Saturday, September 19, 2009

Health and tort reform: it's not about saving money

Many good ideas that have been around for years have benefited from being included under the banner of health reform. However, the recent focus on the cost of reform has made it seem that only ideas that are guaranteed to save money are worth including in a comprehensive overhaul of the system. Viewed in this light, if critics of reform can make the argument that an idea isn't cost-saving, it should be discarded.

Frankly, that's one of the stupidest arguments I've ever heard. Almost everything worth doing in health care costs money. If our top priority is saving money, we should hand out free cigarettes and alcohol to minors and remove seat belts and airbags from cars, because early deaths from cancer, heart disease, and automobile fatalities would save the health care system billions of dollars in health care expenses for seniors in the long run!

As Dr. Steven H. Woolf of Virginia Commonwealth University argues in an excellent policy paper for the nonprofit group Partnership for Prevention, health reforms should emphasize interventions that provide good value, rather than cost savings. Mammograms and Pap smears don't save money (because most women do not have breast cancer or cervical cancer), but our society generally regards the prevention of late complications of breast and cervical cancer to be a good thing. Gym memberships and healthy food choices cost money, but since exercise and healthy eating prevent heart attacks in some people, most would agree that those costs are worthwhile.

Another good idea that's been taking a beating recently is tort reform, or putting limits on malpractice lawsuits that drive up the price of malpractice insurance, drive up overall medical costs through doctors who practice defensive (or in some circles, CYA) medicine by ordering unnecessary tests and procedures, and in some states have led to an exodus of specialists in high-lawsuit areas such as obstetrics and neurosurgery. Yet recent newspaper articles have asserted that enacting tort reforms would be unlikely to save significant health care dollars.

Although I think this point is debatable, it's another case where the answer really doesn't matter. Tort reform is a good idea, whether it saves money or not. It is ridiculous that the only way that a patient (or grieving family member) can obtain money to provide for someone crippled by a bad health outcome is to sue the doctor, whether or not the doctor was "at fault" or not. As a result, the vast majority (greater than 90 percent) of patients who probably deserve compensation for medical errors never see a dime, and those who do receive compensation after years of litigation end up giving much of what they win to their lawyers.

Health reform would benefit greatly from including tort reforms modeled on existing no-fault compensation programs, such as the National Vaccine Injury Compensation Program or the Virginia Birth-Related Neurological Injury Compensation Program. That way, patients who suffer medical misfortune would get the funds they needed for care, good doctors who made mistakes would be able to apologize without fear of a lawsuit, and aggressive malpractice attorneys would get exactly what they deserved: nothing.

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