Burnt Orange Report

Instapundit had that today too. I've always like the DMN.

Not quite the Startle-Gram, representing one of the most conservative major cities in TX, running Krugman and Dowd all the time and having to fire staff members for branding the Young Conservatives of Texas 'jackbooted little fascists' or some such.

GAO Report and Prop 12
Prop 12 will place a limit or cap on non-economic (pain and suffering) damages.

GAO recently released (August 2003) a report to Congress titled “Medical Malpractice- Implications of Rising Premiums on Access to Health Care.” The GAO performed several studies and analyses. Some of the analyses included Texas and other studies did not.

Have caps on pain and suffering lowered the growth of malpractice premiums in the past?
GAO report: Yes (GAO-03-702, “Medical Malpractice- Implications of Rising Premiums on Access to Health Care,” p. 30).

Are medical malpractice claims the greatest contributor to increased premiums?
GAO report: Yes (GAO-03-702, p. 9).

What Texas included in the study about the causes of increased premiums?
Yes (GAO-03-702, p. 9 footnote 14).

Will caps lower the price of malpractice premiums in the long run?
GAO and Congressional Budget Office (CBO): Yes, a federal cap will drive down the long-term price of malpractice premiums (GAO-03-702, p. 34). Passing a cap in Texas will hopefully add momentum to legislation for a federal cap.

Are doctors practicing defensive medicine (i.e. ordering more tests in fear of missing something and being sued)?
GAO report: Yes (GAO-03-702, p. 26).

How much does defensive medicine drive up medical costs?
GAO report: Unknown, not enough data (GAO-03-702, p. 26).

Other than defensive medicine, what other malpractice related issues are driving up medical costs?
GAO report: GAO confirmed that some hospitals are paying for all or part of their physicians’ high premiums in order to maintain access to care. GAO also confirmed that some physicians and nursing homes are continuing to give access without malpractice insurance (GAO-03-702, p. 25).

Did this GAO report directly address healthcare access in Texas?
No.

Is there a lack of access to care due to malpractice premiums in Florida, Nevada, Pennsylvania, Mississippi, and West Virginia?

GAO report: Debatable. In the few localized instances and often in rural areas in Florida, Nevada, Pennsylvania, Mississippi, and West Virginia that received much media coverage, GAO confirmed that certain events (such as ER closure in Nevada and patients in Mississippi having to drive 65 miles to deliver because OBs closed their rural practices) were in fact due to high premiums.

“We [GAO] confirmed instances where physician actions in response to malpractice pressures have resulted in decreased access to services affecting emergency surgery and newborn deliveries in scattered, often rural areas of the five states. However, we [GAO] also determined that many of the reported physician actions and hospital-based service reductions were not substantiated or did not widely affect access to health” (GAO-03-702, p. 12).

In other words, GAO claimed that statewide problems with access to health care due to high premiums in the five states studied did not exist. AMA contested the GAO claim (GAO-03-702, p. 38). Many opponents of Prop 12 are misusing the above GAO statement to claim that a national healthcare crisis does not exist. This GAO report did not investigate access to health care on the national level. GAO has yet to determine if there is a national healthcare access problem due to high premiums, and GAO will continue to monitor the problem for Congress.

Are doctors leaving these five states (Florida, Nevada, Pennsylvania, Mississippi, and West Virginia) because of the high premiums?
GAO report: A few have left, but there is no great exodus of doctors from these states.

Are doctors choosing to limit high-risk services in the above five states?

GAO report: Further, the GAO found that physicians were not limiting higher-risk services such as mammogram and spinal on state-wide levels. (GAO-03-702, p. 12).

The confirmed instances of limited access to care are few, but they maybe implications of a greater problem for the underserved. One implication is that rising premiums could lead to a lack of access of health care for the underserved (Mississippi example). Another implication is that these few incidents are random and that they indicate nothing. For the GAO’s complete analysis, please refer to pages 12 to 18 under the subheading “Implications of Rising Malpractice Premiums on Access to Health Care.”

If access to health care for the poor is not a problem in Texas, do we wait until premiums get so high that we do have problems with access to health care for our less fortunate? Vote Yes for Prop 12 and reduce the malpractice premiums.

Kurt Reyes
Medical Student
UT Health Science Center at San Antonio

Source: GAO (http://www.gao.gov/new.items/d03836.pdf)

Let's look at that report more closely. Here are some if its conclusions (see http://www.gao.gov/cgi-bin/getrpt?GAO-03-836):

1. There is no medical malpractice crisis. In its study of five states without major tort reforms, the report concludes that the doctors have wildly overstated their case. E.g. "We also determined that many of the reported physician actions and hospital-based service reductions were not substantiated or did not widely affect access to health care" (p. 12). "Although some reports have received extensive media coverage, in each of the five states we found that actual numbers of physician departures were sometimes inaccurate or involved relatively few physicians" (p. 17). "Contrary to reports of reductions in mammograms in Florida and Pennsyslvania, our analysis showed that utilization of these services among Medicare beneficiaries is higher than the national average in both [states]" (p. 21).

