Is it time for malpractice reform?
Very interesting article by Joanne Kenen in The American Prospect:
Year after year, Republicans try to pass legislation that would limit medical malpractice awards. Fix the tort system, they argue, and we fix rising health-care costs. And year after year, Democrats resist placing arbitrary caps on awards to people who may have suffered from an egregious medical error. The fight plays out like a predictable old Western — good guys versus bad guys. Depending on your politics, the villain is either the greedy doctor or the greedy trial lawyer.
Health reform invites a fresh look at malpractice. The Republican tort-reform agenda hasn’t magically fixed what ails American health care in states that have tried it. But progressives can test new models of medical malpractice reform because — done right — they may lead to a more consistent, more timely, and more equitable approach to compensating people who have been harmed. As Ezekiel Emanuel, a bioethicist and White House adviser on health policy, writes in his book Healthcare, Guaranteed:
There’s little question that the system is broken … Numerous studies have shown that the majority of patients who suffer a medical error are not compensated, while a select few win outsized awards. And on average, patients must wait nearly five years to resolve claims and receive payments from a malpractice case — six if the case is related to the delivery of a baby.
The experiences of individual patients and families in the legal system can be wildly inconsistent, creating what the Republicans with some justification call "jackpot justice." Meanwhile, doctors complain of malpractice premiums that vary enormously depending on the state and the medical specialty, from around $10,000 to $100,000 or higher. Beyond addressing these problems, new methods may also encourage a more vigorous "culture of safety" in a country where some 200,000 people die each year from medical errors, hospital-acquired infections, and avoidable complications — many of these safety challenges are systemic, not the fault of individual sloppy doctors.
Health-care reform isn’t just about covering more Americans and controlling costs. It’s also about quality. Repairing health care requires "delivery-system reform" — moving away from inefficient and inconsistent care and toward more coordinated, value-driven medicine. But it’s hard to get doctors enthused about adopting a "less is more" approach if they fear lawsuits from patients who think less is simply less and believe they have an inalienable right to more and more. More CT scans. More back surgeries. Even more colonoscopies. Overtreatment has many causes — the idiosyncrasies of a physician’s training, local practice patterns, the doctor’s bottom line. But many experts believe that limiting "defensive" medicine, which is notoriously hard to quantify, would at least remove one barrier to fixing the broken system. Economists may believe that "defensive medicine" is less of a problem than doctors do. But it’s the doctors who have to accept the new care models — and get their patients to follow…
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