For the Repugs, it's all about the health of their wallets, and there's nothing -- nothing! -- else they care about. Oh, right, and gay marriage.

To quote Stephen Colbert, "facts have a well-known liberal bias".

This study makes the usual two errors.

1) Anasthesiology is NOT representative. The reason that anasthesiology was able to reduce its error rate so hugely was the invention of the blood oxygen monitor, since 95% of anasthesia risk is due to impaired oxygen uptake. There isn't a comparable single cause of harm for most medical specialties.

2) Avoiding harm costs money. "How much is spent on lawsuits" is only the tip of the iceberg of the costs. The fact that almost no GP's still deliver babies, and that a standard pre-natal care and delivery package costs 10x what is did 20 years ago (meaning that people without insurance are much less able to afford care, and rural people are often a very long way from the nearest practice that will deliver babies) is also a cost.

Here's a question about the Clinton/Obama article in the NE Journal of Medicine:

Who actually wrote it?

I know that most published pieces under politicians' bylines are ghosted by someone else. So are most of their speeches, and nearly all of the legislation they sponsor. It's longstanding practice in Washington, well accepted there and elsewhere. And just as the captain of a ship is responsible for what happens on board, a politician deserves credit (or blame) for what gets printed with his name on it.

But...this is only common practice. It isn't a right. No Senator is entitled to never have to answer who wrote his (or her) speech, or bill, or article in the New England Journal of Medicine. No staffer -- or lobbyist -- is entitled to anonymity. Who knows, it might even turn out that some politicians could be replaced by the people who write their speeches.

Now, why should Sens. Clinton and Obama have to answer a question that few other politicians do? Well, I'm not saying it's fair; I'm just suggesting we have to start somewhere, and this is as good a place as any. So -- who wrote this article for Sens. Clinton and Obama?

The answer is that insurance companies make bad investments, which causes them to raise malpractice premiums to cover the loss. Only a small percentage of plaintiffs get any kind of award at all, let alone over-large ones.

Now I'll click the link.

Just once, can somebody just tell us how much was spent on Health Care last year, or any year, and how much was awarded in malpractice payments? What percentage of health care is malpractice?

No medical reform proposal is serious unless it includes more doctors and lower salaries for the present ones.

Both are unpopular with the AMA, therefore politically unfeasible. That is a comment on the current political system - not the basic proposition.

Medical injuries would be better handled by a no-fault workers compensation type system. This would be more efficient and - most importantly - would reduce legal fees.

Bottom line, no medical reform proposal is serious unless - upfront - it can yield ALL the following four results:

. more doctors
. lower salaries for these doctors
. fewer lawyers
. lower salaries for these lawyers

Alan:

Are you not including settlements prior to trial in your definition of "award"?

kevin: 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.

gop motto: nothing ventured, nothing gained...

no matter how ethically challenged it may be...

250k huh....

weird that its the same amount california used as a cap in 1977...

and lord knows...health care hasn't risen much since then...

just one more example that ... they won't stop on their own....

tomeck:

Here are the figures I've seen. In March 2006 Towers Perrin released its U.S. Tort Costs: 2005 Update. The study found that over the 29 years since 1975, when medical malpractice insurance data were first separated out from other types of liability, medical malpractice cost increases have outpaced other tort areas, rising at an average of 11.7 percent a year, compared with 9.0 percent for all other tort costs. In 2004 medical malpractice costs totaled over $28.7 billion, up from about $26.5 billion the previous year.

A February 2006 study, prepared by PricewaterhouseCoopers for America’s Health Insurance Plans, examined the factors contributing to rising health care costs and analyzed where the health care dollar goes. It found that medical liability costs and defensive medicine account for 10 percent of medical care costs. Defensive medicine is when doctors order more tests, prescribe more medication and make more referrals than they believe are necessary to protect themselves from being accused of negligence.

Here's why I asked for your distinction, Alan:

New research from Jury Verdict Research shows that after three years of median medical malpractice jury awards holding steady at about $1,000,000, in 2003 the median rose to $1,200,000. The range of awards continued to moved upwards as well, from a low of $5,000, more than three times the amount the previous year, to a high of $112 million, up from $95 million in 2002. The average award in 2003 declined slightly from about $5.56 million in 2002 to $4.7 million in 2003. Although only a small fraction of cases go to trial, court awarded damages influence out-of-court settlements. Settlements too have shown a steady increase, from a median of $400,000 in 1997 to $700,000 in 2003.

http://www.iii.org/media/hottopics/insurance/medicalmal/

Clever how the insurance companies have convinced the doctors that lawyers are the enemy. Does anyone really think that the insurance companies will lower the premiums if the threat of costly lawsuits are reduced. Since the companies operate in their shareholders interst my guess is that the premiums will not fo down but will continue to go up and the only thing that will improve is the profits of the insurance compnaies.

Doug

Thanks, but I found this too.

"The best attempt to synthesize the academic literature on medical malpractice is Tom Baker's The Medical Malpractice Myth, published last November. Baker, a law professor at the University of Connecticut who studies insurance, argues that the hype about medical malpractice suits is "urban legend mixed with the occasional true story, supported by selective references to academic studies." After all, including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending."

While his figure doesn't include "defensive medicine" the two disagree by a factor of 20.

http://www.slate.com/id/2145400/

I agree there is a disagreement.

I ran into a thread a while back where a doctor defended his personal billings amounts on the basis of repaying the huge debt load : seeing his analysis, serious dissent STFU.
Ezra's source, Healthy Policy quit and referenced Healthy Policy and Research, which is also quiet.
Meanwhile, at TPM Cafe, Howard C. Berkowitz seems worth chasing down.
bluegalinaredstate.blogspot is the medical researcher known as Global Citizen who sometimes enters the fray here.

