Essay
Washington Post: What Crisis?
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An Op-Ed piece at NYT gives us this:
Seducing the Medical Profession Published: February 2, 2006 New evidence keeps emerging that the medical profession has sold its soul in exchange for what can only be described as bribes from the manufacturers of drugs and medical devices. It is long past time for leading medical institutions and professional societies to adopt stronger ground rules to control the noxious influence of industry money on what doctors prescribe for their patients.
Seducing the Medical Profession
Published: February 2, 2006
New evidence keeps emerging that the medical profession has sold its soul in exchange for what can only be described as bribes from the manufacturers of drugs and medical devices. It is long past time for leading medical institutions and professional societies to adopt stronger ground rules to control the noxious influence of industry money on what doctors prescribe for their patients.
The rest of the piece has examples of excesses and a simple and appropriate conclusion. I point this piece out because of the swift-boating of lawyers in the last few years. Lawyer jokes have always been around, perhaps thanks to that old loon Socrates, but the spectre of “rising malpractice costs” has been weilded quite effectively, especially by the conservatives (since trial lawyers are the paymasters of the Democrats), to further tar lawyers and present insurance costs as a malpractice problem.
The AMA has been a willing participant, labelling this the “malpractice crisis“. The noble myth that doctors are looking out for their patients, always, lends weight to such claims and reasoning. It is worthwhile hence to note the behaviour of doctors and where their loyalties lie, as illustrated by the NYT article above.
The malpractice crisis myth has been exposed many times over, including a piece by Business Week which not only found the empirical data (on malpractice costs and settlements) unconvincing but also identified the real cause of rising insurance costs as the insurance industry’s investment adventures (and subsequent losses) during the tech boom years.
Below are excerpts from relevant articles:
Washington Post: What Crisis? GAO: Malpractice Premium Spikes Don’t Force Out Docs By Sandra G. Boodman Washington Post Staff Writer Tuesday, September 16, 2003; The stories are legion: pregnant women unable to find doctors to deliver their babies because disgruntled obstetricians have closed their practices or retired in droves; white-coated physicians hitting the picket lines and threatening to shut down emergency rooms; desperate patients forced to travel long distances to find a specialist willing to perform lifesaving surgery. The culprit, according to the American Medical Association (AMA) and President Bush: multimillion-dollar jury awards in malpractice cases that have resulted in insurance premium increases so huge that they are forcing doctors out of business and jeopardizing patients’ access to health care. But a new study by the General Accounting Office (GAO), the investigative arm of Congress, has reached a very different conclusion about the effect of rising malpractice premiums on consumers. Investigators who studied nine states found instances of localized but not widespread problems of access to health care mostly in “scattered, often rural, areas” that have long-standing problems attracting doctors. And many of those highly publicized accounts of doctors who have retired or moved are, according to the GAO, either “not substantiated,” temporary or involved only a few physicians. In Pennsylvania and West Virginia, for example, two of 19 states designated by the AMA as being in a “full-blown liability crisis,” the number of doctors per capita has actually increased in the past six years, according to the GAO.
Washington Post: What Crisis?
GAO: Malpractice Premium Spikes Don’t Force Out Docs
plsfield:creditWashington Post Staff Writer
plsfield:disp_dateTuesday, September 16, 2003;
The stories are legion: pregnant women unable to find doctors to deliver their babies because disgruntled obstetricians have closed their practices or retired in droves; white-coated physicians hitting the picket lines and threatening to shut down emergency rooms; desperate patients forced to travel long distances to find a specialist willing to perform lifesaving surgery.
The culprit, according to the American Medical Association (AMA) and President Bush: multimillion-dollar jury awards in malpractice cases that have resulted in insurance premium increases so huge that they are forcing doctors out of business and jeopardizing patients’ access to health care.
But a new study by the General Accounting Office (GAO), the investigative arm of Congress, has reached a very different conclusion about the effect of rising malpractice premiums on consumers. Investigators who studied nine states found instances of localized but not widespread problems of access to health care mostly in “scattered, often rural, areas” that have long-standing problems attracting doctors.
And many of those highly publicized accounts of doctors who have retired or moved are, according to the GAO, either “not substantiated,” temporary or involved only a few physicians.
In Pennsylvania and West Virginia, for example, two of 19 states designated by the AMA as being in a “full-blown liability crisis,” the number of doctors per capita has actually increased in the past six years, according to the GAO.
