Healthcare Reform... "All Bleeding Stops Eventually"

Healthcare reform is as vital to our nation's survival as is correcting the economic recession. The current state of US healthcare is critical and may prove fatal to our way of life if not comprehensively addressed.

In surgery we have a time honored expression -- "all bleeding stops eventually" -- which means either quickly and decisively take steps to address the pertinent issues or watch the patient die. Doing nothing or delaying is an option but either course mandates a death sentence for your patient.

I agree with the concept of a public option. I agree with President Obama's 8 stated healthcare objectives. I agree with a 1/3 of a percentage point increase in the Medicare payroll tax to fund the program. But what has not been addressed is the need for tort reform and managing the healthcare expectations of American citizens.

A significant portion of the healthcare dollar is spent/wasted on testing and procedures to protect the caregiver and hospital from overzealous lawyers. These tests and procedures are not necessary to properly care for the patient. They are routinely ordered and performed to assuage the fear that one day in the future your actions may be second guessed and scrutinized out of context.

Mal-occurrence is far more likely than malpractice. Gross malpractice is unacceptable. But mal-occurrence is a part of life. Despite everyone's best efforts and good intentions the outcome may be far less than desired. Gross and egregious malpractice should be compensated within reason but mal-occurrence should not.

Also, the potential for enormous jury verdicts and the costs associated with defending frivolous lawsuit have driven the price of malpractice insurance to unimaginable levels, if obtainable at all. The costs associated with caring for insured, poorly insured and uninsured people has made the business of healthcare unsustainable for the physician, the hospital and the ultimate payor (be it the insurance carrier or the government).

At some point, the unrealistic expectations of US patients need to be addressed. Americans are under the misconception that just because they want it or saw it advertised on TV they are entitled to it regardless of the cost.

Patients routinely walk into my office (and every other physician's) demanding unnecessary, un-indicated, expensive testing and diagnostic imaging (MRI, PET scans etc...). A vast percentage of their visit is wasted arguing about the appropriateness or medical necessity of their demand. Many times they ultimately storm out of the office in a huff muttering that they will not pay the bill, what a terrible doctor I am and that they will find a better doctor that will honor their request. Unfortunately, many practitioners acquiesce in a misguided attempt to maintain the relationship, appease the patient and get through their long day without further conflict.

Last but not least, some very sobering facts need to be openly discussed. 90 cents of every healthcare dollar are spent in the last 10% of life. As a nation, can we afford this going forward? Is this a reasonable expenditure of finite resources? To provide basic healthcare for every American citizen we must re-allocate funds. This will require a significant change in the manner in which we care for the elderly and others in the twilight of their lives.

The US healthcare system cannot be all things to and for all people. We simply can't afford it.

Without meaningfully addressing tort reform and patients expectations the probability of significant monetary savings and improvement in the all important quality of care is a lost cause.

The concept of service to community starts now. We must all give and make compromises for the health of our nation. Please remember that if we delay or fail to act..."all bleeding stops eventually".

Comments

[S1m0n]

The biggest driver of malpractice damage awards is the enormous cost of providing a lifetime of future medical expenses for someone who has been injured and who as a result cannot afford health insurance to cover this now-existing condition.

If healthcare reform is done right, this problem will be resolved.

[WinterParkMom]

47 million un insured
20 million under insured
Subtract 10 million poor/indig­ent/mental­ly ill, etc, who are uninsured and will have to get free care = 37 mill un-insured who can pay.
18.5 million can pay $50/mo = 925,000,000
18.5 mill can pay $100 = $1,850,000,000
20 mill under insured will switch and can pay $100 = 2,000,000,000
That is a grand total of $4,775,000,000
That is FOUR BILLION, SEVEN HUNDRED SEVENTY FIVE MILLION DOLLARS IN PREMIUM PAYMENTS PER MONTH. FIFTY SEVEN BILLION THREE HUNDRED THIRTY MILLION PER YEAR IN PREMIUMS FOR ONE SET OF PEOPLE.
That does'nt count the millions who'll switch from private companies if they can pay $100 or 200 per month and have their entire family covered even with pre-existing conditions. Repeal bush tax cuts asap another 700 billion.
After thinking about it more, institute a 1 penny federal sales tax on EVERY item. I can hear the opponents shouting about making the poor poorer, but my statement is 1 cent on each item NOT on every dollar or hundred dollars. From candy bars tto big screen tv's to your house. 1 cent on everything. If your grocery bill was $100. for 53 items, your bill would be $100.53. That's not putting people in the poorhouse especially when we've already been dealing with price increases

[TJ Streak]

So exactly how do unnecessary tests which do nothing to help a patient (i.e. the meaning of unnecessary) do ANYTHING to decrease malpractice exposure?