Tomeck,

The two studies disagree by a factor of about 20 BECAUSE he is excluding defensive medicine, where the majority of the cash costs are. (Lack of medical treatment for the poor is a cost--probably the biggest cost, but it's not a cash cost.)

Sorry, that should be "Health Policy and research"

"The reason that anasthesiology was able to reduce its error rate so hugely was the invention of the blood oxygen monitor..."

So, why was the blood oxygen monitor invented? Sure, it was invented to save lives, but like the safety switch on your lawnmower, the hand guard on your tablesaw and the child safety caps on your pill bottles, isn't fairly safe to say that the blood oxygen monitor was created at least in part to curb the lawsuits that resulted from anesthesiology malpractice?

And while we're at it, do you really think trial lawyers are to blame for GP's no longer delivering babies? Or is it possible that increased specialization of medicine is to blame? I don't know about you, but if my insurance covers a OB-GYN the same as a GP, my babies are being delivered by OB-GYN's 100 percent of the time.

Doug M:

All you have to do is to look at the financial statements of Hartford, Aetna, etc. I don't have time to excerpt them now but it is pretty obvious what is going on.

Another huge cost in medical care: Carrying costs for physicians.

When a physician sends a bill to an insurance company, the bill should be paid. When it is delayed, there is a cost. The insurance company makes money by having the use of the money longer, and the physician loses.

Then they have to resubmit, and call on the phone, and follow up.

Some estimates indicate that 10 % of medical costs are involved with these delays.

"Only 150 of the cases in which the researchers couldn't detect injury received even token compensation. Indeed, a bigger problem was that 256 cases were thrown out of court despite evidence of harm to patients by physicians."

Conclusion? There aren't enough medical malpractice awards.

" 195,000 Preventable Deaths Every Year
In its report, the IOM estimated that 98,000 people die each year due to preventable medical errors, at a cost of $29 billion. Subsequent studies claim the number may be even higher. In 2004, HealthGrades released a report which found that the IOM severely underestimated the number of deaths caused by medical errors each year. Its data suggest that the true number was closer to 195,000 deaths annually, nearly twice the number reported by the IOM. "

Having had a couple of interns as close friends, I have heard a number of hilarious tales of deadly medical incompetence.

Excuse me; but I WANT my doctor performing "defensive medicine".

Just like I want my taxi driver to perform defensive driving.

Taxi driver may feel like he can get away with driving 80 down city streets to get me to my destination faster and cheaper, but at the end of the day, I'd rather not have spent 2 hours waiting for the emergency crew to pry my body out of the wrecked cab either.

Again - here, we're disagreeing on a very simple matter. How much "defensive medicine" is necessary and reasonable. I've got an idea - let's let an insurance industry spreadsheet jocky determine that. 'k?

"Defensive medicine" is an example of the symbiotic relationship that exists between the medical establishment and trial lawyers. Doctors order a variety of exotic and expensive tests and diagnostic procedures, which they then "blame" on trial lawyers, all the while failing to mention the fact that each extra test puts more money in their pocket. If every trial lawyer on the planet disappeared, does anyone seriously believe doctors would significantly cut back on tests and diagnostic procedures? No, because doing that would significantly reduce their incomes. 50 years ago, physicians were prosperous, upper middle class citizens. Today, physicians are among the wealthiest members of our society. The real secret: restrict the supply of new physicians. Whoever it was who suggested the need to increase the number of physicians is exactly right.

Alan:

I am not arguing whether insurance companies make bad investments. My question to you was re: your "Only a small percentage of plaintiffs get any kind of award at all, let alone over-large ones." Are you including "settlements" in that estimate?

Conclusion? There aren't enough medical malpractice awards.
Posted by: The Fool on July 11, 2006 at 1:43 PM | PERMALINK

No - the real question is:
Is our current system of malpractice law an effective deterrent for negligent doctors?

Answer: obviously not.

So, how do we discourage negligent doctors?

By letting them skate through a malpractice suit with an insurance premium so that all doctors share the risk (and cost) for a penalty which is meant only for a few bad doctors?

Or by getting the AMA to start pulling licenses?

The Frist v. Clinton/Obama approaches perfectly highlight the difference between the GOP and an improved Democratic Party.

The GOP is all about businesses and rich people, and their bottom line. The Democratic Party is, or at least should be, about the people.

Whoever it was who suggested the need to increase the number of physicians is exactly right.
Posted by: chasmrich on July 11, 2006 at 1:48 PM | PERMALINK

We have been arguing this healthcare thing on this blog for 3+ years. Every time there's a thread, at least one or more persons mentions that the cause of all the woes is the tyranny of the AMA monopoly.

Then the next time a thread pops up, its Kevin trying to point the finger somewhere else. No blogger, or mainstream media, as far as I know, have ever hosted a serious discussion about the AMA monopoly and the market distortion it causes. You'd think that the free marketer righties would bring it up - but none of them would know a free market if it bit them in the ass (as it frequently does).

The GOP is all about businesses and rich people, and their bottom line. The Democratic Party is, or at least should be, about the people.
Posted by: RT on July 11, 2006 at 1:57 PM | PERMALINK

They BOTH should be about the people.

Neither are.

