First, Do No Harm

Untitled

First, Do No Harm

The Institute of Medicine (IOM) is a highly respected, non-profit organization whose goal is to provide "unbiased, evidence-based, and authoritative information and advice" on improving the health of Americans.

It's nice to know that a group of dedicated health care professionals is keeping a watchful eye on the nation's vital signs. But like a doctor breaking bad news to his patient, some of what they have to tell us is anything but comforting.

When your doctor is giving you a physical exam, the two words you least want to hear are Oh-Oh. Here are two Oh-Ohs from the IOM:

About 18,000 Americans die every year because they don't have health insurance. According to the IOM, "Uninsured Americans get about half the medical care of those with health insurance. As a result, they tend to be sicker and to die sooner."
Medical care can be hazardous to your health. In 1999, the IOM reported that tens of thousands of Americans die every year due to medical mistakes. In To Err is Human, the IOM cited two disturbing studies:

That as many as 98,000 Americans may die each year due to medical error is nothing short of alarming. Even in a nation of almost 300 million, the cost in human life and in the unimaginable pain of the victims' families is staggering. And there is an economic cost as well. In America, the cost of medical error resulting in injury is estimated to be as high as $29 billion a year.

But rest assured, the administration of George W. Bush intends to do something about it. How? By capping the amount of money that victims of medical error can be awarded in a court of law.

In 2003, President Bush urged Congress to adopt a set of medical liability standards, such as limiting awards for non-economic damages (for example, "pain-and-suffering") and limiting punitive damages to "reasonable amounts." According to a 1/16/03 White House press release, "These standards can reduce health care costs for all Americans by $60 billion or more, and improve access to quality health care as well."

In his first term, the President didn't have the votes in Congress to push his plan through. But at a two-day economic summit in Washington DC this month, the President insisted that he is still "passionate" about controlling medical liability damages.

At the summit, the President attended a panel discussion on "the high costs of lawsuit abuse," where he compared the current medical liability system to a "legal lottery." I don't think the President gets it. No matter how much money victims or their families "win" in this lottery, they are painfully aware that the price of the ticket was much too high.

Apparently, the summit was more of a pep rally than a lively and productive exchange of ideas. According to the Sacramento Bee, "there were no dissenting viewpoints" among the "35 carefully selected" attendees. However, Todd Smith, president of the Association of Trial Lawyers of America and definitely not an invitee, had this to say:

"President Bush's economic plan pretends that taking away the legal rights of American families will reduce health care costs. He unashamedly advocates legislation that would protect insurance industry profits and prohibit any punishment for the makers of dangerous drugs like Vioxx, while penalizing your mother for being abused in a nursing home or your daughter for having her baby killed by medical malpractice."

There no doubt are excesses in the system - frivolous lawsuits, outrageously high attorney contingency fees, astronomical awards to victims and their families. But the solution isn't to impose arbitrary limits on the damages that a jury thinks are justified in a given situation.

Capping damages removes a key incentive for health care providers to maintain the highest standards of quality. If the financial impact of medical error is subject to federal controls and limitations, the penalties become just another cost of doing business, to be considered when balancing cost vs. quality of product. And in a health care system where tens of thousands of deaths per year are already caused by medical error, we should not risk tipping the cost-vs.-quality scale any further towards the bottom line.

So how do we reduce medical error? Actually, America already has a plan in place that keeps medical error from jumping even higher. As effective as this plan is, we are virtually alone among the wealthy countries of the world bold enough to try it. We simply put health insurance beyond the reach of millions of Americans. As noted in the IOM's first Oh-Oh above, "uninsured Americans get about half the medical care as those with health insurance." Think of how many more thousands of lives medical error would claim each year if the 45 million currently uninsured Americans had twice the access to medical care that they now have.

Apparently Gordon Gekko was right - Greed is good.