Reforming Medicine And Liability
President Obama took the topic of reforming health care directly to the doctors who deliver it in a speech to the American Medical Association Monday.
"To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact," Obama said.
The president pushed “public” health insurance, another word for a government-backed insurance plan, and breaks for doctors challenged by trying to deliver high quality health care in too little time.
One of the biggest rounds of applause came when Mr. Obama said that medical malpractice needs change.
Without promising capping medical malpractice awards, the president recognized the doctors’ fear of lawsuits.
“Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”
The president received a round of booing when he said he would not back caps on jury awards in medical malpractice cases.
Outgoing AMA president, Nancy Nielsen, said the president was the first Democratic president to discuss liability reform.
"What we were very pleased about was that he is open to considering options that would lower the cost of defensive medicine” – that is delivering what could be excessive medical care to cover the doctor from potential liability," she said.
The incoming AMA president, J. James Rohack said that doctors need a “safe harbor” that offers protection in a court room for not ordering a test. Unless that happens, they are going to order the test, he said.
In InjuryBoard Voices today, Cecelia Prewett writes that changing the legal system will not create a cost savings.
She points to a Congressional Budget Office (CBO) report and a recent Government Accountability Office (GAO) analyses, which shows physicians will over-test and over-treat purely for financial reasons, unrelated to liability concerns.
Studies show that medical malpractice cases are actually filed in a small proportion of the cases where a doctor has made a mistake on a patient. Others show that about five percent of doctors are committing the bulk of medical malpractice, yet medical societies are hesitant to take away a doctor’s license to practice.
The Chicago Tribune in a two-part report in May (Part 1, Part 2) revealed the suffering by patients of a couple of Chicago OB-GYNs, with decades-old records of malpractice allegations.
Public Citizen reports that Minnesota, Maryland, South Carolina and Wisconsin are among the worst with the lowest rates of disciplinary action against acts of malpractice.
Public Health Plan
Republicans believe the word “public” is masking a government health insurance plan that would compete with private insurers. Doctors believe that a government plan would echo the low Medicare rate of compensation which pays doctors based on the number of patients they see, not the quality of outcomes.
The president said that the public plan is a friend of the doctor not their enemy because the current rate of escalating health care costs is unsustainable.
He blasted the opposition to public health plans fueled by lobbyists and interest groups which have “used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.”
Instead - doctors would be able to spend more time with patients, following up and seeing them through to a positive outcome, which would be the basis of compensation instead of focusing on a formula, the Sustainable Growth Rate (SGR) formula, which is tied to politics and a state budget and which threatens doctors with a five percent payment cut each year.
“That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient’s bedside to check in or makes you call a loved one to say it’ll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that’s what our health care system should let you be.”
The president suggested bundling payments, transitioning to online medical records, and using doctor teams to treat patients.
Without holding a line on spending, the president said one of every five dollars will be spend on health care at the present rate within a decade, and in 30 years, it will be one in every three dollars.
The Wall Street Journal has the text of the president’s speech. #