Dr. Scott Berlin has delivered close to 2,000 babies since 1994, but an increase in malpractice insurance rates announced this week prompted a decision to close up shop.

The Long Island obstetrician will owe $190,000 in liability costs after the state's Department of Insurance announced a 14% insurance rate hike, effective July 1.

"You can't do enough deliveries to pay for this. It's undoable at this point," Dr. Berlin, 45, who will join a gynecology practice at Lincoln Hospital in the Bronx, said. "It's a rotten taste in every obstetrician's mouth right now in New York."

"Whole states are demonstration projects," said Rep. Lamar Smith, R-Texas. "Texas passed tort reform in 2003 and ... insurance premiums went down 30 percent. California passed tort reform and premiums went down 40 percent. Let's enact tort reform. Let's not just try that with demonstration projects. We already know it works. Let's put it into law."

During his address to a joint session of Congress, the president argued that some lawmakers will resist any health care reforms. But then in a bid at bipartisanship, he said he agreed with doctors -- and Republicans -- looking for changes to the way medical malpractice lawsuits are litigated.

"I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs," the president said.

Smith said Texas has already proven the effect of tort reform on medical care.

When Texas passed tort reforms in 2003, medical malpractice insurance premiums went down and doctors started rushing back into the state. At least 10 counties that had zero obstetricians, for instance, now have one, and more than two dozen other counties have seen additional obstetricians seek licenses there.

"We now have women that are getting their care in local communities whereas before, for their obstetric care, they had to drive hundreds of miles to be able to get it," said James Rohack, president of the American Medical Association. "Before the reforms, there was such a shortage of obstetricians, many expectant mothers had to drive long distances for care. The liability reforms changed that."

Many doctors pay $100,000 to $250,000 a year in malpractice insurance even if they've never had a judgment against them. Neurology leads the list of high-cost malpractice insurance. Obstetrics isn't far behind.

Supporters of tort reform argue that expense doesn't just drive up the price of medical care, it also leads to defensive medicine, meaning doctors order all sorts of tests they wouldn't otherwise order just to make sure they won't get sued.

In one study of doctors in Massachusetts, 83 percent of respondents said they ordered tests they thought were unnecessary just to protect themselves from liability. And that, doctors argue, adds huge amounts to the nation's health care bill.

"Defensive medicine is a very important component of the health care equation," said Dr. Albert Strunk of the American College of Obstetricians and Gynecologists. "It's also a component that is notoriously difficult to evaluate in terms of actual dollars. We've seen estimates anywhere from $60 billion a year to $200 billion a year as far as defensive medicine is concerned."

the Senate is counting on hefty excise taxes assessed on the different players in the medical industry for a big chunk of funding. Altogether, insurers, drug companies, and device makers could be on tap for roughly $120 billion in fees over the next decade. Problem is, a big portion of those taxes are likely to be recouped in the form of higher prices or increased premiums. "It's a fiction," says Roberton Williams, a former Congressional Budget Office official now with the nonpartisan Urban Institute's Tax Policy Center. "The excise taxes won't be paid by the companies; they'll be passed right back to their customers."

To put it in a nuthouse, Republicans must get 4 of those toss-up Dems to vote Nay, while the Democrats must get 69 of the toss-up Dems to vote Yea.

It should be obvious now why Squeaker of the House Nancy Pelosi (D-Haight-Ashbury, 100%) has not yet called the vote: The risk is too great that the Nay-sayers will get their 4 before the Yes-men get their 69. And she won’t call the vote until the whip-count shows better odds for ObamaCare than against it.

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As a more practical matter, the closer we edge to the November 2nd elections, the greater the pressure on the toss-up Dems to vote Nay, since that is the way most of their constituents want them to vote.

I would guess that the window will firmly shut in late May or early June; after that — with one dangerous exception — ObamaCare cannot be enacted, for reasons of politics.

The one dangerous exception is the putative “lame-duck” period of the second session of the 111th Congress… the short interval after the elections but before the 112th Congress is seated on January 3rd (per the Twentieth Amendment to the U.S. Constitution).

During those two months, every representative in the House already knows whether he has been reelected, and the Senate bill is still in effect.

A defeated Democrat has nothing to lose by voting for ObamaCare. If enough of those currently leaning towards Nay are defeated, they may, in a fit of vindictive revenge against the constituents who fired them, vote in as perverse a manner as possible. (Though of course, it’s unlikely the reconciliation side of the package could also be enacted during that period.)

This is the most likely time for ObamaCare to be enacted, since it would then have virtually no consequences on its supporters: Many of the Democrats voting for it will have already been defeated; and for those from moderate districts who were nevertheless reelected, a December vote gives them the maximal “memory-lapse” time before facing voters again in 2012. - Hot Air

Once upon a time near Sherwood forest, a group of peasants were discussing the problem of bandits in the forest.

"Oh, sure Robbinhood talks a good game, but really, the poor aren't being helped and we are all getting robbed."

"Yeah, you are far more likely to be clobbered and stabbed than get anything worthwhile from that scoundrel."

"I agree, I don't even dare go thru the forest to sell my stuff at market. He steals so much it's not even worth it." "And all Robbinhood ever handed back to this poor person is this pearl hatpin."

"So we are agreed, this isn't working out?" "Hey, you know I actually know who he stole that stickpin from, just give it to me and I'll hand it back to her, you'd look pretty silly with a pearl hatpin sticking out of your hat anyway."

"Yeah, but it's my pearl hatpin now."