It’s the medical errors, stupid

July 13, 2006

I’m a little late on this one, but if you haven’t read Ezra’s piece in Slate on the “medical malpractice myth,” it’s definitely worth checking out.

The Republican answer to runaway health-care spending is to cap jury awards in medical malpractice suits. For the fifth time in four years, Senate Majority Leader Bill Frist tried and failed to cap awards at $250,000 during his self-proclaimed “Health Care Week” in May. But this time, the Democrats put a better idea on the table.

Sens. Hillary Clinton and Barack Obama also want to save on health care. But rather than capping jury awards, they hope to cut the number of medical malpractice cases by reducing medical errors, as they explain in an article in the New England Journal of Medicine. In other words, to the Republicans, suits and payouts are the ill. To the Democrats, the problem is a slew of medical injuries of which the suits are a symptom.

The political debate is extremely significant. Literally every time Bush is asked a question about health care and/or the uninsured, he responds by talking about lawsuits and “tort reform.” The cap on jury awards remains a perennial legislative priority for the GOP.

But politics aside, there’s also a public health issue that needs to be taken seriously by policy makers. Most of what we hear from politicians on the issue is wrong.

For example, Ezra noted one comprehensive, independent study of medical errors, which used a conservative methodology, and concluded that “doctors were injuring one out of every 25 patients — and that only 4 percent of these injured patients sued.”

We don’t have a lawsuit epidemic; we have a system in which there are surprisingly few medical suits.

Moreover, the GOP’s criticisms of the system completely can’t withstand minimal scrutiny. Ezra cited multiple studies showing that about nine in 10 malpractice lawsuits had genuine merit, and baseless lawsuits are frequently thrown out of court. For that matter, jury awards over the last several decades have not grown much at all, and the total cost of these suits is less than one-half of 1 percent of health-care spending. The GOP talking points, in other words, a bad joke.

Dems, particularly Sens. Obama and Clinton, are emphasizing grants for successful programs that reduce medical errors, help patients, and reduce the need for lawsuits. If Republicans can tear themselves away from their nonsense about trial lawyers and runaway juries, it’s an approach they’d likely be able to get behind.

Read Ezra’s piece; it’s a good one.

I also believe that fewer medical mistakes would be made if doctors didn’t have to work so hard and see so many patients. Allowing Insurance companies with their group rate, HMO mentality dominate our health care system, has done our whole heath care system great harm. Ask any Doctor if this is true. Insurance companies only want doctors to practice medicine if it does not interfere with their bottom line.

  • Actually, they both miss the point. If there are so many errors, then there should be lots of malpractice suits which means lots of payouts which means an increase in malpractice insurance yielding a steep increase in medical costs. The problem is that malpractice suits have been flat for years. So have the payouts. Any increases malpractice insurance is a function of the stockmarket going down (that is how insurance companies make their money – not so much on premiums). Kevin Drum has alot about this and Gary beckerwrote about this last year. The whole malpractice issue is a red herring. I do not know all the causes of the inflation of medicine in this country, but this is NOT where we should begin.

  • As someone who’s spent the last few years with some major medical issues – and trying to deal with all of the billing snafus that come with them – and who’s also worked at an insurance company, I’ve got a few theories myself about the problems with our medical system.

    1. The costs are not disclosed up front. Instead, doctors have some “negotiated” rate with the insurance company – this leads to doctors billing ridiculous amounts to insurance just to see what sticks. The insurance companies all have different allowable amounts, and those with the lower ones tend to have fewer doctors “in network.”

    Because of this, the insurance companies have to allow higher rates if they want their customers to have adequate choice. Naturally, those costs are passed onto the patient in the form of deductibles, co-pays, and higher out-of-pocket maximums.

    2. Billing screw-ups. Here’s a hint for all CBR readers: NEVER PAY THE FIRST DOCTOR BILL! In seven years of dealing with my back (two surgeries), my wife’s various conditions (heart, thyroid, post-partum) and my son’s heart (atrial eptopic tachycardia), I have never, ever, received a bill that was correct the first time. Doctors know this, but don’t care – they send out the bill and, sadly, enough suckers pay it thinking that’s that. Well, it’s not.

    And the insurance companies aren’t any better. I have personally witnessed managers telling claims adjusters to hold a payment, intentionally goof the paper work, or take other actions just to keep the insurance companies money a little longer in the hopes that the patient would pay it (due to the incorrect bill above). And, again sadly, it happens more often than it should.

    If they could refine their billing procedures, insurance companies and the doctors offices wouldn’t have to put in so many hours dealing with billing issues.

    3. Greed. Have any of us ever seen a doctor drive a used Kia? Probably not. The fact is, entirely too many doctors have some sort of god complex and feel as though they are entitled to huge houses and fancy cars. Yes, I realize some of their income is market driven, but having been around docs for my entire life (my mother is an OR nurse and has been for nearly 40 years), my guess is about 95 percent are arrogant assbags.

    The way to solve this is to institute a few requirements:

    a.) They must volunteer either for Doctors Without Borders or to work in a low-income hospital for a certain time. This (in theory) should teach them the compassion they truly should have for someone in their position. This requirement should also have to be renewed every 10 years.

    b.) Once their practice starts, a percentage of their cases have to be pro-bono to low-income families. Again, the services they provide are for the good of society, not the good of their bank accounts.

    Greed also affects the insurance companies, yet I’d be interested to see how much their executives make. My solution would be to make them non-profits. This does NOT mean that they can’t look to make money – it just makes them less beholden to shareholders/owners and would allow them to worry about the patients, effective cost management, and making money, in that order.

