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Gutsy, But Frank and Fair
In one speech, President Obama confirmed what had become obvious in the past few weeks: He not only wants to lead on health-care reform but also wants to define the terms of engagement. Quite to the contrary of most pundits, the President has preemptively stated which parts of the upcoming legislation is open to compromise and which are not. Further, he took a nominally supportive stakeholder and showed a real willingness to take them seriously if they will meet the challenge.
While he could have spent the entire speech with feel-good talk about fixing the sustainable growth rate (Sustainable Growth Rate legislation, in place since 1997) , financial incentives for adoption of the electronic medical record and reducing regulatory and billing complexity, he plunged directly into the hard and cold facts of reform.
Importantly, he opened the door to real malpractice reform, but surprisingly drew a line in the sand at capping non-economic damages (the basis for most state-based reforms). He did not shy away from other topics with considerably controversy: shifting government support toward primary care (training and reimbursement) and reducing low-value health care (controversial only if you are practicing low-value medicine!)
On a personal level, I was impressed that he did not only address the concerns of the membership. He reminded the audience that there are real people with real problems out there. And that the problems will only get worse through inaction.
Winning over the membership of the American Medical Association may not be necessary, but it certainly would help. The AMA may only represent a very small fraction of all physicians, but they can be quite monolithic and passionate. While the President may very well just miss Chicago, he made a strong statement in making this trip. Only time will tell whether the public groundswell will push the AMA to truly engage in this process--or whether the AMA's current tepid support will ultimately hurt the chances of passage.
By
Howard Forman
|
June 16, 2009; 10:17 AM ET
| Category:
Health Care Reform
,
Insurance
,
Leadership
,
Medicare
,
Primary Care
,
Public policy
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Posted by: lensch | June 19, 2009 4:54 PM
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Facts on Malpractice:
1. The total of all malpractice insurance premiums amounts to 0.56% of health care costs.
2. The CBO has examined the idea of defensive medicine. They found no difference in practice between states with limits on tort settlements and those with no limits.
3. There is no correlation between the price of malpractice premiums and the amount given out in malpractice settlements.
4. The price of premiums does (anti) correlate with interests rates.
5. If you take all the money given out in malpractice settlements over $250,000 in NJ ( a state without caps) in a year and give it to physicians, each doctor would get $15.
The first four come from the book The Malpractice Myth by Peter Baker (U of Chicago Press) while I believe the last is from Uwe Reinhardt (sounds like him).
Thus the doctors are wrong on almost every count. Malpractice premiums are not a significant factor in health costs. Physicians order unnecessary tests and treatments even when there are draconian limits on lawsuits as in Texas. Caps would save us nothing. The price they pay for insurance has nothing to do with the large settlements given out, and the total amount of money involved in these settlements is trivial. What they believe is a fantasy.