Gods in White Coats Hold Key to Health Care: Margaret Carlson
Commentary by Margaret Carlson
June 19 (Bloomberg) -- Give me your arm, make a fist, relax. This isn’t going to hurt.
It always does but that just makes doctor and patient even. What really, really hurts, physicians say, are medical malpractice suits -- those humongous awards ladled out by gullible juries are more painful than a thousand hypodermic needles.
If only President Barack Obama would fix that, the American Medical Association says, it would be more open to his reforms. When the president traveled to Chicago last Monday to ask for the AMA’s support in overhauling the nation’s health-care system, some of his prescriptions were welcomed with applause.
When he said that he wouldn’t propose a cap on malpractice awards, he got booed.
It’s hard to picture that authoritative figure with the stethoscope descending to heckle a president. Should the moment make it to YouTube, it will make the man in the starched white coat harder to believe next time he says take these too-invasive procedures and call me in the morning.
But a funny thing has happened over the last decade that organized medicine doesn’t talk about. All those exorbitant awards that made the cover of Time magazine and provided grist for “60 Minutes” and “Dateline”? They’re old.
Juries, the backbone of the legal system, heard the stories, too, and started making the awards smaller so that the number of medical malpractice verdicts among the top jury awards declined dramatically over the past 20 years. So far this year, of the top 25 jury awards, only one was a malpractice case.
Deserving Victims
Amitabh Chandra, a Harvard University economist, said such awards are “a drop in the bucket,” about $3.6 billion out of $2.3 trillion spent annually on health care, with much of that money going to deserving victims.
It’s not exorbitant awards breaking the system, it’s the practice of overly defensive medicine -- tests, procedures, referrals, hospitalizations, and prescriptions ordered by physicians and justified by the fear of malpractice suits.
Ask your own doctor if he orders unnecessary procedures to protect against litigious patients and he’ll likely hedge a bit, say rarely, but go off into a brief speech against tort lawyers.
But it isn’t so rare. In a 2008 survey of specialists in Massachusetts, 83 percent reported practicing defensive medicine. According to researchers at Dartmouth Medical School, almost $700 billion a year is wasted on unnecessary care.
It’s easy to see one reason for that: it’s better to be safe than sorry. What a sickening feeling for the doctor who gets the call that he missed a growth on a lung or a dangerously clogged artery.
Follow the Money
But there is a perverse outcome when fear of lawsuits combines with a fee-for-service setup. Doctors may believe over- servicing patients is where peace of mind lies, although studies show it doesn’t. It also happens to be where the money is.
Alan Woodward, vice chairman of Massachusetts Medical Society’s professional liability committee, estimates that 10 percent of health-care costs go to defensive medicine justified by the threat of lawsuits. A first-of-its-kind survey of physicians by the Massachusetts Medical Society on the practice of defensive medicine showed that the practice is widespread and adds billions of dollars to the cost of health care.
Not only that, it reduces access -- the insured get more care than they need and the uninsured much less -- and adds to risk. Too much medicine is not a victimless crime. Although patients get a break on some diagnostic procedures -- does anyone want to undergo an extra colonoscopy -- it doesn’t mean increased reliability. Errors and complications can occur in the most routine situations. Over-exposure to radiation is a real risk.
Creeping Socialism
But when doctors are told that reform is going to correct an out-of-whack incentive system, they scream socialized medicine. Let a bureaucrat get their hands on my practice, the cry goes, and the result will be people waiting months for surgery and lines out the door for check-ups.
Congressional Republicans amplify the concern. Recently Senate Minority Leader Mitch McConnell warned darkly that Democrats were intent on putting “bureaucrats between patients and doctors.”
Well, we already have bureaucrats between patients and doctors and socialized medicine -- it’s just that the bureaucrats are from Aetna.
Fear of rationing by government is irrational. Insurance companies have perfected that art of claim denial at call centers that suck up your health-care dollar. I’m a lawyer and I can’t decode the “explanation of benefits” (or non-benefits) letters I get.
Code of Silence
Malpractice suits will only go away if doctors find a reliable way to police themselves. Peer review doesn’t work. No one turns in doctors publishing puff pieces about drugs and devices they’re being paid to like. They practice omerta when it comes to testifying against a fellow doctor.
Woodward has a solution. “To resolve disputes,” he says, “use mediation and arbitration.” But, he says, doctors will be less likely to have to resort to that if they explain to a patient what went wrong, “offer timely and fair compensation” and “a sincere apology.”
With such a system in place at the University of Michigan, Woodward says, lawsuits have dropped to 70 from 300 and malpractice-insurance premiums have dropped by a third.
Imagine the god in the white coat admitting error. I promise, really, it isn’t going to hurt.
(Margaret Carlson, author of “Anyone Can Grow Up: How George Bush and I Made It to the White House” and former White House correspondent for Time magazine, is a Bloomberg News columnist. The opinions expressed are her own.) |
