April 05, 2004
While Nero Fiddles Health Care in America Burns
Health Care in America continues it long painful decline while the Republican led Congress and the Bush Administration do nothing but pay lips service to the problem, which does nothing to stem the decline. A story in today’s Chicago Sun-Times highlights the growing problems doctors face while trying to provide quality care to their patients. And the soaring, un-checked cost of malpractice insurance is surely at the top of the list.
While the President, Republican leaders and the insurance industry point to the rising cost of malpractice litigation—and resulting payouts—as the reason for the dizzying pace of malpractice insurance premium increases, recent reports indicate it has do more to the insurance carriers trying to shore up lost profits from investments in the stock market—their primary source of income. The cost of settling claims, which actually dropped last year, has little to do with the crisis reports say.
Yet another bait and switch by the Republicans at the expense of us all; how much tomfoolery, half-truths, and neglect is enough, before the American public cry foul?
As the article in the Sun-Times points out, doctors in certain fields are now being priced out of business by absurd malpractice premiums that are in some cases approaching $140,000 a year! How long before the sky falls and the average American can no longer receive decent health care, or find a qualified doctor to administer it, without traveling tens of miles from home?
I say that time is now, given that my spouse cannot find an OB/GYN or Neurologist within 50 miles of our home in the second largest city in the state of Illinois. And we jointly cannot find a non-resident Primary Care Physician for continuity of care; both of our doctors left the state citing the ballooning cost of malpractice insurance as a one of the primary reasons for their exodus.
I quite frankly am fed up with government (state & federal) no longer working for me, but against me at almost every turn. How about you?
Posted by V. Edward Martin at April 5, 2004 01:28 PMMr. Martin, good article. I disagree partially on the issue of skyrocketing Dr. insurance premiums. There is a wealth of evidence in the news archives and a host of sites and medical journals that demonstrate that a large minority of Dr.s and hospitals are in fact negligent and a recent report puts 80,000 people per year are misdiagnosed or wrongly treated or medicated.
Any attempt to address the issue of malpractice insurance must be accompanied by addressing medical malfeasance and negligence, especially when that malfeasance and negligence is brought about by greed which dictates more surgeries, more procedures and more patients than are safely accomodated.
Truth is, the quality of medical care in America including a host of unrequired and unnecessary procedures, justifies high insurance rates. To fix malpractice insurance pricing but neglect medical care quality is to give license to hospitals and Dr.s to err without limits or concern. The only realistic check and control supporting quality medical practice is high insurance premiums. It motivates hospitals and Dr.s toward caution to avoid even greater increases. Remove it without implementing some other quality control system with teeth will be disastrous for hundreds of thousands of patients per year in the future.
Posted by: David R Remer at April 5, 2004 02:02 PMV. Edward:
I’d agree that health care is a huge issue of importance facing the US. But even the article you linked to suggests different reasons than you do.
“The Illinois State Medical Society believes the way to curb malpractice costs would be to limit the amount of money juries could award for non-economic damages…”
“Illinois doctors are hoping for relief from Congress, which is considering a $250,000 cap on non-economic damages. In the meantime, the medical society is lobbying for incremental tort reform measures in Illinois.”
Edward, tort reform is a necessary avenue to pursue. So is oversight of insurance companies and their policies. One without the other wont solve the problem.
There is a third part to the problematic cost of health care, which might just be the hardest to change. People don’t want to be responsible for their own problems, and the medical community is complicit in creating diagnoses that allow people to be “sick” rather than responsible. Take the new “designer diagnosis” of Adult ADD, which allows those with short attention spans to claim a disease, rather than to work on the problem. This, along with the high degree of medicating minor issues such as heartburn, anxiety etc, could be the most pervasive issue of all.
Health care is a stealth monopoly, because regardless of which clinic or PPO or HMO you go to these days, all of them are under the licensing control of the AMA. With a single chooser of winners and losers in a market, that market is not “free” in an Adam Smith way. The result is a health care system with all the drawbacks of “socialized medicine” in the bureaucratic swamp of paperwork and regulations, but with none of the affordbability to the average consumer, or accountability to a voting constituency.
The reform of this “opportunity to improve” would be three-fold.
1) Make medicine a truly free market by breaking up the AMA monopoly (just like they did to Telecomm and tried but failed to do to Microsoft), such that AMA-licensed clinics, et al., would have to COMPETE with those licensed by other approaches to medicine, or other organizations with similar scientific bona fides.
2) Limit malpractice punitive damages to 3x the total of compensatory. When you sue a doctor, you’re suing not just that doctor, but all the people who pay health insurance premiums. So show at least a LITTLE bit of restraint.
3) And this is a biggie which is really a part of a larger proposal I would make to reform the taxation and public assistance systems in America:
- Health care (insurance premium) costs should be rolled up into an amount, with other costs of basic living like shelter, food, transportation, etc., which should make up a new universal standard deduction. This should be measured at each location based on zip code, as a sort of economic “census”.
- The new universal standard deduction should be THE ONLY deduction from total income (of all sources), at tax time. If the remaining amount is positive, tax that amount at a FLAT RATE (a rate to be determined by annual referendum, by the voting public). If the remaining amount is negative, that amounts to the level of public assistance for which the tax filer qualifies, IF they either work full-time, or are handicapped, or above the retirement age. If they work part-time, they earn a proportion of the assistance commensurate with the number of hours worked.
The functions of many current government bureaucracies could really all be rolled up into that of the IRS, who would no longer be the crypt-keepers of immeasurably-complicated tax laws. This would amount to a federal government with far lower “overhead” in the way it does business.
