Tort reform MUST be one element of any health care system overhaul that seeks to reduce costs and extend coverage to everyone. This morning in a New York Times cover story President Obama was reported to be in support of some kind of tort reform ...
In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.
Follow me over the fold to learn why this is an idea whose time has come.
Creating a national health care system that provides coverage to everyone (whether with single payer, a public option, health care cooperatives, or some other mechanism) will require identifying areas that don't serve the overall goal of wellness for the greatest number of people, and then squeezing out the related costs so those dollars can be repurposed to areas that do.
Candidates for repurposed dollars include private health insurance profits ...
According to the report, the big three carriers in Washington, Regence BlueShield, Premera Blue Cross and Group Health Cooperative saw profits increase from $11 million in 2002 to $243 million in 2003 and $431 million in 2006. Their cash surplus went from $833 million in 2002 to $2.2 billion (with a "B") in 2006. Interestingly enough they did it while covering less people. Over 2.37 million people were covered by the three in 2002 compared to 1.9 million in 2006. So the cost of health care is still going up, but the profits by private health insurance companies are rising even faster. The article shows medical costs rose 16 percent in the same period that health insurance profits went up 23 percent.
... excessive non-therapeutic testing ...
“Peter Orszag, director of the Congressional Budget Office, estimates that 5 percent of the nation’s gross domestic product-—$700 billion per year –goes to tests and procedures that do not actually improve health outcomes…The unreasonably high cost of health care in the United States is a deeply entrenched problem that must be attacked at its root."
... end-of-life spending ...
Overall costs and types of services. Totaling both VA and Medicare benefits, elderly veterans incurred an average of $43,795 in the final year of life, 40% more than an average Medicare beneficiary accrued during the final year of life. Costs for elderly veterans started increasing rapidly in the final year of life and accelerated sharply during the final 90 days of life. Most of the cost increase near the end of life was for acute hospital services; acute hospital care accounted for 44% and 60% in year 2 and year 1 before death, respectively, and 78% in the final 30 days of li
... and tort reform ...
That “leading study” was a 1996 paper by Stanford economists Daniel P. Kessler and Mark McClellan. McClellan – who is both an economist and a physician – served more recently as President Bush’s senior White House policy director for health care, and is now the head of the Food and Drug Administration.
The Kessler-McClellan study is one of the few academic studies that has ever attempted to measure the cost of “defensive medicine” attributable to lawsuits. It did so by examining the cost of treating hospitalized heart patients in states that have caps on damage awards and other restrictions on malpractice suits, and comparing them with the costs of treating similar patients in states without such limits on lawsuits.
The Kessler-McClellan conclusion: We find that malpractice reforms that directly reduce provider liability pressure lead to reductions of 5 to 9 percent in medical expenditures without substantial effects on mortality or medical complications. We conclude that liability reforms can reduce defensive medical practices.
The Kessler-McClellan study won the 1997 American Economics Association’s award in health economics.
... among others.
Universal health care coverage (my preference is single payer) is such an important goal that we must be willing to make tough choices about how we allocate limited resources. Ultimately we need to make the system as efficient (meaning putting the resources where they will be best used) and fair as is humanly possible. Each piece of the health care system (doctors, nurses, hospitals, big pharma, patients, big insurance, et al) will be forced to re-examine the way they approach health and will be required to make what they think of as sacrifices.
On the patient side (which is what I am) we must collectively confront the notion that there is always someone to blame when things go awry. My experience in general life situations (and translated into the medical realm by a brother who is an ER doctor) is that people often look for external reasons as to why something happened ...
I struck out because the sun was shining in my eyes.
I didn't get an "A" because the test was unfair.
I hit that tree because of the slick roads.
I never learned how to play the piano because my parents didn't force me to practice.
My 81 year old life long smoking uncle died because the nurses and doctors screwed up his medicine.
I don't see how we can have meaningful health care reform (and universal coverage) unless each and every constituency takes reform to heart.