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The Unreported Story - Med Mal and Catastrophic Coverage

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As everyone has read and seen by now, most of the post-speech coverage has been about Rep Wilson's disrespectful "you lie" outburst at our President. (shameful, rude, appalling -- and his lack luster apology was insulting ---but I digress)  Not much attention was paid to the two new pieces of policy that were added to the debate by the president.  The first is a policy that John McCain advocated for during his campaign:  a new, low cost catastrophic coverage insurance plan that would be available through a national "high risk" pool to protect people on day one while other insurance options are phased in over a number of years.  This type of insurance is certainly not comprehensive and does not cover the routine and preventive care that is so crucial to improving patient outcomes.....but it will at least prevent financial ruin if someone has the bad luck of getting hit by a car, or having a major illness with months of medical treatment needed.

The second, of course, is the fact that the President addressed medical liability reform.  He charged Secretary Sebelius to implement immediate medical malpractice reform projects that to curb the practice of defensive medicine.  You may remember from my post last week, I wrote about how Newt Gingrich and I agree on this point....and how the President as a Senator, co-sponsored legislation with Hilary Clinton to  provide liability protections for physicians who disclose medical errors to patients and would encourage early settlement before litigation is pursued.

We don't have much more detail about how the President would like HHS to move forward with this charge.  I assume that they are still figuring it out.  I see an opportunity here to get the physician community more engaged in the process so they feel that their concerns are being addressed.  If you are going to do it, do it right....and take credit.

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  1. Philip Levitt, M.D.


    I have been involved with the malpractice mess for years. The best evidence we have and also the most conservative estimate is that in 40% of closed malpractice cases there were either no damages or no medical error, usually the latter. That's a lot of "frictional" costs for nothing. It goes almost without saying that these frivolous suits drive up the cost to the individual practicing doctor. Nobody can agree on the cost of defensive medicine. The cost of consultations with specialists to cover oneself is often left out of the discussion. I was told by my own defense attorney once to get as many second opinions as possible in a difficult case.The concerns of the physicians have to be reconciled with the valid ones of patients injured in the system. A small percentage, some say as little as 17% of the malpractice premium dollar gets into the hands of injured patients at the end of the tort process. High premiums have lead to low payouts or doctors going bare. Attorneys will rarely take underinsured cases, so that real justice can be elusive. My aunt and the mother of our billing manager were both victims of negligent care, so I have seen this from both sides.

    The Swedes have a workers comp like arrangment that does not assign blame and compensates everyone hurt in the system. Self reporting by providers is encouraged. It's uncler what they do with or to the doctors who make mistakes. The culture does not exist here to permit such a system to take hold. Everything here is secretive and defensive.

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