Peter Orszag, Former OMB Director, Reveals The 'Biggest Gap' In Obama's Health Care Law

WASHINGTON -- Perhaps no Obama administration official who helped craft the Affordable Care Act had a larger imprint -- save the president himself -- than Peter Orszag.

The former Office of Management and Budget header was instrumental in plotting out the economic rationale for revamping the health care system, occasionally irritating Democrats for his willingness to trade politically-worshiped ideas for more esoteric policy levers. The final product ended up reflecting much of his outlook, perhaps most concretely in the creation of an independent advisory board to help control Medicare costs.

But in a speech on Thursday, Orszag copped to having regrets of his own. And, once again, the policies prescription cut against the Democratic Party's traditional mores.

From his speech today at the Peterson Institute for International Economics:

From a substantive perspective this was perhaps the biggest gap along [the encouraging best-practices] dimension: If we had a medical malpractice system that reinforced that emphasis on best practices we would be in a much better position; so if that pop up screen for my doctor in five years also meant that the doctor knew that if he or she followed those best practice protocols I couldn't sue him or her that would help to drive a lot more medical practice.

The debate over tort reform and medical malpractice is, I think, significantly off. The whole debate is over whether we impose caps or not or whether we dial down liability when you are found to be negligent. The core problem in the medical malpractice system, however, is the entire basis upon which it is operational. That basis, so called customary practice, means that it is a nebulous standard and doctors inevitably line up sort of following the social norms among doctors in their area in part because that customary practice protocol means that they have to in order to avoid liability. We should have a best practice emphasis whenever possible.

Tort reform was, in fact, addressed during the course of the health care debate, offered by the president late in the process as a concession to demonstrate the extent of his reach for bipartisan support. But the final agreement, sending grants to states for projects to study how to decrease medical liability and increase patient safety, fell far short of what Republicans wanted. Their vote for the overall bill was never contingent on strong tort reform measures in the first place.

That Orszag would endorse this approach doesn't necessarily put him at odds with the president, who has been speaking about the need for elements of tort reform since September 2009.

Now a vice chairman at Citigroup, Orszag told the Huffington Post after his speech that he will be writing an essay shortly expanding on his vision for best-practice based tort reform.

Comments

[Reese Anderson]

01:38 AM on 06/22/2011

There is a total lack of understanding of how expensive the fear of lawsuits is. Probably 80% of CT/MRI scans are ordered by physicians to protect themselves against potential suits though they know the benefit/cost ratio doesn't justify them. The amount of record-keeping and time/employee expense needed to provide maximum protection against frivolous suits is HUGE. Many call for evidence-based best practices, but if MDs practiced in such a way and the fluke case gets by them, they are exposed to a large suit loss due to jury ignorance of the complexities(and sympathy for the patient), so they order additional tests/scans. On the other hand, many requirements under Medicare for hospitals/ O.R.s are generated by some intuitive bright idea of some bureaucrat w/o any scientific basis; but everyone must comply at great expense and with almost no hope of recinding the rule.
Some of the "best practices" called for in the comments here are actually demands for perfection. What is the chance that the best Dr. in history could properly sort out, diagnose and treat someone with 21 illnesses(11 serious) to that patient's satisfaction at all times(assuming the patient stays on all meds, including the psych meds). Even if the Dr. was correct, the patient is still be free to file suit, and even if acquitted, the Dr. faces months of stress and countless hours of hassle.

[chuckslawncare01]

05:58 PM on 06/04/2011

Is Huffington Post Democratic based ? just wondering !

[chuckslawncare01]

05:54 PM on 06/04/2011

If you find yourself between a rock and a hard place remember who put you there . Thank you Mr.President !!

[MHT73]

10:44 AM on 05/31/2011

Doctors could cut the rate of malpractice, and the cost of malpractice insurance, by policing themselves. In survey after survey they admit to seeing other doctors make serious mistakes and doing nothing about it. Compare that to how you'd feel if a family member was injured by a hit-and-run driver, and there were witnesses who could ID the guy, but wouldn't.
If they really wanted to cut malpractice premiums, they'd turn in the docs who are causing the injuries and driving up the price.

[Muswell Hillbilly]

02:01 PM on 05/30/2011

I laugh when I hear Republicans, who whine about socialism, advocate putting caps on medical malpractice lawsuits. In other words, Republicans want the government to dictate to people that their pain and suffering can't be worth more than $250,000. Talk about taking away someone's indvidual freedom and liberty.
Plus, what about states' rights??? Shouldn't the states be able to determine their own tort laws?

[SisterAnn]

12:20 PM on 05/28/2011

It makes sense that they pay more for testing and less for lawsuits. It also makes sense hospitals should be charged a lot-til it hurts, for letting a doped or drunk doctor near a patient or operating room.

There are people whose life is ruined by medicine and bad medical care. They should be compensated.

It could be done in a sane, practical way.

