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October 2004 Articles You may also Download This Eidition in it's entirety using the Link Below The Health Care Crisis in America: Part 2 By Dan E. Austin, MD In our first installment of this report, we looked at the primary factor contributing to the crisis of health care, namely the cost of health care. In this continuation piece, we will consider two more factors. The medical malpractice and prescription drug crises.
Medical Malpractice Insurance Crisis Indeed, for many affected physicians the crisis is real. The average cost of medical malpractice per year for all specialties has slowly risen from about ten thousand dollars about seven years ago to any where from twenty thousand to forty thousand dollars depending on what part of the country we are considering. For specialties like OB/GYN, it is virtually unbelievable. The average annual rates are anywhere from seventy five thousand to one hundred and twenty five thousand dollars, and for physicians with any pending malpractice claim, we move into an area averaging one hundred and twenty five thousand to one hundred and seventy five thousand. The rates are simply absurd, but who is to blame? Doctors believe the malpractice lawyers are the principal cause for the mess, and one can add in the judicial system that awards these crazy amounts to claimants. The insurance industry in turn will quickly add its increased premiums. What about the greed of the insurance industry itself? For every dollar they pay out, they collect two dollars from physicians. It is simply a system gone amok. Two weeks prior to the writing of this article, the entire physician staff at Prince George’s Hospital in Cheverly, Maryland voted unanimously to completely boycott malpractice insurance altogether as a requirement for practice in the hospital. This is only the beginning of a system that is simply out of hand. The governor of the state of Maryland, tried to push a bill last month through the state assembly of Maryland to address the state crisis, but the democratic-run assembly with a Republican governor with much on his plate has yet to come up with any result, while in the mean time, the crisis looms on. The governor of Nevada successful passed a tort reform act in that state and at least for now, it stopped a crisis of the exodus of physicians from that western state. It is difficult to understand why this eminent issue of such that brings an intense magnitude of suffering on a segment of society that performs such a vital need is so easily ignored. The republican-run US congress took on the issue of Tort reform a few months ago, with much debate and lots of pressure from the senator from Tennessee, majority floor leader Frist, himself a physician, but in the end, the senate had nothing to show for its debate.
The issue is somewhat disturbing, in that the lawyer-dominated law making body of the country is so ill-concerned about another professional group (physicians) that should enjoy similar prestige in society. Otherwise, it can only be assumed that it is an issue of squeezing the pockets where it hurts on both sides. It is the nature of the beast as they say, so physicians pay more malpractice; they make enough money, it should all add up well at the end. In the mean time, a good twenty percent of physicians are forced to retire early, many cannot even afford to practice. At a recent regional American Medical Association meeting in one of the southern states, a group of physicians took the issue personally, opting not to see family members of lawyers as an in-your-face type of retaliation. Not a very professional approach for the Hippocratic oath and noble elite professionals like medical doctors, but times are rough and the issue is really hurting the pockets. Its seems the issue is heading towards a national show down. The majority of states may successfully try some stop gap measure as a handful of states have already attempted, however the issue is across state lines, and something has to be done. The only viable option to consider is tort reform; all the other options would be faced with such opposition as might even threaten the free market economy as seen from the side of the insurance companies. Also threatened would be the democratic bill of rights of individuals that the lawyers group has so well politicized in order to keep that dollar flowing from settlements of lawsuits. Unfortunately for the physician’s groups, they are caught in between these two giants of the new world economy. The physicians are going to have to roll up their sleeves, work together and come up with some tough options and put up a good fight at this time; otherwise they will be reduced to simply watching as one by one they would see their earnings eroded and slowly eaten away by this litigious beast. In the meantime, the cost can be passed on to the consumer, the patients, and the forces of the markets would determine the price. This of course doesn’t help the consumer, and we can see why there is a health care crisis which is certain to be around for a while. Pharmaceutical Drug Costs: Major Crisis Contributor The cost of pharmaceutical drugs has continued to rise in the past few years in America and more so than any other industrialized nation. Across the border into the Canada, the same drug companies sell the same drugs for fifty to eighty percent less. In Canada, the prices are set by the government bulk buying rates for the whole country because of the national government health system operated in Canada. The powerful pharmaceutical industry complains of lack of safety when re-imports are brought back to the US from Canada. More openly they complain that high US prices go to cover the cost of research and encourage further drug development. There is no question that the price of prescription drugs is fueling this crisis. Many states and municipalities are already going across the border to buy these drugs for their employees. Recently the state of Vermont has sued the Federal Drug Administration order to force their way into legalizing this practice of going across the border to Canada to buy at Canadian rates. This would be an interesting case to watch closely because of these developments. There is really no other viable option at this time, except for the pharmaceutical industry to see this as an eventual loss and come up with some equitable bulk rate system for the US to avert the exodus to Canada for lower drug prices.
The Crisis Continues For now, the heat is on, and the health care crisis continues. In the last part of our article we will look at government health care programs and the government’s contribution or solution to the health crisis, and in conclusion we will look at alternatives and options available that may avert or at least palliate the present health care crisis.
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