I mean, isn't a malpractice lawsuit based on the notion that the doctor performed unnecessary and ineffective treatment which did nothing to help the patient -- or worse yet, the unnecessary and ineffective treatment actually harmed the patient?

Isn't the act of performing unnecessary and ineffective tests malpractice in and of itself? At the very least, it would appear to be an assault on the patient?

Is it the fear of malpractice lawsuits which causes doctors to engage in unnecessary and ineffective treatment? Or is it the doctors make more money by mistreating their patients by subjecting them to unnecessary procedures? And if the government and insurers refused to pay for unnecessary treatment, would the doctors still provide it? That is, if doctors were told they do CYA on their own dime, would they continue to do it?

What this doctor is admitting is that they are billing the government, insurers and private patients for unnecessary care. We have a word for this: fraud.

[rjmiller]

Doctor's get sued for not finding things. You come in for Symptom A and are found to have Problem A, and given Drug A to solve it. Days later, you collapse. It seems you also have Problem B that is much worse but may not have been apparent at the time, but would have been found if the doctor had done an MRI. Time to sue.

This is like calling a plumber for a leaky faucet, he tightens it and fixes it, and then later a pipe in another part of the house bursts. People don't expect a plumber to routinely check every single pipe in their home.

However, people that watch "House" expect a team of doctors to give them individual care and run a litany of insane, expensive tests.

[aurora19]

First, less than two percent of the cost of the healthcare system is the result of litigation. This includes lawsuits, defense, and the cost of settling.

Second, the reason our system of medical malpractice shifts costs to patients and not institutions is because in most states hospitals cannot be sued. Instead, you have to sue your doctor. The better reform would be to allow patients to sue hospitals for bad practices.

Third, there is a lot more malpractice than what is prosecuted. A Harvard study found that about 1/50 suits that could be brought are brought.

Fourth, a big portion of our costs are the result of hospital acquired infections. We spend billions of dollars a year to take care of people because of the infections they get in the hospital. These infections can be prevented by washing your hands.


Doctors are not safer because patients cannot demand they compensate them for the full extent of their damages. Most medical malpractice claims actually settle at the limit of the insurance policy.


In order to win a medical malpractice claim, you have to show that the doctor did not adhere to normal practices. If doctors know a test is not necessary, they should not do it. There is no legal risk in doing the right thing.

The increase in medical costs, which have really ballooned in the last 20 years, does not correlate with the rise of medical malpractice litigation, which has increased at a static rate for forty years.

[itolduso]

Clear, concise, reasoned....and beautifully stated. I wish you were leading our national health care debate.

[emerywood]

No other country in the entire world has our medical legal system of litigation, the expenses of which are all borne by the patients ( who contributed to physician's and hospital's malpractice insurance premiums in the form of increased fees ). Why do we insist on jury trial when a committee of
experts from both sides ( medical and legal ) can readily determine liability in all cases ? A jury of
ordinary citizens without medical knowledge surely cannot be compared to a committee of experts
in matters of fairness. And what about the vast majority of cases settled out of court ? Where are the juries in these cases ? Every case requires a lawyer on both sides and each case usually lasts
for years before it ends. Imagine how much money are spent on fees alone for plaintiff and defense.
But the most ridiculous of all is the fact that anyone can sue any physician and hospital for any occurrence, real or imagined because he or she does not have to pay anything win or lose. That is better than buying a lottery ticket which one has to at least pay a few dollars. And we wondered why there are so many medical malpractice cases in America compared with the rest of the world ?

[jalowe1957]

All bleeding stops eventually?

Not until a woman reaches menopause.

As for men, it's when they no longer experience menstruation envy.

[johnsopinion]

Sorry, Doc.

You say:
"Gross malpractice is unacceptable."

Is this saying that "SOME malpractice is acceptable?"
To whom?

And you say:
"But mal-occurrence is a part of life."

As are "overzealous lawyers."

What's your point?

