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Doctors Boo Obama
As a rule, people don’t boo Barack Obama, the first rock star president. But on Monday, that’s exactly what happened. On a charm offensive in support of his health care reform efforts, Obama addressed the American Medical Association, the nation’s largest physician lobby. The doctors in the audience booed him for revealing that he didn’t support the group’s pet cause—caps on damages in medical malpractice lawsuits. Nonetheless, he did win some applause by adopting the doctors’ language and referring to the “defensive medicine” that is supposedly driving up health care costs.
In a carefully parsed speech, he said, “Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”
It was a cagey move. In throwing the docs a bone, Obama embraced one of their most cherished arguments: that “defensive medicine” is driving up health care costs. But this bone doesn’t have much meat on it. Defensive medicine is doctors’ favorite anti-lawsuit argument. It goes something like this: The mere threat of malpractice lawsuits drives physicians to overprescribe expensive tests and procedures, ergo, making it harder for malpractice victims to sue would bring down health care costs.
I’ve been looking at this issue for years, as have many government agencies. Like them, I’ve basically concluded that defensive medicine is a myth. Think of it this way: How many Americans are really out there complaining that they’ve received too much health care? More common are stories like this one about a case that went to the Texas Supreme Court in 2007. The plaintiff, Sharon Boyd, 57, made four different visits over 16 months to three different doctors, complaining of rectal bleeding and constipation. Not one of them ordered a single diagnostic test, not even a colonoscopy, which is recommended for everyone over 50, bleeding or not. Finally, three years after her initial complaints, Boyd demanded a colonoscopy. Turns out she had stage 4 colon cancer. She died not long after finding a lawyer.
There are whole legal practices devoted to little but litigating missed cancer diagnoses like these. Reading their files is a harrowing experience. Most people are lucky to get their insurance to pay for a routine trip to the doctor, much less a battery of unnecessary tests. As the Government Accountability Office and others have pointed out, doctors usually order unnecessary tests only when they can benefit financially. That’s one reason Medicare spending on imaging services like MRIs and CT scans doubled between 2000 and 2006, according to the GAO.
Obama must know all this. His embrace of "defensive medicine" suggests he really wants the AMA to get on board with his reform plans. Still, no amount of bone-throwing is likely to persuade the AMA to support meaningful health care reform. Hillary Clinton tried this same anti-lawsuit gambit back in the early 1990s and we all know how well that worked out. Obama’s situation is probably even more hopeless because he’s making promises that the AMA must know he can’t keep. Here’s why: As a constitutional law professor, Obama knows well that most of the legal measures doctors support to reduce “defensive medicine,” including the much vaunted “health court” proposals, are fundamentally unconstitutional. They tend to violate people’s Seventh Amendment rights to a jury trial, among other things. Moreover, with Democrats running the House and Senate, restrictions on medical malpractice lawsuits are most likely dead on arrival.
It’s not just trial lawyer money that will doom the effort. Trial lawyers don’t have nearly as much money as doctors and insurance companies, for one thing. But also, there are some powerful lawyers in Congress who will put up a big fight on this one on principle. Among them: Republican senator and onetime trial lawyer Lindsey Graham from South Carolina, who voted against malpractice reform bills in 2003 and 2004. Sen. Arlen Specter (D-Pa.), another former trial lawyer, has also been a reliable opponent of lawsuit restrictions. Obama’s own vice president might pose the biggest obstacle to any attempt to limit malpractice suits. Joe Biden was a trial lawyer himself (as is his brother and son, Beau), and the biggest donors during his political career have been fellow plaintiff attorneys. Biden has never once supported a tort reform bill in Congress; it seems unlikely he would start supporting such proposals now.
Even if Obama could surmount the opposition in his own party to push through some sort of legal protections for bad doctors, it’s still extremely unlikely that he’ll win over the AMA. The group is one of the nation’s most retrograde political institutions. As Kevin Drum has pointed out, the AMA adamantly opposed the creation of the same Medicare system they now argue should pay doctors more money. In the 1930s, the AMA tried to ban its members from working in fledgling HMOs created during the Depression to try to provide health care to the legions of unemployed. The organization ended up convicted of violating the Sherman Anti-Trust Act.
The AMA has locked arms with such lobbies as the tobacco industry, earning large sums for running cigarette ads in its prestigious medical journal for decades. During the malpractice insurance “crisis” of the early 2000s, the AMA provided political cover to poorly managed insurance companies that lost millions in the stock market on Enron and other investments and then tried to make up the difference by jacking up doctors’ malpractice premiums. The AMA lobbied for lawsuit restrictions that generally do little for doctors but much for the bottom lines of insurance companies. In 2003, Donald Palmisano, the president-elect of the AMA who encouraged President George W. Bush to “get out the grassroots” to pass restrictions on lawsuits, was actually the founder of a malpractice insurance company and on the board of another big malpractice insurer.
