Today's Seattle Times editorial lavishes praise on Mrs. Gregoire1 for her supposed leadership in an alleged breakthrough on medical malpractice reform: "Gregoire herds cats to malpractice law"
Gov. Christine Gregoire's strong suit is getting feuding interests in a heated political fight together until they reach agreement. The latest example is her notable leadership on medical-malpractice law.We know that some of the Times editorialists have a deep emotional investment in Mrs. Gregoire's political future, but give me a break. As the Times' news page reports, the so-called med mal deal didn't accomplish very much. The Republicans in the legislature characterize it as:
It’s a bit like having your toe worked on when you need bypass surgery. It’s great to fix your toe, but that’s the easy part. We won’t get to true liability reform until we operate on the heart of the matter.”
1 Received more than $600,000 in campaign contributions from attorneys for her inconclusive quest to win the largest number of legal votes for governor in 2004. (Dino Rossi, by way of comparison, received $55,000 from attorneys).
Posted by Stefan Sharkansky at February 22, 2006 11:54 AM | Email ThisYeah, Chris, this looks like a huge breakthrough for the state.
Posted by: Regret on February 22, 2006 12:39 PMOh, I forgot! You people are in favor of these limits for OTHER people -- not yourselves.
Posted by: headless lucy on February 22, 2006 02:51 PMThis is probably the best you can do without hurting the innocent injured party. What we really need is some insurance reform so that the majority of good doctors are not paying for the mistakes of the few.
Posted by: JDB on February 22, 2006 03:40 PMIf I were the subject of such a terrible act, I would expect to get medical treatment inasmuch as it were possible to restore the damage. I would expect economic damages to be paid by the doctor (or his insurance company). I would also expect an investigation into why the doctor did such a terrible thing. And if the doctor was found at fault, I would want him to lose his license. But if it was some other flaw that could have been prevented, I would want whatever was to be blamed to be immediately remedied.
What I don't think is fair is me asking the hospital and insurance companies for millions of dollars just to pay my legal team for putting on an act about how emotionally damaged I am.
Let's take a more realistic example. Let's say my wife (who is due in May) gives birth to a child with MS. This is a real tragedy, but do I have the right to sue the doctor? Is it the doctor's fault? Is it the hospital's fault? Whose fault is it? If anybody would be to blame it would be myself and my wife for contributing the genetic material, or perhaps God for permitting such a terrible tragedy. I don't deserve to take money from doctors or hospitals or tie them up in courts because I happened to have a child born with MS. And that's something that happens today, right now, and it is why OBGYN's can't work in this state.
Posted by: Jonathan Gardner on February 22, 2006 03:42 PMCapping Medical Malpractice Insurance rates will only drive Medical Malpractice Insurance providers out of our state. They must operate at a profit or they wouldn't operate at all. Without Medical Malpractice Insurance providers, no doctor would dare practice medicine. The risk would just be too great. They would all pack up their medical bags, pile into the ambulances, and drive to Idaho. We would be left going to herbal remedies and acupuncturists to cure our diseases.
Just remember what happened when the federal government capped gasoline prices in the 70's. All of a sudden, you couldn't buy gasoline anymore.
Posted by: Jonathan Gardner on February 22, 2006 03:46 PMThere is a limit to the economic damages naturally. For instance, if a doctor messed me up so bad that I could never work another day and I had to have 3 nurses watching over me constantly just to keep me alive, that will run up quite a bill. But it can only go so high before it is exhausted.
Emotional damages can potentially be awarded in the billions of dollars. The only limit is what the jury feels like limiting it to. Each year, the limit seems to rise higher and higher.
I we put in any cap, no matter how high and unreasonable, it would fix the problem because insurance companies could predict what the maximum amount of damages from a bad doctor would be and adjust accordingly. But as it is now, insurance companies have to build up serious bank to protect themselves from future lawsuits.
There are two sides in this battle: The trial lawyers, who want to raise the limit to the billions and beyond, because they get to pocket it, and the insurance companies and doctors, who are trying to create an environment where everyone can get the medical care they need at a reasonable price.
Which side would you side with? Those who lifestyle is to sue and collect, or those whose lifestyle is to serve and heal? We should trust the doctors and insurance companies on this issue.