[expired]

Health Care: The Public Plan Option

These Democratic Senators have NOT agreed to support it:
Senator Blanche Lincoln (D-AR)

Senator Tom Carper (D-DE)

Senator Maria Cantwell (D-WA)

Senator Ron Wyden (D-OR)

Senator Bill Nelson (D-FL)

Senator Ben Nelson (D-NE)

Senator Mary Landrieu (D-LA)

Senator Kent Conrad (D-ND)

Senator Max Baucus (D-MT)

Senator Dianne Feinstein (D-CA)

Senator Evan Bayh (D-IN)

Senator Mark Pryor (D-AR)

Senator Joe Lieberman (I-CT)

Senator Mark Warner (D-VA)

These names are reported by The Hill here and here

Update: Senator Kay Hagan (D-NC) says she supports a public option.
Update: Senator Jeff Binghaman (D-NM) says he supports a public option.

You can also contact the White House and voice your opinion
Comments: 202-456-1111
Switchboard: 202-456-1414

[drkazmd65]

Good,... both of my Senators are not on the list,... I can pester them a bit less frequently on this particular topic now,...

But until the day they pass a version with a Public Option - I will be monitoring them closely.

[TremoluxMan]

The call for Tort reform and capping medical malpractice awards is a Red Herring. I thought this was interesting:

According to a report from Public Citizen, the total number of medical malpractice lawsuit payments has fallen to a record low, accounting for only 0.6% of all healthcare costs in the United States. The consumer advocacy group is calling on Congress to put safety measures in place to reduce the number of preventable medical mistakes instead of enacting further limits on patients’ ability to pursue compensation.

There is no room to quote more fully on this, but the report shows that malpractice awards have steadily fallen over the years. The reason, as pointed out above, is more profit driven than a case of CYA in case of lawsuits.

[PrudenceWorthington]

I just adore the conspiracry theory, promoted by one of your readers, that the Hospitals and Doctors are the cause of the this crisis. Have you checked the average cost of Malpractice inusurance lately? And yes, the author did point out one aspect of patient abuse, but just as this blogger was oblivious to these issues, Americans on the whole will not conform to any sort of understanding or even mass behavior with regards to health care or anythin else, for that matter. So along with insurance changes, the laws for malpractice need to change too. Let's say we charge legal fees and court costs to anyone who brings a case and loses. That would effecitively end the televison adverstisements for ambulance chasing lawyers. And while we are at it, lets treat those very same lawyers as social pariah. If no one will hire them or even speak to them, they might use their powers for good. I admit it is not as expedient as a old fashioned biblical stoning, but someone outlawed old testament justice long ago. Which explains why Americans are such selfish creatures.

[chocolatecity]

"Last but not least, some very sobering facts need to be openly discussed. 90 cents of every healthcare dollar are spent in the last 10% of life. As a nation, can we afford this going forward?"

No, but who is going to tell the American people that grandma can't have her shoulder replacement surgery because she is too old.

[outragedkar]

A shoulder replacement is not the type of surgery Dr. Benjamin is discussing (not to mention the fact that you better find an EXCELLENT joint replacement surgeon for a shoulder replacement, not just an average run of the mill orthopedic surgeon). FYI: Most really good joint replacement surgeons are very honest about when someone is too old to be a replacement candidate. Quality of life and safety tend to be huge factors relative to appropriate candidates.
On the other hand, very few families and primary care physicians actually discuss end of life issues early. That discussion needs to happen earlier than it does.

[bbtri]

Lawsuits are only a small part of the over treatment and over testing problem. The financial motive behind it is that hospitals, doctors, and the rest of the medical industry gets paid for the number of tests, treatments, procedures performed, and drugs dispensed, rather than for results.

[itolduso]

Let's not forget that those fancy new machines aren't cheap....if you only use them when they are 'medically justified', how are you going to pay them off? Funny how many Doctors are also the biggest investors in private MRI labs and medical testing facilities that offer the very latest in high-tech equipment...... those 'factories' gotta keep running to show a profit.

[tompoe]

There is no need for tort reform. Unless, of course, the good doctor can point to overwhelming abuse by patients. Gee, I didn't see that argument made. Wonder why?

[DallasMike]

I guess you have not seen the TV comercials asking people if you have had side affect from a pill aproved by the FDA to call some lawyer so you can get in on the multi $Million/Billion lawsuit.
We the tax payer, pay for the defense of these lawsuits in one form or another.

[BobLablah]

I'm still not sure why the health care system needs to be changed so drastically.

[tompoe]

When your health fails, you'll know why. You need to listen to those who have been where you will be.