I don't think anyone's yet pointed out something crucial to this discussion (if I missed it up in the thread, apologies):
Almost every study to address the issue recognizes that there's a crucial component to the problems that do exist in the realm of medical malpractice and the costs thereof.
That is, in just about every specialty, there is a small coterie -- usually under 10% -- of clinicians who generate a hugely disproportionate fraction of all problems in that field. It's sort of like the old 80/20 rules of business -- less than 20% of the docs cause something approaching 80% of the damage.
Yet the medical and legal systems both, in effect, almost seem to conspire to keep this knowledge from public view, or from being acted upon. There are rarely, if ever, any enforcement mechanisms to identify and either rectify or purge the problem-causing doc's.
In other areas -- the obvious one being auto insurance -- problem-creators are identified, and must pay higher rates, in reflection of the higher costs to the insurance firms of carrying the offending drivers. A rational medical insurance, and medical practice, world would operate this way -- and better if there were means of disciplining the offenders, and even better still if it made the info available to the public. But even leaving those parts aside, to whatever extent (I've seen numbers ranging from about 1% to over 20%, largely depending upon whether the costs of "defensive medicine" are included or not) the costs of malpractice do increase the costs of the delivery of medical service, those costs could be reduced HUGELY -- probably by over 50% -- if there were just SOME mechanism for identifying the problems, and assigning some financial responsibility appropriately ( eg, insurance rates reflective of the number/severity of problems; sanctions, including de-licensing if need be; etc).

When medical costs are paid by the government some day, who pays for malpractice?

the gop plan for defensive medicine is...

to take such decisions out of the hands of medical professionals...

and let the consumer decide if such tests are "needed"...

lol

Are we just going to assume that all lawsuits and settlements are necessarily frivolous? And how is "frivolous" defined?
No doubt many doctors and insurance companies consider any and all medmal suits "frivolous", as opposed the patients who had the wrong limb amputated.

Jack Sprat,

Maybe my point wasn't clear. The reason that one technological change (blood oxygen monitors) made such a big difference for anasthesiologists was that there was only one problem to avoid--oxygen deprivation. In most areas of medicine, there are many different possible problems, so no simple technological change would help in the way the blood oxygen monitor would.

On GPs vs obstetricians--people might choose an OB if there was one available, although some people would still prefer their regular doctor. The problem is that there are fewer OBs than GPs--in many rural areas there is a GP half an hour away, but the nearest OB is 2 hours away. In such a case, many people would probably go with a GP--but malpractice costs have pretty mcuh driven the GP's out of the field.

RT:

You don't think trying to get control of 10 - 20% 10 of medical care costs is "for the people" too? That being said, I have no problem, in theory, with reducing medical errors on the front end as well (although I have yet to read the specific article ghost-written for Clinton / Obama).

From what I can tell, the various state bars are better at suspending or pulling the licenses of bad lawyers than the AMA is with bad doctors.

although I have yet to read the specific article ghost-written for Clinton / Obama

How do you know it was ghost written? You're not doing much for your credibility by just assuming so, and by singling these two out you also expose your political bias--although that's been fairly obvious all along.

The plethora of sleazy ads by dime-a-dozen trial lawyers touting gargantuan jury awards for medical malpractice undoubtedly contributes, not insignificantly, to the perception that malpractice awards are out of control and runious to the economy.

I see that OsamaBeenForgotten beat me to the point re: the concentration of Bad Doctors, and as usual, put it better than I did -- wasn't ignoring that post; it posted while I was writing.

chasmrich on July 11, 2006 at 1:48 PM said:
"Today, physicians are among the wealthiest members of our society."

Half right: those that own their own practices often are.

But for those that work for HMO's, and some that are part of PPO networks, the trend as I understand it is in the opposite direction. Doctors in such situations often find their incomes much reduced compared to independent practitioners -- AND they may find themselves stripped of decision-making power in the delivery of medical service to their clients -- oops, I meant patients (soon we'll be "end users" or perhaps just "the product") -- or worse. Often, there are financial disincentives to the delivery of proper medical service, and/or incentives to just process the patients in ways that are less costly, even if less effective. And often, services that might be best performed only by doctors are devolving into the hands of the even-less-expensive PAs and NPs.

It would be interesting to see a study comparing how many doctors and other medical professionals are leaving the field, as the insurance firms and their GOP mouthpieces often claim, because they've been run out by the cost or unavailability of malpractice coverage, versus how many are leaving the profession because of the above problems in performing their careers as they had expected to when they entered the profession.

(One of my former docs -- a truly wonderful one -- retired way before he had expected to for just such reasons.)

Actually, I think it was Zathras who brought up the ghost-writing above.

As for "wrong limb amputations" in the U.S., those are extremely rare because the correct procedure itself is no longer that common -- I can't imagine any such instance that is not settled prior to trial -- when I'm talking about "frivolous", its NO PHYSICAL INJURY whatsoever.

Peter:

If you don't think $28.7 billion for medical malpractice costs is "out of control", what's your definition of "out of control"?

Sam

I'm leery of including "defensive medicine" as a cost of malpractice because as others pointed out, it's hard to define where that line is and if it's really there because of malpractice insurance or sound medical advice. It's like saying that safety features in cars should be counted as a cost of insurance payouts for accidents.

Case in point. My daughter had a series of headaches. Her perscription for her glasses changed quickly. Her doctor told me that one possibilty for that was a brain tumor, so he ordered an MRI. The good news was that there was no tumor. Defensive medicine? Perhaps. Doctor covering his ass? Maybe. Did I want the procedure done? You betcha'.

I think that Kevin's question: "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." actually points to another bottom line - if you reduce the number of medical errors you reduce the number of people who were hurt.

If you reduce just the payouts - those people are still hurt. They just don't get the same recompense for their injuries. (And yes, the lawyers get less too.)

That's what the big story here: all these articles point to a slew of problems in the basic of getting the right treatment in US medical care. And I'll bet that's one of the reasons that US health care statistics are pretty poor compared to other major industrial countries.