Posted by: Jonathan Gardner on February 22, 2006 03:53 PMFor those of you who think doctors get paid too much, first follow a good doctor around for a week, especially a one in a "high risk" area. Then think about the fact that seriously ill children and adults have to come to Seattle from Alaska, Idaho, Oregon, and western Montana. Chasing out the physicians who chose the riskier specialties will decrease the high level of care Seattle is noted for. This may not seem like a big deal for most of you, but when you need a pediatric neurosurgeon, a world class oncologist, or a top level trauma care, you probably won't want to go to another state to make sure you or your loved ones are getting first rate care.
And for those who are about to remind us of the number of uninsured in this state, just keep in mind that Children's Hospital and Harborview provide several million dollars of uncompensated care every year. Take time to actually study the economics of the situation instead of falling for Gregoire's silly "leadership" exercise.
Posted by: Burdabee on February 22, 2006 04:03 PMI believe that originally damage caps were implemented in California, but without insurance rate caps and there was no significant decrease in premiums during that time. Only after they capped the insurance rates did the system correct, and I think it has worked there.
Posted by: Palouse on February 22, 2006 04:42 PMThey cannot be allowed to steal land without compensation! Period!
Posted by: GS on February 22, 2006 06:18 PMThe biggest victory in the deal is the actual reporting of data (i.e., how much is actually paid out). Without good data to start out with, neither side has a leg to stand on in regards to solving the problem.
All Mr. Dino would have done is cave into the insurance industry. Get real. That is not a solution. You complain about CG, well, open your eyes. Mr. Dino was beholden just as much to the other side. Where are the politicians that have some guts to stand up to the big money interest groups and actually look out for the normal people?
Where are the Bill Proxmires of today? Proxmire fought for government waste and spent a couple hundred dollars in his last campaign, mainly on postage to send back campaign contributions. This is the politician we need and we should demand. With the talk now that the U.S. Senate campaign could cost $40M plus, why doesn't that money get spent on something real that could help people? What a waste of money. The rich just get richer (on both sides).
Posted by: tc on February 23, 2006 05:51 AMWow, not even close to being on topic. But thanks for playing anyway.
Mr. Gardner:
I said nothing about capping rates; I said we needed reform. And not only would no doctor practice without insurance, they cannot practice without insurance. It is sort of required.
However, the capping of awards will hardly help the situation. Large awards in med-mal cases that go to juries are fairly rare (juries hate finding against doctors, and if the doctor is clearly liable, those cases settle long before you get to trial).
There has never been an award of non-economic damages in the “billions of dollars” in any med-mal case in this country. Insurance companies can calculate what the maximum amount of damages they have to pay out are with or without a cap, that is what insurance companies do. And it is not like insurance companies are losing money.
There are four, not two parties to this. 1) The Plaintiff’s bar, which simply wants to make money (good old American value that), 2) Doctors, who don’t like lawyers, and who have to deal with Insurance companies, 3) Innocent Patients who have been harmed by the doctors negligence, and 4) Insurance companies, which simply want to make money (good old American value that). The insurance companies hardly want to “create an environment where everyone can get the medical care they need at a reasonable price.”
But let’s talk about a concrete example. Plaintiff V is a 23 year old who is mis-diagnosed with uterine cancer. V is given a hysterectomy, and must live on hormones for the rest of her life. She will never be able to have children. For the sake of argument, let us assume that the doctor was clearly negligence, and that a reasonable doctor would have caught the error and never had performed the surgery.
What are V’s damages? Her economic damages are fairly low (a few weeks off work because of the surgery, the cost of her medication, and the surgery (which was covered by her health insurance, so anything she recovers will be paid back to V’s health insurance carrier). If that was your wife (and congratulations on your pending blessing), could you really say that her emotional damages are worth only $250,000 (as the last initiative would have capped them)?
And it is not like Med-mal cases are easy. There are plenty of law firms that have been destroyed because of the expenses in a med-mal case where the jury finds against them. As I said, the good cases get settled pretty quickly, and the majority of the rest end in defense verdicts. Given that it is well established that about 10% of all doctors are responsible for about 80% of all claims, med-mal claims are hardly the reason why most doctors pay as much as they do in insurance.
