WSJ: Kicking the Malpractice Tort Out of Court

[spursncowboys]

http://online.wsj.com/article/SB10001424127887323869604578366770324716616.html


A promising idea that is gaining traction is to completely overhaul medical malpractice by kicking it out of courtrooms. Two states leading the way are Georgia and Florida, where lawmakers are considering repealing their medical tort system and replacing it with a medical-compensation board similar to those used for workers' compensation. Bills for the Patients' Compensation System have been introduced in both states.Getting rid of the entrenched malpractice system could have a major impact on health-care spending because one of the biggest cost drivers is "defensive medicine." Doctors tend to prescribe more tests and medicines and specialist referrals than necessary, all in an effort to protect themselves against malpractice accusations in the event that something goes wrong.
Defensive medicine occurs every day in doctors' offices and hospitals. We all pay for it with higher insurance premiums and larger out-of-pocket expenses.
Gallup surveyed doctors in 2010 just as President Obama was pushing the Affordable Care Act. The survey found that one in four health-care dollars spent in the U.S. can be attributed to the routine practice of defensive medicine. According to the independent health-care-economics firm BioScience Valuation, the annual cost of defensive medicine in America today exceeds $480 billion.
The Patients' Compensation System, or PCS, being studied in Georgia and Florida is a no-fault, administrative model for addressing medical injuries. Patients unhappy with their care would file a claim to a panel of health-care experts. If the panel found that a medical injury had occurred, the injured person would be compensated. Without the involvement of the current adversarial legal system—in which cases often drag on for years, only to be settled out of court—payments to the injured would come much faster, mostly likely in a matter of months.
The benefits of this system to taxpayers and patients would be enormous. According to BioScience Valuation, if the compensation system were adopted in Georgia, over the course of a decade with physicians stopping the practice of defensive medicine, the savings in Medicaid to state taxpayers would be $3.1 billion. In Florida, the estimated Medicaid savings would be $16.8 over the same period. The savings in private health plans would be considerable as well.
Patients who may have been harmed by a doctor would also have greater access to justice. Joanna Shepherd Bailey, an associate law professor at Emory University, has found that about half of trial attorneys in the United States refuse to take malpractice cases unless the potential damage awards are $500,000 or greater. Under the PCS, any patient who was found to have been harmed would be fairly compensated at a rate determined by the board.
Where would the money come from? Not from taxpayers. Instead, a fund would be created from malpractice premiums paid by medical providers. With no more litigation—and no more legal costs driving up the quest for big awards—large savings would inevitably result. The premiums paid by doctors would be substantially lower than the ones they currently pay.

[boutons_deux]

everything depends on who composes the compensation boards

The way America, the red states, and the health care industry have been fucking over citizens, safe bet is that the boards will be stacked with pro-health care, anti-patient members.

[ElNono]

death panels!

[Trainwreck2100]

nice idea that could work but in the end would most likely be corrupt as fuck

[ElNono]

I personally take the numbers with a grain of salt since the report was commissioned by a group that pitches tort reform.

Here's an interesting counterpoint (http://centerjd.org/system/files/CJDGAF.pdf) (PDF)

[FromWayDowntown]

So we don't want government having any real involvement in the delivery of health care, but having the final say in determining whether a health care provider complied with the standards of ordinary care in delivering those services? Makes absolutely perfect sense to someone, I'm sure.

[George Gervin's Afro]

How did tort reform work for Texas?

[TeyshaBlue]

How did tort reform work for Texas?

http://www.spurstalk.com/forums/showthread.php?t=128644&p=6425003#post6425003

Still one of the best articles I've read on this.

[vy65]

So we don't want government having any real involvement in the delivery of health care, but having the final say in determining whether a health care provider complied with the standards of ordinary care in delivering those services? Makes absolutely perfect sense to someone, I'm sure.

Your point is well taken but, government involvement in the delivery of health care is inevitable. All the proposal does is change the forum from the courtroom to the medical board of review room.

[ElNono]

Your point is well taken but, government involvement in the delivery of health care is inevitable. All the proposal does is change the forum from the courtroom to the medical board of review room.

Stripping citizens of their due process right as part of the transfer... for what? A 'promise' that it will be 'more fair and speedier'? Count me on the highly skeptical.

[spursncowboys]

Stripping citizens of their due process right as part of the transfer... for what? A 'promise' that it will be 'more fair and speedier'? Count me on the highly skeptical.
You consider what the trial lawyers do is due process? Emassing the case in "victims" and letting those people get less than one percent of the pay out, which more times than not is done in a settlement, out of court.

[ElNono]

You consider what the trial lawyers do is due process? Emassing the case in "victims" and letting those people get less than one percent of the pay out, which more times than not is done in a settlement, out of court.

Seems to me the problem in those cases is the citizen's arrangement with his/her lawyer. Removing due process for every citizen to somehow 'fix' that problem seems overkill, IMO.

There's certainly something to be said about the 'cost of justice' in this country. But at the end of the day, it's the impartial judges, not the lawyers that award compensation.

[spursncowboys]

ElNono: So it's an ideological concern to you?

If you had to create a bullet style page of problems with healthcare costs, what would you put?

[spursncowboys]

I'm not saying this is an end all solution but I like the idea of it. Florida and Goergia are big enough able to be a good control to see if this helps or does absolutely nothing to the cost. This is an improvement to the Texas model, which has allegedly done nothing to costs-but has increased the number of dr's per thousand people.

