Last month’s issue of
Forbes highlights a growing problem in medicine—excessive compensation. What should we do, if anything, to people profiting generously from a $2 trillion dollar healthcare system with costs spiraling out of hand? For example, one New York lawyer works about 40 cases of birthing malpractice a year. He charges routinely that mistakes made during the birth caused a baby’s situation, such as cerebral palsy. Usually, insurance companies settle out of court. In one case mentioned in the article, he made over $10 million for the baby’s parents, took $1.4 million for himself, and then asked the judge to up his cut to $2.2 million citing long hours and complexity of the case—even though both arguments are expressedly forbidden as ways to improve payment in New York’s sliding scale method.
Today more than a quarter of all Americans are uninsured. I am one of them. My employer offers no coverage, even though I work 40 hours a week. My wife, still a student, gets minimal coverage. This topic has engendered discussion from the white house to my interviews at medical school, as doctors and politicians alike try to grasp the gravity of the situation and direction reform must take. What should we do? A couple weeks ago, in Massachusetts, the House of Representatives passed a
version of a bill put forward by Gov. Mitt Romney. It still needs approval by the State Senate before it becomes law. This bill would require employers to provide minimal coverage for workers.
But on the flip side, surveys show that at least 70,000-90,000 people in Massachusetts make more than three times the poverty level and do not have coverage. These individuals obviously choose not to, because monetarily it is well within their ability. The proposed bill would also require people above the poverty line to have some form of medical coverage. Problem solved, right? Wrong.
The “taxachusetts” bill (as a Bostonian called his state when I was talking to him on the subway), provides a viable way for the government to help curb the rising number of uninsured. I think it might be the best plan I’ve heard of so far, but that doesn’t make it the right way of dealing with the problem.
I work with
Buruli ulcer. It is a disease endemic in West Africa and Northern Australia. The bacteria enter through a cut in the skin, then causes a bump to form. Eventually that bump opens into a painless skin lesion (ulcer) that gradually gets bigger until it may cover up to 70% of the body. Eventually, the immune system gets a hold of this bug, and the lesions scar over; often resulting in contracture deformities.
If a doctor put a bandaid on the bump or small lesion then nothing would happen. It might protect the lesion from secondary infections, but not stop its growth or eventual scarring. The only way to treat the disease (since antibiotics do not work) is to cut out the bump before a lesion is formed and stitch up the skin, or cut away the lesion and use skin grafts to fill it back.
I have a feeling America’s heathcare system is a large nodule about to ulcerate. Public policy initiatives, although great bandaids, are not surgical excisions and will not stop the progression of the ulcer. The heart of the healthcare matter, is two issues. 1) litigation causes huge costs to hospitals and doctors that are passed down to consumers, and 2) as medicine gets more advanced costs rise to pay for the increasingly complex procedures and research.
If America’s lawmakers and policy wizards can strike to the heart of these two issues, the cost of managed healthcare will decrease, and more people will be able to afford health insurance.
Attacking these two issues also allows us to bypass the horrid idea of standardizing healthcare like Canada and Great Britain. My coworker Mike’s sister lives in Britain, and when she needed an MRI, she had to wait months because of the waiting list. In medicine, hours and days can mean the difference between life and death, let alone months. Socialized medicine brings medicine down to the lowest level of service possible, because it does not allow for prompt and efficient care, nor give incentives to healthcare workers to enter medicine and succeed. With socialized medicine comes standardized salaries, and the decreased pay will dissuade more prospective doctors from joining the profession. Hence, a lower caliber doctor will practice, and he or she will have less incentive to work their hardest to save a patient because the return on such sacrifice is less, and often futile when a patient must wait long periods for critical tests or treatments.
So how do we deal with the problems? First, we need better tort reform. My grandfather died due to malpractice. I know it happens, acutely. However, many lawsuits, like Mr. Moore’s cerebral palsy lawsuit, are frivolous. An overabundance of information shows that nothing in the birthing process can cause cerebral palsy, but insurance companies settle out of court because it’s less costly then waging legal war, and the cost is passed on to you and me. All states should pass laws limiting damages juries can award, as well as payment lawyers can make from a verdict. Also, physicians need to create a contractual relationship with the patient that says something to this effect:
“You, the patient, contract with me, the physician, to provide your healthcare. By signing this contract you acknowledge that there are many physicians and you have chosen me to direct your care of your own free will and knowledge. You consent to all treatments I deem necessary except those that are expressedly forbidden by your faith or creed, and if you refuse tests and procedures forbidden by your faith or creed, you take full legal, ethical, and physical responsibility for the outcome of the whole course of treatment. Also, you acknowledge that human error is part of the fallible nature of man and if you feel that I did not perform to the best of my ability and this caused undue harm to the outcome of the course of treatment, you agree to settle such grievance outside of court via arbitration.”
Obviously this language is just my own words, but the gist can be put into binding legal jargon. Such a disclaimer would free the doctor to pursue the course of treatment he or she feels is best for the patient and limit liability for errors.
In addition, government subsidies for increased competition among medical technology companies will drive down costs of tests. Also, physicians need to set up advisory boards that deal with test efficacy. The Anesthesiology society of America did so in the late 1990s and malpractice insurance has only risen along with inflation since then. Test efficacy boards will determine if tests are being order too much, instruct doctors, and find machines that do not fail, or techniques that work better, to lower malpractice incidence and rates.
Ultimately, this requires a concerted effort by both the government and physicians in tackling these two issues. Doing so will defeat the ulcer at its source, before it festers.