[PCPrincess]

11:32 AM on 05/27/2011

Well, so far I haven't seen any posts relevant to the issue he spoke about. What he is talking about is the STANDARDS doctors follow to insure themselves against getting sued. If a doctor is sued, he/she can state that all STANDARDS were followed. However, what he mentioned during his speech, is that the standards themselves are the issue. Doctors should not be following the standard of "all doctors do it this way, therefore i'm safe", they should be following a higher standard; a standard of BEST practice. Best practice standards would ensure that doctors would need to perform, not to the average standard of all doctors, but to a standard of, this is the 'best' medical standard I can perform. This standard is the one that would be used by doctors to protect their butts so to speak, thus ensuring patients would have higher quality care from the get go.

[CB5]

09:37 PM on 05/27/2011

Pc Princess what a great point. Plus, Doctors should not be managed or own by insurance companies. Their standards should let them operate independently. Glad you brought that up - HMDWeekend

[SisterAnn]

12:00 PM on 05/28/2011

He is right when he pushes for Best practices.

I have had a bad health problem overlooked because the doctors seemed to think I was just in their office for the fun of it. They left something in me and it made me sick but they seemed to think since my blood tested ok and I looked good then I was fine.

Best practice, hopefully, would have called for an xray in the area where the problems I complained about stemmed from. I had a kidney stone years later and they found the first problem, when they xrayed me.

Maybe it is just my fate in life, but I continued having trouble with them finding my health problems. Two years ago, I ended up in the hospital and they found all of them.. It sounds unbelievable but I found on my medical records that I have 21 health problems. 11 of them are serious.

You can't sue after two years in this area even if you didn't know what the problem was until later. Anyway, I blame myself this last time, I didn't push hard enough because I was afraid of what I might have.

[Dixie Dawg]

10:00 AM on 05/27/2011

Democrats will never buck attorneys as they have their hands deep in their pockets.

[livelongandprosper]

09:35 AM on 05/27/2011

And in related news on HP's main page, a $58million malpractice award. Really?

[m1903a4]

09:33 AM on 05/27/2011

In a masterpiece of placement, the headline directly below this one was "Family gets $58 Million in record breaking malpractice suit."

[SisterAnn]

12:44 PM on 05/28/2011

Those high lawsuits never get paid. They are thrown out of court or lowered on appeal in another court.

[livelongandprosper]

09:31 AM on 05/27/2011

The elephant in the room that no one wants to talk about is that we cannot afford to have net reductions in health care spending. It is already too much of our economy. Reducing the size of the industry by 20% would take 2% out of GDP and cause another rescession.

What we need are market based reforms where people make their own cost / benefit calculations for what type of care they want.

[Rogo99]

05:12 AM on 05/28/2011

And you call yourself "Live Long and Prosper"? Not going to happen in your kind of system. This should have been Single Payer or Public Option from the start. In your scenario, the health insurance industry still runs the show, and they're in it to make a profit, not provide care.

[SisterAnn]

12:24 PM on 05/28/2011

If medical insurance and health costs were less, that would free up money for people to spend at other businesses.

People can leave their jobs and start a business, too, under Obama's health care reform. They don't have to keep a job because of insurance. It will be portable.

[Subjectivity]

09:31 AM on 05/27/2011

Asking a Democrat to do tort reform is like asking a fox to watch a hen house.

[ljm123]

09:28 AM on 05/27/2011

A study published in the journal Health Affairs found that medical liability is responsible for only 2.4 percent of the country’s annual health care spending. They found the annual cost related to medical liability is $55.6 billion. Most of that spending ($45.6 billion) is related to defensive medicine — the tests, drugs and other procedures that doctors prescribe in order to limit the risk of being sued for malpractice. The researchers said their findings indicate malpractice-related costs are neither insignificant nor a cure-all for the nation's skyrocketing health spending trends

[SisterAnn]

12:37 PM on 05/28/2011

Lawyers represent the patient with no charge if the patient loses. They charge a lot when they do win. They are out a lot of money on a case, win or lose.

The $45.6 billion would be widdled down a lot by stopping the overcharging done for almost every medical procedure, equipment and prescriptions.

[creationwaits]

09:24 AM on 05/27/2011

I the government has to lie to the public to get their support for a plan, that should be a big red flag to everyone. And that is exactly what they did with Obamacare. Why do most of the spending provisions of a law passed in 2010 not go into effect until 2014, but most of the taxation provisions go into effect immediately? Isn't that odd? Yes, it's odd, but it was done that way since the CBO is obligated to score the cost of a bill over a decade, and this made the bill look deficit neutral, even though it will not be once it is fully operational. It was, essentially, a lie, perpetuated with no exceptions I am aware of by the entire Democratic party to get you to support the bill. That ought to give everyone pause.

[Dixie Dawg]

10:01 AM on 05/27/2011

fanned and faved

[dlaurels]

09:12 AM on 05/27/2011

Yet again, Huffington Post's lead is misleading.