Anyway, with health insurance premiums being rolled into either a tax deduction or public assistance benefit, this would be a de facto “public health care” system, with the exception of individuals who are able to work and simply refuse to do so. It would be private, though, in that private companies would still be offering the care.
Tort reform is a big Republican fake issue that’s been around a long time. It was previously called liability reform, common-sense legal reform, and now tort reform.
There is only one way for a guy who gets his leg cut of, rather than his kidney removed, by a negligent doctor to seek redress: a lawsuit. Any attempt to eliminate that avenue or put a low-ball cap on damages for something like that is just wrong.
Skyrocketing malpractice insurance is a big problem, but that’s not the way to solve it.
Insurance premiums don’t correspond to lawsuit payouts. Payouts have been steady for the last 30 years, but premiums have risen dramitically. Why? Because insurance companies invested money in the market in the 90’s to keep their rates low. When Bush wrecked the economy, they got screwed and they’re making up for it by raising insurance premiums.
Lawsuits, payouts, and damage awards account for only one half of 1% of health care costs. The CBO says, “Malpractice costs account for a very small fraction of total health care spending; even a very large reduction in malpractice costs would have a relatively small effect on total health plan premiums.”
In other words, if we completely eliminated all malpractice lawsuits, it would only lower health care costs by less than 1%.
Here are some real (Democrat) solutions.
Instead of pushing some phony tort reform issue, we should just solve the problem.
Lee, I’m a bit shocked to see you try to claim *competition* as a “Democratic” solution. Your union bosses will be visiting you shortly to remind you that competition is BAD, and any true Democrat must always advocate a government or union monopoly to stifle business at every turn. How can you possibly countenance any semblance of Capitalism and be able to show up to a Ted Kennedy rally with a straight face?
I agree with all of the above.
Tort reform is needed and is a sham in many bills.
The AMA is a professional organization that supposedly regulates it’s own. It doesn’t.
Frankly, regulation of the insurance industry and licensing of doctors by a gov’t entity is the only way that I can see to deal with these issues.
Unfortunaltely, we have allowed corporations to become political lobby groups which have corrupted our political system and these reforms won’t come unless we take away the power of corporations to act as political bodies.
As to tort reform, a loser pays system could well stem the lawsuit happy society we live in.
In fairness to doctors, they don’t have all the answers and cannot cure everything and treatment
is not riskless. Our courts need to recognize this.
David, I agree and disagree with your stance. Yes the over 80,000 people per year that are misdiagnosed and or wrongly treated or medicated is overwhelming and needs to be addressed. But, I disagree that high Dr. insurance premiums, put all of us at risk, is the way to balance the equation.
There was a news sound-bite on the local news last night about an OB/GYN doctor who had never been sued in his twenty years delivering babies, but his malpractice insurance has gone up every year for the last five year, topping $75,000 this year. And the doctor is on notice that his insurance will be going up to $110,000 next year. Where is the equality in this situation? Who losses if this doctor decides to end his practice?
I assert that nothing short of insurance sector greed justifies the high cost of malpractice insurance. But the solution is for Congress to address Tort reform, and the fleecing of American doctors by the insurance industry. Better yet, let’s once again try and pass some sort of viable universal health coverage…
Lee, I’m a bit shocked to see you try to claim *competition* as a “Democratic” solution. Your union bosses will be visiting you shortly to remind you that competition is BAD, and any true Democrat must always advocate a government or union monopoly to stifle business at every turn. How can you possibly countenance any semblance of Capitalism and be able to show up to a Ted Kennedy rally with a straight face?
Ciggy, you need an intervention to clear your system of all that right-wing propaganda you’re obviously getting.
Pay attention and you might learn something. Democrats aren’t represented by the very small wacko-lefty fringe, just like (I’m pretty sure) you guys aren’t all crazy-eyed religious crackpots.
Lee, I get called a “right winger” by those on the left, and a “left winger” by those on the right, so neither epithet really phases me.
What I really would like to explore in more detail is just how it would be possible for the left to reconcile itself with free market economics and still remain true to its promises of “social justice” to the working poor. I am honestly interested in both and unlike hard-liners on both sides of the mainstream party aisle, I don’t think they are necessarily incompatible.
The biggest task is to disabuse people of the notions they have about Republicans and Democrats. When you have the super-rich like Kerry and Soros writing your policy for you, you are NOT the “party of the little guy”, by any stretch of the imagination. That’s the left. And when you have ignoble welfare contracts written for defense contractors, for things that contribute not a damn thing to the solidity of national defense, well that gives the lie to both assumptions people make about the right: anti-welfare and pro-defense.
An economy is like an internal combustion machine. Profit motive is the fuel, and regulation is the engine block. When you have all engine block and no fuel, you get nowhere. When you have all fuel and no engine block, the only way you get anywhere is by recoil from the explosion when you light a match.
Social Justice must be preserved in pursuit of a better standard of living, but a better standard of living must be an integral part OF what constitutes Social Justice.
The Swedish example is paraded as “socialism that works”, but there they replace the fuel with one that exists nowhere else in the world: a work ethic that values work as its own reward. The Soviets tried the same thing in Russia, to no success at all, and I would dare say it wouldn’t go over very well here in America either.
Anyway, continue to plot your intervention. Brute force is always a Leninist option, when giving lip-service to Social Justice. Meanwhile the real pursuit of that goal will continue independant of partisan jingoism, by people interested in solutions, not slogans.