    Okay … sorry for the thesis.

    But this is an issue that has profoundly affected me for nearly a decade. So when I hear the right scream about tort reform, I want to drive to wherever that politician is located and punch him/her in the mouth.

    It’s nice to know there’s finally a study that proves it’s total crap.

  • Don B is right.

    I think it was the Grace commmission that found that the primary cause of changes in the cost of medical liability insurance was the return on the investments by the insurance companies.

  • Get this country onto a National Health Program. Take all the money that’s being poured into premiums…and court costs…and legal fees…and use it to fund the program. We’ll end the “problem” of malpracitce expenditures when we get rid of privatized insurance, ambulance chasers…and “corporate bottom lines” that take precedence over medical needs….

  • “Get this country onto a National Health Program.” – Steve

    Wouldn’t work as long as we have our CEO president running the country like a ‘business’. Especially not like one of HIS ‘businesses’.

    For a national health care system to work, you have to believe in Government…

    … and treat Malfeasance as a capital crime.

  • Thanks for mentioning Ezra’s article, which contains a lot of truth. Competent lawyers who represent malpractice victims screen their cases quite carefully. These cases are very expensive to prosecute, what with the need for the plaintiff to provide expert medical testimony on the negligent care (testifying doctors don’t come cheap), and frequently the lawyers have to fund the costs of the cases. Lawyers who accept questionable or outright frivolous cases will soon find themselves in the poor house. To say that there are many frivolous malpractice cases is simply not true, for economic reasons as much as any other. The point about there not being enough malpractice cases is a valid one. As a lawyer who has represented malpractice victims for more than twenty years, I can say that I review many cases where I believe I can prove the doctor’s negligence, but the damages I can recover for the patient are too small to justify the time and expense necessary to prosecute the case. For these victims, it would be helpful if there were a system in place that would objectively evaluate the care they received and compensate them for their losses, but do so at a reasonable cost. I recall that several years ago, one state (I believe it was Florida, but I’m not certain) enacted a law that required the losing party in a malpractice suite to pay the winning party’s lawyer fees, in addition to the actual damages (the usual rule is that each party pays his own lawyer fees, regardless of the outcome). I recall reading that this resulted in quite a few meritorious, but small damage, malpractice cases being filed, and won. Soon thereafter, the doctors’ lobby in the state successfully had the law eliminated. The bottom line on medical malpractice cases is that Bush and his ilk have siezed upon them for political purposes: if legislation can be enacted that will limit these suits, or the damages that can be recovered in them, not only will the insurance companies’ coffers swell, but the plaintiff malpractice lawyers, who generally contribute to the Democrats, will not have the funds to support the Democrats. Rove got Bush on the “tort reform” bandwagon years ago, when Bush was running for governor in Texas, and the two of them have ridden it ever since. As is so true on so many topics, these guys don’t care about what is true, only what proves to be politically expedient for themselves.

  • I remembered being impressed by what Wes Clark said about setting standards for treatments and using information technology to prevent errors during his 2004 campaign. Here are several snippets from his healthcare plan (which also provided universal coverage for children):

    Establish an Independent Commission to Determine the Value of Health Services/Benefits.

    A new commission would use the best scientific and clinical research to provide comparative information about therapeutic interventions to consumers, health providers, businesses, federal, state and local governments, and health plans. It would focus on three priorities:
    Promoting Prevention, Diagnosis and Management of Health and Disease. Early diagnosis and management of conditions like high blood pressure and diabetes can reduce health complications and costs. The Commission would work with the U.S. Preventive Services Task Force to identify specific, effective preventive services, evaluate their cost effectiveness, and develop recommendations for increasing their use.
    Promoting Comparative Information and Evidence-Based Medicine. The plan would trust health clinicians rather than HMO executives or pharmaceutical company marketers to recommend what works best and what should be covered. The Commission would work with the Agency for Healthcare Research and Quality, the NIH and others to develop measures of relative value for alternative physical and mental health interventions.

    The Commission would publish guidance on comparative effectiveness of alternative therapies and preventive services to help both public and private purchasers design their coverage policies.

    Promoting Information Technology to Reduce Medical Errors and Administrative Costs. Unlike most other industries, health care has been slow to adopt information technology. This not only yields high administrative costs but results in medical errors. The Clark plan would promote, through financial incentives and requirements, the use of electronic medical records, computer-aided decision tools for providers, reminder systems for patients and other systems that could streamline health care.

  • The left is missing the boat on this…

    Doctors are getting squeezed between collusion in the big business insurance industry and malpractice premiums that are sky high and growing at an astounding rate. Combine that with a high cost of living and you will understand why in many areas like my own here in NJ, there are overwhelming numbers of surgeons and surgical subpecialists retiring without being able to sell their practices.

    It has been shown again and again in independent study that malpractice awards have little to do with negligence and almost entirely to do with the degree of injury. Claims get settled merely because the threat of a large award can END a doctors career.

    This is one topic that noone will understand until they try to find a doctor in their insurance plan and can’t; or worse — to find a surgeon in their county only to find that they either are gone, or no longer do any high risk procedures, and can no longer get care in the areas the require.

    Medical errors will happen, but that should not guarantee a payout, nor should a random sway of an uneducated jury end a young doctor’s career.

    Remember big business can afford to play the game of averages. The individual cost of a lawsuit against a doctor can range from at the very least 100,000 dollars to easily half a million in a moderately large suit. That is a large amount when there is no burden on the prosecution to PROVE negligence.

    Unfortunately … the only response will come when a senator’s son suffers head trauma and dies due to the lack of a local neurosurgeon who can relieve an emergent hematoma.

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