Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, September 24, 1994 TAG: 9409270021
SECTION: EDITORIAL PAGE: A9 EDITION: METRO
SOURCE: JOHN E. LANE III
DATELINE: LENGTH: Medium
As a preliminary comment, your lack of cited authority is suspect, and the editorial comes as the ranting of a street-corner doom-monger. Where are your sources? Let the reader see what's behind your opinions, which appear to offer little more than lap-dog yapping to protect the medical-malpractice insurance industry, at the public's expense.
You say the price of medicine is inflated in part by malpractice insurance and ``sometimes excessive and unnecessary tests and procedures ordered by doctors practicing defensive medicine, with the courts, more than patients, in mind.''
First, some basics on malpractice. A Harvard medical practice study determined that in New York state hospitals in 1984, approximately 27,000 negligent events occurred, with 7,000 deaths and 900 permanent disabilities. Taking these figures to a national average, medical malpractice kills more than 80,000 people and injures many more thousands.
What has the medical community done about the ``soggy bottom'' doctors who commit malpractice? Disciplinary actions have actually decreased relative to the number of doctors out practicing. Only 1,974 doctors out of 623,000 were disciplined in 1992. Is there any wonder the legal system has been the only effective forum of discipline?
Next, consider malpractice insurance. You say medical-liability costs are increasing at four times the rate of inflation. In 1991, $4.8 billion in insurance premiums was collected from health-care providers. National health-care expenditures in 1991 were $752 billion; thus malpractice insurance cost about 0.64 percent of national health care for 1991. This means about 26 cents out of a $40 office visit went to pay malpractice premiums.
Consider ``sometimes excessive and unnecessary tests.'' Dr. Arnold S. Relman, editor-in-chief emeritus of the New England Journal of Medicine stated: ``Self-referral is a prime example of the current and growing encroachment of commercialism on medical practice.'' What is self-referral to the patient? It's the doctor recommending tests when that doctor owns all or a part of the testing facility.
Five recent studies showed that doctors who indulge in self-referral order testing up to eight times more often than referring doctors, and self-referring doctors' costs were up to seven-and-a-half times higher than when outside services were used. Self-referral breeds price gouging, but the medical community basically refused to police itself. So, at last count, 14 state legislatures (including Virginia's) passed laws that either prohibit or limit self-referral.
What good has come of malpractice suits? Well, an incompetent doctor, who finally gets disciplined by a state board, can simply move and set up shop again in another state. About all there is to stop him or her is a malpractice suit, even if only one in eight malpractice victims files a claim.
The insurance industry wants you to think there is a crisis; if no crisis, then no insurance premium. The unknowing patient, the fearful doctor, the overcharging doctor, ultimately, all are dupes, fooled by the insurance industry's propaganda machine, second only to the tobacco industry in audacity.
In the final analysis, the insurance industry, for the most part, has long been exempt from anti-trust regulation. Hence, it doesn't care who fears whom, so long as those fears produce insurance premiums.
I heard a respected federal judge in Northern Virginia once suggest that the whole malpractice ``crisis'' would best be cleared up by imposing full-bore, undiluted anti-trust law upon the insurance industry. Well, why not?
John E. Lane III is a Roanoke attorney.
by CNB