Friday, April 08, 2005

Should Congress pass the president's medical malpractice proposal?

Yes, says Sally Pipes, in the Daily Herald, from Provost, Utah.
Medical malpractice lawsuits have been driving up the costs of health care for decades. In recent years, they have actually started to limit patient access to quality care.

From 1975 to 2002, malpractice insurance premiums increased at four times the rate of inflation.
By 2002, the malpractice cost to Americans was $25 billion -- or $250 per American household. That's more than half of what the average household spent on prescription drugs.

Lottery-size awards drive the problem. The average award increased from $700,000 in 1999 to more than $1 million in 2001. Seven of the top 20 lawsuit awards in 2001 and 2002 were for malpractice resulting in a combined cost of $3 billion. Up to 40 percent of the awards wind up in the pockets of lawyers.


Most recently, a study by health economist and former Clinton administration official Kenneth Thorpe found that premiums in states with limits on non-economic awards are 17 percent lower than in states where attorneys have free reign.

A national solution is exactly what the doctors are ordering.

The House of Representatives has twice passed legislation only to see it die in the Senate where the trial-lawyer lobby has many friends.
And, no, says Michael Saks.
The best way to prevent medical malpractice litigation is to reduce the incidence of medical errors and injuries.
So what? What does this have to do with the subject at hand, which is the ridiculous size of the jury awards?

Proponents of the legislation argue that litigation adds to health-care costs because doctors and hospitals pass those costs along to consumers. But that is exactly why health-care providers cannot complain too loudly about malpractice premiums: it is patients, not providers, who ultimately are expected to pay the bill.
Not true. Those of us who work in medicine know that we don't get to pass along our expenses. While malpractice expenses continue to go up, most of us are facing competitive pressures to decrease or maintain our charges.

Second, that litigation "surcharge" buys patients deterrence against error, harm and the resulting costs, thereby keeping the total real cost of health care lower. As the deterrence factors go down, injuries, and the total real cost of health care rise.
Wait a minute! I thought you just said the "surcharge" argument didn't apply because we just pass the costs on. Now you are arguing that this cost, which we don't actually pay because we pass it on, keeps us from making errors. Fellow physicians, you don't do good work because you are ethical, smart, hard-working or concerned about your patients! You don't have pride in a job well done! You avoid errors because you have malpractice insurance!!! The ONLY reason you try to avoid errors is to avoid a lawsuit! Betcha didn't know that. Thanks, Mike.

Come to think of it, this is very relieving. Imagine, you don't have to care whether you hurt anyone with your car, because the only reason you drive carefully is to avoid an increase in your car insurance.

A relatively few doctors cause most of the carnage. About 5 percent of doctors are the focus of half the lawsuits. Removing those doctors would reduce quite a lot of malpractice, malpractice suits and the costs of both.
So get rid of those guys. BTW, who are they anyway? I'm going to have to pay more attention at my next staff meeting. I guess 5 out of every 100 of us are real f**k ups.

When the relatively few cases that get filed reach trial, juries give doctors considerable benefit of the doubt. Of cases where insurers believed their clients committed malpractice, half of the victims lost at trial.
Really? Where did you get this kind of information? How can you know whether the insurer believes the doctor committed malpractice? I can't believe any malpractice insurer would publish this kind of data. Imagine: Boy did we get lucky. That SOB really reamed that patient, but that great jury found for us!

And those few who win usually are under-compensated. Though the law says that victims of negligent injuries should be fully compensated for their losses, research finds that only 10 to 20 cents are paid on each dollar of economic loss.
Again, I find this hard to believe. Let's see the evidence.

Proponents argue that provisions such as caps will make doctors more willing to disclose their mistakes and thereby reduce future errors. How caps can do that is a mystery. Moreover, existing federal law already protects the confidentiality of such communications.
It's a mystery only because you think we don't have empathy or a conscience. Federal law protects information released in confidential peer review situations. However, ask any physician who's been involved in peer review what lengths are observed to prevent the discovery of that information. If a physician even removes the report of a peer review from the immediate peer review environment, like to take a copy home to generate a response, it can be discovered and used against her in a malpractice case.