Medical malpractice liability insurance reform

[shireen]

Hi ...

I'd like to start a thread on the medical malpractice liability insurance reform that's been a hot topic. Why? Because I don't understand what the hell is going on!

For the longest time, I was a casual observer of this story ... I'd read about it in the Sun, shake my head in disgust, and move on to the next disgusting piece of news.

Then my obgyn had to drop the "ob" part of her practice, and I got livid. This lady is an incredible doctor; bringing babies into the world is a labor of love for her (pun intended). For 2005, the vampires wanted $120,000 for the ob premium. She could not afford it.

I just spoke to someone at Senate legislative services... she said that the special commission's report is going to be out soon. I'm also going to try to find some coherent background info (all this legalese makes my head spin).

So, if anyone understands this issue and has comments, or can provide links to some readable stuff, please post!

cheers,
shireen

[lwrachel]

1. reform overdue!

[AndyTiedye]

6. Unless "Reform" Means You Can't Sue a Doctor No Matter How Badly...

...they mess you up. Unfortunately, that's what it means.

[burythehatchet]

2. I've spent 22 years in this business and it is frustrating

to try and get the parties to do the right things. The basic problems relate to privatization of services that should really be in the public realm, i.e., universal health care. What kind of links are you looking for because the there are many facets to this issue and very few comprehensive analysis'. There's legal, quality, finance, and distribution issues that will continue to prevent a comprehensive solution as long as their incentives remain as they are. Conflicting goals = high cost and lower efficiency.

[jimquilty]

3. the first thing you ought to know

is that the only real reform that is needed is a reform of the insurance industry. Trial lawyers - of which I am one - are the republican target for all that ails the system. The reality, however, is that the increase in premiums that drive some doctors from certain areas of practice has to do w/ insurance companies recouping $$$ they lost or amping up profits for shareholders when the market is down and/or they put their funds in underperforming investments. Lawsuits represent 1-2% of the total cost of healthcare. Moreover, we have empirical evidence that "reforms" in the form of caps that have been adopted in several states actually have no positive effect on insurance rates. In facts, the states with caps, in many instances, saw their premiums rise at a faster pace than non-cap states. All of this is validated in a non-partisan congressional study of the issue that was released last year just before congress was set to vote on related issues. The republicans attempted to delay the release of the report. The reality is that the legal system is stacked in favor of the docs and hospitals. The number of lawsuits and level of recovery has remained relatively flat if not declined.

[burythehatchet]

5. I don't disagree with most of what you say

and I'm looking at it fromo the standpoint of what would reform the system.

Now you have to ask yourself - How do you propose to "reform" the insurance industry?

These intractable problems arise when multiple parties all have to plenty to gain by continuing the current mode. Under this system, Insurance companiesget away with muder, attorneys get away with inordinate fees (with all due respects - I managed a large captive insurance company that underwrites med mal and I see the abuse on ALL sides), and practitioners get away literally with murder. There are tons of legitimate claims that are never filed.

So before you suggest that one party or another is to blame, you have to refocus a broader perspective if you want to accomplish change.

[shireen]

15. Re: I don't disagree with most of what you say

It sounds like an impartial entity is needed to resolve this stuff. We can't depend on elected officials to do this as long as they're dependent on corporate donations. I wonder what it would take to *really* put all parties in their place? Really frustrating.

Universal Health Care is such a good idea. Why don't the knuckleheads get it?

[Stinky The Clown]

8. I have a question on this issue for the docs and attorneys here

During the campaign the Kerry team, mostly in the voice of John Edwards, spoke about a plan to reduce the number of truly frivolous lawsuits and to also help the medical community escape from the stink of bad docs.

Essentially, they called for (what seemed to me to be) narrow forms of peer review. In very simple terms they called for lawyers who file more than some set number of suits found by their peers to be frivolous to be prevented from further work in the medical malpractice arena. In a similar vein, they asked that the medical profession do a better job of peer reviews of their own people.

The whole notion behind this was that if they cleaned up their own there would be a reduced need for government intervention and all the ills of intended and unintended consequence, most of which usually least favors the public.

My own industry, highly specialized and employing at most a few thousand individuals worldwide, has a code of professional standards and has used them to censure (the farthest we can go) our members who transgress.

The difficulty, it seems to me, is the fact that the associations and/or professional societies (ABA, AMA, etc) that represent professionals have, in many cases, two conflicting roles. On the one hand, these organizations are about establishing standards and, yes, codes of ethics. Their work is to raise the professionalism and level of quality of their constituents. On the other hand, these same organizations have the role of trade association, who's job is to promote and protect their industry against all attacks on the *business* aspects of the professions. In my industry, this has been identified as an issue, but never solved.

Does any of this make sense to the lawyers or doctors on here? I'd be very interested in hearing your views.

[shireen]

16. Re: I have a question on this issue for the docs and attorneys here

Just a comment ...

I don't know how well peer review works. I'm in a scientific field. Getting peer reviewers for funding proposals is like pulling teeth. Time is a big issue for these very busy people.

It's hard for me to see doctors in the role of peer reviewers, unless they're semi-retired. They're under pressure to have a certain amount of patients for the practice to make a profit. My primary care doc, whom I love, is constantly working. She takes her current caseloads home with her each night. When I was in the hospital, she'd come by on weekends and late evenings. She has young kids; this is a trememdous sacrifice she's making to care for her patients (no matter how well she gets paid). I keep chiding her about it, and she keeps telling me "l love my job".