[ElNono]

ElNono: So it's an ideological concern to you?

My concern is with surrendering constitutional rights in the name of some alleged benefits. Specifically in doing so without actual evidence that A) the replacement system is fair or as good as the one it's replacing and B) it will drive down cost of care for the citizens involved.


If you had to create a bullet style page of problems with healthcare costs, what would you put?

In no particular order, although some are costlier than others:

- Pricing: Everybody down the healthcare provider food chain prices bear to market. That is, they price to what they think will bring maximum revenue, not what gives most accessibility, affordability or will cover their costs + modest profit. This is a dilemma that has existed forever not just in the US but everywhere else. This is a far more complex problem that what I could type on a single paragraph, but there are different solutions to this, although none of which will please the service providers.

- Overhead: The insurance middle-man not only adds costs not involved in actual care, but also insulates the patient from direct contact with the provider on the billing side, oftentimes making patients fairly unaware on how much things cost in general. Even the so called not for profit insurances sometimes only work with affiliated service centers, which means the patient ends up paying the same but with fewer choices or poorer care.

- Competition: There's no reason not to have insurance companies compete across state lines if they chose to do so. Another angle here is patent protection, which has a lot to do with pricing.

- Cost of living: This one is what it is. This is a rich country by any measure, and thus it's more expensive to live here, pay the bills, etc. Thus costs are higher.

[ElNono]

I'm not saying this is an end all solution but I like the idea of it. Florida and Goergia are big enough able to be a good control to see if this helps or does absolutely nothing to the cost. This is an improvement to the Texas model, which has allegedly done nothing to costs-but has increased the number of dr's per thousand people.

Hey, I said I was merely skeptic. I would agree the state level is the place to try that kind of stuff out.

[Th'Pusher]

SnC what do you think about this oped re healthcare?

Republicans are losing elections they could win by slavishly clinging to untenable solutions for skyrocketing health care costs that voters reject.


The House Budget Committee, chaired by Paul Ryan, is proposing a plan to balance the budget in 10 years. That requires lowering the trajectory of Medicaid and Medicare costs, which account for 24 percent of federal spending.

Ryan proposes offering seniors the choice of a subsidy to buy private insurance or continuing in the existing Medicare system, and giving the states block grants to manage Medicaid.


Conservatives believe seniors could shop for health insurance, as they do for groceries, to drive down prices. The states, freed from excessive federal oversight, could similarly drive down costs.
That’s absolute fantasy.


Seniors would confront large insurance companies armed with too little information, and limited choices or monopolies when they purchase drugs and hospital care. That's not a fair fight--like individuals with bows and arrows vs. B-52s.
Already, large employers operate in a similar market space—free to negotiate with health insurance companies—and even they have not been able to harness rising health insurance premiums.


To put it mildly, Granny will not do any better than GM jawboning Humana and Walgreens. Federal Medicare spending could only be cut by providing inadequate subsidies that would require seniors to pay much larger premiums and out-of-pocket costs than they currently bear with traditional Medicare.


Similarly, it is doubtful that the states, acting individually, can do a better job of negotiating reimbursement rates for Medicaid services for the poor than does the federal government. In fact, the Ryan solution could drive up prices, because providers could play off states against each other.


The Ryan approaches were incorporated into the 2012 GOP presidential platform and rejected by voters.
If the House budget plan incorporates these approaches, Republican Senators will be forced to choose between supporting those or abandoning the House budget in favor of Senate Democrats’ plans for higher taxes. That could prove poisonous for Republican Senators seeking reelection and House Republicans considering runs for Senate seats.


Sometimes markets don’t work—that’s why we don’t have private fire departments selling subscriptions, or memberships, and why taxi fares are regulated in major cities. Or even more, why governments regulate utility rates-- deregulation of electricity has usually been a disastrous experiment, as in California a decade ago.


Every other major industrialized country has given up relying on competition to harness health care costs. The chances that Ryan has come up with a better idea--and can sell it to the public in the teeth of Democratic opposition--are laughably nil.


When confronted by those facts, conservatives often point to single provider systems in Britain where some citizens complain about long lines and inferior care.


Germany has a private provider system quite similar to the one evolving with ObamaCare—everyone has to play and most folks are covered by mandatory government-subsidized, employer-based insurance; however, unlike ObamaCare, that system aggressively regulates prices through private-sector consensus building.
Again, like, a utility--that’s the point.


Germany caps health care spending, and sets provider prices through a complex system of private sector negotiations that divides up the pie.


Americans spend nearly $10,000 per person on health care, while the Germans spend half as much. By most measures, German health care is as good or superior to what Americans receive.


Just like the government doesn’t always know best, markets and competition don’t always contain costs effectively and provide the best outcomes. Germans--who aren’t liberals-- get it, but conservative Republicans don’t.


Moreover, a German solution, by costing the federal government so much less, streamlining the morass of regulations and reporting requirements, better engaging private providers, and reducing federal and state costs, would actually reduce and better limit the bureaucratic burdens insurance companies and government agencies impose on health care providers.
As long as unbending conservatives like Paul Ryan control Republican thinking on fiscal policy,the GOP will not offer solutions to the nation’s budget woes that attract popular support, it won’t win back the Senate in ’14, and it faces terrible difficulties winning the presidency in ’16.




Read more: http://www.foxnews.com/opinion/2013/03/14/conservative-economist-explains-why-ryan-budget-plan-is-all-wrong-for-gop/#ixzz2ODwJ66By