You ask who I side with? Simple, I side with the victim first, the doctor second, and to hell with the rest. Good doctors should not be forced to pay for the bad, but a person who is injured by a doctor should be fairly compensated. A one-size-fits-all approach such as a cap only assures that some victims are not fairly treated.
That is why Governor Gregoire’s negotiated settlement is not such a bad idea. It at least moves everyone in the right direction without harming the victims. Add in some decent insurance reform and some other legal reforms, and we could have a system that is fair to both the doctors and the victims, which is what in the end we should want.
You make a reasoned argument about a commonly muddled and confusing set of issues.
One question: You say, "med-mal claims are hardly the reason why most doctors pay as much as they do in insurance." If this is so, what is the reason?
Although not in the Medical Malpractice feild, I have done a lot of insurance defense work myself so I know that the reason is not a matter of insurance conglomerate "profiteering" as Gregoire and her ilk like to suggest. If it were that simple, the objective socialist solution is clear . . . state government risk management (Workmen's Comp).
Real solutions (market solutions) require a clear understanding of this question.
I agree that a good understanding of the root causes is the only way you can get to a workable solution. However, as I suspect you know, the answer is fairly complex.
I will note that while the insurance companies are not “profiteering,” none of them are going bankrupt writing coverage for health practitioners. I will also note that there has never been a case of rates leveling or going down where there has just been med-mal tort reform. It is only with insurance reform that you get better rates.
Part of the problem is the risk pool. Since it is a small portion of doctors that cause a great majority of the problems, you have good doctors paying for bad. Part of the problem is that in Med-mal cases everyone goes to Def-con 1 immediately. Having an arbitration requirement (while allowing appeal), is probably a good thing (Note: Washington requires some form of alternative dispute resolution before trial, and now has added an arbitration clause), as it would hold costs down and give a victim a chance to be heard. Part of the problem is that insurance companies care more about their shareholders and their bottom line over their customers. Part of it is judges that should be more willing to throw out questionable cases. Borderline Plaintiff cases of all sorts should be dismissed instead of given the benefit of the doubt. Lastly, part of the problem is that doctors don’t police themselves as hard as they do. Given that a small group is responsible for a majority of the problems, getting rid of that small group would do more to help everyone from doctors to patients than tort reform ever will.
I don’t think Governor Gregoire’s reforms will solve the problem, but it is a step in the right direction. Given the animosity on all sides, the fact that she has got thing moving in the right direction says a lot for her. The Governor is not perfect, but she does shine at pulling disparate sides together and finding solutions. Not a bad thing to have in a Governor.
Nice deflection. When you assert that while”the insurance companies are not “profiteering,” none of them are going bankrupt writing coverage for health practitioners,” you are simply acknowledging that “insurance reform” means restraining profits. What else?
This whole premise (assuming that greed is the motive behind excessive profits) poses an inescapable internal contradiction. If profiteering is in fact the problem with health care insurance, why are insurance companies NOT competing for those profits by lowering their profit expectations to expand their profit base? In point of fact they are, and wherever government regulates profits, the consumer takes the hit in increased health care costs. Government regulation is already a significant part of the problem.
Liberals like Gregoire who ignore the profit motive and the fact that the insurance industry is an essentially competitive one miss the whole point, and they do so intentionally. They intend to blame the wrong culprit so they can create a government system to supplant the market one. They refuse to tell the truth about what is causing the real escalation of health care costs and the effect a government system would have on the quality of a “socialist” system.
Saying that ”there has never been a case of rates leveling or going down where there has just been med-mal tort reform,” is the exacting equivalent to saying there has never been a case of rates going down where there has just been “profit-control insurance reform,” and yet in the latter instance, rates go up for the key reason; health care is not a right, and government intrusion is costly and inefficient.
The “million dollar question” you asked says it all, ” could you really say that [hypothetical V’s] emotional damages are worth only $250,000 (as the last initiative would have capped them)?
Why not? How much are V’s emotional damages worth? Who's greedy here? What is the REAL problem? Instances of pity and guilt or rational solutions?
I suspect that your answer would support the premise that med-mal tort reform is a useful alternative. Insurance company profiteering is a red herring and you know it.
Thanks for the comments.
On the first part we might agree (but not for the same reasons). I see that Mrs. Gregoire is actively seeking perfection in the art of slash~&~burn politics. There is no underhanded deed that she won't stoop to. There is no unholy alliance that she won't form. She is not only incompetent, but unscrupulous.