Nicely said, Kevin.

Doug M: You don't think trying to get control of 10 - 20% of medical care costs is "for the people" too?

Why should I think that? In the economy as it's presently structured, what evidence is there that the health care customers would benefit more than trivially?

Besides, once again, the question is how you achieve the reduction of defensive-medicine costs. ISTM that both Frist and Clinton/Obama would have similar effects, but by very different means. And Frist's means would be by helping out insurers, while Clinton's and Obama's would be by keeping instances of malpractice from occurring upfront.

...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.

Another excellent example of typical Democratic policy. Somehow, the "solution" is a nebulous 'improvement' that can't actually be measured, and doesn't require them to actually 'do' anything, or be 'accountable' for anything. The 'improvement' will just spontaneously happen somehow.

The one consistent undercurrent that is evident in liberal ideology is contempt for average people. Basically, they expect all the 'fools' in fly-over land to buy into this crap. But, since the people in fly-over land aren't actually fools, it winds up backfiring at election time.

just asking: Are we just going to assume that all lawsuits and settlements are necessarily frivolous? And how is "frivolous" defined?

their goal is transparent..

puntive caps at 250k?....

now that is frivolous...

its like saying saddam is a threat..

400k troops in 1991
150k troops in 2003..

see....they wont stop on their own..

you have to make them....

sportsfan79: the "solution" is a nebulous 'improvement'

gop solution is ..

give up your rights in a court of law..

in a free market...

and install a cap on "punitive" awards where it was in calif. 30-years ago..

250k...

gop's excuse?

its like iraq...if we are dumb enough to get taken..

its not the republicans fault..

Klein's first two sentences are incorrect:

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...

In fact, the Republican proposal is to not cap awards for economic damages caused by the malpractice, such as full medical costs, lost wages, rehabilitation, re-training, transportation, home care, etc., etc. These economic damages can amount to millions of dollars.

In addition to economic damages, jury awards can include an extra amount for non-economic damages, called "pain and suffering". The Reps proposed limiting the "pain and suffering" component to $250,000. The overall malpractice award would remain unlimited.

Note that the plaintiff's attorney typically receieves a fee of 33% plus his expenses. In total, the plaintiff's attorney will get about half of the award. Since the Dems are in the pocket of the plaintiff's attorneys, no reform will be enacted.

Malpractice losses are covered by premiums. The doctors and hospitals cover their premiums by adding the cost to our medical bills. Of course, a percentage of these large premiums sticks to the malpractice insurance companies.

In short, you and I are paying more for medical care, in in a way that enriches lawyers and insurance companies.

From what I can tell, the various state bars are better at suspending or pulling the licenses of bad lawyers than the AMA is with bad doctors.

Docs are licensed by state boards, not the AMA. The AMA is a lobbying group to which about 1/3 of MDs belong and 0% of DOs belong. Hard to have a monopoly when you merely represent 20% or so of the total and don't really have any power over those people. I get a quarterly report from my state's Medical Board with lists of disciplinary actions including license terminations. It's public record. I don't like the AMA and have never belonged, but it doesn't make sense to bash them for something they don't do.

It's not clear to me why you people think that lowering pay will improve quality. If I made much less, I'd be forced to return to engineering which pays only a little less, but which offers far better hours. The people who go into medicine are not choosing between patient care and burger flipping, but rather patient care and other professional jobs. Then they are giving up a minimum of seven years of income while training. Paris Hilton might be able to afford to be a doctor for little or no income (except she doesn't like to read), but those of us from the middle class couldn't afford to make that sacrifice, if there wasn't some hope of making it up with a professional's income.

If you don't think $28.7 billion for medical malpractice costs is "out of control", what's your definition of "out of control"?
Posted by: Doug M. on July 11, 2006 at 2:22 PM | PERMALINK

$300 Billion to secure the non-existent WMD in Iraq.
That's fucking out of control.

sportsfan79: Another excellent example of typical Democratic policy. Somehow, the "solution" is a nebulous 'improvement' that can't actually be measured, and doesn't require them to actually 'do' anything, or be 'accountable' for anything. The 'improvement' will just spontaneously happen somehow.

1. This stuff is actually quite measurable. "The Best Care Anywhere" (Monthly, Jan-Feb 2005, not online) got into that somewhat. Many things you'd think can't be measured can be. On that topic generally, I strongly recommend Soft sciences are often harder than hard sciences, by Jared Diamond (Discover, August 1987).

2. Given the lack of willingness of the current GOP Administration to subject itself to any yardsticks of progress to measure its success or failure by, and given the cooperation of the GOP Congress in helping the Administration elude any sort of oversight and accountability, that's a truly amusing thing for you to be saying.

The one consistent undercurrent that is evident in liberal ideology is contempt for average people.

Let's see: the GOP solution is to limit the compensation to malpractice victims. The Dem solution is to reduce the number of malpractice victims. I think it's pretty clear which one shows contempt for average people, and which one doesn't.

How much did WWII cost (adjusted for inflation)? Was that war also "out of control" in your opinion?

That last post was to Osama_Been_Forgotten.

ex-liberal: In addition to economic damages, jury awards can include an extra amount for non-economic damages, called "pain and suffering". The Reps proposed limiting the "pain and suffering" component to $250,000. The overall malpractice award would remain unlimited.

Why should non-economic damages be limited to $250K?

Just as a hypothetical, if the surgeon accidentally castrates me, the economic harm done to me is minimal, since I'm not Jeff Gannon. But I would have lost something that I consider worth a hell of a lot more than $250K. (Would you give up your nutsack for $250K? Didn't think so.)

