A new study underscores that tort reform will just hurt women, children and the poor
Is defensive medicine a big driver of healthcare costs? A new study debunks the notion, again
Tort reform," which is usually billed as the answer to "frivolous
malpractice lawsuits," has been a central plank in the Republican
program for healthcare reform for decades.
The notion has lived
on despite copious evidence that that the so-called defensive medicine
practiced by doctors merely to stave off lawsuits accounts for, at best,
2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're
a problem that exists mostly in the minds of conservatives and the
medical establishment.
There
seems little reason to pursue (malpractice reform) as a means to
dramatically reduce health care spending in the United States. - Healthcare analyst Aaron Carroll on proposals to limit malpractice lawsuits
A new study
led by Michael B. Rothberg of the Cleveland Clinic and published in the
Journal of the American Medical Association aimed to measure how much
defensive medicine there is, really, and how much it costs. The
researchers' conclusion is that defensive medicine accounts for about
2.9% of healthcare spending. In other words, out of the estimated
$2.7-trillion U.S. healthcare bill, defensive medicine accounts for $78
billion.
As Aaron Carroll observes at
the AcademyHealth blog, $78 billion is "not chump change ... but it’s
still a very small component of overall health care spending." Any "tort
reform" stringent enough to make that go away would likely create other
costs, such as a rise in medical mistakes generated by the elimination
of the oversight exercised by the court system.
Since
it doesn't appear that "tort reform" would have any effect on this
spending, Carroll says, "there seems little reason to pursue it as a
means to dramatically reduce health care spending in the United States."
The
prevalence of defensive medicine may be overestimated by doctors
themselves, Rothberg and his colleagues found, because many procedures
are ordered in part defensively, but partially or mostly for legitimate
diagnostic or therapeutic reasons. "Tort reform" would only eliminate
orders made purely because of fear of litigation -- that is, 100%
defensively -- and that's a tiny percentage of the total.
Tort
reform has seldom been about reducing healthcare spending. For
Republicans, it's about de-funding a bloc of reliable Democratic Party
supporters -- trial lawyers.
That's
why the suppression of malpractice lawsuits has remained part of
Republican and conservative orthodoxy despite the evidence that its
impact on healthcare spending would be minimal. Even in conservative
healthcare pundit Avik Roy's supposedly objective proposed alternative to the Affordable Care Act (which we examined here), malpractice "reform" retains its pride of place.
Roy
acknowledges the findings that defensive medicine accounts for only 2%
to 3% of spending, but writes, "nonetheless, reform is warranted." He
asserts, curiously, that "the U.S. health care system is uniquely
vulnerable to frivolous malpractice lawsuits." But if the numbers don't
validate that claim, what does?
The minimal impact of defensive
medicine on healthcare costs demonstrates the injustice of the stringent
limits on malpractice lawsuits advocated by doctors, insurance
companies and Republican policymakers.
As we've pointed out in the past,
"pain-and-suffering" damage caps and other stratagems to discourage
malpractice lawsuits benefit mostly insurers. Their impact falls
disproportionately on women and families with infants, because their
economic damages, which remain subject to jury awards, are hard to
estimate and typically underestimated.
As
for "frivolous lawsuits," defined as cases that should never have been
brought at all, they're a lot rarer than most tort reform advocates
admit. Studies have documented that the vast majority of them don't
yield a payment to the plaintiff. The converse is a bigger problem --
genuinely injured patients who can't get redress because the courthouse
doors have been shut to them. The victims there are often lower-income
or unemployed patients.
The quintessential tort reform law is California's MICRA,
to the state's shame. The Medical Injury Compensation Reform Act capped
noneconomic and nonmedical damages in malpractice to $250,000 in 1975.
Inflation has eroded that sum to the equivalent today of about $57,000
in 1975 dollars.
To
have retained its value, the MICRA limit would have to be raised to
about $1.1 million today. That's the goal of Proposition 46 on the
November ballot. Even though the MICRA increase has been yoked to a
silly plan for drug testing of doctors, it's worth your vote.
Roy's
proposal would impose the same $250,000 limit on noneconomic damages
for any patient receiving a federal health insurance subsidy under the
Affordable Care Act or enrolled in Medicaid, Medicare or any other
federal program.
Why them? Apparently only because they're within
the grasp of federal law. Roy all but acknowledges that there's no
legitimate economic reason for this punitive approach. It won't save a
significant amount of money. It won't change the direction of healthcare
costs. It's just nastiness, and as is usual with conservatives
approaches to healthcare, it punishes the most defenseless members of
society. Healthcare policy should do just the opposite.
source
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment