States, not Congress, address tort reform

This issue remains the most important issue in health care! Without a better way to handle malpractice we will eventually have decreased access to care. Physicians cannot practice when overhead exceeds reimbursement.

The most important issue in health care? Maybe from your perspective, but not from that of your patients. And the evidence that doctors are leaving the field because of malpractice premiums doesn’t even rise to the level of anecdote. Why use one standard of evidence in medicine and another in setting public policy?

If there’s less risk when we ultraspecialize, why is it that the most ultra of the specialists have the highest malpractice insurance rates?

There is higher risk with the subspecialties. BUT……there is higher reward.

You see the shortages in areas when the reward is not commensurate with the risk.

Mammography is one example. Low reimbursement with potentially high risk if the patient develops cancer. The nature of mammograms is such that a plaintiff attorney can always find someone willing to say some little squiggle on the mammogram was really a cancer someone should have noticed (in retrospect).

Other examples are geriatric care, especially nursing homes. Obstetrics. You find OB/GYN’s dropping OB privileges to do just GYN, you don’t often see it the other way around, dropping GYN to do just OB. Hospitals frequently have rules over how long a doc must be in a hospital before dropping OB (“X” number of years, or sometimes cannot drop OB at all if doing GYN). There’s a reason for that, beyond the obvious hassle of the odd hours.

I am being asked to cover the nursery and attend obstetrical deliveries for the baby. I’m trained for it. Did it in the past, but chose to stop, and now I’m being asked to come back (hard to find enough people to do it). But I’m not obligated to do so. Why should I? The liability risk is high, and the reimbursement (Medicaid) is low.

Friends in the insurance industry tell me they have a saying, “You can insure a burning house. It’s easy to calculate the premium. The premium will be the cost of clearing the site, plus the cost of materials and labor to rebuild the house, plus an administrative fee”.

You would not have problems finding radiologists to read mammograms if the service paid a fee compatible with the risk.

But I have to agree, this is not a problem in the minds of the public.

Not yet.

It will not be a problem in the eyes of the public until they find there are no doctors to care for them when they need it.

Problem is, by the time that becomes obvious to a significant number of people, even if you could snap your fingers and make the malpractice problem magically disappear, it will take upwards of a decade to replace the doctors lost.

You will lose the doctors in the specialties and geographic areas where the reward did not equal the risk. So even if you remove the risk, the reward is still low, and those areas will be the hardest sopts to fill.

Oh, and maybe we won’t get that $250K limit on noneconomic damages, maybe it will be $300K or $500K. The idea is, the limit has to be predictable.

So pick a number and stick to it. Yeah, I’d prefer $250K, but even if it is $500K, the idea is, we know what it will be at worst, and can insure ourselves accordingly.