President Obama addressed the American Medical Association this past week.  He laid out his vision for health reform.  Many in the audience applauded his general statements of reform.  But when it came to specifics, there were skeptics.  The President seems to believe that health reform can be accomplished without major tort / malpractice reform.  He seems to believe that health reform can only be accomplished if the federal government offers an option for insurance.  He seems to believe that costs can be contained if only doctors would practice medicine based on judgment, not defense.

Unfortunately, real health reform, may be slipping away as the President fails to provide the much needed courage of leadership on the difficult choices. Let’s examine just a few of these choices.

TORT / MALPRACTICE REFORM

Without a meaningful attempt to reign in the trial lawyers lobby, cost cutting will not occur.  As we have pointed out in a previous post (Medicine’s Most Expensive Technology: The Doctor’s Pen June 10, 2009), physicians control much of the costs of the system via the tests, medicines and procedures they order.  The vast majority of “excess” that occurs in these areas is due to concern about “covering your bases” in case a lawsuit occurs.  The government has focused on physician ownership, when in fact, that is a small, perhaps negligible part of the issue.  The real nemesis here is the trial lawyers lobby.  The President, a lawyer, seems unwilling to address this issue head on in a serious way.  States that have malpractice caps have seen moderation in rates.  Caps on damages in these states almost always apply only to PUNITIVE awards, NOT to medical expenses.  Recall the definition of punitive: inflicting or intended as punishment.  The very nature of this implies that physicians and other health care providers intentionally seek to harm patients.  The number of cases of gross negligence, when compared to the overall number of malpractice claims is minimal.  The vast majority of suits are filed for “bad outcome” (generally complications) and to a lesser extent for “wrongful death” (meaning the doctor caused the death needlessly through action or inaction).  In almost all of these cases, no claim can be made for willful malice, negligence or intent to injure, only error – and in most cases not error, just that things did not go the way all hoped for.

FEDERAL INSURANCE OPTION

This one is actually easy.  Anyone know of any health insurer offering PRIMARY health coverage to individuals who are of Medicare age?  Well, if you are working and have group coverage through an employer you might, but the vast majority of Medicare eligible citizens will find NO primary option to standard Medicare – a government health insurance program (well sort of, since there is some adjustment of premiums based on income, it is also a form of health insurance welfare).  As for Medicaid, the same is true.  The fact is that if the government offers a tax payer financed option t0 compete  on the open market, you will, over a relatively short time, have no private health insurance options available for primary coverage.  To be sure, supplements will abound, just as they do under Medicare, but in essence, there will only ONE health insurance plan and that will be the government option.  Which means . . . all citizens will have to have the government option for their primary coverage, since the private market will offer only supplements to those already covered by the government plan.  I know, I know . . . the President said this is not his intention, that this will not happen . . . folks, wake up . . . Mr. Obama knows full well this IS what will happen (and that is the meaning of IS).  He talks softly and reassuringly on this issue, but the outcome is already well known.  Once again, just look at the example of Medicare.

COST CUTTING

His comments about guidelines and such, lead one to believe that he views “medical judgment” as a matter of following written codes of practice/conduct (i.e. cookbook medicine) and that if doctors will only do so then malpractice issues will fade away.  This is naive at best, and disingenuous at worst, as he knows full well that exercising true medical judgment requires freedom from frivolous legal actions and the freedom to make choices for individual patients, not blindly follow an outline based on meta analysis of published studies with expert opinions added in.  This site is well versed in modern medical guidelines and algorithms.  They are helpful and continuing to update them is both challenging and useful.  But they are NOT a substitute for sound, medical judgment when caring for the unique ills of an individual patient.  They are a tool, not a panacea.  Cost cutting efforts by doctors will only have broad acceptance when medical malpractice abuse is eliminated.

In the end the road to Real Health Reform is not as complicated, expensive or disruptive as the President and many around him would have us belivee.  Common sense, with a dose of true market oversight and meaninful regulation is all that is required to address most of what is wrong (see Details on “the plan” @ http://realhealthreform.wordpress.com/the-plan/details-on-the-plan) . . . obi jo and jomaxx

In his remarks, he noted that for the vast majority of Americans, physicians “are the health care system” and are therefore an integral part of any reform discussions. He also noted that while he does not support caps on non-economic damages in medical malpractice cases, he does support reform of the system so that doctors are not forced to practice defensive medicine and can go back to treating their patients in the manner in which they feel is best, without having to look over their shoulders. He also noted that his intention is to allow physicians to stop spending their time acting as administrators and accountants and allow them to instead be physicians.

Obama takes healthcare campaign to doctors – http://www.boston.com/news/health/articles/2009/06/16/obama_takes_healthcare_campaign_to_ama/

Cost Concerns as Obama Pushes Health Issue – http://www.nytimes.com/2009/06/16/health/policy/16obama.html?_r=1&ref=us

Obama opens to applause at AMA – http://www.suntimes.com/news/politics/obama/1623150,obama-chicago-health-care-reform-ama-061509.article

Obama strengthens pitch for health care at AMA – http://www.usatoday.com/news/washington/2009-06-14-health-care-reform-tax_N.htm

Obama calls cost of healthcare a threat to economy – http://www.latimes.com/news/nationworld/nation/la-na-obama-ama16-2009jun16,0,2626159.story

Obama pitches health care reform to MDs – http://www.washingtontimes.com/news/2009/jun/16/obama-pitches-health-care-proposal-to-doctors/?feat=home_headlines-

Obama pushes for healthcare reform – http://www.ft.com/cms/s/0/c5583f24-59cc-11de-b687-00144feabdc0.html?nclick_check=1

Senate Mulls Over Health-Bill Details – http://online.wsj.com/article/SB124506633511614937.html

Obama Tells AMA Current Health System Not Working – http://www.bloomberg.com/apps/news?pid=20601202&sid=aX9aTOF6pQKg

Despite differences, Obama and medical community vow reform – http://features.csmonitor.com/politics/2009/06/15/despite-differences-obama-and-medical-community-vow-reform/

Obama tells AMA U.S. health-care costs are a ‘ticking time bomb’ – http://www.chicagotribune.com/business/chi-biz-obama-ama-meeting-june15,0,5236331.story

Obama presses doctors to back health care overhaul – http://news.yahoo.com/s/ap/20090616/ap_on_go_pr_wh/us_obama_doctors;_ylt=AgYroJQmkU1FiizWex6dY2Rp24cA;_ylu=X3oDMTJubzR0ZjFuBGFzc2V0A2FwLzIwMDkwNjE2L3VzX29iYW1hX2RvY3RvcnMEcG9zAzEyBHNlYwN5bl9wYWdpbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA29iYW1hcHJlc3Nlcw–

Obama’s counterattack on healthcare – http://thehill.com/leading-the-news/obamas-counterattack-on-healthcare-2009-06-15.html

Will Doctors Buy ObamaCare? – http://www.forbes.com/2009/06/15/obamacare-ama-congress-business-healthcare-obamacare.html

Obama’s Doctor Knocks ObamaCare – http://www.forbes.com/2009/06/18/obama-doctor-knocks-obamacare-business-healthcare-obamas-doctor.html

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