As to the second part, there is simply no evidence to support your contention that she even attempts to "pull(ing) disparate sides together and finding solutions" much less shine at it.
Nice try at spin there JDB/Biteme/Toadstool
Posted by: alphabet soup on February 25, 2006 12:35 PMIt’s called the art of the meaningful sounding but inconsequential statement in support of empty nonsense.
Yeah right . . . you bet . . . Greggies a real charmer that one (snerk)
JDB (no doubt) believes that he said something substantive. Humorous.
Interesting that you picked up on just one element of my criticism. I also discussed the risk pool, and it would seem that how the risk pool is managed would (if the insurance companies are to be believed) take care of many of the problems inherent in the system.
However, if we are to take you at your word, then there is no problem. Doctors need to simply accept that the insurance companies care only about maximizing profits, and that no mater what you do to the rest of the system, their premiums will keep going up because of that pursuit.
I’m not happy with that. As I outlined, for a good solution, everyone has to give a little. That is what is interesting in the solution that Governor Gregoire has put forward and will be enacted into law. Everyone gave up something. Not a bad start.
Blaming the tort system is more of a red hearing than blaming the insurance companies for raising rates because of bad investment, not because of problems with their risk pool. I’m still waiting for those in favor of caps on an innocent victims damages to please show me one case where you believe the victim was given too much money. Do you have an example?
And, other than putting a cap on an innocent victims recovery, do you have any solutions yourself?
Soup:
Other examples? How ‘bout getting a compromise on the water policy bill that has been battled over for about 10 years? Or getting through the transportation bill last year? Considering that you all claim that she is a lame duck governor that no one likes, that is amazing leadership on her part. Heck, even you have to admit that.
Again, you clearly prove my point. You say,”if we are to take you at your word, then there is no problem. Doctors need to simply accept that the insurance companies care only about maximizing profits, and that no mater what you do to the rest of the system, their premiums will keep going up because of that pursuit.” Can you read? If you take me at my word, there is a big problem; it’s just not associated with what you refer to as, ”the insurance companies for raising rates because of bad investment.”
I said that Government regulation is already a significant part of the problem and only loosely associated with insurance companies (and their profitability) as a cause of increased insurance rates. As a matter of pure practicality, there is no reason why we should not place caps for awards on innocent victims damages. An argument ad absurdum in either direction only supports a strong implication that unlimited damages are not good for the system.
Again, the “million dollar question” you asked says it all,” could you really say that [hypothetical V’s] emotional damages are worth only $250,000 (as the last initiative would have capped them)?”
I answered . . . Why not?
How much are V’s emotional damages worth to you? How much are A through Z’s emotional damages worth to your insurance premiums? Who's greedy here? What is the REAL problem? Such instances of pity and guilt used to justify programs is nothing more than slick manipulation in direct substitution for solutions.
In terms of the overall issue at hand, both blaming the tort system and blaming the insurance companies for raising rates are red hearings. When you refer to “risk pool” management, you imply that those who need health care deserve it whether they can afford it or not. Insurance companies are free to exploit profits if they want to, but if they do so they will not last long, because others will take their place in the market system. The more liberal democrats place regulations on the system, the more problems arise.
It is possible to completely ruin health care by pandering to the notion that it is a right. Liberals intend to blame the wrong culprit so they can create a government system to supplant the market one. They refuse to tell the truth that what is causing the real escalation of health care costs is a burgeoning “socialist” system already in place and they ignore the effect a government system would have on the quality of health care.
Thanks.
"It is possible to completely ruin health care by pandering to the notion that it is a right. "
You do realize you are conflating two very different ideas. This thread is on malpractice insurance, not health insurance.
You want to control health insurance costs, the best thing you can do is get people into routine physicals, encourage well baby care, and catch problems early. Those simple steps will do more to control health care costs than anything else you do.
As for malpractice insurance (which is what I was talking about when I mentioned managing the risk pool), most information I have indicates that the vast majority of claims come from a small percentage of doctors (about 10%). Get that 10% out of the risk pool (and we can discuss the various ways, from setting up a state run high risk system to taking their licenses away), and you will have more control over the rising malpractice rates than through any other reform.
