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January 16, 2003

Bush Misses Point on Medical Malpractice

Bush is ramping up the campaign to hit consumer rights around medical malpactice.

I'd just revive what I said last summer in a column about why universal health care is the real answer to the medical malpractice crisis:

The US spends far more of its Gross Domestic Product on health care (13.0% in 2000 and rising) than any other nation, yet it delivers more unequal care with greater gaps and poorer health care results for the overall population. If you compare us just to other developed nations in Europe or Japan, you'll see the US comes far back on most infant mortality and life expectancy numbers, even though those countries spend less on health care.

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 those with limited health 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.

Conservatives bash lawsuits but they donít face the fact that they are the inevitable result of privatized medical care.

It goes back to international comparisons-- every other developed nation delivers universal health care for less money and with less lawsuits. All of which are not unconnected.

Posted by Nathan at January 16, 2003 04:44 PM

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I don't know if anyone else has noticed, but doctors in at least three states -- West Virginia, Pennsylvania, and New Jersey (Nathan's backyard) -- have either struck, or have threatened to strike, over the issue of malpractice insurance. The doctors refuse to perform any non-emergency medical service, essentially. And the explicit issue in PA and NJ is tort reform -- putting caps on malpractice suits, let's stick it to the trial lawyers, etc.

If I were paranoid, I'd point out that both PA and NJ have Democratic governors (Rendell and McGreevey, respectively). However one might interpret that, though, it does seem interesting to me that the doctors are mouthing insurance company rhetoric re tort reform and trial lawyers -- when not all that long ago doctors were (rightly) pissed off at insurance companies regarding their reimbursement procedures. Maybe you don't have to be paranoid to smell something fishy here, or are doctors just really dumb?

Posted by: Father O'Blivion at January 17, 2003 12:09 PM

I think doctors are facing a real problem with skyrocketing malpractice insurance. And they want it solved. And they don't really care if it's taken out of the hide of trial lawyers and their patients or taken out of insurance company profits.

But with Bush in office, they know it's unlikely to be the latter, so they are piling onto "tort reform" as the only political solution likely to pass right now.

Forget whether they believe it-- it makes sense strategically for them to go where they think they get immediate results. Sad but probably true. If Gore was in office, they'd probably happily be mouthing off at the obscene profits of the insurance industry.

Posted by: Nathan Newman at January 17, 2003 12:22 PM

When you put it that way, Nathan, it makes more sense. It will be interesting to see how Rendell and McGreevey handle it -- the article that you linked to mentioned that Rendell opposes Bush's proposal. FWIW, PA's kinda ripe now for some sort of "tort reform" -- among other things, they reformed their state court venue rules to make it more difficult to "venue shop" for plaintiff-friendly courts in med-mal suits (i.e., you can't sue a doctor whose main office is on the Main Line in Philadelphia [a more "plaintiff-friendly" venue than, say, Montgomery County] when he has only a small satellite office in Philadelphia). That may make sense, but it and other reforms may open the door to other, more extensive reforms (and the PA doctors explicitly stated that they didn't think the reforms went far enough). They've had a pretty interesting series of articles in the Philadelphia Metro paper on this issue over the past week, FWIW.

Agreed, though, that something should be done about doctors' malpractice insurance, and of course med-mal judgments are a part of it. Though by no means the entirety. Also interesting how these ardent Bushie states-righters are trying to bypass state tort law with federal legislation, hey? (sarcasm)

Posted by: Father O'Blivion at January 17, 2003 12:40 PM

Universal healthcare delivers less for more. More bureaucracy, more micromanagement, and indeed more money pay for a standard of care arguably worse than our standard of indigent care. Pathetically, this all but ensures the two-tier system for anyone with money comes to the US or elsewhere. Waiting lines are a mile long for most non-emergency surgeries, prescription costs are lower, but research and development suffer. Any time there is a discernable problem with healthcare the answer is to throw more money at it, at great expense to the taxpayer. If it fails it is irrevocable, and represents a massive expansion of state power that could easily extend to other areas (when you pay 45-55% of your GDP to the government, how can it NOT assume a greater role in life). The market has its problems, but they pale in comparison to those of universal healthcare...intern in government overseas or work in the pharmaceutical industry and you'll understand why.

Posted by: Russel at January 26, 2003 10:43 AM

A couple of questions:

1.) MD's seem very upset, but no income statistics are provided. Are MD incomes going down? Up, but slowly? Keeping pace with the CPI? Why is this information not part of their case? If they are really being hurt financially, it would seem an obvious part of their argument.

2.) Even under government universal care schemes, the higher income levels will always get the care they demand (i.e., pay for it). Is there no such thing as adequate, but inexpensive medical care? Why hasn't our free market economy provided such an alternative. Why is there no price competition?

Just asking.

curious bob

Posted by: curious bob at February 2, 2003 11:29 PM

I have a couple of questions on this subject of medical malpractice lawsuits:
1) if insurance companies are making such huge profits, why are so many leaving states without 'caps' on medical liability, and why are there no replacement companies flocking to fill the gap?
2) what is the average amount paid in medical insurance premiums by such doctors as obstetricians and neurologists and oncologists and bone surgeons, for example, and what is their average net income before tax after paying their overhead expenses of office staff salaries, rent, insurance etc. AND what is the percentage of liability insurance cost to this net income?
3) what is the average income of trial lawyers who pursue medical malpractice lawsuits? When they win, how much do they earn in fees? In awards? When they settle, what is their take?
4) why are there so many rules regulating lawsuits? These rules have been added little by little over the years, and some are even in violation of the constitution itself. These rules make it almost impossible for the average person caught up in a lawsuit to understand or to protect himself against clever, skilled lawyers. The fees charged by lawyers will bankrupt the average citizen, and maybe even the average doctor. On top of this are "settlement" costs, and/or jury awards. At $200/hour, a lawsuit which uses only 100 hours, or 2-1/2 weeks of a lawyer's time costs $20,000!!! Even if the defendant wins! And if he loses, he has to pay the plaintiff's lawyer's fees as well.
Most lawsuits drag on for months or even years. The up front costs are staggering.
5) Finally, does anyone really believe that the lawyers who pursue medical malpractice lawsuits are on the side of the "victim"? Is it not much more likely that they are interested in self enrichment?

Fran W.

Posted by: Frances Wettstein at March 30, 2003 07:31 PM

I respect liberals wanting to cover all Americans, but in my case I had excellent insurance, but have gone uncured due to doctors being too scared to consider more options. (i have even been told this flat-out). People go to Delaware for obstetrician services; maybe I should go down there for my head.

See there really is 'two-sides' to this. The UNINSURED (disfortunate lower-class and temp-workers), and the INSURED who spend years looking for a doctor willing to take even the slightest, most miniscule risk.

I lean right.

Posted by: Jon A at January 23, 2006 03:58 AM

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