Wednesday, September 29, 2004

Hiram offers up his thoughts on Medical Malpractice reform, and Rick offers up an Amen. I know Rick and I have met Hiram, they are nice guys. But on this one I have to totally disagree with them.

OneMan's family pays for Malpractice Insurance (for Mrs. OneMan) I have a different perspective on the issue.

The argument that the high cost is all about the fact that insurance companies are just greedy and/or have had a poor return on their investments is idiotic. If that were true then some enterprising insurance company could step into the medical malpractice insurance realm and make a killing.

If I could offer malpractice insurance at just a 10% discount vs. other carriers I would have doctors breaking down my door and I would make a fortune.

However the opposite is true. Firms are leaving the business in this state (last item). Do you think it is because they are making so much money? My wife's carrier (for Nurse Practioners (her premiums along with other NPs have nearly doubled in the last 3 years) no suits, no disciplinary actions) informed us that coverage may not be available in all states next year and coverage for part-time NPs may come to an end as well. Are these really the actions of a company making a killing selling insurance?

Some say putting price controls on malpractice premiums that is the solution. That will just drive more insurance companies out of writing malpractice insurance and help eliminate what price competition there is. Please show me a market where price controls have lead to lower costs and/or more options?

Why do some states have a problem in this area and not others, is it because doctors are really bad in Chicago or this example from DeKalb

In 1985, Dr. Roger Haab, now an internist with the DeKalb Clinic, was working in an emergency room—a high-risk environment. His malpractice insurance was $3,500 a year.

Today, as an internist with no claim or judgment in his entire career, his malpractice insurance is $35,000 a year.
Than they are in other locations in the midwest?

For example, a neurosurgeon’s malpractice premium costs $58,020 in Wisconsin—and $228,396 in Illinois.

Are you trying to tell me that cost difference is because doctors are 4x worse in Illinois or that the insurance companies here are really bad with their investments? Perhaps the reason is that Wisconsin has caps on 'Pain and Suffering' and a state fund that covers large payouts?

By putting reasonable caps on 'Pain and Suffering' not caps on lost wages, not caps medical costs and not on continuing care you can create a much more predictable model that will make it less risky for insurance companies to write malpractice insurance.

For example in Madison County the average malpractice payout went from $276,000 to $495,000 between 2002 and 2003 do you think that was because the non-pain and suffering costs went up that much or were there bigger pain and suffering payouts.

The California cap law has resulted in slower premium growth and a reduction in pain and suffering payouts.

Are bad doctors part of the problem, yes. Are medical mistakes part of the problem, yes.

Ask Sen. Gary Forby (D-Benton) (3/4 of the way down) if there isn't a problem with malpractice insurance in this state.

The sad fact is doctors are leaving parts of this state and hospitals are dropping services because of malpractice insurance costs. Is it because doctors in some parts of the state are statistically that much worse? No. It's because Juries are.

Sorry this is vaugely ranty, it's late...


1 comment:

Anonymous said...

You make lots of good points, One Man. Others in this current online debate have as well.

This will sound hokey at first, but what's really needed is leadership. I'm not talking about flag-waving leadership. I'm talking get everybody together and make them cut a deal leadership.

In situations when neither side wants to give in, the governor has to be the one to take control and force a solution. But Governor Blagojevich doesn't want to throw the lawyers under the bus, so he can't possibly be an honest broker.

Appointing a surrogate, as the governor has done, is no real solution unless Blagojevich is willing to give that surrogate the power to make some very unpopular decisions and then back him all the way and expend lots of political capital to pass his plan. I'm not sure if that will happen. In fact, I'm pretty dubious.

And even though you make some good points, the Illinois State Medical Society is also at fault here. The docs own a med-mal insurance company, which has often taken precedence over physician priorities during the legislative negotiations. It's a tricky conflict of interest because the docs started the insurance company, ISMI, during the first med-mal crisis in the 1970s when other companies were fleeing. It now covers over half of all docs, so they obviously need ISMI, but ISMI is also an obstacle to a solution.

A lot of this is cyclical, as the ups and downs of the issue for the past 30 years have proved over and over again. The first time the Il Supreme Court struck down a state med-mal law was during the aforementioned 1970s crisis.

The two sides did make remarkable process in the spring, believe it or not, but the guv needed to step in at the end and force everyone to agree to the last remaining items. He wouldn't do it. Until he truly steps all the way up, nothing will get done.

- Rich Miller
Capitol Fax