standard practices that could be used to eliminate them. They were well received and followed. In the next 15 years, while malpractice rates for other specialties rose faster than inflation, rates for anesthesiologists stayed constant without even adjusting for inflation. Effectively, they declined.
Doctors are extremely resistant to having standard practices imposed upon them, even to the point of not washing their hands between seeing patients. Evidently a policy of washing hands is “some bureaucrat” coming between doctor and patient.
November 5th, 2009 at 12:42 pm
That means using additional tests to narrow down the possibilities. The additional test is supposed to supply additional information. If the additional test supplies only redundant information, it is of significantly reduced value. The additional test may well be unwarranted, but a doctor might order it anyway, because they are shielded from the reasons not to.
November 5th, 2009 at 12:49 pm
“… Like they know that fewer work hours for an intern will lead to better doctors …”
That’s ridiculous. Nobody claims that. People contend that fewer hours make the intern a better doctor at that moment.
For the long term, the question is whether or not the long hours of internship actually help make doctors significantly better. No one thinks the long hours make them worse in the long run. Assuming that longer hours have diminishing (not negative) returns on doctor quality, at what point is the higher quality no longer worth the diminished capacity of the exhausted intern. If you save one life because you’re a better doctor, but kill two people due to exhaustion induced mistakes as an intern, it is not worthwhile to be a better doctor.
November 5th, 2009 at 1:11 pm
Tyro Says:
November 5th, 2009 at 10:20 am
The habits of the small town elite like Armey are quite amusing to behold. Here in the world of the actual elite professional class, we are content merely to make lots of money and achieve professional accolades for our work, rather than trying to convince everyone in earshot how important we are.
===========================================================
He he he! Armey has a PhD in economics and was a university professor before he ran for Congress.
November 5th, 2009 at 1:14 pm
That means using additional tests to narrow down the possibilities. The additional test is supposed to supply additional information. If the additional test supplies only redundant information, it is of significantly reduced value. The additional test may well be unwarranted, but a doctor might order it anyway, because they are shielded from the reasons not to.
Exactly. It’s possible that as someone who consumes very little health care despite excellent (government-provided!) coverage, I am underestimating the amount of unnecessary testing that is taking place. If that’s true, then we still need to look at the reason unnecessary testing is being ordered, and I’m not sure that, at the heart of it, it’s fear of malpractice. I think you are much closer to the truth.
November 5th, 2009 at 1:18 pm
James Gary, Thanks for you comments, “Josh, Malcolm Gladwell’s reasoning in Blink is completely specious, and so is yours. Knee-jerk contesting-every-premise is a tactic that intellectually honest people discard after adolescence.”
The proof for the hours issue comes from the lack of change in patient outcomes as reported by this NEJM article,”Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units.” NEJM 2004;351:1838 in which decreasing work hours had no effect on patient survival, morbidity, or length of stay in intensive care units and from this study showing that fewer work hours results in attenuated direct patient-care experience, Recent changes in the workload
and clinical experience of pre-registration house officers: experiences over four years in south-west England. Med Educ. 2000;34:371-3. Thus, fewer work hours do not help patients, even in the sickest setting, and limit resident education. For the second point, there is a large literature demonstrating that chronic fatigue causes as many attention-related errors as acute fatigue (for example, The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003;26:117), so how would increasing attending fatigue improve patient care? Moreover, to use the ridiculed method of obviousness,the medical skills of medical residents with constant back up is like a 16 year old who can only drive when dad is in the care making him go slow. No autonomy, no development, no independence…a limited physician.
And Malcolm Gladwell’s section on diagnosing MIs in emergency rooms, the section to which I was referring, shows by study, that more information wasn’t helpful. Knee-jerk my ass.
November 5th, 2009 at 2:59 pm
Now I understand why people like Armey can complain about people being “overinsured.” He certainly is.
Is it wrong for me to imagine him getting E. Coli poisoning from eating in a chain restaurant, and then being denied coverage?
November 5th, 2009 at 8:14 pm
In addition to being a physician Josh B is a complete tosser.
The authors’ conclusion in the paper he so disingenuously cites is Interns made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts. Eliminating extended work shifts and reducing the number of hours interns work per week can reduce serious medical errors in the intensive care unit.
The study was not designed to measure comparative outcomes on patient survival, morbidity, or length of stay in intensive care units as Dr. Asshat implies. In fact both the interns on the traditional schedule and those on the shorter intervention schedule were constantly observed by physicians who on rare occasions intervened to prevent possible harm to the patient.
From the paper,
In the vast majority of cases, the serious errors identified by observers were promptly addressed by medical staff with no need for action on the part of the observers. Nonintercepted serious errors were generally detected by observers when they were discussed by clinical staff. In the handful of cases in which observers identified possible errors in the making with substantial potential to cause harm, they immediately alerted clinical staff to prevent harm to the patient.
So James Gary was completely right at #13
Josh “physcian” B. is a dishonest tool.
November 6th, 2009 at 1:33 am
Armey is insecure – He fears ( or used to) that his rural PhD is looked down on by the Larry Summers of the world.
November 6th, 2009 at 8:11 am
I have no doubt that tort reform would save a ton of money – for doctors. That’s why doctors think it’s such an important issue.
$54 billion divided by 300 million Americans over 10 years is eighteen dollars. If only Republicans had the power to let me risk it and pray that a negligent doctor never injures me, I could get two pints of Guinness and a half rack of ribs during happy hour! Every year! If only Republicans had the power to cut my taxes, I could tip the waitress too.
November 6th, 2009 at 3:47 pm
Yeah – BIGSHOTS just tell the waiter what they want the kitchen to make for them, and then the little people in the kitchen farmer-blow loogies into in and then serve it.