Pass health care reform first,
then tackle the malpractice mess
This piece appeared
in the blogs at
Author: Samuel Metz
Too many Oregon legislators
refuse to support Gov. John Kitzhaber's health reform bill
(Senate Bill 1580) unless it contains medical malpractice
reform. If their goal is to kill the bill, they will
succeed. If their goal is to create an authentic
long-lasting solution to our malpractice mess, this
strategy will be disastrous. Here's why.
Most states and our federal
government struggled with tort reform for decades. With
one exception (see below), none produced even a hope of a
permanent solution. The chances of our Legislature
succeeding in the next month where all previous attempts
failed are imperceptible.
Of these previous attempts,
most only revised monetary caps on awards. However, health
care dollars spent on defensive medicine are nearly
eightfold larger than that spent on premiums; nationally,
$55 billion versus $7 billion. While caps temporarily
reduced malpractice premiums in some states, the vastly
greater sums spent on defensive care remain unchecked. No
level of award caps will remove the need of physicians to
protect themselves by practicing defensive medicine.
Health care dollars are not
saved with caps.
These cap proposals dodge
the sordid reality of our malpractice morass. Less than 3
percent of medically injured patients ever receive a penny
of compensation. Less than half the money paid in premiums
ever gets to patients; legal costs consume the rest. Caps
will not increase the number of injured patients receiving
compensation, nor will they reduce the number of lawsuits.
Furthermore, every state
legislature enacting caps in one session finds the next
year's session inundated with well-funded lobbyists from
physicians and attorneys, all ready to take up weapons
again. This war never ends.
The single state with a hope
of effective malpractice reform is Vermont. Under its
proposed health care system, every patient receives needed
care for any injury, medical or not, regardless of the
presence or absence of negligence. No injured patient need
resort to legal action to get needed medical care. The
system also created a compensation fund specifically
designed to award financial support to medically injured
patients. The amount is determined by patient need, not
proof of physician culpability.
One final point: The public
perceives that we physicians act on negligent care only
after court action. In many cases, sadly, this is true. If
we are to assure patients they do not need lawsuits to
promote better care, we physicians must be more visibly
proactive in policing ourselves. This means having medical
groups, hospitals and medical boards detecting and
remedying negligent care before court action occurs and,
hopefully, before patients are injured.
Oregon deserves the chance
to provide better care at lower cost promised by the
health care transformation act. It also deserves
authentic, long-lasting medical malpractice reform. We are
unlikely to get that reform with caps, amendments to an
already controversial bill, or before the next full moon.
Pass the health care transformation act first, and then
give tort reform the detailed and unhurried attention it
Physician Samuel Metz is
a member of Mad As Hell Doctors and Physicians for a
National Health Program, both of which advocate for
publicly funded universal health care. He lives in