I can think of plenty of less...erm, personal examples, but I wanted to get the point across.

"One of my former docs -- a truly wonderful one -- retired way before he had expected to for just such reasons." - I hear that frequently about doctors retiring prematurely because the practice of medicine has just become so unpleasant and unrewarding. Is there no one but me who thinks that's basically bullfeathers? [No disrespect intended to you or your former doc.] The fact that they can choose premature retirement, to my mind, reflects how much money they must have earned. How many of us could retire comfortably years before we had planned?

ex-liberal: Note that the plaintiff's attorney typically receieves a fee of 33% plus his expenses. In total, the plaintiff's attorney will get about half of the award. Since the Dems are in the pocket of the plaintiff's attorneys, no reform will be enacted.

So what's your problem, then, with the Clinton/Obama approach? It would reduce malpractice award payouts - and attorney fees too - by simply reducing the harm done to ordinary people that the awards are there to compensate for.

What's your beef? And how does this show that the Dems are in the pocket of the trial-lawyer lobby? Seems to prove just the opposite.

chasmrich:

Who said anything about "comfortably"? The medical doctor I know who retired early downsized severely and moved out of the State to reduce his expenses.

RT:

Would loss of consortium (sp?) be capped at $250,000? Also, are you denying that the vast majority of plaintiffs' attorneys' political contributions go to Democrats?

Osama_Been_Forgetten:

World War II cost the modern-day equivalent of $5.1 trillion. But, I would argue that 9/11 actually cost the U.S. more than even Pearl Harbor (5 of 8 battleships were sunk, sinking, or totally damaged on 12/7. The remaining 3 were at least damaged somewhat. 3 cruisers, 3 destroyers, and a seaplane tender were severely damaged. 96 army aircraft and 92 navy aircraft were destroyed and 159 more damaged).

The shorter Korean conflict cost us $434 billion in inflation-adjusted dollars. The Vietnam War -- which lasted 8 1/2 years -- cost $614 billion in
inflation-adjusted dollars.

Some sort of cap on noneconomic damages seems to be a good idea, but not limited to medical malpractice cases. Since there is no rational way to value pain and suffering, loss of consortium etc., one award is just as "accurate" as another and reducing the range of options for the jury will reduce geographic and ethnic disparity in such awards. Reducing the speculative nature of noneconomic awards would also facilitate settlements, reducing transaction costs and and court backlog. The cap should be indexed for inflation. I would also support a floor or schedule for these kind of damages, particularly in wrongful death cases for the same reasons.

Vance:

How about indexed to differing costs of living regions around the country too?

Doug, I was assuming a change in state law rather than a national program.

As you know, the thread is bashing Frist's NATIONAL level proposal -- I'm the first to admit that one size does not necessarily fit all -- perhaps $250,000 would be fine in one State, but not in another where the cost of living is already twice as high?

Doug M.: Would loss of consortium (sp?) be capped at $250,000?

Frist wants to cap noneconomic harm at $250K. How am I economically harmed by being gelded? If I were to never have sex again, I would not be a nickel poorer; my life would be poorer, but not my wallet.

Also, are you denying that the vast majority of plaintiffs' attorneys' political contributions go to Democrats?

No, not at all. What I'm saying is that if the instances of malpractice are reduced, so are the consequences of malpractice, and in any sort of reasonable world, the suits, trials, awards, and attorneys' fees also are reduced.

So this plan, if successful, would work against the economic interests of the trial lawyers that the Dems are supposedly in thrall to.

How am I economically harmed by being gelded?

That probably depends on your line of work.

I think that $250,000 is too low a cap and can't take into account the wide variety of situations. A person confined to a wheelchair for life with a painful and humiliating condition should recover more than someone that had a headache for a couple of days.

That's why I favor some sort of schedule, where the jury decides between several possible qualitative states maybe ranging from "minor pain" to "severe and prolonged pain and suffering" with the judge applying a legislatively chosen amount to the decision.

As indicated this reform should not be limited to medical malpractice cases.

The Florida Senate hearings on malpractice tort reform were the most illuminating ever. For obvious reasons, someone in the Senate worked hard to require the lobbyists testifying before the hearing to swear an oath to tell the truth -- noting they could be prosecuted for lying. When the Medical Assc and the Insurance directors testified, they oral testimony contradicted their written reports and previous unsworn testimony. The president of the FL medical assc admitted there was no doctor shortage and the the insurance industry lobbyist admitted there was no crisis. http://www.sptimes.com/2003/07/16/Opinion/Political_malpractice.shtml

In California, when asked to to do the same on hearings on workers comp reform, the California Manufacturing & Tecnology Assc refused to testify, sending a letter that they could not guarantee the truth or accuracy of their lobbyists' claims. So,after outright admitting they routinely lie in legislative hearing testimony, why are they ever listened to at all?

RT wrote: Why should non-economic damages be limited to $250K

If you take the view that liability should be unlimited in every way, then it shouldn't be limited.

However, the problem is cost. Patients are paying for the non-economic damages. How much more do you want to pay for your medical care in order that an occassional malpractice victim can collect extra millions?

I would rather have medical care be generally affordable than see a few patients collect windfalls.

RT wrote: So what's your problem, then, with the Clinton/Obama approach? It would reduce malpractice award payouts - and attorney fees too - by simply reducing the harm done to ordinary people that the awards are there to compensate for. What's your beef? And how does this show that the Dems are in the pocket of the trial-lawyer lobby? Seems to prove just the opposite

I don't believe the Clinton-Obama approach will work. My wife is on the faculty of a medical school. She and her colleagues are smart, trained and hard-working. They're doing the best they can to improve the safety and effectiveness of medical care. BTW they have made a lot of progress. Medical care is improving all the time.

