Medical-Tort Law: Ranking the States

How much do a state’s laws governing medical malpractice and other torts relevant to health care affect the availability of care?  Plenty!

Lawrence J. McQuillan’s & Hovannes Abramyan’s 2010 edition of the U.S. Tort Liability Index, which has a number of measurements included in the U.S. Index of Health Ownership, ranks states according to 42 variables.

Eight of the measurements in the U.S. Tort Liability Index are relevant to the U.S Index of Health Ownership: One output and seven inputs. The previous edition of the U.S Index of Health Ownership included six measurements of medical tort, but McQuillan & Abramyan have discovered more variables for their 2010 edition of the Tort Liability Index, allowing more detailed measurement.

As a partial update of the U.S. Index of Health Ownership, this brief analysis calculates a medical-tort index from a simple average of the eight relevant variables.  Mississippi, Nevada, Michigan, Colorado, and Louisiana lead the pack; while Vermont, Rhode Island, Kentucky, Pennsylvania, and Iowa bring up the rear. Even the leaders, however, lag in some measurements.

Mississippi, for example, leads on procedural rules: Pre-trial screening or arbitration and conditions on the use of expert witnesses. However, it does not limit lawyers’ ability to abuse their privilege by limiting their share of awards. Colorado and Louisiana also fail to impose limits. Unfortunately, the laggards do not show a similar pattern: The bottom five states perform poorly in all eight measurements.

Reducing the burden of medical tort is critical to increasing Americans’ health ownership and reducing medical costs that curtail our access to care. Some progress is evident, but states aiming to improve their medical-tort laws still have a long way to go.

Legislator Laments “Federal Incoherency” in Medicaid

A Democrat state representative in Washington discusses his frustration in trying to deal with federal chaos in funding for Medicare and Medicaid. He writes, “expect cash-strapped states to cut Medicaid eligibility, reduce benefits and increase co-pays. All with an additional 16 million Medicaid enrollees expected in 2014 when the federal health-care-reform bill expands eligibility. This is hardly what was hoped for back in March. A federal commitment to health care cannot be only rhetorical. Nor can we feel sanguine about the ability to assume new obligations when old ones are neglected.”

U.S. District Judge Denies Governors on Lawsuit

Last week, Gov. Chris Gregoire of Washington, Gov. Ed Rendell of Pennsylvania, Gov. Bill Ritter of Colorado, and Gov. Jennifer Granholm of Michigan all filed a motion in federal court, seeking permission to submit a friend of the court brief. They wanted to go in the record in favor of the new federal health care law, in the case that some states are bringing against the U.S. Government. In at each of the four states, Republican attorneys general joined in the suit over the objections of the Democratic governors.

The federal judge in the case, Roger Vinson, said no, but that the governors may try again should the case go to trial.

The Effects of National Health Care Law on Business, Doctors, and Medicaid

It’s going to take a while for the effects of health “reform” to make themselves known. The Washington Policy Center has recently tried to figure how how ObamaCare will affect the state of Washington. Here’s some information from one of the center’s latest e-mail missives. All items are in PDF:

In The Impact of the National Health Care Law on Businesses in Washington State, WPC Health Care Policy Analyst Dr. Roger Stark discusses the specific consequences the recently enacted national health law will have on employers and employees, including increased costs and fewer choices.

In The Impact of the National Health Care Law on Doctors and Other Providers in Washington State, Dr. Stark shows how the reform will impact the 1,400 long-term care, rehabilitation and other sub-acute care facilities, and approximately 12,050 physicians in Washington. Under the new law, the only way for the government to hold down costs will be to place more regulations and price controls on the health care delivery system.

In The Impact of the National Health Care Reform Law on Medicare and Medicaid in Washington State, Dr. Stark discusses how one-half of the funding for the new national health care reform law will come from almost $580 billion in cuts in the Medicare program over the next ten years. In addition, an estimated 280,000 to 360,000 more people will be added to Washington’s state Medicaid program.

Are Jeff Bezos and Drew Carey Backing ObamaCare or Consumer-Directed Health Care?

I’m not quite sure, but I was interested to see them lead a group of investors committing $6 million to Qliance, a “primary medical home” that made its name with a business model that bypasses health insurance.

Qliance notes that 40% of health spending is chewed up by insurers, and it claims to use the savings by cutting out insurers to improve access and quality of care.

Qliance is a primary-care practice with three locations in the Seattle area.  Obviously, $6 million of venture capital is meant to finance a significant expansion.  With ObamaCare giving direct control of medical practice to the U.S. Secretary of Health & Human Services and various Czars to be appointed by her, it seems like a inopportune time to pour money into a consumer-driven medical venture.

However, Qliance announced in December that the Senate had added a last-minute amandment to the bill to allow such ventures to operate in the future “exchanges.”

