Health Care Alternatives

September 6th, 2009

One of the most disturbing aspects of the health care reform debate is the confusion and complexity of the various proposals under consideration in Congress. It’s clear, though, that what’s there now, in particular H.R. 3200, isn’t going to fly.  As Congress rushes to cobble together something they might be able to pass and send to the President, it seems inevitable that it’s going to be a mess of a hodge-podge of cutting-and-pasting.

We would all be better served if the President and Congress would just slow down, take a few breaths, and forget about the self-imposed deadline of getting a bill — any bill — passed by the end of the year.  Enough people know that something needs to be done about health care costs and availability.  Once they come up with something reasonable, they’ll eventually be able to pass it, and probably with a reasonable degree of bipartisanship.

The Brookings Institution has published a study that would be useful for everyone to read and consider.  Among the ideas in their study is an intelligent approach to malpractice reform (an important part of overall tort reform), which in my mind is an essential step in controlling health care costs.

You can read the executive summare (very short) or the full report (not too long).

From an editorial in The Washington Post:

The discussion about health-care reform has featured a lot of talk about “bending the curve” of rising health care costs without a lot of detail about how. A useful new study from the Brookings Institution’s Engelberg Center for Health Reform helps fill that gap. The report, “Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth,” is the product of 10 health-care experts who span the political spectrum, from Mark McClellan, who headed the Medicare program under President George W. Bush, to Harvard economist David Cutler, a health-care adviser to numerous Democratic politicians, including President Bill Clinton and candidate Barack Obama.

The group’s essential and unsurprising conclusion is that existing mechanisms for purchasing and delivering health care are fundamentally flawed. Individuals don’t have the correct incentives — or even adequate information — to reduce costs. Insurance companies make money by managing risk — cherry-picking the healthiest enrollees — rather than by competing on value. Doctors, hospitals and other health providers are paid based on the quantity of services they provide rather than the quality of care they deliver.

Thus, the group endorses changes such as raising the tax on sweetened beverages to target obesity and offering premium rebates to customers who improve their health or eliminate risk factors. It argues for capping the amount of health insurance that employers can provide tax-free, “to encourage carriers to design and workers to choose more cost-effective coverage.” It proposes overhauling Medicare payment practices to reward performance and promote preventive care, and it endorses an entity that could propose fast-track policy changes for Medicare and Medicaid.

Some of its suggestions are part of the pending legislative proposals, but too much has been left out or watered down. Among the more intriguing ideas is a thoughtful approach to malpractice reform: The group suggests creating “health courts with specialized expertise in medical liability”; shielding providers from lawsuits if they adhere to “evidence-based guidelines”; and establishing “a legal pathway for early communication, apology and compensation.”


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2 Responses to “Health Care Alternatives”



  1. Brian |

    The issue with a court that specializes in medical liability is that it would still depend on a jury as mandated by the 7th amendment. There are lots of things that we do that are evidence-based that seem not to make sense or are even counter-intuitive. It makes it difficult for a layman to understand sometimes. Lots of these evidence-based practices rely on complex statistical analyses that are even beyond the understanding of those that deliver care. I took 39 hours of math, and some of thise stuff makes my head spin.

    FWIW, I really liked the essay you linked a couple days ago. Until we become the paying customers, costs are going to continue to rise.


  2. Tom |

    The Seventh Amendment right to jury trial in civil cases doesn’t apply to the states, where most medical malpractice cases are tried. Most civil cases are bench trials now. However, I can see that juries would be a problem, as they are in any case where highly technical or scientific evidence is involved. Most judges also aren’t equipped to handle these kinds of issues, and maybe specialized courts with specialized judges would be a better solution.

    Malpractice reform, as the Brookings report briefly outlined in their proposal, has to include some alternatives to huge cash awards. There should be a cap on all categories of awards. I also think contingency fees should be outlawed; lawyers should try all cases for the same exorbitant fees they usually get. In class action cases in particular, it’s not unusual to see the lawyers make millions while each plaintiff in the class gets very little. Do away with contingency fees, and there will be fewer lawyers chasing ambulances and shopping for friendly state jurisdictions. That would immediately reduce malpractice awards, which would help lower overall health care costs.

    Unfortunately, we aren’t going to see the Democrats pursue tort reform (including malpractice reform) because of the huge payoffs they receive from trial lawyers — sorry, I guess I meant to say campaign contributions, not payoffs.

    I assume the essay you refer to is How American Health Care Killed My Father. It is good, and some of his ideas are interesting. But I really don’t see how we’re ever going to get to a system where most people pay their own way in realistic terms. There’s always going to be health insurance, and the government is always going to be involved in some way. I hope we can find a way to reduce costs and improve quality and access; however, the proposals now floating around in Congress certainly aren’t the answer.


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