It is incredible to me that, amid public concern over the leading healthcare proposals, congressional leadership continues to stonewall any discussion of legal overhaul. They have effectively left the field open to Republicans, who now have seized the center with proposals for special health courts and other ideas that enjoy broad support from almost all healthcare constituents, including consumer groups and patient safety advocates. See here, here and here. I know the trial lawyers give Democrats a lot of money, but can this possibly be smart politics?
The only substantive retort to solving the problems of tort, at least that I've heard, is that the CBO found last year that it couldn't find consistent evidence that fixing malpractice laws would save money. there's also no hard evidence that overhauling fee-for-service reimbursement will save money either--but almost everyone associated with healthcare understands that cost-containment requires a fundamental change in the culture of health care delivery, starting with getting rid of the incentives (both positive and negative) to always do more.
Today's New York Times op-ed by Jon R. Gabel addresses the fallacy of looking for hard data with fundamental change. "The budget office has particular difficulty estimating savings when it considers more than one change at once.... [I]f both malpractice reform and comparative effectiveness studies were instituted simultaneously, they might work together to yield substantial savings."
Creating a reliable malpractice system with special health courts will not solve all the problems of healthcare, but it will solve some. Reliable law is also a necessary foundation for other changes in the culture of healthcare delivery. Persuading doctors to use email with patients not only requires a new reimbursement system (Britain now pays doctors more for using email) but also requires a system of justice that reliably supports doctors who use this imperfect but highly productive form of communication.
Congress should listen to doctors and patients. They see these problems with modern healthcare. The fact that it's hard to "score" the precise savings doesn't mean that the changes are unimportant. I recall the statement attributed to Einstein: "Not everything that is important can be measured, and not everything that can be measured is important."
(Photo: Flickr User aflcio2008)
Today's Headlines From The Atlantic
business Lead Us Not Into Debt
Find God and lose your credit cards
religion Did Christianity Cause the Crash?
Preachers spread a gospel of debt
books Books of the Year
The 25 best in a crowded field
VOICES
"The Annual Misuse of Hate Crime Statistics" 11.24.09 3:57 P.M.
Structural Versus Cyclical Deficits 11.24.09 2:29 P.M.
Hope Fades 11.24.09 4:26 P.M.
Journalism Dudes... 11.24.09 2:02 P.M.
Manufactured failure #6: the wrapup 11.23.09 10:22 P.M.
TSA vs. Lizard Smugglers 11.24.09 2:55 P.M.
Putting the 9/11 plotters on trial 11.24.09 11:22 A.M.
Philip K. Howard
Copyright © 2009 by The Atlantic Monthly Group. All rights reserved.
This is an emotional issue and we all should support covering individuals through private health insurance. To conquer these serious changes, doesn’t it seem right to advocate for greater transparency in both quality and price information, for it overlaps with many other issues? http://www.friendsoftheuschamber.com/issues/index.cfm?ID=300
I didn't mean to post this here. please delete.
One of the reasons you fail to see any significant attempt at tort reform from Congress is because many believe this kind of reform is best done at the State level. And it has been done at the State level. Texas, Florida, California, etc. have all passed extensive tort reform laws. And guess what, every State that has done this kind of reform has had their health insurance costs increase.
It's a bit ironic that Republicans want to increase tort regulation at the Federal level instead of letting the States make that call, but I'm not entirely opposed to reform either - just don't buy into the hype that it would lower health insurance costs. Private health insurance costs will continue to rise at unsustainable levels with or without tort reform.
If "many believe" the reform should be made at the state level, but you argue (without citing any evidence) that state level reforms are ineffectual. I don't think you make your point very well.
Texas and Alaska have both enacted tort reform at the state level, with beneficial results, vis-a-vis health care costs.
The way I see it, we're faced with a two-headed monster. Either we're passing governmental 'reform' of our health care system, or we'll see a continuation of escalating costs...
But I don't see that getting government involved is going to lower costs either. If anything, we're looking at a trillion dollar liability for governmental health care - and I really don't think we can afford to 'save' money like that.
And that money comes from... where? You? Me? The businesses that'll be charged higher tax rates, which will be directly passed to us? Folks in China buying our debt? Magic money trees?
We're told we've got to do this to 'save' money - but to me it's like a guy making $30k a year going to buy a new car that's going to cost (after rebates and deals and such) about $60k. He's going to have to cut SOMETHING to afford that - whether housing, food, utilities, clothing, or insurance. He could get a better job (IE increase national GDP) but that's not terribly likely due to past bad decisions he's having to live with.
Honestly, if we 'save' much more money like this, and we're really screwed.
Medical Malpractice settlements usually pay out three things.
Past, present and future medical expenses for treatment of the injury caused by the medical malpractice
Other financial damages and economic damages that the malpractice caused
Compensation for pain and suffering
Passage of the public option and covering everyone would eliminate the need to cover future medical expenses, arguably the most costly part of the settlement. This can make a huge impact on the costs associated with malpractice suits and costs to hospitals and physicians. This would be without passing laws that limit the citizenry's access to the courts.
You selectively quote Gabel to support your somewhat vague argument. The point of what he actually wrote is that the CBO has a track record of wildly overestimating health care costs.
Special health courts may actually increase citizenry's access or use of a medical justice system. The system in place now is painfully slow and inefficient. Because of expenses inherent currently, plaintiff's attorneys often turn away injured victims with legitimate complaints. Estimates are that only 4-7% of victims actually file suit. This could be because they are uncomfortable with the adversarial system in place now or maybe they just don't want to deal with trial lawyers. A more user friendly system such as Mr Howards's health court model may bring justice to more victims and continue to hold physicians accountable. As a physician, I can tell you I would send fewer patients for CAT scans and to the emergency room "just to cover myself" with Mr Howard's health court model.