Obama’s attempt to woo these people by embracing one of their bogus arguments seems a bit pointless. The AMA may be the loudest voice of the medical profession, but it doesn’t represent most doctors. Recent estimates suggest that only 15 percent of the nation’s practicing doctors are even members of the group, down significantly from where it was during the last big health care fight. Not only do its members rely on Medicare for income, but a large percentage of them are also old enough to be covered by it. In the end, the AMA doctors may come to regret booing the most popular president in recent memory. It could be that Obama can reform health care without them.
Different sh*t same day. We
Different sh*t same day.
We are all screwed until some balance returns to society. E.g., let the rich be rich, just not as rich and do not let the poor be so poor either. Most important, the middle class is essential to the stability of society. Right now there is (functionally) no middle class because very few who claim to be "middle class" actually have a positive net worth. They too are poor, they just don't yet realize it.
What is the Middle Class?
The Middle Class is more of a mindset than an economic status. Many of us that were born into the middle of the middle class during the last century are now on the edge of it and run a good chance of raising children who wont be in the middle of it at all. i know many people raise middle class who have children who are for all intensive purposes working poor.
The mindset of being middle class keeps us invested and that is important. If you see yourself as middle class, I argue that you are more likely to "enfranchise" yourself. if you view yourself as poor or working poor, you are more likely to see yourself as dis-enfranchised and thus tune out to what is going on.
Constitutionality?
I think that the Constitutionality issue is a bit overblown. Yes, flat-out elimination of any right to a jury trial would like be found unconstitutional, even by the current wingnut court. (Scalia, believe it or not, would probably vote to strike it down: he is a real nut about the right to jury trial. If it were not heard in chancery or admiralty in 1789, Scalia would send it to a jury.)
But tort deformers would be a bit more subtle, like having a health court decide on whether summary judgment is appropriate. For you nonlawyers, that is a big exception to your right to a jury. A defendant gets summary judgment when, if the court reads all material disputed facts in the plaintiff's case favorably to the plaintiff, the plaintiff still wouldn't have a case. This is quite constitutional. If set up right, the health courts could be predisposed to find summary judgment for the defendants most of the time.
Or all med mal cases could be shuttled to federal court. With a few exceptions, federal judges are far more pro-defendant than state court judges.
I agree, however, with Mencimer's political arguments. There is no way, with a Democratic Congress, that tort deform is going through.
reform myths
The myth that lawsuit costs are the reason doctor's insurance costs are increasing has long been since debunked. If a doctor commits malpractice or through inadequate or obviously inept actions causes me or my family harm I want to be able to sue as is my right. Tort reform doesn’t discriminate between legitimate complaints and illegitimate ones.
MEDICAL BALANCE ESSENTUAL.
Perhaps I can say, “Been there, done that.” After all, at my age, born in 1932 I have the right. A long life of injuries and accidents and operations brought me to experiences of both having no insurance and having one of the best. One need not ask themselves as they sit on the bed or in the bed lying down who that lady is that comes in with a clip board and pen under her arm.
She will be the financial recorder of whether or not you have insurance. It matters to hospitals and it matters to doctors offices, and it equally matters to ambulance services if one has or has not any insurance. Upon each visit some organization MUST pay the bills accumulating as time goes by into days or weeks or months.
There was a time when many cities gave free hospitalization to its citizens. In the case of Boston the city paid the bills for your care. I should know, as from the forties with appendectomy operations and future physical problems bills piled up and the records of my medical history were stacked higher as each visit was made.
During those days in the beginning Blue Cross, the basic insurance which guided others to follow was relatively cheap. This is no longer so.
Working for a firm it matters to them just what must be laid out for your hospitalization when or if the time comes for such care. So many firms are dropping these packages since they no longer are able to continually pay for medical insurance plans for its workers.
The government cannot burden themselves forever in aising insurance costs which are sening financial charts off the wall. There must be a balance for us to survive.
Obama cares more about popularity than policy
Obama proves that the president is about corporation control and not party affiliation or ideals. He went in as a reformer, and is governing as a status quo guy. he has flipped on White House transparency, “don’t ask don’t tell,” prosecuting torture, on prosecuting the bush administration, on continuing military commissions that keep people locked up indefinitely without trial, continuing the eavesdropping on american citizens, on the defense of marriage act, and has now passed a token resolution regarding same-sex partnerships for federal employees. What makes us think that he will not flip on health care too? Republicans are calling him a socialist, when he appears to me to be the most republican president since Reagan. He is more concerned with being popular than instituting policy. what a dissapointment! no wonder that fly was buzzing him during his last interview. he's full of what flies like most--shit.
OOPS!
You weren't supposed to notice all that!
