Senator Maria Cantwell and Health Care

Yesterday, I somehow got invited to a health care forum held at Spokane's city hall, sponsored by Maria Cantwell, one of Washington's U.S. senators. This is what happens when you get on one email circulation list - you end up on all of them. But I was glad to get the invitation and attended. As noted in an earlier entry, I'm willing to participate in this push for health care reform. That makes information key.

What an interesting forum! It was a panel of health care experts, and included physicians, nurses, hospital CEOs, and insurers. One of the key points at the outset was how there are fewer primary care physicians now than ever before. This is an issue that my sister (an ER doctor) has mentioned. It impressed me that this panel was on top of that issue, and that Sen. Cantwell has proposed a bill in Congress to attempt to support primary care physicians financially. Apparently Spokane has a lot more primary care physicians (i.e., family doctors) than a lot of places around the country. Also, and I did not know this, it turns out that Washington is a cutting edge state in the medical field in a lot of ways. I did know that my monthly insurance premiums are cheaper here than they would be in other states. Apparently that has to do with various networking and streamlining programs - designed at cutting costs - that the state of Washington has.

It was also interesting to hear how states with the highest per patient medicare costs do not provide better health care. In fact, the opposite appears to be true. Here's an article from the New Yorker where the reporter went to McAllen, Texas - with the highest per capita spending of medicare is - to try to figure out why the costs are so high there. The article compares costs in McAllen to El Paso - a similarly situated community where the costs are half the costs of McAllen.

Also interesting was the intention of the panelists and the senator to figure out a way of acknowledging quality care versus quantity care. Right now, the financial reward goes to quantity (number of tests done, procedures, etc.).

There was one guy there, a doctor, who was chosen to be on the panel because of his advocacy for a single payer system (meaning, a publicly funded private health care system). Every time he talked, the audience clapped. Tough crowd for the follow-up speaker, who happened to be an insurance guy. Though he did hold his own. One thing he said, which I think took a lot of courage, was that there are no "sacred cows," that what might be best for the country may not be best for the insurance companies, and that the insurance companies will have to bite the bullet and accept that. He also spoke about how his company (Blue Cross Blue Shield) had promoted a wellness program, and that 1,500 employees had lost a total cumulative of 18,000 pounds through the program. It seemed almost symbolic of what needs to happen with the health care system overall. You know - cut out the fat.

At about the same time yesterday, in Chicago, President Obama was talking to the AMA about the problems with health care costs - too much discussion about insurance, too many tests being run. He told the doctors, "You entered this profession to be healers - and that's what our health care system should let you be." (Here's a short article on his speech, though I don't particularly care for the "corrupt" comment. To me, the health care system is like the legal system, when it comes to the professionals - most doctors, like most lawyers, do a stand-up job. And then there's the few that ruin it for the rest of us.)

Speaking of lawyers... With health care, there is that additional issue of lawsuits, and the cry for tort reform. It came up only briefly in the forum. Personally I've never filed a medical malpractice case (and have turned down several). And I'm sympathetic to doctors who feel they are in front of a firing squad when they practice medicine. I see it, I understand it. I'd like to see control. No sacred cows.

I do have strong feelings, however, against capping jury awards, for at least two reasons. First: the claim that awards are getting larger is only reflecting the change in laws already, since many states (like Washington) have created huge procedural and financial hurdles to even filing a medical malpractice lawsuit so that, now, virtually the only cases filed are the ones where damages are both substantial and easily proven. And those are the cases that we, as a society, would want to see filed - where we want to see some justice done. Second: insurance companies feed on caps. When there is a cap, insurance companies do not settle cases. It is only the threat of a large jury award that brings insurance companies to the negotiation table. And even then, the agents can be so arrogant, and their actuary tables so set up, that they simply ignore plaintiffs until the day the case is set for trial. If there were caps, the insurance companies would no longer have anything motivating them to settle.

Lawsuits only bring money. It is an incomplete system. But money brings motivation, creates accountability down the road. And the losses suffered are often phenomenally real. How much money would you be willing to accept for a doctor amputating the wrong limb by mistake? None, I know. No money can compensate. That doesn't mean that no money should be paid. Luckily, amputating the wrong leg is the extraordinary case, not the ordinary one. It's the kind of case that can be absorbed in a responsible health care system. So - how do we protect those patients with legitimate, significant claims while also giving good doctors relief from bad lawsuits?

I do think there's a difference between negligence and gross negligence - a mistake, versus a mistake of such grand proportions that we all are shocked it could possibly have occurred. Maybe there is a line to draw there, when it comes to medical malpractice cases. But have no doubt - if power corrupts, then absolute power corrupts absolutely, and insurance companies with capped jury awards is not a world you want to live in.