Wednesday, December 7, 2016

Health Care and Tort Reform

Dr. Tom Price

One of the signature issues of Donald Trump’s campaign was the repeal of the Affordable Care Act or Obamacare. However, I noted in an earlier post that Obamacare was actually repealing itself. Premiums are increasing at double digit rates and already high deductibles are getting even higher. Also, the number of insurance companies participating is getting smaller and smaller.

Just this past week Connecticut announced that HealthyCT, one of its most promising non-profit health insurance coops, would go out of business on December 31. In the past couple of years the enrollment numbers had not met expectations despite lower than average premiums, and claims had skyrocketed. At the same time, the Federal funding that was designed to help these coops get off the ground has now run out. The State announced that existing claims would be paid out of an insurance industry fund designed to rescue insolvent companies. HealthyCt’s remaining customers will have to find new coverage.

I suspect that the fate of HealthyCT is being replicated all over the country. Premiums are increasing all over and claims continue to rise. Apparently, some states are now down to only one health insurance provider. A recent article in the Wall St. Journal suggested that about 40 different proposals to replace or change Obamacare have been proposed by Republicans in Congress in the past four years but not one has been able to get past President’s threat of a veto.

This week President-elect Donald Trump announced his nomination of Representative Tom Price of Georgia to become head of the massive Department of Health and Human Services (HHS). As a Congressmen, Price has championed a replacement for Obamacare based on 20 years of experience as an orthopedic surgeon and on his belief that the less government interferes in healthcare the better.

What can the new administration do to rein in rising health care costs? I’m sure that the will be many different suggestions and plans but I would just like to mention one. If the government or Medicare can regulate what hospitals, physicians, and drug companies receive for their services, I don’t see why it can’t pass significant tort reform and limit the size and extent of medical malpractice awards to attorneys who typically get 33% of the claimant’s award. I also don’t see why enormous punitive damages that do not benefit the actual claimant should be permitted.

Medical malpractice insurance makes up a huge part of the expenses that hospitals and physicians must pass on to their patients. Why should this be a political issue? Why have liberals and Democrats always opposed tort reform? The doctors and hospitals that actually provide the medical care must accept what Medicare and Medicaid allow but there is practically no limit on what lawyers, who add nothing to medical care, can charge.

Just recently I read that a commuter train conductor who crashed his train into the landing platform in New York’s Grand Central station was suing the rail line for $10 Million. He had fallen asleep on the job and his train crashed after hurtling through the Grand Central tunnel at over 80 miles per hour. Nevertheless, his attorney claimed that the rail company should have installed fool-proof braking devices in all trains to protect against conductors like his client.

I am not saying that all medical malpractice claims are like this one but even if they are not, what reasonable person would think a lawyer should get over $3 Million for one case? Anyone on Medicare who looks at the monthly claims report knows that the medical insurance company, following Medicare guidelines, typically reduces the hospital or doctor bill substantially. When I had radiation treatment for prostate cancer, the hospital billed my insurance company over $120000. I have no idea how the hospital arrived at that figure but it accepted the insurance company allowance of about $14000 of which I had to pay 20%.

It will not surprise me to see tort reform in the medical proposals emanating from the new Congress. The lawyers have a powerful lobby and taking it on will be a test of the dedication of Donald Trump and the Republicans to reforming health care.


1 comment:

  1. Cenzo from Fairfield comments:

    It's about time you wrote a concise and to the point blog. The lawyer issue goes without saying. Their bullshit is killing the country. The ACA does have a couple of good items, most notably the elimination of the pre-existing condition penalty and keeping junior on until age 26( you and I both realized years ago the pre-ex problem). They should retain the positive in the ACA and rewrite it from there.