Let me respond. . . . .

From: Fredrick H (MD, PhD, JD)
To: Gilbert R (Large Med. Grp Exec Dir)

>>Extend high-deductible insurance to the uninsured.
    Medical care is so expensive today, that many WITH insurance go bankrupt just from the deductibles and co-pays. People who can't afford the initial testing end up waiting till the disease becomes a disaster.
 
    This guy talks from the perspective of a rich practicing internist, who has no problem meeting a high deductible.
 
>>Demand real tort reform.
    I just lost a dear friend of 45 years to a complete medical screw-up. More people die of medical screw-ups than of auto accidents. Instead of giving providers a license to kill with impunity by removing their liability for their screw-ups, we need laws that require more oversight, mandatory safety procedures, and severer penalties for preventable errors.
 
>>Extend liability to the government as well private insurers.
    This is a red herring! Give me one example of a doctor who has been held liable for failing to do a procedure when an insurer refused to allow it.
 
    That said, I'm all in favor of heightened liability for ALL insurers and HMOs, not just government ones, for actions which unreasonably lead to harm to patients. That said, I see such actions far more with private insurers than with Medicare.
 
>>Increase rather than decrease reimbursements to doctors and hospitals.
    Yes, every pig wants his place at the trough! We should pay reasonable costs for medical services, but we have no obligation to make every doctor a multimillionaire and every hospital exec a multihectamillionaire.
 
>>Subsidize primary care education.
    I agree that we should encourage doctors to go into primary care. One way is to pay for their medical education in return for service in primary care. Another is to divert some of the money going to specialists to primary care doctors. Another is to allow more well-trained well-spoken foreign doctors into practice if they agree to do primary care.

Give up legal rights?

From: Fredrick H (MD, PhD, JD)

Sent: September 10, 2009 2:20:56 PM EDT

Gilbert: Is it worth giving up our legal rights to be compensated for negligence, to save a mere 2% of medical costs?
Is it worth giving up that impetus for doctors to be careful with patients' lives and health?
 
    What does "Defensive Medicine" really mean? It means that when a doctor is not 100% sure of a diagnosis, he is willing to take the chance that the patient will be physically injured, but NOT willing to take the chance that he himself will be injured financially. If he's not confident enough to defend his decision in court, why is he confident enough to use it on a patient?
 
    "Defensive Medicine" is GOOD medicine, because it doesn't take unnecessary chances with patients' lives!
We have enough medical errors as it is. Imagine what it would be like if we removed the doctors' sense that he might be called upon to justify his treatment?
 
    A "medical court" to preview medmal complaints might be a good idea if there were ANY way of assuring it was unbiased. I see no way. Doctors invariably circle the wagons when one of them is accused, if only because they think that they themselves might be next. And such a panel without doctors would be absurd. Also, people who see disasters day after day become inured to the horror that an ordinary citizen might recognize. They'd become like those judges who refuse on procedural grounds to free prisoners shown to have been wrongfully convicted. We see it as a gross injustice - they see it as just another case.
 
    Perhaps such a panel would be useful if its conclusion was merely Advisory, and might convince a plaintiff or attorney to withdraw a case without merit. Or even make them pay defendants costs if they proceed against the advice of the panel, and lose. But, why should it be asymmetrical? Why shouldn't doctors be penalized for a frivolous defense?

From: Bradley C.R . (MD, DLFAPA)

Sent: September 10, 2009 3:11:27 PM EDT

Hi Fredrick,
Our system should operate on a system of check and balances, but our current tort system does not protect our legal rights and needs revision in order to do so.
There are many other motivators for doctors to be careful for patient’s lives and health.
The current system is more like a raffle for a few who have serious adverse events often not associated with malpractice, while not addressing the greatest source of malpractice because it is protected by ERISA.  (Ed Comment - it prempts certain legal actions.  Fredrick responded: "I completely agree! ERISA preemption should be dumped, and it would be helpful to have neutral court-appointed experts in ADDITION to the hired guns picked by each party.").
The concept of “loser pays” would be worth considering in tort reform.

I had a conversation with an ER physician who stated they order a 6 figure amount of tests on each shift for defensive medicine purposes.
I had a conversation with a pediatric neurologist who stated there are a shrinking number of pediatric neurosurgeons because the malpractice insurance costs are too high to enter the field. She stated there are now less than 100 in North America. I see some senior OBGYN doctors retiring sooner they otherwise would because the cost of malpractice insurance is excessively high for someone in a part time practice.
The massive class action suits against drug companies, etc. give huge amounts of money to a few and contribute to increasing overheads that add to making medications unaffordable to the masses.

Although rights need to be preserved, improvement is needed in the current system to truly our protect rights and to also protect us against the opportunists that exploit the system.
 

The following is a statement from American Association for Justice President Anthony Tarricone.  He asks members of AAJ to call thier Senators and speak to the following  key points:

Medical malpractice is about real people, with real injuries. The Institute of Medicine estimates that 98,000 people die each year in the US from preventable medical errors. And, this number does not even include the countless other people who are injured by medical errors. Rather than reforming the legal system that provides protections to these injured patients, we must focus on reforming the medical system in this country to prevent these errors from ever happening in the first place.  
 
Americans should not have to give up rights, in order to gain the right to healthcare. President Obama has repeatedly stated that in America, healthcare is a right.  Likewise, Americans should not have to relinquish their constitutionally protected 7th Amendment rights in order to gain access to quality healthcare. Patients’ rights are not a bargaining chip. 
 
Health courts would be an expensive, bureaucratic nightmare. They would exchange a patient’s constitutional right to a jury trial for a schedule of pre-determined outcomes that would be handed out by judges more interested in appeasing special interests than rendering justice to the injured patients standing before them. And health courts would not protect patients from wrongdoers, but instead, would shield doctors and hospitals from accountability for their careless, harmful acts. Health courts truly are an unfair proposition for patients. 
 
Practice Guidelines should not create immunity for negligence. Giving doctors immunity for complying with guidelines is an idea at odds with the fundamental principle of practice guidelines which has always been to improve patient quality by giving doctors some type of guidance when making decisions based on sound medical expert research. Practice guidelines were never intended to be stringent, inflexible rules for doctors to follow in exchange for legal immunity.

Fredrick makes a 'final' comment: "I agree that much room for improvement exists in the current medmal system, but I don't consider further burdening the victims counts as improvement."