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Monday, February 8, 2010

tort reform--the key to unlocking health care reform gridlock?

Democrats and Republicans are talking about health care reform. This is good.  Tort reform absolutely needs to be a part of this discussion.

I watched a brief snippet of Bill Reilly interviewing John Stewart, and Reilly asked Stewart why, if Obama wanted to compromise with Republicans on health care reform, did he not agree to make tort reform part of the package. This is, I would surmise, a big issue for Republicans.

According to John Stewart and other Democrats, the primary reason for not including tort reform in the health care reform bill is that the CBO (Congressional Budget Office) has estimated that tort reform would only save 11 billion dollars in a year, a measly 0.5% of the overall health care budget.  This is based on an estimated small effect on utilization of health care resources and a significant effect on the cost of malpractice insurance, taking into account also the savings seen in states where tort reform has occurred.

This vast underestimate of cost savings is an important reason why practicing physicians need to be part of crafting this bill.  11 billion dollars saved assumes that each of the more than half a million doctors (estimates of numbers of practicing physicians vary, probably there are around 800,000) in the US will save $20,000 each. I personally know that most of us could easily save $20,000 in a week if we didn't order excessive tests and consults due to the perceived risk of being sued.  Add to this the wasted time reviewing and explaining the results of these,  and the numbers get staggeringly higher.  Physicians in high cost areas of the country could save astronomical amounts of money.

Why is this not seen in the states with tort reform laws? I can speak to that.  I practice in Idaho, where a cap on non-economic damages passed several years ago.  This has reduced the numbers of suits and the level of damages, as well as malpractice insurance costs, but doctors' attitudes have not changed significantly because the specter of being sued continues to loom.  More substantial tort reform is necessary, to make recognition of error and compensation for it a regular part of practice. We need education in practices that are effective, and an open attitude toward improving performance and recognizing errors.

If real, substantial tort reform is something Republicans value in a health care reform bill, they should get it. The concept of tort reform is dear to most physicians and to a majority of Americans as well, and including it in this bill would probably put an important and realistic shine on its image.

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