I disagree with you that tort reform and insurance reform are “red herrings.” However, perhaps we can agree that they are not silver bullets. The tort system does raise costs, and might not be the most efficient way of dealing with problems of malpractice. However, proper regulation (and as you probably well know, the insurance industry is and has always been a highly regulated industry) is also necessary if you are going to provide doctors with relief while still providing victims with fair compensation.
The point is that if you want a better system, everyone will have to give a little. Again, that is what Governor Gregoire has accomplished with this round of reforms. It is only a start, but hardly the great step toward socialism you seem to think it is. It is also only a step in the right direction. If you want, we can discuss other possible steps, but I think you will admit, at least we are moving in the right direction.
”You want to control health insurance costs, the best thing you can do is get people into routine physicals, encourage well baby care, and catch problems early. Those simple steps will do more to control health care costs than anything else you do.”
This argument is completely unsupportable because it is not true. I agree that preventative care is useful in reducing health care costs across the board and that is why I support the health care accounts with options and incentives proposed by the Bush administration. Otherwise, there is simply no way to effectuate preventative care, and it becomes nothing more than an empty slogan for a feckless notion.
As for malpractice insurance . . . [re managing the risk pool], most information I have indicates that the vast majority of claims come from a small percentage of doctors (about 10%). Get that 10% out of the risk pool . . . and you will have more control over the rising malpractice rates than through any other reform.”
If you look closely at the stats you will find that the small percentage you cite of doctors practice specialties comprised mostly of emergency medicine, and OB/GYN. I agree that a look at this area (or other key areas) is appropriate. Placing caps on damages might prompt further action in that regard and it might not, but neither you nor I know for sure. One thing sure, Gregoire's efforts will not.
The reason that I say that tort reform and insurance reform are “red herrings, is because there are more decisive and appropriate steps that can be taken to bring health care costs back into a reasonable range, and they persuade people that something decisive is being done when it isn't. Illegal immigration reform is bigger than either tort reform or insurance reform will ever be. We have the best health care system in the world, and it is good because it is fundamentally a market based system. Anyone, anywhere in America at almost any time can receive care without proof of insurance or resources to pay for it and this is because the law says so.
Doctors do not practice because they want to do good for others as much as that they want to earn a good living for themselves by being of service. All other things being equal, there are millions of people who contribute nothing to the infrastructure, and who pay nothing for their health care especially in the areas of emergency medicine, and OB/GYN.
The simple fact is that we can afford it at great cost. . . but why should we?
I don't agree, we are not going in the right direction.
Regarding tort reform which was the main subject our exchange, the “million dollar question” you asked says it all,
"could you really say that [hypothetical V’s] emotional damages are worth only $250,000 (as the last initiative would have capped them)?”
I answered . . . Why not?
How much are V’s emotional damages worth to you? How much are A through Z’s emotional damages worth to your insurance premiums? Who's greedy here? What is the REAL problem? Such instances of pity and guilt used to justify programs is nothing more than slick manipulation in direct substitution for solutions.
Why not engage a significant challenge to your own question?
Thanks.
Posted by: Amused by liberals on February 28, 2006 02:44 PMMy understanding of the risk pool assessment is not that the 10% represents high risk practice areas, but that the 10% represents doctors across all practice areas that (for whatever reason), are not practicing medicine well. This could be because of burnout (there was a great article about five years back in the New Yorker by an orthopedist on this), or substance abuse, putting profits ahead of providing good care or the fact that someone has to be a bad doctor (they can’t all be gems). If you have a link to a study that shows otherwise, please provide it, as I would find that interesting. But, as you agree, we would need to look at this any other areas.
I do not agree that malpractice and health insurance rates are inevitably linked. There are many other factors that drive up health costs and therefore health insurance rates. One is your example that anyone can go to an ER and get treated. The problem is that instead of paying thousands for emergency treatment, you could take care of many of these problems if you spent hundreds on maintenance care.
As to the innocent victims recovery for their pain, suffering and emotional lost, the problem is of course how does one come to a fair valuation. Undoubtedly there is a difference between a person who has an extended recovery and extra surgery because someone left a sponge inside them, to a women who looses her ability to have children and must be on hormone therapy for the rest of her life because of a bad diagnosis of cancer to the damages if a doctor removes the wrong leg in an amputation to the emotional damages to a spouse when there love one dies because someone missed a diagnosis for cancer or heart problems that should have been caught early and prevented. Then throw in a case like the surgeon who carved his initials into a woman’s abdomen in NY (although, note, probably not covered by malpractice insurance).
