Next week congress returns after recess and the president will be addressing its members to make a final push for health care and health care insurance reform. Some have suggested the president will recommend initiatives directed at tort reform, something that could not only reduce health care costs by as much as 30 billion dollars, but also insure sufficient support to pass his health care initiative.
Having been very active in the movement for medmal insurance and tort reform, having sat at a table with one physician to discuss these issues, having listened and talked to Senator Obama and other democratic legislators in Springfield during the Illinois medmal crisis 2004-2006, I worry about the substance of any tort reform initiative proposed by the president. How many times did the democratic leadership in Illinois strike down physician proposals, and worse yet, draft their own proposals that in the end proved to indorse reform in name only? I can almost guarantee “reform in name only” will be the substance of any proposal coming out of the Whitehouse unless we start laying out some minimal expectations. To this end, my next several blogs will address this issue in hopes of sparking conversation on the topic. This first effort will present a few generalities and personal experiences.
The problem:
In Madison Co Illinois in 2005, if you were a practicing physician chances are you were involved in 1-3 law suits or knew someone that was. That region had become the national home of the class action legal machine and the impact of this on an already faltering medmal climate pushed things over the edge. Every other commercial on tv involved an “ambulance chasing” legal add and filed lawsuits sky rocketed with medmal insurance companies raising their insurance rates to compensate for potential losses. Often, one of the first things out of a patient’s mouth was whether I thought they had a case to file suit againts a business, neighbor, doctor or hospital; filing lawsuits had become a sport!
I knew an obstetrician who had never had a case filed against her yet her insurance premiums went from$23,000 to $140,000/year. Her take home for spending 24 years in school, 65 hour work weeks, delivering 20 babies/month was less than many accountants and lawyers.
In the end, over 200 physicians moved from our 2 county region. Patients who lost their doctors sought care in the emergency rooms which distracted from the care of patients with critical medical issues. Hospitals went on “diversion” because of overwhelmed EDs, and worse of all, not even hospitals across the state line would accept our patients, who were stuck driving around in ambulances with nowhere to go, because they were from Madison County. Now, if you think I’m blowing smoke about this I can introduce you to a couple guys, one had his heart attack in the back of an ambulance because he could not get into a ER, the other sat by and watched as his traumatically amputated thumb rotted because no one could provide restorative emergency care. If you had a significant head injury in our region in 2004-2005 you were dead because all of our neurosurgeons had left and getting another facility to accept you was near impossible.
I became politically active because I had to care for many of these disenfranchised patients and I was looking at having to leave the state myself. I, often with my family, always with other health care providers, would spend 1-2 days a week lobbying for reform in the state capital. I recall my outrage when the presentation of a reform bill slated for debate was tabled one day so that Bo Derek could make her presentation for saving old horses from the glue factory (kid you not). We challenged the democratic legislators in the hallways afterward (including a few you’ve probably heard of) knowing that this was simply another in a line of stunts on their part. I mentioned the emergency room overcrowding and patients being harmed; they laughed at us and called us liars.
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Studies have suggested that 40-85 % of medmal lawsuits “substantially lack merit” and the costs of these, about $30 billion a year, drive up physician overhead. This combined with decreased physician reimbursement is responsible for many doctors leaving or limiting their practice and refusing to participate in government health care programs. With appropriate intervention I believe physicians could tolerate decreased reimbursement. Hospitals, nursing homes, and clinics (who must also insure) would be able to redirect money to provide for more health related community initiatives. This will only happen however if 1) The proposed tort reform adequately addresses the problem and 2) The proposed tort reform sufficiently reassures the medical community so the benefits of decreasing medmal costs and decreasing costs of “defensive medicine” may be realized within 1-2 years—not slowly-if at all, over the next 1-2 decades.
Next: Some examples of lawsuits gone wrong and what we can do to cap it.
Food for thought: Has anyone considered the potential benefit and cost savings from “Legal Services Reform”? Maybe the government should control the country’s law practices in effort to control costs and provide uniform legal services to all citizens, regardless of how potentially profitable a lawsuit or other legal intervention might be.
Pissydoc
Tort reform is needed, but the current (?) health care reform plans are overloaded as it is. Separate legislation might be the ticket. In the meantime – to counter the sometimes false tales being put out by the antireformists – one might recall the Dennis Quaid case in Texas where the film actor’s daughters were nearly killed by sloppy providers giving them adult heparin. Quaid and his wife rightfully sued the hospitals involved. If they do this to someone famous, what about us “common folk”. Yes, so-called “frivilous” lawsuits should be curtailed, but the patient’s right of redress in cases of provider wrongdoing should be preserved … As far as saving money is concerned – any worthwhile reform should include penalties for doctors & other providers who shill for phamaceutical companies, insurance lobbyists, supply houses, etc. The recent DOJ case against Pfizer is adequate evidence that waste can be curtailed – and billions saved – by vigorous prosecution of providers and corporations that engage in fraudulent activities.
By: Fred O'Neill on September 4, 2009
at 4:07 pm
I understand, but this is like getting tainted hamburger at a taco bell; via the media something like this sounds like an out of control national problem when its not. Of course medical mistakes happen and they ALWAYS will–the delivery of medical care can be complex and overwhelming especially when hospitals don’t have the money to hire enough of the best and brightest because of government cut backs. We’re all human and humans screw up, sometimes in very bad ways. In this case no one said there should not be retribution for such things but should there not be reasonable limits that do not result in crisis for our health care system. Also remember that for each case like this there are HUNDREDS (thousands?) of others without merit, many of which get thrown out after thousands of dollars have already been spent in defense. We need to focus on the facts of the issue, not the headlines. I’m actually reading the bill, something alot of people screaming on both sides refuse to do, and much of what is in there increases medical overhead and decreases reimbursement. What do you think might happen with the doctors and hospitals without something to decrease their costs? Do the math.
By: pissydoc on September 4, 2009
at 4:47 pm