Health News and Scoops

Health care reform is currently a hot topic, but, like it has been for years, it is one that tends to make great progress in words and little progress in action. The current health care system in the United States is a futile cycle that only ends up generating heat rather than energy. The problems are clear; the solutions are not. We need to lower costs. We need to ensure that everyone is insured. We need doctors to perform fewer expensive, unnecessary tests to lower costs. Doctors need to perform more unnecessary tests to avoid litigation. Ah ha! One of the major dams in the flow of health care reform is litigation. Medical tort reform has attempted to surface itself in congressional debates on a yearly cycle, yet with the storm of medical lawsuits in the media “calming down,” its presence has all but disappeared, to the public.

This week in the New England Journal of Medicine, a panel of medical law experts argue that medical liability reform packaged with federal health care reform is the best way to go about making a change. Why? Because defensive medicine is driving the cost of health care to the roof, and change in litigation could provide some possibility for how to fund the potential health care reforms. In addition, health care reform is going to need the support of physicians, particularly when they are being asked to forgo more of their income for the sake of broadening access to health care (keep in mind the half of a million dollars in debt that many new M.D.’s find themselves in at this time).

Litigation reform would most likely gain the support of physicians, as well as many key Republicans, piecing together Obama’s desire for health care reform in a bipartisan fashion. Two major reform possibilities are outlined in the article mentioned, the first being the Patients’ Choice Act, and the second being the Fair and Reliable Medical Justice Act, proposed by Republicans in both the House and Senate. The Patients’ Choice Act calls for a behind-the-scenes litigation policy, where physicians and surgeons would verbally disclose their mistake to the patients and subsequently offer a payment deal. The patients wouldn’t have to accept, but it has been shown that nearly all patients accept pre-trial deals. This approach seems a little bit too sketchy, and gives off a hiding in the shadows feel, but perhaps the non-public aspect to it would be more favorable to physicians and may avoid the injury to their career that lawsuits often cause.

The second approach, and the most reasonable in my opinion, is the Fair and Reliable Medical Justice Act, where a committee consisting of uninvolved, neutral medical experts would decide whether the physician acted properly in the case at hand.   This approach seems the most practical because juries, without expertise, tend towards the emotional aspect of the trial. Bringing a child without her arm into the courtroom almost always leans the jury towards the patient, even if the medicine was perfect.

Another positive aspect of this approach is the ability to judge physicians on Comparative-Effectiveness Research (CER). This would provide physicians and surgeons with incentive to make decisions based on CER rather than continue defensive medicine, which would reduce cost and improve CER research simultaneously. Reduce costs and improve care? That might be too logical, but we’ll just have to wait and see.

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