I know that Hillary and Barak are smart people, but they're not trained in medicine nor have they devoted their lives to medicine. It's most unlikely that they can create an approach better than the medical care professionals have done. A program designed by medical amateurs is more likley to be useless or even counter-productive.

So, the Clinton-Obama proposal is just a red herring, designed to make it easier to justify doing what the plaintiffs' attorneys want -- keeping malpractice costs high.

But, since the people in fly-over land aren't actually fools, it winds up backfiring at election time.
Posted by: sportsfan79

How patronizing of you to assume how people in "fly-over land" will react. They aren't the fools, you are. If Frist's transparent blow job to the insurance industry ever passes, God help you if you have a family member seriously injured due to malpractice.

My mother-in-law went in for hip surgery, and the anastesiologist gave her an epidural, despite the fact that she had scoliosis, becasue her doctor hadn't noted that on her chart. She came out a parapalegic, needing daily nursing care, since my father-in-law couldn't carry her around. How is that going to happen on $250K, sportsfan? You are a pathetic Bush apologist who doesn't give a fuck about what's right or wrong, just about what's Bush. But don't worry, sportsfan, my MIL died before the costs got too high and ate into their savings. You're a fucking joke.

The Republican'ts have a curious mental disability. They think nothing bad will ever happen to them. Comes, I think, from worshiping money & therefore thinking that they are rich BECAUSE they are blessed.

Remember how the guy parcelling out the 9/11 money gave much more to the investment bankers' families than to those of the dishwashers at Top of the World? Just wait until a few investment bankers end up brain dead from malpractice and get only $250k in damages. You'll see the Can'ts turn so fast it will make your head spin.

I would rather have medical care be generally affordable than see a few patients collect windfalls.

General damages are awarded to compensate for lost income and pain and suffering. They aren't a "windfall" for the injured party, who wouldn't get a large award had they not suffered significant injury. [I am willing to consider that their lawyer might be getting a windfall - if you want to talk about reducing contingent fees we might be able to agree on something.] Nor are jury awards or malpractice settlements really the reason why the costs of medical care have been rising so precipitously in recent years. I find your comment overly simplistic, inaccurate as to the facts, wrong as to cause and effect, and rather mean spirited. In other words, typically Republican.

MeLoseBrain? wrote:
My mother-in-law went in for hip surgery, and the anastesiologist gave her an epidural, despite the fact that she had scoliosis, becasue her doctor hadn't noted that on her chart. She came out a parapalegic, needing daily nursing care, since my father-in-law couldn't carry her around. How is that going to happen on $250K, sportsfan? You are a pathetic Bush apologist who doesn't give a fuck about what's right or wrong, just about what's Bush. But don't worry, sportsfan, my MIL died before the costs got too high and ate into their savings. You're a fucking joke.

Your "mother-in-law" was married to your "father-in-law"? Are you sure? Did you just make that whole story up just so that you could go on a rant with a bunch of f-words thrown in?

I wouldn't put it past you or your ilk. Based on experience, I absolutely believe that a typical liberal on this blog would stoop to making up a story just to spew more trash.

On GPs vs obstetricians--people might choose an OB if there was one available, although some people would still prefer their regular doctor. The problem is that there are fewer OBs than GPs--in many rural areas there is a GP half an hour away, but the nearest OB is 2 hours away. In such a case, many people would probably go with a GP--but malpractice costs have pretty mcuh driven the GP's out of the field.

While less and less GPs (or more correctly, family practice docs) are doing OB, I would argue that this decision has less to do with malpractice costs and more to do with lifestyle choices. My wife just graduated from one of the largest and most established family practice residency programs in Texas. Her program is actually one of the few that has a major focus on OB and provides for a "High-OB Track" so that residents can gain additional OB experience during their residency. Residents who are interested in OB can gain enough experience during their 3 year residency that they can pretty much skip doing an 4th year OB fellowship which is the path that a lot of family practice residents follow if they are serious about OB.

Yet with all this focus on and support for training in OB, what percentage of family practice residents in the program are actually interested in pursuing OB in their professional careers? In my wife's graduating class of 12, she is the only one. And that trend is continuing in the underclasses. And remember, this is a residency program that actually has a focus in OB unlike the huge majority which do not.

I've talked to a lot of the residents and of course whether or not to practice OB is a big subject of discussion among the residents. My wife says that while malpractice concerns may be a concern, it isn't really the reason why no one wants to do OB anymore. The real reasons are really two: Lifestyle and fear.

Regarding lifestyle. A doctor who is serious about OB is going to be on-call a huge amount of time. And, unlike other medical issues, a lot of labor and delivery work is simply waiting...and waiting....and waiting. When you have a family all that time on call and waiting in the hospital is a killer. My wife has frequently been called in for a delivery around say dinner time and ends up waiting for hours while the woman is in labor, often not getting home until after midnight. That sort of thing just doesn't happen when you have patients hospitalized for other reasons. Also, you really really need to keep your skill level up if you are going to practice OB at all, which means doing a lot of it. There are a huge number of family practice residents who look at the lifestyle sacrifice that OB practice involves and say "no thanks, I'd rather have my time off with my kids than spend the rest of my life on OB call"

The other factor is fear. Labor and delivery is risky stuff and when things go bad they can go horribly bad horribly fast. It's one thing to assist in a delivery when you have experienced OBs standing by your side. It's a whole different thing to know that everything is on your shoulders when you are out in some rural hospital. A whole lot of family practice residents are just plain afraid of doing OB work. My wife has come home after bad deliveries positively shaken. And after seeing mothers and babies die in the delivery room she's come very close to giving up OB completely. There are just a whole lot of family practice docs who would much prefer to spend their days doing things like well child checkups, fixing broken arms, prescribing lipitor, and tracking diabetic elderly than going anywhere near a delivery room.

