Tuesday, August 31, 2004

Two Republican lies about medicine

I caught the tail end of Bill Frist's Republican National Convention speech on PBS today, followed by commentary from two Republicans (no Democrats; yes, it's ridiculous). There were probably more lies and distortions than I could count in real-time during those scant ten minutes, but here are two big ones.

Lie Number One: Frist claimed that Bush will not spend federal money to have human embryos destroyed. Luckily for Frist, relatively few Americans read Michael Kinsley's articles on the subject (more via Manu). But it's still a load. Q: Why won't anybody else in the mainstream media call the Republicans on this hypocrisy? A: Unlike Michael Kinsley, most editors are chickenshit.

Lie Number Two: Both Republican followup analysts (actually Republican politicians from swing states, but whatever) claimed that medical malpractice lawsuits were the major cause of high health care costs. Now, I'm not going to pretend to be an expert on the health care system, but this claim is rather transparently a piece of rhetorical judo to deflect the anger of physicians and patients from the extortionate insurance agencies and drug companies onto a Democratic constituency, as S. Polakow-Suransky explains. Especially compelling quotes from Polakow-Suransky's article:

  • ...contrary to the administration's line, increasing jury awards are not single-handedly driving premiums through the roof. Rather, a steep decline in insurers' projected investment income is largely responsible for rising rates. Medical-malpractice insurers do not invest heavily in stocks; in fact, approximately 80 percent to 90 percent of their investments are in the bond market, and bond income has been declining. Moreover, insurance companies are technically barred from recovering past losses by raising premiums, an argument the AMA parrots to dismiss claims that insurance companies are at fault. But insurance companies do regularly raise rates based on projected investment losses. For medical-malpractice insurers, investment income represents a far greater share of profits than in other lines of coverage due to the long lag (up to 10 years) between premium payments and claim payouts. And when investment income evaporates, it hits hard. AIR's J. Robert Hunter, an actuary and former Texas insurance commissioner, tracked premiums and insurance-industry investment returns over the last 30 years. He found that each of the three malpractice insurance "crises" directly coincided with declining insurance investment returns.

    Translation: when bond income declines, insurance companies try to recoup the reduction in profits by squeezing doctors (and, indirectly, patients). To add an extra dash of audacity, they ramp up the political pressure against malpractice lawyers. It's a devious one-two punch: jack up prices, then blame your political opponents for the result.

  • Far more effective than an arbitrary cap on damages would be a more systematic effort to weed out bad doctors and prevent malpractice in the first place. Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, says, "You should protect patients with doctor discipline and protect good doctors with low premiums." Public Citizen ranks state medical boards according to their records of disciplining negligent doctors. "Five percent of the doctors account for 50 percent of the malpractice payouts," he says. "The primary failing is at disciplining doctors. A lot could be remedied by taking bad doctors out of practice."

    If we aggressively took out the bad 5% of doctors, malpractice costs would drop dramatically. Malpractice awards exist for a reason: some doctors are fuck-ups. Doctors should direct their anger against the fuck-ups who are harming patients and their fellow-doctors alike, not the lawyers who try to recoup some measure of retribution for patients.

p.s. Health care experts could probably point out some important flaws in the following proposal, but it seems to me that we could

  1. have the government offer insurance companies a voluntary "super-insurance plan" that would pay the balance of malpractice awards above a certain cap, and
  2. require that any doctor whose policy incurs this bailout be barred from practicing medicine in the U.S., now and forevermore.

So, doctors and insurance companies would have a choice: either pick a (pricey) policy in the unregulated, unlimited-payout system, or pick a (cheaper) policy covered by a limited-payout system with strong doctor accountability.

p.p.s. I am now listening to the Governator talking about how he became a Republican after hearing Nixon speak. Nixon. Nixon. What universe do Republicans live in where Nixon was a President to be proud of? Watergate was bad enough, but even before that, Nixon's Southern Strategy turned the Republican Party into the toxic, unholy alliance of plutocrats and crypto-racists that it is today.

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