Health “Reforms” a Boon to Trial Lawyers

There are a lot of losers in the new health “reform” bill, starting with, well, almost everyone who’s a patient. But fear not, some people do gain.

Who? Ambulance chasers, for one, according to Joseph Nixon, a senior fellow with the Texas Public Policy Foundation. “Few groups make out better under the congressional leadership’s health-care plans than personal-injury trial lawyers.”

He finds at least “26 new opportunities for plaintiff lawyers to sue doctors for malpractice” (emphasis added).

So as we’re going to encourage more people to visit the doctor (by growing Medicaid and subsidizing health insurance), we’re going to discourage doctors from practicing medicine, by laying a number of new legal traps.

Contrast this possibility with the reality of what has happened in Texas. Nixon knows a few things about the Lone Star state, since he is the author of reforms enacted there a few years ago.

In the 6 years since the state enacted tort reform, 18,000 doctors have moved in and set up shop. Some portion of that number, no doubt, is due to the state’s favorable economic situation (growing population, no income tax), but some of the credit goes towards new rules meant to curb frivolous lawsuits and reduce the need for defensive medicine.

A new federal law would likely inhibit other states from following the example of Texas. Worse, it could invalidate the reforms that Texans have benefited from since 2003.

Just another example of how “health deform” will hurt. I’m sure we will be finding more skunks at this party as time goes by.

Say No to “One-Size-Hurts-All” Solutions

Before Texas enacted tort reform, a major hospital system in the state paid $100 million a year in liability defense. After tort reform, it paid $2.3 million. “Much of that savings,” say Gov. Rick Perry (R-Texas) and Newt Gingrich, “has gone into expanding health-care services in low-income neighborhoods.”

With that as an example of what state-focused reform can do, the two lament the top-down, rule-from-above approach favored by Congress.

In a transparent attempt to bribe governors and state legislatures into accepting 15 million to 20 million new people nationwide onto Medicaid rolls, Congress is proposing a series of additional subsidies to states to cover 90 percent of the costs of the newly mandated populations. In true Washington form, these handouts would be debt-financed, through the generosity of foreign bankers, to be paid back by future generations of American taxpayers.

Because politicians are more concerned about “covering the uninsured” than what that coverage actually does, Medicaid payments to doctors are notoriously low, providing them few incentives to see new patients. Medicaid is also rife with fraud, yet Congress turned down a proposal that would clean it up.

Perry and Gingrich end by calling for giving states the power to customize solutions to their own situation. The alternative, they say, is “one-size-hurts-all.”

Use Tort Reform to Increase Access to Health Care

Joe Nixon recalls what Texas has done with medical malpractice reform, and suggests that other states do the same. “These common-sense reforms,” he says, “have led to a massive increase in the accessibility of health care in Texas, huge growth in the capital infrastructure of hospitals and clinics, hundreds of millions of dollars more each year in charity care and Texas’ adding more than 16,000 new doctors in just six years.”

Nixon is a former Texas legislator, and currently serves as a policy fellow with the Texas Public Policy Foundation.

Is there a Doctor in the County?

Living in a thinly populated area has its advantages but also some disadvantages–such as not having a doctor within 40 miles.

The Austin American-Statesman puts some numbers on something I've read of before, which is the fact that some Texas counties don't have a resident doctor. How many? Try 27.

Some of the problems lie in the lack of opportunities: "A lot of people aren't looking to live where there's no movie theaters, a limited number of churches, no choices in schools." Being the only doctor in an area also makes it hard to take a day off.

Tort reform has helped some, by making medical malpractice insurance not so expensive. The Texas Public Policy Foundation reminds us, however, that government payment schemes (remember, Medicare is the single-largest payer of health care in this country) distort the supply of doctors. It also says that restrictions on the supply of nurse practitioners don't help matters.

An Extra $4,265 in Costs for Texans

How much would health care proposals in Congress cost? The Texas Public Policy Foundation says another $4,265 over 10 years for every Texan.

You can read the report (PDF) or listen (MP3) to Donna Arduin, one of the authors of the report, discuss its finding.

Texas Gave Tort Reform a Chance

Gov. Rick Perry (R-Texas) argues an obvious but important point: Medical malpractice reform is nowhere in the national debate on health care, and it should be.

Perry offers up his own state as an example of the problems caused by medical lawsuits, and what a state might do about it.

The problem:

Just six years ago, Texas was mired in a health care crisis. Our doctors were leaving the state, or abandoning the profession entirely, because of frivolous lawsuits and the steadily increasing medical malpractice insurance premiums that resulted.

Two thirds of our state's counties had no practicing obstetricians, and for pregnant women that meant long trips in cramped cars and higher fuel bills. Sixty percent of our counties had no pediatricians, which often meant delayed, or denied, health care for sick children.