"sportsfan79" wrote:

Your "mother-in-law" was married to your "father-in-law"? Are you sure? Did you just make that whole story up just so that you could go on a rant with a bunch of f-words thrown in?

Much like fellow conservatives Al and American Hawk, I see I have rated my own personal imposter on the WM website. A dubious honor. Also very childish. But whatever floats your boat.

--The real sportsfan79

My real response to MeLoseBrain would be more to the effect that your mother is still entitled to un-capped judgement and benefits to cover nursing care. The 250K cap only applies to "pain and suffering" claims, as noted upthread.

My response didn't have any swear words though, so hopefully you can still understand it MeLoseBrain.

Zathras: Who actually wrote it?

Next thing you know, you'll want to know who wrote Profiles in Courage.

I see that OsamaBeenForgotten beat me to the point re: the concentration of Bad Doctors, and as usual, put it better than I did -- wasn't ignoring that post; it posted while I was writing.

chasmrich on July 11, 2006 at 1:48 PM said:
"Today, physicians are among the wealthiest members of our society."

Half right: those that own their own practices often are.

But for those that work for HMO's, and some that are part of PPO networks, the trend as I understand it is in the opposite direction. Doctors in such situations often find their incomes much reduced compared to independent practitioners -- AND they may find themselves stripped of decision-making power in the delivery of medical service to their clients -- oops, I meant patients (soon we'll be "end users" or perhaps just "the product") -- or worse. Often, there are financial disincentives to the delivery of proper medical service, and/or incentives to just process the patients in ways that are less costly, even if less effective. And often, services that might be best performed only by doctors are devolving into the hands of the even-less-expensive PAs and NPs.

It would be interesting to see a study comparing how many doctors and other medical professionals are leaving the field, as the insurance firms and their GOP mouthpieces often claim, because they've been run out by the cost or unavailability of malpractice coverage, versus how many are leaving the profession because of the above problems in performing their careers as they had expected to when they entered the profession.

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Its probably too late to for this to do any good, but since someone quoted Tillinghast Towers Perin (TTP), here is some relevant info:
1. One of TTP's businesses is insurance- its an insurance company
2. Another of its businsesses is consulting to the insurance industry, in fact it is considered a major consultant to the insurance industry.

As such it is an interested party in the poltics of tort reform.

As to their "study" its been criticsized- "Although TTP's estimate is widely cited by journalists, politicians, and business lobbyists, it is impossible to know what the company is actually measuring in its calculation of tort costs, and impossible to verify its figures, because TTP will not share its data or its methodology, which it claims are 'proprietary.'"

Also its my understanding that it purports to be a cost benefit analysis, but "TTP admits that the tort system has benefits (e.g., the peaceful resolution of disputes, deterrence of unsafe products and practices) but does not estimate their magnitude. It even suggests that "compensation for pain and suffering is seen as beneficial to society as a whole." But TTP makes no attempt to measure the benefits of the tort system and offers no insight into whether the tort system's costs outweigh its benefits (TTP 2004, 10)."

Okay- in no particular order:

Chevre's benefits to medmal reform did not include better healthcare or better access to health care.

For those comments acknowledging someone in the health care field as smart, hard working and doing the best that they can- you have heard the tales from your acquaintance about the people in the healthcare field who shouldn't be allowed near a patient.

False sportsfan- last time I checked, my father-in-law was married to my mother-in-law, but maybe I am just special that way.

Defensive Medicine ??? Most Insurance companies pay MD's a set fee per patient, the a tinsy portion of a reasonable charge for each visit or procedure...however, MD's get bonus's (like profit sharing) so, there is a counter-balancing financial interest there- FWIW- the MD's I know, both of them) try to maintain a chinese wall between the financial side of their practice and the treatment.

Finally, no one seems to be talking about the simple truths in this story - 1: ALL politicians want to do is get re-elected; 2) getting elected costs money;-

I doubt any of the politicians Bill, Hillary or Barack give a hoot about medical malpractice issues- they will all say anything that will raise money and appease their respective base. Not that I am cynical.

RT, many states with caps on non-economic damages have exceptions for gross negligence, like amputating the wrong leg.

Why- an MD who graduates at the bottom of the class is likely to be a shitty doctor. Well, there are alot of shitty lawyers, accountants, plumbers,nurses, bloggers, etc. out there also. Unfortunately, we are not a self-regulating industry. Revocation of medical licenses is soley in the jurisdiction of the state medical board. Visit your state's web site and see if they're doing their job.

As for improving the actual rate of malpractice, it CAN be done.

1. You can, as someone noted above, increase the punitive damages for doctors and hospitals who have frequent malpractice incidents.

2. Many malpractice incidents are not caused by "bad" MDs or nurses, but by systems that breakdown and prevent critical information or care getting to the right person at the right time. An example would be a bad hand-off of a patient between the ER and the OR, and no one realizes that a patient may have an extra clamp unaccounted for inside them after they've been sewn back up. Or, as someone cited above, a patient didn't have a health condition listed on their chart which would've made a difference in how they were treated. The fault in these examples is the SYSTEM, which lacks foolproof protocols and procedures. In the example above, WHY was the OR not notified about a clamp inside a patient coming from the ER?? It wasn't because the MDs or the nurses were stupid. WHY was a critical piece of information missing from a chart? Is it because the staff was in a hurry due to an overloaded work schedule? Or was it due to extreme tiredness? Such cases can be looked at, studied, and conclusion can be reached about common factors that may be the root causes.

