The Filutowski Law Firm, PLLC

While the U.S. remains divided on the efficacy of health care reform, an article in today’s Business Week outlines valuable research from Harvard and other research institutions on the true cost of health care and its unrelatedness to tort reform.   Medical malpractice lawsuits and the practice of defensive medicine account for a nominal percentage of the overall cost of national health care.  Proponents of tort reform, who think that changing state laws to limit the amount recoverable by damaged plaintiffs will make health care more affordable for others, must take a harder look at the facts.

Each year 100,000 individuals die from medical errors committed in the U.S.  Only 4% of the surviving heirs pursue legal action.

Moreover, malpractice lawsuits are only one of a number of factors considered in the insurance premium equation. The cost of malpractice insurance premiums are determined by the underwriter for the insurance company who runs a risk assessment of the doctor’s specialty, history, patient demographic, among other factors.  These all affect the size of the premium.  The more errors previously committed by the doctor, the higher the premium.

In assessing the overall cost of health care, experts say medical malpractice premiums only account for 5% of the cost of health care.

To avoid errors, many doctors practice what we have heard in the media called “defensive medicine” – taking additional care to ensure no malpractice lawsuit will be brought against the doctor.  This defensive practice actually leads to more attentive, thorough health care.  e.g., when involved in an automobile collision and paramedics arrive to the scene – your blood pressure is taken at least 3 times to ensure your systems are properly functioning.  e.g., when you arrive to the ER with complaints of whiplash symptoms following a rear-end collision, x-rays of your head, chest and neck are taken to ensure there are no broken bones.  Better to be comprehensive with your health, rather than sorry and discover something later that should have been properly detected and treated earlier.

No one disagrees that health care is a necessity.  This country is privileged to have talented physicians, who unfortunately are placed under great pressures by the insurance companies (like the rest of us).  Insurance companies offer one-sided rules to physicians in how they must document treatment, submit bills with appropriate diagnosis codes, ensure they are an “in-network” provider or “preferred” provider, etc.   Doctors stress about which form of insurance will be accepted; whether they are going to get fully paid by the insurance company or at a reduced, “contract” rate; whether the provided  treatment is “covered” under the policy, or excluded since it was for a “pre-existing condition,” etc.

These stresses pressure doctors to operate quickly and with a high-volume of patients, so that they can submit enough claims to their patients’ insurance companies in order to make overhead that month. Whether someone may sue the doctor is a secondary fear that arises as a result of the pressures doctors undergo in the day-in, day-out practice of pushing papers to insurance companies.

Most physicians want a public option.

Many people are quick to discuss health care reform & tort reform in the same breath, but the two are like comparing apples to oranges.  Texas passed tort reform three years ago, yet continues to have the nation’s most expensive health care.

Confusing issues does not lead to viable solution or even a reasonable debate. The hard data and statistics must be fully explored by experts to determine what the *real* cost of health care is and the best way to resolve hte issue.  The U.S. sometimes forgets that hundreds of other nations share this world.  And those other nations, including developing nations, have higher-ranked health care systems than the U.S.’s, according to the World Health Organization (WHO).

No effective answer will develop overnight.  Rather, a transparent dialogue among policy makers, insurance companies, doctors and patients is necessary to create a reasonable solution.