You were supposed to be dazzled by the change in the President's name, his party label, change in his complexion, his ability to speak a coherent sentence, and the pattern of his necktie changing from a red one sporting bloated little pachyderms to a blue one with a jackass pattern! Those are the things you're expected to concentrate on!
It's obvious you haven't been absorbing your prescribed daily dose of NASCAR, Oprah, The Brett Favre Soap Opera & David Letterman.
Get with the Program, R. Joe!
Hey, lay off. Obama is
Hey, lay off. Obama is change I can see, and seeing is believing, right?
This corporate healthcare fix
All I ask is for you to follow the money? If healthcare was just a loss leader why are so many fighting about single payer? Why is that? Physicians and insurance companies already bloated with premiums and denial of all of those sick for such a long time of their life making money from this mess we call healthcare. You know what let me tell you a secret a long time ago all those insurance companies so intent on our welfare threw my dialysis patients to the wind. After as they say privatised the profits and socialised the loss the federal government picked up the peices of end stage renal patients needing dialysis.You see there was no chance left for them to make money. It just became a loss leader for them. And you know what when oure government took it over it works so well, it works perfectly. I never hear patients cant get a machine to dialyse on. I never hear my patients are queing up just for a machine.. Why not because a federally funded healthcare system works so well but the only problem is that nobody makes money from this.
Our mostly spanish population in LA simply work untill they die. Now my Barac is thinking about cutting payments to all of us out here hospitals that take people with no insurance. I wonder is this all about population control? If it is then I surely made a big mistake. Barac I want my money back.
Maggie RN CCRN.
The premise of this article is plain wrong
Receiving too much uncoordinated, non-effective care is one of the major contributors to our health care cost problem. I suggest the author spend some more time in an ER or with other physicians to see the pressures faced in system where there is no financial reward and little thanks for a job well done at low cost, versus unlimited financial and career ending liability for mistakes made at even the greatest expense to all of us.
If we force doctors to test every patient for 1/1000000 possibilities, then we better be prepared to pay the cost.
Good Article, Thanks
Good analysis, thanks, but I must tease you:
'Joe Biden was a trial lawyer himself (as is his brother and son, Beau)...'
I'm pretty sure Biden's mother would strenuously object to that phrasing.
And did you really mean to call Joe Biden a ...... ......?
liability
I have been a surgeon in a small town for 15 years. I try to give everyone good care. Most of my colleagues and I see several uninsured patients a week, including late night and weekend emergencies. I feel the burden of increasing overhead, including med malpractice insurance premiums that have doubled over the past decade. Insurance payments to doctors, including medicare, have continued to decrease over the past 12 years or so. I find myself fairly often practicing defensive medicine. This does increase costs. Real life in the trenches.
The idea that doctors
The idea that doctors ordering extra tests is a source of great expenditure is absurd on its face. The marginal cost of an extra lab test or an extra xray is literally pennies or a dollar or two at most. The important costs are in the fixed costs associated with hospital salaries, plant, and equipment. Those costs remain whether Dr. X orders 1 test or many. A much more relevant problem is why do we have so many vacant beds and near empty hospitals. Maybe some of those need to close which would result in far greater savings than questionable tests being ordered. Michelle Obama was a highly paid hospital exec. I'm sure she knows all about the cost structure of hospitals.
They add up. no lab test
They add up. no lab test costs less than 50 bucks, many are 3-400 dollars, and CT scans and MRIs cost thousands? since youre so smart, you knkow this all already
defensive medicine is real!!!
I'm sorry, but this author is simply wrong. I am a physician, just finishing my residency, and I have witnessed and continue to witness my attending physicians practicing defensive medicine almost every day. That has been true in 2 very different cities and in all types of hospitals and clinics, from the VA to the public county hospital to children's hospital to the specialty centers. We are CONSTANTLY ordering more tests than are needed because we don't want to miss that fracture or bleed or whatever, the likelihood of which is very rare, because it might result in a multi-million dollar malpractice suit. As for how much defensive medicine feeds into the healthcare mess, I don't know, but I reiterate: it is real! By the way, I am the most liberal of the liberal, so know that this is not coming from your typical conservative doc. :-)
haha go work with an ER doc
haha go work with an ER doc and tell me defensive medicine doesnt exist. Not even close.
$1000's of dollars are spent on each CT scan, just to prove nothing was there at the time of the patients' visit. that's about 50% of the cost of the patient's visit. easily avoidable.
to all you people providing
to all you people providing anecdotes about this so called defensive medicine -- What is your explanation for it not showing up in the studies? Your anecdotes are not enough for me. I need numbers and studies. So far the ones I have seen have shown that defensive medicine is a myth or exaggerated at best. If you really believe what you say then SHOW ME THE NUMBERS! Your anecdotes are worthless to me and our worthless in a reasoned scientific debate on the issues.