When Republicans talk about how the American health care system should be reformed, they typically mention two things: allowing insurance firms to sell policies across state lines, which I wrote about last week; and malpractice reform.
Former House Speaker Newt Gingrich, who is considering another run for the White House, has touted malpractice reform as one of the primary "solutions" he would pursue if elected president. He claimed during a GOP-sponsored panel last week that malpractice reform would nearly eliminate unnecessary care that results from all those tests doctors order and drugs they prescribe just because they fear being sued. "The cost of defensive medicine today," he claimed, "is $800 billion a year."
Newly-elected Republican governors, like Bill Haslam in Tennessee, are also pushing malpractice reform at the state level. They contend that such reform -- favored by businesses and medical associations -- would not only bring down the costs of health insurance premiums, it would also bring doctors flocking to their states to practice.
They often cite Texas as a role model. In 2003, the Lone Star State enacted the sort of malpractice reform now being called for by many Republicans nationwide. Several other states, including California, have also enacted malpractice reforms. The various laws and proposals all have one thing in common: a cap on how much a patient could recover from the courts if harmed because of errors made by doctors or hospital personnel.
But a closer look at what has happened in Texas raises doubts about many of the claimed benefits of malpractice reform.
Over the last decade, health care spending and individual out-of-pocket health insurance expenses have actually risen faster in Texas than in the rest of the country, says Alex Winslow, executive director of Texas Watch, a nonpartisan organization that advocates for consumer and patient rights.
At the same time, the number of people without insurance in Texas has continued to climb. In fact, according to the U.S. Census Bureau, Texas leads the country in the number of residents without health insurance. One out of every four Texans is uninsured, compared to about one in six in the nation as a whole.
While some doctors have indeed moved from other states to Texas, the state still ranks 41st in the number of doctors per capita. Texans continues to face an acute shortage of primary care physicians in particular, especially in rural areas.
Some other stats from Texas Watch: Family health insurance premiums have risen almost five times faster than income, and Medicare spending has risen 16 percent faster than the national average since Texas capped noneconomic damages at $250,000. And four of the country's 15 most expensive health markets as measured by Medicare spending per enrollee are in Texas.
I asked Alex Winslow, what he thought about Tennessee Governor Haslam's proposal to repeat the Texas experience in Tennessee. Here's what he said:
Tennessee families should not be forced to endure the same pain that Texas families have faced for the last eight years. In Texas, we have learned firsthand what happens when you severely restrict the rights of patients. Insurance companies and some corporate medical providers get richer while patients struggle to keep pace with soaring medical costs and inadequate access to care without doing a single thing to deal with the epidemic of medical errors. If Tennessee lawmakers are serious about reforming health care, they should focus on the real problems of cost, access, and quality and not be distracted by the insurance industry's talking points.
Winslow correctly notes that the insurance industry is a leader in the effort to get malpractice reform implemented in both Washington and the states. Keep in mind that insurers also sell policies for doctors to protect them from litigation. They have a vested interest, just as the doctors do, in getting lawmakers to cap damages.
If they are successful, the rest of the country will likely look more like the Lone Star State. They say everything's bigger in Texas. That includes medical bills.
This was also published by the Center for Public Integrity at publicintegrity.org.
Follow Wendell Potter on Twitter: www.twitter.com/wendellpotter
It's all about the money- and the lawyers are acting like leeches whose host has been taken away.
Is the tort reform legislation perfect in Texas? Absolutely not......
We have seen patient rights become restricted, and that's something the Texas Legislature needs to address. As we move forward and try to figure out how to keep healthcare costs in check, we all need to keep in mind that there is not one solution to fix everything. We need to tackle this problem by problem, and according to doctors and healthcare professionals all over the country, medical malpractice insurance reform is one of them.
Potter is spinning numbers and facts.
Just because the healthcare costs keep rising in Texas does NOT mean that the tort reform has failed. There is more to healthcare costs than tort law. Same argument applies to raising health insurance costs.
Many Texans are uninsured because there are many independent contractors and enterpreneurs, and illegal aliens. Hence, many have no insurance.
