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August 25, 2002

Malpractice Crisis from Health Care Inequality

The Times today deals with the crisis for many hospitals from soaring malpractice insurance rates. This can be framed as a narrow debate between the evils of tort lawyers versus insurance company greed that speculated its assets and lost in the stock market bubble, but the source and solution goes to the heart of problems in the US health care system.

The US spends far more of its Gross Domestic Product on health care (13.0% in 2000 and rising) than any other nation (see these figures), yet it delivers more unequal care with greater gaps and poorer health care results for the overall population than many other developed nations. Yet if you look at Table 2 in those OECD figures, you'll see the US comes far back on most infant mortality and life expectancy numbers compared to countries spending less on health care. Here's a more direct attack on US health care results.

So how does this relate to medical malpractice? Rather simply-- while health care is uneven and unequal in the US, there is a lot of very good care going along with the very poor health care. At the simplest level, when doctors are skimping on health care for the poor without insurance, they inevitably are creating the conditions for lawsuits.

But more deeply, the very unevenness of health care in the United States means that we have no consensus on what constitutes reasonable care by a doctor. Some doctors do a wide range of tests for their richer patients, so others who suffer because their doctors failed to do similar tests demand in court that they be compensated for that failure. Given the inequality in our health care system, it seems impossible for any other result to occur. Merely enacting "tort reform"-- ie. punishing victims -- just encourages doctors to keep shortchanging the health care of the poor.

But if we solve the problem of lack of access to health care, we would inevitably solve the malpractice lawsuit problem at the same time.

The advantage of universal health care is that it creates a clear standard of care. What government pays for becomes the reasonable standard of care, a standard that can be debated democratically at appropriations time for the health care budget rather than haggled for erratically in the courts. It is no coincidence that European countries deliver better health care at a lower cost without as many lawsuits-- it's all part of the related advantages of universal health care.

Posted by Nathan at August 25, 2002 08:18 AM

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You are obviously biased when it comes to health care and the role of physicians. It is true that some doctors are enticed by HMOs. However, the majority of physicians are limited by the coverage of insurance companies. I will illustrate by example. I was taking care of a child who was in the hospital for pneumonia. The usual tests and treatments were initiated. When the child was stable and ready to go home on antibiotics specific for the bacteria, The insurance company refused to pay $90 for the medicine. I had to threaten the insurance company with readmitting the patient and giving 10 days worth of IV antibiotics ammounting to 7-10 thousand dollars.
We physicians are the good guys and want nothing more than to give unfettered care to our patients.
There is an element to society that feels that doctors are deep pockets and a free meal ticket. We warn people of the risks and side effects of medications and procedures; and, believe it or not, if a person has surgery it is going to hurt and it is going to leave a scar. It will also take at least 6 weeks before a person will feel close to normal again. There are many bottom feeders who burdin the courts and physicians with trivial law suits because they didn't listen in the first place or they witheld vital information that could assist in making a diagnosis. We loose sleep when these things happen. We feel badly because in spite of our best efforts patients are unhappy with the end result or things went wrong. Things do go wrong, and it is not anyone's fault. It just happens. Law suits based on probable events and acts of GOD, not true malpractice, lead to job dissatisfaction. This prompts many to leave medicine.
Keep driving doctors out of medicine and you will have a difficult time finding someone to take care of you when you REALLY need it.

Posted by: DE at February 1, 2003 02:55 AM

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