preview.tinyurl.com/mnt7zo -> prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/
post&posall=Bar1,TopAd,Position1,Position1B,Top5,SponLink,SponLink 2,SFMiddle,Box1,Box3,Bottom3,Right5A,Right6A,Right7A,Right8A,Middle1C,B ottom7,Bottom8,Bottom9,Inv1,Inv2,Inv3,tacoda,SOS,CcolumnSS,Middle4,Left 1B,Frame6A,Left2,Left3,Left4,Left5,Left6,Left7,Left8,Left9,JMNow1,JMNow 2,JMNow3,JMNow4,JMNow5,JMNow6,Feature1,Spon3,ADX_CLIENTSIDE&pos=Middle1 C&query=qstring&keywords=?
post&posall=Bar1,TopAd,Position1,Position1B,Top5,SponLink,SponLink 2,SFMiddle,Box1,Box3,Bottom3,Right5A,Right6A,Right7A,Right8A,Middle1C,B ottom7,Bottom8,Bottom9,Inv1,Inv2,Inv3,tacoda,SOS,CcolumnSS,Middle4,Left 1B,Frame6A,Left2,Left3,Left4,Left5,Left6,Left7,Left8,Left9,JMNow1,JMNow 2,JMNow3,JMNow4,JMNow5,JMNow6,Feature1,Spon3,ADX_CLIENTSIDE&pos=TopAd&q uery=qstring&keywords=?
Mr Bradley also suggested that medical courts with special judges could be established, similar to bankruptcy or admiralty courts. On "This Week With George Stephanopoulos," Senators Orrin G Hatch, Republican of Utah, and John Kerry, Democrat of Massachusetts, seemed to agree that medical malpractice lawsuits are driving up health care costs and should be limited in some way. "We've got to find some way of getting rid of the frivolous cases, and most of them are," Mr Hatch said. But some academics who study the system are less certain. One critic is Tom Baker, a professor of law and health sciences at the University of Pennsylvania School of Law and author of "The Medical Malpractice Myth," who believes that making the legal system less receptive to medical malpractice lawsuits will not significantly affect the costs of medical care. Q A lot of people seem to have taken up the cause of tort reform. Why isn't it included in the health care legislation pending on Capitol Hill? It's become a talking point for those who want to obstruct change.
A As the cost of health care goes up, the medical liability component of it has stayed fairly constant. That means it's part of the medical price inflation system, but it's not driving it. The number of claims is small relative to actual cases of medical malpractice. Q But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice. That puts litigation costs and malpractice insurance at 1 to 15 percent of total medical costs. A We have approximately the same number of claims today as in the late 1980s. The number of medical encounters between doctors and patients has gone up -- and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries. A The best data on medical errors come from three major epidemiological studies on medical malpractice in the 1970s, 1980s and 1990s. Each found about one serious injury per 100 hospitalizations. There hasn't been an epidemiological study since then, because people were really persuaded by the data and it's also very expensive to do a study of that sort. These data were the basis of the 1999 report from the Institute of Medicine, "To Err Is Human." A Those same studies looked at the rate of claims and found that only 4 to 7 percent of those injured brought a case. And because the actual number of injuries has gone up since those studies were done -- while claims have remained steady -- the rate of claims is actually going down. Q So the idea that there are lots of frivolous lawsuits is . Q In those cases that are brought, are jury awards excessive? These tend to be on non-economic damages -- not medical expenses or lost wages, but typically on pain and suffering. There is pretty good research on that, showing it reduced medical liability payments. These caps vary from state to state, but they're generally set around $250,000 to $500,000. Q Many people would think that a quarter-million to a half-million dollars is a lot of money for pain and suffering. A When California adopted its cap in the mid-1970s, it set it at $250,000. Since then, think how much inflation has eaten into that. Q So a patient can get reimbursed for medical costs, but they're limited for pain and suffering. But in fact, they don't, because the lawyer has to be paid. These cases can cost $100,000 to $150,000 to bring, so the patient has to deduct that amount from any award. A You need expert witnesses who must be compensated for their time, which is valuable. It's not worth bringing a suit if the potential award is less. Your appendix bursts, and you spend a couple weeks in the hospital. I've had lawyers tell me they would not take a case like that, even if it's a slam-dunk. The damages wouldn't be enough -- medical expenses, maybe a month of lost salary, although the patient might have short-term disability insurance that would cover a large part of that. Q So you're saying that a case has to be serious to be worth trying. A The medical malpractice system only works for serious injuries. Lawyers discourage people from bringing suits if their injuries are not serious in monetary terms -- a poor person or an older person who can't claim a lot in lost wages. That's why obstetrician-gynecologists pay such high premiums. If you injure a baby, you're talking about a lifetime-care injury. That's the reason I say if people are serious about tort reform, they should improve compensation for moderate injuries. They say it would make the system more expensive, not less expensive. That says to me that the critics are not serious about tort reform. Q But it's not just the cost of premiums and litigation. What about the charge that it causes doctors to practice "defensive medicine," ordering tests that are expensive and unnecessary? A A 1996 study in Florida found defensive medicine costs could be as high as 5 to 7 percent. But when the same authors went back a few years later, they found that managed care had brought it down to 25 to 35 percent of the total. Liability is supposed to change behavior, so some defensive medicine is good. Undoubtedly some of it may be unnecessary, but we don't have a good way to separate the two. A It was published in The Quarterly Journal of Economics by Stanford economist Daniel Kessler and Dr. Mark McClellan, who was head of the Centers for Medicare & Medicaid Services under President George W Bush. For two types of heart disease -- heart attacks and ischemic heart disease -- the authors found that 5 to 7 percent of the additional costs in Florida, compared to other states with lower medical malpractice liability, could be attributed to defensive medicine. Using that estimate, some politicians used to say that medical malpractice cost the system $50 billion a year. But you can't blindly say that all diseases are the same as heart disease, and if you want a nationwide estimate, you can't say every state is the same as Florida. Furthermore, the second study, published in 2002 in The Journal of Public Economics, found that much of the difference disappeared as managed care took hold in Florida in the 1990s. Q But many doctors complain about having to practice defensive medicine. But when you dig down, you find that what's really happening is that doctors tend to do what other doctors around them do. They go along with the prevailing standard of care in their region -- which in many cases isn't even a state, but a city or county. Q If medical malpractice doesn't explain the high costs of our health-care system, what does? We're also a rich nation, and the richer you get, the more money you spend on health care. And compared to other countries, we have heavy administrative costs from the private-insurance system. Q If it's not true that medical malpractice is driving the high cost of medical care in this country, why won't the argument go away? A It makes sense to people intuitively -- in part, because they've been told it so often. And it's a convenient argument for those who want to derail the process. Maybe they're raising it to say, we'll back off tort reform if you back off the public option. Q What about former Senator Bill Bradley's idea that medical courts with special judges should be established? A Mr Bradley has been backing tort reform for as long as I can remember, so this is h...
|
http://csua.com/feed/