In Florida, where the state medical society told congressional investigators that all the neurosurgeons in Collier and Lee counties had stopped practicing, the GAO found at least five such specialists at work in each county. Although medical groups have repeatedly warned that doctors are reluctant to come to Florida because of escalating premiums, the GAO found that the number of new medical licenses issued by the state has increased in the past two years. A study released last week about Maryland, where medical groups have warned about a “crisis” caused by rising malpractice premiums, reached similar conclusions. Researchers from Public Citizen Health Research Group analyzed government data and found that the number of malpractice claims filed per physician declined significantly between 1996 and 2002, as did the amount paid by insurers to cover claims. And while some groups have warned about an “exodus” of physicians, the number of doctors in the state actually increased between 1996 and 2002, according to the advocacy group. “Every 10 years we hear the same thing: that all the doctors are leaving, that patients can’t get care; it’s sort of a ritualized dance,” said J. Robert Hunter, former federal insurance administrator who is now director of insurance for the Consumer Federation of America, a Washington-based advocacy group. “And the reason is always the same,” added Hunter, who also served as Texas insurance commissioner. “The AMA and insurance companies blame the tort system.” Previous malpractice “crises,” Hunter said, occurred in 1975 and the mid-1980s and represent cyclical economic fluctuations; the latest downturn was delayed by the sustained economic boom of the 1990s. “What the latest GAO report shows is that the threat about access to health care is largely overblown,” said Maryann Napoli, deputy director of the New York-based Center for Medical Consumers. “It’s interesting that [organized medicine] always zeroes in on pregnant women every time there’s a so-called crisis. […] Hunter, an actuary, said that he oversaw the production of a study last year for a coalition of 100 consumer groups that tracked 30 years of malpractice payments and insurance premiums. The report concluded that there has been no malpractice “explosion” during the past three decades and that payments have been “extremely stable” since the mid-1980s. Premiums paid by doctors, Hunter’s study found, “do not correspond to increases or decreases in payouts,” but “rise and fall in concert with the state of the economy. . . . Insurance companies raise rates when they are seeking ways to make up for declining interest rates and market-based investment losses.” That conclusion is similar to one reached by the GAO in a report released last June. Among the causes of the latest round of malpractice premium increases, the congressional investigators found, were insurers’ losses in their investment portfolios, inadequate reserves to pay claims and artificially low rates set during the 1990s when many companies vied to attract policyholders. […] But while doctors’ groups often talk about how ruinous malpractice lawsuits are for physicians, the cover story in the May 23 issue of Medical Economics, a magazine widely read by doctors, had a more reassuring message. “The vast majority of malpractice claims are dropped by the plaintiff, dismissed by the court for lack of merit, or settled before trial for an amount within the defendant’s policy limits,” senior editor Berkeley Rice noted. “Of those cases that do go to trial, most end in victories for the defense.” Nationally, studies have found that doctors and hospitals win about 70 percent of cases that make it to a courtroom. Multimillion-dollar awards by juries are often bigger than the amount actually paid by an insurance company or doctor; these awards can be reduced by a judge, overturned on appeal or, more commonly, are the subject of negotiations between lawyers for both sides that dramatically reduce the amount a victim receives. […]
In Florida, where the state medical society told congressional investigators that all the neurosurgeons in Collier and Lee counties had stopped practicing, the GAO found at least five such specialists at work in each county. Although medical groups have repeatedly warned that doctors are reluctant to come to Florida because of escalating premiums, the GAO found that the number of new medical licenses issued by the state has increased in the past two years.
A study released last week about Maryland, where medical groups have warned about a “crisis” caused by rising malpractice premiums, reached similar conclusions. Researchers from Public Citizen Health Research Group analyzed government data and found that the number of malpractice claims filed per physician declined significantly between 1996 and 2002, as did the amount paid by insurers to cover claims. And while some groups have warned about an “exodus” of physicians, the number of doctors in the state actually increased between 1996 and 2002, according to the advocacy group.
“Every 10 years we hear the same thing: that all the doctors are leaving, that patients can’t get care; it’s sort of a ritualized dance,” said J. Robert Hunter, former federal insurance administrator who is now director of insurance for the Consumer Federation of America, a Washington-based advocacy group.
“And the reason is always the same,” added Hunter, who also served as Texas insurance commissioner. “The AMA and insurance companies blame the tort system.” Previous malpractice “crises,” Hunter said, occurred in 1975 and the mid-1980s and represent cyclical economic fluctuations; the latest downturn was delayed by the sustained economic boom of the 1990s.
“What the latest GAO report shows is that the threat about access to health care is largely overblown,” said Maryann Napoli, deputy director of the New York-based Center for Medical Consumers. “It’s interesting that [organized medicine] always zeroes in on pregnant women every time there’s a so-called crisis.
[…]
Hunter, an actuary, said that he oversaw the production of a study last year for a coalition of 100 consumer groups that tracked 30 years of malpractice payments and insurance premiums. The report concluded that there has been no malpractice “explosion” during the past three decades and that payments have been “extremely stable” since the mid-1980s.
Premiums paid by doctors, Hunter’s study found, “do not correspond to increases or decreases in payouts,” but “rise and fall in concert with the state of the economy. . . . Insurance companies raise rates when they are seeking ways to make up for declining interest rates and market-based investment losses.”
That conclusion is similar to one reached by the GAO in a report released last June. Among the causes of the latest round of malpractice premium increases, the congressional investigators found, were insurers’ losses in their investment portfolios, inadequate reserves to pay claims and artificially low rates set during the 1990s when many companies vied to attract policyholders.
[…]
But while doctors’ groups often talk about how ruinous malpractice lawsuits are for physicians, the cover story in the May 23 issue of Medical Economics, a magazine widely read by doctors, had a more reassuring message.
“The vast majority of malpractice claims are dropped by the plaintiff, dismissed by the court for lack of merit, or settled before trial for an amount within the defendant’s policy limits,” senior editor Berkeley Rice noted. “Of those cases that do go to trial, most end in victories for the defense.”
Nationally, studies have found that doctors and hospitals win about 70 percent of cases that make it to a courtroom. Multimillion-dollar awards by juries are often bigger than the amount actually paid by an insurance company or doctor; these awards can be reduced by a judge, overturned on appeal or, more commonly, are the subject of negotiations between lawyers for both sides that dramatically reduce the amount a victim receives.
[…]
[I must note that I have edited out a few general AMA attempts at defense from the above, which you can read by following the link]. Most importantly, the article concludes:
“What’s often lost in this discussion is that there is much more malpractice than there are malpractice suits,” Napoli noted. A 1991 study by Harvard University researchers, still regarded as the most influential of its kind, found that acts of medical negligence are eight to 10 times more common than malpractice lawsuits.•
“What’s often lost in this discussion is that there is much more malpractice than there are malpractice suits,” Napoli noted. A 1991 study by Harvard University researchers, still regarded as the most influential of its kind, found that acts of medical negligence are eight to 10 times more common than malpractice lawsuits.•
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