Potter says that Texas still suffers from doctor shortage. Don't you think that the reform has the potential to at least alleviate the shortage? When I review job offers, I always review state malpractice laws and medical malpractice insurance rate before I consider the offer.
http://www.nytimes.com/2007/10/05/us/05doctors.html
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true
Both of these are issues primarily that affect the middle class and the poor. So why do you think the Republicans will care about them?
Eliminating defensive medicine would HELP to bend the costs curve down. Noone claims that tort reform is the magic pill for balooning healthcare costs. Bill for medical services is likely to increase because of aging population and new medical technology. However, nationwide malpractice reform would help in at least curbing the growth.
From my own perspective, here is the model of a reform which would stop me from practicing defensive medicine:
1. Jury by medical peers, or special medical malpractice court system.
As it is now, my fate in a malpractice court is decided by laypeople. Jurymen do not have sufficient education to make these sort of decisions. I want my case to be decided by someone who knows science, medicine, AND my medical field.
2. Caps on pain and suffering.
As it is now, sky is the limit, and the lawyers know it. Why sue for only 2 million, if you can sue for 20 millions? Why not 50? This is absurd.
3. Looser pays the costs of the lawsuits. Expediting the legal process.
As it is now, it is a win-win game for lawyers to sue, because even if their case has no merit, they can give the doc an offer doc cannot refuse: "Doc, I will either drag you through courts for decades, or you settle'. This has to stop.
I know the costs of defensive medicine from a different perspective - that of the patient. I can't tell you how many hours I've waited in emergency rooms, in excruciating pain, because yet another test was needed in order to prove what my doctors already knew was the case. Malpractice suits don't just hurt doctors.
What people need to understand is that there are inherent risks in medicine. I've had several botched surgeries - yes, they were painful, and yes, I was angry about it, but I never even considered suing. If tort reform doesn't happen, you're going to see fewer and fewer qualified doctors, and more and more patients needlessly suffering in hospital waiting rooms.
Defensive medicine has become part of my practice. I spend taxpayer's money every day to cover my a**. I don't get paid more for ordering extra tests and consults, but I am insulated from the extra costs which I am causing. I do it because it gives me peace of mind, and heck it's 'free', so why the hell not.
I have 12 years of medical education and 1 year of practice under my belt. What do YOU have to tell me that I'm wrong?
If a Texan is telling a tale no doubt it is a whopper. Republicans have wasted what little credibility
they had left.
I eagerly await your columns here in the Huffington Post; I love them.
You write about something of great concern to all Americans: lowering costs of healthcare.
One thing I haven't seen adequately addressed anywhere is lowering the costs of the actual treatments insurance companies pay for.
I believe the cost of healthcare with Obama's plan will probably sink us. What most people don't realize is that we could "cover" every man, woman and child in this country, if less expensive, more effective treatments were utilized—treatments like those I feature in my recently published book, "Honest Medicine." The treatments I write about have been used successfully for 25-90 years to treat life-threatening conditions, such as MS, lupus, rheumatoid arthritis, Crohn’s disease, liver disease and pediatric epilepsy. (The treatments are: Low Dose Naltrexone for autoimmune diseases, the Ketogenic Diet for pediatric epilepsy, intravenous alpha lipoic acid for terminal liver disease and some cancers, and Silverlon for non-healing wounds.)
However, because these are not big blockbusters for any pharmaceutical company, most doctors don’t know about them. But all four have lots of science and studies behind them—and even more important—lots of patient-based evidence. Also, each treatment has many patient advocates (and, in some cases, several physician advocates, too) who are working hard to tell the world about them.
I hope someone with influence (like you) will take a look at this angle. I think it could help solve our problems.
Julia Schopick
HonestMedicine.com
Thank you for your comments and your support.
Wendell Potter
How can this -be-?
Let's face it, folks, practically none of the current conservative policies actually address their stated goals.
Again, WHAT was the reason for welfare reform?
We should listen to republicans why?
Looks like we've been concentrating on "REFORMING" the wrong things. Corporate welfare reform is what REALLY needs reforming. Funny, you never hear republicans screaming about the REAL bankrupters of the American economy.
I am glad someone is finally calling them out for this. It needs much more publicity, as do the failure of Conservative policies in general here.
I'm sure your outlook is bleak.
You are insulting and wrong.