Perhaps it's time to pull academic medical ethicist into this problem. Perhaps they're the people who will treat everyone fairly in untangling this mess. If you know of any articles by them, please let me know.

[shireen]

13. Re: the first thing you ought to know

Just wondering ... what do Republican trial lawyers think of all this? Do they exist?!

[DavidMS]

19. I have to agree

I would love to see a "Maryland Mutual Medical Insurance Company," non-profit insurance cooporative that would exist to provide doctors in maryland with cheap insurance by being member owned (they wouldn't have a profit motive to boost rates) and would increase competation in the market.

[shireen]

10. Re: I've spent 22 years in this business and it is frustrating

That's depressing. Universal Health Care is never going to happen as long as corporations have a strangle-hold on politics!

The thing I'm most interested in right now is understanding why Mike Miller and other Democrats are opposed to Ehrlich's proposal (i've not read it yet, on my reading list).

There's been a lot of thrashing of trial lawyers. Why? Is it just a few ambulance-chasers who are giving all trial lawyers a bad name? Even my doc, who I consider a reasonable person, is mad as them. She thinks that the main reason Miller was oppossed to it is because he used to be a trial lawyer.

Are the insurance companies hogging the money? Are they the culprits?

Basically, why is the system so broken? How are the various participants in this issue to blame?

[burythehatchet]

18. ...

Insurance companies are simply creditors who need a required ROR for their investors. They're not going to behave responsibly, and unfortunately, trying to reform that sector is more difficult than reforming healthcare.

Tbirulent attacks against trial lawyers are simply because they are an easy and identifyable target. There are some firms that have learned techniques to basically hold providers ransom, and while they do not account for a huge portion of the cost, they do influence how others law firms do business. Its basically a race to the bottom. This area needs to be reformed. Personally I have been very frustrated in trying to stop some long standing practices. For example, when one looks at the cost of a claim, we have to count not only the compensation for the plaintiff atty, but also your own atty. Its very difficult to justify a scenario where you pay the your own atty 100K, you pay the plaintiff 80K and the plaintiff atty gets 70K. It makes no sense. Legal expenses account for almost 50% of the cost of claims. That's just one example, there are more.

There are no culprits and there are no saints in this equation. The reason this situation is allowed to exist is because everyone makes money from it. Claims drag on for years, depleting management resources away from the very thing that they are trying to achieve and prevent claims.

Personally, I believe that there should be no caps of any sort. However, every claim must be arbitrated and mediated before clearing some very high hurdles to litigate. Most injured parties just want to be made whole.

This would not be such a big problem with universal health care.

[Sandpiper]

4. Beware the red herring that insurance premiums are tied to lawsuits

The "tort reform" crowd likes to throw this one around, not withstanding the fact that it has been proven false.

Here's a good primer:

http://www.consumerwatchdog.org/healthcare/nw/nw003146.php3

[shireen]

11. Re: Beware the red herring that insurance premiums are tied to lawsuits

Thanks for that very interesting link. Intuitively, as someone who knows little about this convoluted issue, regulation makes sense. And I agree that caps have the potential to hurt patients.

I like the idea of sound regulation of insurance companies, but that's as un-Republican as gay marriage. :-(

[Warpy]

7. insurance companies lost money in the stock market

after Bush got into office. To compensate for the loss of revenues, they decided to raise premiums. That's one part of it.

Another part hitting OB docs especially hard is the problem of unrealistic expectations. People think they're guaranteed a risk free pregnancy and delivery and a perfect infant. They're wrong, pregnancy and childbirth may be normal conditions, but they are risky. When it's your child who is hurt, you look for somebody to blame, and that's usually the poor doc.

Then you have the real problem, the hiddnen one. People get huge settlements for badly injured family members because we have no national health insurance, and the awards are based on a lifetime of high medical expenses.

Another part of the problem is that 5% of the docs out there are resposible for 50% of the malpractice payouts. Nobody's cut off their insurance or otherwise policed them. It's really hard to get a doc's license pulled, and when you do, he just goes to another state.

Most huge awards are reduced on appeal, which is how our system is supposed to work. However, it costs money to fight one of these suits, and insuarance companies try to settle out of court.

So you see there are many parts to the problem. Patients who have been injured by a negligent of malpracticing health provider are not the problem, nor are the lawyers.

[shireen]

12. Re: insurance companies lost money in the stock market

"Another part hitting OB docs especially hard is the
problem of unrealistic expectations.  People think they're
guaranteed a risk free pregnancy and delivery and a perfect
infant.  They're wrong, pregnancy and childbirth may be normal
conditions, but they are risky.  When it's your child who is
hurt, you look for somebody to blame, and that's usually the
poor doc. "


That's exactly what my doc said, and I agree. But there has to
be some kind of support system for kids who are accidently
injured during birth. Ideally, that should be the government's
role. 

This sounds like a real tangled mess. 

We need intelligent thoughtful fair legislators. Is that an
oxymoron?  

[DaveinMD]

9. this reform

is part of the Republican continued assault on groups that support Dems. The true goal is to eviscerate trial lawyers, thereby cutting off a major funding source for Dem candidates. Real mal pract reform would be insurance reform. But Medchi is a part owner of medical mutual. Its a blatant conflict of interest.

[shireen]

14. Re: this reform

I've been puzzled about MedChi. When I first asked my doc to point me to some websites, she sent me to their website. I was surprised to see they were in the insurance business. Is this a case of a wolf in sheep's clothing?

[DaveinMD]

17. they are the official rep of doctors

but they make money by getting a cut of insurance profits. Its a definite conflict.