I got riled up earlier this week when I heard a local radio interview with a California ER physician talking about the role of ER usage in driving up health care costs. Apparently there was a meeting in San Francisco of ER physicians and they were releasing a study claiming that use of ERs for basic healthcare by the uninsured is a relatively small cost issue. This runs counter to the conventional wisdom so it was interesting. During the interview the physician quickly moved on to the assertion that liability reform is the big answer to reducing health costs in the US. This argument drives me up the wall because there’s lots of real data that proves it’s not true, but the proponents of liability reform don’t seem to care about the data.
Here in California we’ve had liability reform for medical malpractice claims since 1975. It has exactly the kinds of caps and limits that are being proposed nationally and which the ER physician group apparently supports. California’s experience with these tort limits is that while they have definitely reduced the number and cost of liability claims, and have made malpractice insurance cheaper and more easily available for California physicians, this has not translated into significant savings in the cost of health care in California. [Anybody living in California knows it has not become a nirvana of inexpensive health care.]
Because California is not the only state which has passed tort reform for medical malpractice claims, there is similar data available from other states as well. The CBO reviewed this issue several years ago, and the truth of the matter is, while there is definitely some money to be saved if you institute malpractice tort reform, the total dollars are estimated to be quite small compared to the total bill for health care in the US. People who talk about tort reform as the solution to the nation’s high cost of health care are either ignorant or liars. Given the fact we have a number of states that have the sort of tort reform being championed at the national level, I’m baffled by the lack of interest in the data to be derived from these state experiences.
Harvard did a study 15-20 years ago looking at the potential cost of going to a “no fault” medical malpractice system. That study concluded doing so would essentially bankrupt the health care system because there is so much real negligent care that injures patients. As it turns out, statistically, only a small percentage of the victims of true negligent care file lawsuits. Nobody is certain why this is true, maybe the victims never realize what really happened, or they do know but they like their doctor and don’t want to sue anyway. In any event, according to the Harvard study, a true no fault system that actually compensated all the victims of malpractice would cost far more than the current system, so if you’re looking for cost savings, no fault is not an answer either.
The truth of the matter is there are many drivers of the high cost of health care in the US- heavy use of increasingly expensive drugs, heavy use of expensive technology, lots of high technology and expensive care at the end of life, the cost of liability claims, regional variations in care and lack of focus on “best practices” in medicine [the idea of using aviation style check lists is just now catching on in operating rooms and hospitals], an insurance system that pays for things done, especially procedures, rather than maintaining good health, and many other problems. Sadly, there is no simple answer or silver bullet; driving down health care costs is going to take thoughtful and concerted effort across a wide range of issues and problems. Almost every problem has a simple answer and that simple answer is almost always wrong. So could we all please actually consider the data before braying about liability reform as a solution?