As long as lawsuits can be made the easy scapegoat, then no one is taking a look at hospital systems and procedures and identifying their weak spots and improving them. After all, neither hospitals nor Doctors want to spend the time and money it takes to identify the real culprit in a incidence of malpractice, and instead they would both rather just legislate the lawsuits away.

I think it's very doable to greatly reduce the actual malpractice. (And no, it wouldn't require doctors and nurses to become superhuman.) It would save medical costs, save patients, AND I see no reason why it can't actually be an achievable goal. It seems to me that simply to take away the right of a citizen to sue for damages does nothing to address the reason why damages happens in the first place. At the very least, under our current system, it is only the threat of punitive damages that keeps the medical profession accountable to the public at all.

The underlying tenant for all insurance companies is that the larger the pool (of insured) the cheaper the cost. The insurance industry however, has divided the various medical specialties into separate insurance entities therefore, the fewer the neurosurgeon as opposed to GP's the most expensive the premiums and costs are. Increase the pool decrease the costs. (This is the reason universal health care works) Secondly, the medical malpractice insurance industry will pay off claims that are false (it happened to doctor acquaintence of mine)giving a false picture of claims paid and reasons for premium increases.

A friend had a life threatening emergency in Kuala Lumpur, just last week. Congestive heart failure brought on by a lung infection. Batteries of tests, in ICU for three days, in hospital for seven days. This is a state-of-the-art hospital with very good doctors, in case you’re wondering. Total cost, around $6000.

But then, Malaysians do not expect to automatically get wealthy beyond the dreams of most mortals simply by working in the medical fields in just about any capacity. (Nurses excepted of course. The are, after all, the workers and this is American capitalism.)

James of DC, your post is frightfully ignorant. Did it occur to you that the salary of a patient transporter in the US (minimum wages) might be 100x that of one in Malaysia? That a nurse in the US is paid $30/hr? Did it occur to you that cheap overseas labor is true for medical care as well as manufacturing? How about real estate? The surgical mask I put on today was not made in the US, but I bet the hospital got charged alot more.
And spare me the bullshit about the "noble Malaysians." They want to get wealthy too, like the rest of Asia. If you think medicine is the way to become "wealthy beyond the dreams of most mortals," please tell me how many billionaires and centi-millionaires are MD's, except for the ones who are CEO's of HMO's.
Grapeshot, the problems with "SYSTEMS" are mostly hospital problems. I can personally guarantee you that many doctors despise many hospitals and their incompetence. Unfortunately, medicine has been extremely tardy in adopting information technology- we exchange information via snail-mail and faxes. Finally, could you possibly accept the notion that some of us doctors are motivated by helping our patients? Afterall, I do occasionally save someone's life each year.

Didn't Mrs Kitty Killer win a 350,000 thousand dollar medical malpractice suit?

From the article:

"the study found that doctors were injuring one out of every 25 patients—and that only 4 percent of these injured patients sued."

By their criteria, I harm one patient every shift in the ER, and get sued twice a year. How many of you get sued twice a year for doing your job? That's 60 lawsuits over the course of a career. (I am below that stat--only one lawsuit in 3 years. A colleague just got sued for failing to diagnose pregnancy in the ER. Patient wanted 500K. It wasted my colleague's time, her lawyer's time, and now we all do a pregnancy test on every patient, included feminine-looking men because you never know, and apparently this is now our responsibility.) Is this really what you want in health care? For your doctor to spend as much time in the courtroom as in the ER?

By their criteria, I harm one patient every shift in the ER, and get sued twice a year.

Er, no.

Averages usually aren't evenly distributed among populations, and I think its very clear that malpractice suits (and certainly malpractice awards) are not uniformly distributed among medical practitioners. Rather, the bulk are concentrated on a small percentage of practitioners.

I failed to make my point, cmdicely. I meant to illustrate how loose their definition of 'injured' was. I find it hard to believe that an average doc injures one patient per shift, even in a place with high stakes such as the ER. I have at least one or two bad outcomes per shift, though, and if you looked closely at my management of those patients, you might be able to find something that could have been done differently, though whether a different course would have changed the outcome is anybody's guess.

I find it hard to believe that an average doc injures one patient per shift

The study cited doesn't say that the "average doc injures one patient per shift"; even assuming your patient load is average (something I certainly don't have the stats to evaluate), you can't combine averages that way to get a valid conclusion. To say something about that, you'd need to know how the distribution of patient load matched up with the distribution of injuries inflicted.

I meant to illustrate how loose their definition of 'injured' was.

There definition of "injured" was not "had bad outcomes". Their definition of "injured" was if two doctors, working independently, reached the conclusion on reviewing the case that harm was negligently inflicted.

Unless your work has been evaluated that way, and its been found that you negligently injure one patient per shift, you can't make any statement about how many people you injure "by their criteria". You are simply assuming that the average they found is the same as what they would find for you specifically, which is simply not justified.

You can't "illustrate" anything about their definition of injury by making a bunch of assumptions unjustified by their results and claiming that they somehow represent the findings and say something about them.

Strikes by public employee unions are illegal. Mayor Bloomberg should have arrested the union leadership and gotten a judge to impose fines on not only the union organization, but on each union member for each day the strike continued.

How convenient for big business that strikes by the public service workers are illegal, but that screwing those same workers out of their salary and benefits isn't. Why not arrest and jail the MTA leadership and the MTA for every day they force the union employees to work without a contract? Why is the onus on the workers and not on management?

As a letter writer to the Times put it yesterday, a union that cannot strike cannot negotiate. It can only beg.