The day before yesterday the New York Times had a big article on the link between medical malpractice premiums and medical malpractice payments. As Kevin Drum noted yesterday, a good infographic is worth a 1000 words. What jumps out at me is that even at the point of narrowest difference, there's at least $1 Billion in gross revenue for the insurance industry--and at some points, as much as $4 Billion. That's a lot of medical expense that doesn't really have anything to do with medicine. As Drum writes:
To me, the weirdest thing about this whole mess is that doctors continue to follow the insurance companies' lead and demonize trial lawyers as the cause of their problems . . . .common sense suggests that doctors should be genuinely interested in keeping premiums under control, something that even insurance companies admit won't be accomplished by payout caps. . . .California is often held out as a model for the nation because we instituted payout caps a couple of decades ago. But so did a lot of states, and it hasn't helped much. What everyone chooses to forget is that California also did something else: it instituted some of the toughest regulations in the country on insurance companies. That's done a lot more to keep malpractice premiums under control than the payout caps. . . .If the AMA had any sense, they'd team up with the trial lawyers to agree on some sensible restrictions on malpractice suits and then train their collective guns on the insurance companies.Our malpractice system, as it's currently set up, is a tangle of for-profit industries leeching off of what should be a fundamentally nonprofit or lowprofit patient-doctor interaction, and there are too many players in healthcare who are either directly or indirectly arrayed against the patient. A lot of cost and animosity might be saved by realigning healthcare around the person whose health is being cared for.
Which is what makes Andru Ziwasimon's no-insurance clinic so interesting. In a recent highlight of my blogroll I pointed out some of Ziwasimon's work. He used a lot of clever but obviously safe tricks to pare costs for his often impoverished clients: donated diagnosis equipment, volunteer-built facilities, and no need for clerical staff to fill out insurance paperwork. But one cost-saving measure alarmed his friends--he doesn't carry malpractice insurance. A few days ago he explained himself:
for me, malpractice insurance represents a big fat target for frustration and cynicism. the very act of having it invites lawsuits. this dynamic, i've seen in action. patients may even love you as their doctor, but they feel they are "sticking it to the man" by getting money from a big old greedy insurance company, and guess what, they need that money to pay their outrageous medical bill and future medical costs. . . .bottom line is that we all do "mal" practice, we all make mistakes in this work. and we all need protections, but is malpractice insurance really protection? research shows that apologizing is a powerful form of mal-practice protection, but if you have mal-practice insurance or are part of an HMO or mega-system, you will be advised not to admit fault! who does this protect? who is harmed? i apologize when i mess up, it's a basic form of courtesy. . .and here's a connected point... i don't have assets, i don't have a huge salary that can be attached for future earnings. . . .I recall reading about the preventive power of apologies before, and this AP article highlights some of the psychology involved. Basically, patients are less likely to sue if they don't feel their doctors are being arrogant and uncaring jerks. Yesterday in Slate, David Dobbs explained a Swedish no-fault system which seems to be saving costs too. It isn't clear to me if Swedes still do have the option of legal recourse should gross negligence in fact be the issue, but by allowing patients to get some reasonable recompense for honest mistakes, it makes it less necessary for them to aggressively pursue the big payments which necessitate their aggressively proving gross negligence in an adversarial setting. Let's see if doctors can realign themselves with patients.