The solution:

In 2003, I declared the medical liability crisis an emergency item, and the legislature responded, passing sweeping reforms that protected the patient, but also shielded doctors and hospitals from unscrupulous trial lawyers eager to make a quick buck at the system's expense.

The result:

The number of doctors applying to practice medicine in Texas has skyrocketed by 57 percent. In 2008, the Texas Medical Board received 4,023 licensure applications and issued a record 3,621 new licenses.

In all, in just the first five years after reforms passed, 14,498 doctors either returned to practice in Texas or began practicing here for the first time.

U.S. Index of Health Ownership 2nd Edition Is Here

Pacific Research Institute has published the 2nd edition of the U.S. Index of Health Ownership, the only ranking of health care in the states that uses criteria of individual choice.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.

Rationing by Another Name

A common complaint about life when government calls the shots in health care is that services are rationed: You have to wait months for an MRI or even to see a doctor.

Unfortunately, you don't have to travel to Canada or Britain to see waiting lists. You can get a feel for what it's like by being a Medicaid patient here in the U.S.

In Dallas, only 39% of doctors surveyed said they are taking new Medicaid patients. That means people who are on Medicaid (often due to government policies that make private insurance unaffordable) have to wait weeks to see a doctor when they need one.

Here's one story, from the Dallas Morning News:

When Ruth Guerra, 6, tries to write, holding the pencil puts just enough pressure on her left pinky to make it bleed. With her condition, if she falls down while playing or a classmate accidentally brushes against her, she bleeds.

Last week, Sandra Ramirez, Ruth's 33-year-old single mother, took time off from her hourly job at the Dollar General after another one of Ruth's bleeding episodes.

Ruth's elementary school in Crandall sent her to Dr. Turner Lewis, the only pediatrician for miles in Kaufman County accepting new Medicaid patients. But Lewis did not have the advanced training to completely treat Ruth's hemangioma, a collection of rapidly growing blood vessels that makes her prone to bleeding.

Because of a shortage of specialists accepting Medicaid, Ruth must wait until Sept. 9 for surgery.

A three-month wait! Here in the U.S. of A., where new gadgets such as the iPhone are as ubiquitous as Fruit Loops, the poor have cable TV, and we joke about Starbucks having stores within Starbucks, a child has to wait three months to see a doctor, because the public health insurance program her mother depends on is so overused that it pays prices equivalent to the discount bin at a Dollar Store.

No surprise, then, that people in Medicaid, and now even Medicare, are having to wait. Shortages by another name. Turning health care entirely over to government will only spread the misery, not fix it.

Claims-Payment Regulation Fiasco in TX, Take 2

In the late 1990s, Texas passed a terrible claims-payment bill that required 100 percent of all claims to be paid within 30 days. The law was a disaster — one company was fined $60,000 for processing 0.04 percent of claims late — and was later repealed. Now, the state is poised to repeat that disaster with the passage of House Bill 1342.

HB 1342 requires insurers to essentially process a claim in real time, providing the doctor with information on the patient's current deductible, copayment and coinsurance levels. The problem is that the technology to provide this information, ensure the privacy of the patient, and secure the data is not currently available. In essence, any doctor in the state will have access to the private insurance data of each patient.

This requirement to provide all insurance payment information to the doctor at the time of service is likely to be very expensive and has never been tested. No one knows if the information will ultimately be accurate. Claims payment can be delayed for a variety of reasons, including when insurance companies need to investigate further and doctors who may wait longer than 30 days to even submit a claim.

Gov. Rick Perry ought to stamp the legislation with a veto.

(Via CAHI's JP Wieske and Kevin Wrege)

Middle-Class Medicaid in Texas

The Texas Public Policy Foundation on the expansion of SCHIP:

HB 2962, which expands the Children’s Health Insurance Program (CHIP) from 200 percent to 300 percent of the Federal Poverty Level, is on the House Major State calendar tomorrow. Not only will this have a negative effect on the budget, but extending CHIP to families making up to $66,000 per year morphs the program into an expensive entitlement for the middle class. Expanding this program while 170,000 children projected to be eligible for CHIP are still not participating is a wasteful decision. Additionally, HB 2962 creates a buy-in program for families whose net income is between 300 percent and 400 percent of FPL.

Last week, the House Human Services Committee passed HB 1541, expanding eligibility for the children’s Medicaid program from six months to 12. The Legislature should resist efforts to expand this program as it was intended to provide health care to our poorest citizens, and a six-month eligibility period ensures that the services provided are to the truly needy. Increasing the continuous eligibility period will increase the number of Medicaid recipients by more than 250,000 and cost taxpayers almost $300 million in state funds over the next biennium. The 12-month eligibility proposal will be a significant burden at a time when the state needs to restrain spending ahead of a projected budget shortfall in 2011.