I gave Qliance a call, and they were very helpful, directing me to § 10104(a)(3) of the Senate bill (H.R.3590), which amends § 1301(a) of the same bill, to state:

TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MEDICAL HOME PLANS- The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

Hmmm…..  It looks to me that Qliance, and other medical providers, will have to make deals with “qualified health plans” rather than patients directly.  On the other hand, “coordinated” is a pretty broad word.

One critical attribute of ObamaCare is the all-encompassing, arbitrary, and unaccountable power given to the Health Secretary, currently Kathleen Sebelius.  According to Ron Bachman, she’s hiring 700 new bureaucrats to write the regulations for ObamaCare.

Will outfits like Qliance be allowed to compete in ObamaCare?  The President and Sec. Sebelius are advocates of single-payer, government monopoly, health care, so I’m pretty skeptical about their willingness to allow doctors to work for patients, instead of insurance companies acting as public utilities (i.e. ObamaCare).  On the other hand, a future Health Secretary (in, say, January 2013), might be more accomodating.  Time will tell.

Nevertheless, I’m glad that capitalists are still willing to put their money at risk, investing in consumer-driven models in the age of ObamaCare.

More On Buying Health Insurance Across State Lines

I’ve expressed a real lack of enthusiasm for the Republican proposal that Congress should pass a law allowing groups to go jurisdiction-shopping for health insurance, especially in the absence of eliminating the prejudice against individual ownership of health insurance.

One correspondent chided me for allowing states’ “geographic monopolies” to stand in the way of competition. But isn’t that a fundamental characteristic of a state — that it has a monopoly over state laws within its own boundaries? If you don’t like it, vote in a new legislature or move to another state. I live in California, where personal income taxes are way too high and harmful to our welfare. But I’ve never heard a Republican politician propose that Congress pass a law allowing individuals to choose which state’s rate of income tax they pay, so Californians could opt to pay zero income tax by choosing Florida’s tax rates.

In any case, this is irrelevant: States can just go ahead and allow interstate purchasing of health insurance themselves. Here’s a bill in Washington State to allow just that; and here’s one in Georgia. So, just get on with it. There’s no need to wait for Congress to act.

State governments ration “free” cancer screenings

When you empower government to provide “free” health care (paid by others through taxes), government gets to decide when it’s appropriate for you to receive it.  Here’s yet another example from the Associated Press:

…low-income women in at least 20 states are being turned away or put on long waiting lists for free cancer screenings, according to the American Cancer Society’s Cancer Action Network. In the unofficial survey of programs for July 2008 through April 2009, the organization found that state budget strains are forcing some programs to reject people who would otherwise qualify for free mammograms and Pap smears.

…

New York used to screen women of all ages, but this year the budget crunch has forced them to focus on those considered at highest risk and exclude women under 50….

At least 14 states cut budgets for free cancer screenings this year: Colorado, Montana, Illinois, Alabama, Minnesota, Connecticut, South Carolina, Utah, Missouri, Washington, Ohio, Massachusetts, Pennsylvania and Arkansas.

When “Free” Health Care is Unaffordable

The state of Washington has a heavily subsidized health program called “Washington Basic.” It might do you some good–if you can actually enroll.

But there are more people on the waiting list than are actually enrolled in the program.

There’s no escaping scarcity, especially if A is paying for something on behalf of B.

Pelosi Visit Seattle, Says Nothing

Nancy Pelosi made a victory lap in the Pacific Northwest yesterday, and Piper Scott of the Evergreen Freedom Foundation was there to record the event, which he dubbed more of a campaign rally than a press conference.

“A summary of her remarks would be: blah, blah, blah, health care for all, blah, blah, blah, Pres. Obama promised it to us, blah, blah, blah, it will lower costs and reduce the deficit, blah, blah, blah, it’s all the fault of ‘the previous administration,’ blah, blah, blah.”

Scott commends a local reporter who gave her trouble for refusing to say whether people who refuse to buy insurance will be sent to prison.

Will Spokane Residents Vote for “Free” Health Care?

I never thought of Spokane, Washington, as a place filled with utopians, but maybe I was wrong. Next month, residents will vote on a proposed “Spokane Community Bill of Rights.” Like many such documents, the “Bill of Rights” is actually a laundry list of proposed new government programs. Carl Gipson, director of the Center for Small Business at the Washington Policy Center, warns about the open-ended obligation that the law would create:

Perhaps one of the more financially risky elements of the proposal is the stipulation that citizens are entitled to affordable and preventative health care. If the city is determined to cover those costs, and assuming Spokane’s 23,000 uninsured (Envision Spokane’s numbers) are covered using a very perfunctory preventative plan, the costs to the city would still be in the millions of dollars. Supporters of this plan want to implement a fee-for-service model, but under the lax way the statute is written any citizen could file a complaint against the city claiming that the nominal fee is unaffordable.

The center has produced a short review (PDF) of the ballot measure, which would affect not only health care but also the full range of daily life.