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Sun., Nov. 22, 2009

Bill needs bipartisan cost-cutting strategies

As Democrats and Republicans spar over health care reform, both sides duck compromise. Two examples illustrate the counterproductive nature of partisan jabbing.

Exhibit A is tort reform. The high price of malpractice insurance premiums drives the practice of “defensive medicine,” where doctors order extra tests and procedures of dubious value to ensure they won’t be sued for negligence. Estimates of the costs of this practice vary, but it’s in the neighborhood of $100 billion to $200 billion a year. President Barack Obama acknowledged the problem in a June address to the American Medical Association.

But both bills in Congress ignore it, because trial lawyers make big donations to Democrats to block change. Meanwhile, insurance companies and medical associations back Republicans on this issue. If either side gets what it wants, costs in this area won’t be contained. Texas implemented a $250,000 cap on medical malpractice awards, which is the holy grail of tort reformers. Sure enough, it has curtailed the number of lawsuits, malpractice premiums have been reduced, and more doctors have moved to the state. But health care costs continue to rise because the savings are not passed along to the public.

A better solution is the one promoted by Common Good’s Philip K. Howard. He calls for Congress to authorize special medical courts, where experts would adjudicate cases in a timely manner. A landmark Harvard study shows that only 3 percent of harmed patients ever file lawsuits. Medical courts could end this roulette wheel of justice by addressing complaints and establishing a culture where apologies for honest mistakes are not fodder for protracted litigation. Plus, such courts would remove defensive medicine as an excuse for unnecessary tests and procedures.

Exhibit B is advanced care planning, which has come under attack for establishing “death panels.” This fear-mongering may appeal to those who oppose reform, but it is a costly myth. The idea is to allow Medicare to reimburse doctors and nurses for having voluntary conversations with patients about living wills and powers of attorney. The model is La Crosse, Wis., where advanced-care directives are common, because the main hospital has built frank discussions into its routine. The Gundersen Lutheran Hospital eats the cost, but it ought to be rewarded for forgoing tests and treatments that many patients don’t want once they’ve thought it through.

An estimated $100 billion a year in health care costs is racked up in the final two years of life. About 40 percent of that is in the final month. The Washington Post reports that “Gundersen patients spend 13.5 days on average in the hospital in their final two years of life, at an average cost of $18,000. That is in contrast with big-city hospitals such as the University of California at Los Angeles medical centers (31 days and $59,000), the University of Miami Hospital (39 days, $64,000) and New York University’s Langone Medical Center (54 days, $66,000).”

Medical courts and advanced care planning are low-cost, high-yield solutions to medical inflation. If partisans could compromise on these and other issues, it would be a total victory for the public.

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