2. The report was "commissioned" by the proponents of tort reform, who clearly wanted the GAO to buttress their case, but this independent report actually undercuts it.

3. The report notes that the AMA wanted the GAO to withhold release of the report until "state and national medical and specialty associations" could provide better information. But these were the very groups that had supplied much of the data that the GAO used as the basis for many of its findings (p. 38).

4. The report strongly supports the case that there are lots of reasons for the few problems of access to care the GAO could confirm, while the AMA blames everything on medical malpractice litigation. "The problems we confirmed were limited to scattered, often rural, locations and in most cases providers identified long-standing factors in addition to malpractice pressures that affected the availability of services" (p. 13).

5. The GAO is extremely skeptical of the claim that the tort system encourages unnecessary defensive medicine. The report takes the offense against the AMA position by noting that (1) some defensive medicine is good medicine, (2) managed care discourages bad defensive medicine, and (3) doctors do defensive medicine because they make money from defensive medicine (p. 26-27).

6. It characterizes the CBO study on the supposed savings resulting from HR5 as actually finding that state tort laws have no impact on medical spending (p. 29).

7. It criticizes the HHS study for publishing a wildly inflated estimate, based on an improper methodology, of potential savings from defensive medicine (p. 29).

8. It measures growth in claims on a per capita basis, not an aggregate basis. This is the right way to do it, making it clear that claims payments have grown far slower than any measure of inflation, in both cap states and non-cap states (p. 35).

9. The report consistently emphasizes that the surveys upon which the AMA bases its claims have a low response rate and thus "preclude the ability to reliably generalize the survey results to all physicians" (p. 38).

10. It specifically criticizes as unreliable the two data sources relied on by the doctors: PIAA ("it does not share proprietary state-level claims data"); and Jury Verdict Research ("a varied and unsystematic data collection process") (p. 52).

11. The analysis supports the case that the doctors, in effect, blackmailed the legislatures and governors in Nevada, Pennsylvania and
West Virginia (p. 14-15).

12. The one unhelpful finding in the report-that claims and premiums have risen faster in states with caps than without-is explained by reference to the experience in just two jurisdictions, the District of Columbia and Pennsylvania: if these two states are eliminated, then for the time period 1996-2002, average claims payments in the states without caps were about the same as in those states with caps (p. 34-35).

13. It emphasizes that, to the extent that premiums or claims are lower in cap states than non-cap states, multiple factors are responsible-which is the same conclusion as the first GAO report.

All that said and done, let's do something about careless doctors. Maybe that will solve the problem of innocent victimes being injured and killed.

Adam Studnicki
Medical Malpractice Lawyer
Studnicki, Jaffe & Woods, PLLC
http://www.sjwlawyers.com

I agree with Mr. Studnicki's final comment on taking care of careless doctors. Let's get more state money so that the state medical board can investigate and punish those bad docs.

However, I want to also take care of careless lawyers. Let's see how many medical malpractice lawyers really want to pursue frivolous malpractice cases if we pass caps on retention fees and the amount a medical malpractice lawyer receives from a jury's award or settlement.

Currently, malpractice lawyers receive what?...up to 1/3 of the settlement/jury award? Let's cap it at 3% or a maximum of $50,000 per case. Removing the financial incentive in malpractice case will help reduce/remove the frivolous suits.

The GAO report also shows that states with caps on lawyer's fees inconjuction with caps on pain and suffering equals the lowest growth rate in malpractice insurance. There are bad docs, but there are many more bad lawyers. LAWYERS NEED TO BE REGULATED MORE THAN DOCTORS . . .AFTERALL, ISN'T THE RATIO OF LAWYERS TO DOCS AROUND 10 TO 1?

Kurt Reyes
Med Student

Everyone please take a look at Mr. Studnicki's website. He and his associates are testimony of how financial drives lawyers to seek and pursue frivlous lawsuits. They claim they have recovered "millions". These millions result in higher malpractice premiums and also result in some specialties not providing services. For example, if you receive a brain bleed south of San Antonio, TX, the neurosurgeon here will not do any intracranial surgery because of malpracice.

We can let lawyers decide healthcare or we can let doctors decide healthcare. Prop 12 was the first step. We need to cap lawyers' fees.

Kurt Reyes
Med Student
San Antonio

Everyone please take a look at Mr. Studnicki's website. He and his associates are testimony of how financial drives lawyers to seek and pursue frivlous lawsuits. They claim they have recovered "millions". These millions result in higher malpractice premiums and also result in some specialties not providing services. For example, if you receive a brain bleed south of San Antonio, TX, the neurosurgeon here will not do any intracranial surgery because of malpracice.

We can let lawyers decide healthcare or we can let doctors decide healthcare. Prop 12 was the first step. We need to cap lawyers' fees.

Kurt Reyes
Med Student
San Antonio

mango fruit