In the case of lasting physical loss due to a doctors error I am perfectly comfortable in saying that $250,000.00 is much to low. Note, in the three examples given above (loss of limb, loss of reproductive ability, loss of a spouse, especially if that spouse was retired), the economic losses are very small, but the emotional damages are continuous, non ending and something that cannot be recovered in any way. I have little trouble with a jury determining these awards.
This is especially since I have yet to hear anyone give an example, in Washington, of a “runaway jury” awarding ridiculous emotional damages. Do you have one? Heck, can you cite one example of a “frivolous” med-mal claim that went to a jury and in which the plaintiff won an award? Unless you have some examples of the system not working in a way that caps would address, then caps are a non-starter. There may be (and I would argue, are) ways that we could fix the claims system to provide better justice to everyone in the system, but caps won’t get us there.
An easy search of the web yields a plethora of information supporting my thesis. For example: "Our Generation: What tort reform means to me," by Maria Manriquez Gilpin, MD, where Ms. Gilpin says the reason why many have stopped practicing obstetrics altogether is ”First and foremost a lack of affordable and available professional liability insurance, but risk of lawsuits was also compelling. Further she says, ”regardless of where you practice, who pays for your insurance, or whether you personally have been sued for malpractice, I urge you to become involved in the fight for professional liability reform.” As you know this means tort reform.
Of course this is just an example, but it took me less than a minute to find it among a sample comprising 1 of 3,905 results containing “Emergency medicine, and OB/GYN tort reform,” (0.28 seconds). It establishes a strong inference for the assertion that the OB/GYN area of practice is threatened by the increased cost of professional liability insurance, and that malpractice and health insurance rates are inextricably [not as you say inevitably] linked. If they were inevitable, no reform of any kind matters.
You say that, ”In the case of lasting physical loss due to a doctors error I am perfectly comfortable in saying that $250,000.00 is much to low,” and yet you refuse to say why, how much V’s emotional damages are worth to you, and how much are many Z’s emotional damages would be worth in terms of your health care insurance premiums?
It is apparent that you have decided not to answer these questions because a thoughtful response on your part would overcome your case.
You say appropriately that I have not produced,” an example, in Washington, of a “runaway jury” awarding ridiculous emotional damages . . . a “frivolous” med-mal claim that went to a jury and in which the plaintiff won an award?” True enough, but that certainly doesn’t mean they don’t exist.
More importantly in the instant case, what you fail to recognize is that your own assertions defeat themselves on their own merits. You say, ”Unless you have some examples of the system not working in a way that caps would address, then caps are a non-starter.” Since you admit that $250,000.00 is much to low in the case of Z but refuse to specify any appropriate upper limit of damages at all, you are saying in effect that no limits to damages can constitute an unfair burden on those of the medical profession in terms of higher premiums for medical liability insurance. The corresponding (and inextricably linked) consequence is increased Health Care insurance costs for the average consumer (including you).
In any event, if as you say, there are no instances of runaway juries ” awarding ridiculous emotional damages,” why are you concerned with caps? After all, you say that if we ”want a better system, everyone will have to give a little.” Why not give a little.
Instead of attempting to divert attention from the inherent weakness of your own argument, how about answering the real question of what upper limits are appropriate, and act accordingly. Caps are not only a starter, but a useful continuing tool to bring liability insurance for doctors and health care premium costs into line.
Thanks.
Posted by: Amused by liberals on March 1, 2006 11:31 AMDespite your artful dodging and irrelevancies mixed with changes of subject in service to evasion of the facts,it is apparent
that you have decided not to deal with the real issues because a thoughtful response on your part would devastate your case.
Thanks for proving that you are (once again) completely defeated in rational argumentation. Tort reform is a great idea.
No shame though, you can't ever win so long as you pursue a liberal agenda because it is completely devoid of substance.
What is humorous here is watching people like you dance around in the vain attempt to prop it up.
Thanks for the interesting illustration of your liberal democrat delinquency.
Posted by: Amused by liberals on March 2, 2006 09:21 PM