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Wayne Parsons
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Obama makes case for healthcare reform in speech to doctors.

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President Obama yesterday outlined his healthcare reform plans in a speech to the AMA in Chicago. The story was covered by all three network newscasts, though it took second billing to reports on unrest in Iran. While giving the President credit for opening a dialogue, stories last night and this morning tended to cast a skeptical eye on the President’s plans for funding his reforms. Moreover, some media accounts – particularly on network television – described the AMA crowd’s reaction to the President’s speech as negative, and concluded that doctors’ opposition to the so-called "public option" underscores the potential difficulties ahead for Obama’s reform efforts. USA Today (6/16, Wolf), for example, reports, "The mood was upbeat in early March when scores of powerful lawmakers and lobbyists joined…Obama in the East Room of the White House to talk about fixing the nation’s health care system. … Three months later, disagreement has turned to discord over a key element of Obama’s health care prescription: his insistence on a ‘public plan’ to compete with private insurers." USA Today adds, "America’s Health Insurance Plans, an industry trade group, is joined by the American Medical Association, US Chamber of Commerce and others that have expressed misgivings about greater government involvement."" Many other sources covered this topic including: NBC Nightly News (6/15, story 3, 3:15, Williams), the AP (6/16, Alonso-Zaldivar), The CBS Evening News (6/15, story 4, 2:20, Glor), among others.

Two great resources on this subject can be found at:

Debunking the Myth on Defensive Medicine By Cecelia Prewett

Please Mr. President, Don’t Sacrifice the 7th Amendment To Get Health Care Reform – That Is The Old Way Of Washington Politics That You Told Us You Were Going To ChangeBy Wayne Parsons

Malpractice award caps seen as issue of contention. FOX News (6/15) reported, "Obama has never endorsed capping malpractice awards, but has sought to shield doctors who follow standard and established procedures from lawsuits." If protections were created "for doctors who follow procedures from lawsuits" it "would move the debate" about "creating ways for doctors and hospitals to share such information as a means of improving care and reducing unnecessary costs" forward. Many other sources covered this story including: Dow Jones (6/16, Brin), the Chicago Tribune (6/16, Mccormick, Japsen), the Wall Street Journal (6/16, Adamy, Meckler), the AP (6/16, Alonso-Zaldivar), NBC Nightly News (6/15, story 3, 3:15, Williams), The CBS Evening News (6/15, story 4, 2:20, Glor), ABC World News (6/15, story 2, 2:55, Stephanopoulos) and in the Health Blog at the Wall Street Journal (6/15) Shirley Wang also covered the story.

Daschle says Obama is open to malpractice reform. Following up on a story in Monday’s New York Times, CBS News (6/16) reports, "As if taking his case to the most powerful physicians group in the United States to push his controversial health care proposals wasn’t a big enough headline, a New York Times report says President Obama has been working behind the scenes to protect doctors from malpractice lawsuits." Former Senate majority leader Tom Daschle told the Early Show on Monday that "Tort reform is going to be on the table," adding that there is "a clear understanding" that health costs are out of control.

Wall Street Journal criticizes Obama’s views on medical malpractice liability. The Wall Street Journal (6/16) editorialized, "President Obama mentioned the medical liability problem yesterday, and it says something about health-care orthodoxies that even this political gesture sent his usual allies into a fluster." The Journal says, "The trial bar and its Democratic allies say that the threat of lawsuits promotes better care and assures accountability" however, "they’ve fought even modest changes that would offer liability protection if doctors adhere to evidence-based guidelines." Concluding, the paper says that while the Obama administration has billed his "views on medical liability as a ‘credibility builder,’" the "only ‘bargain’ that seems likely to emerge is another major step toward total government control of the health markets."

Washington Times says Obama’s health policies will hurt physicians, patients and hospitals. The Washington Times (6/16) editorializes, "Boos and awkward silences marked President Obama’s speech at Monday’s American Medical Association meeting in Chicago, and for good reason. Not only did he refuse to support caps for malpractice suits, but he said his administration would undercut how much doctors make." The Times notes, "The government is good at ‘saving’ money by simply reimbursing Medicare and Medicaid providers for less than their cost. It is essentially a tax that the government imposes — a tax that doctors and hospitals pay for staying in business." Yet, "this tax raises doctors’ and hospitals’ costs, forcing them to charge private patients more to compensate for the lost Medicare and Medicaid revenue." Therefore, "in the short run, these higher costs will force more people out of private insurance and into Mr. Obama’s proposed government-provided insurance," and eventually, "that means less health care to go around."

Columnist lauds Obama proposal. In his column in the Chicago Tribune (6/16) David Greising writes, "The question President Barack Obama placed before a skeptical American Medical Association conference in Chicago on Monday was whether American doctors wish to be part of the ongoing health-care crisis or help find a cure." He said in reference to the contested issue of medical malpractice caps that "instead of a cap, Obama is looking at evidence-based guidelines for treatment. This approach would protect doctors who follow agreed guidelines from costly malpractice lawsuits, yet leave open the courthouse door for people who have legitimate medical claims." Concluding, Greising writes that Obama’s proposal "is a flexible, comprehensive start to a debate that, at long last, might finally yield meaningful results."

9 Comments

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  1. jacksmith says:
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    AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

    It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

    STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

    We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

    And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

    Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

    Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

    In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

    Contact congress and your representatives NOW! AND SPREAD THE WORD!

    God Bless You

    Jacksmith – WORKING CLASS

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    Vis-a-vis tort “reform”, the issue of evidence-based guidelines is where much of the focus seems to be headed. What is troubling about this proposal is how you define evidence-based.

    By definition, evidence-based can mean any procedure or treatment that has a foundation in scientific evidence. Some treatments may be supported by one or two studies, while others have an abundance of studies showing better outcomes. An example of this is the CDC’s guidelines for controlling multi-drug resistant organisms in healthcare. Much of what is in these guidelines can be said to be evidence-based, but they are clearly associated with poor control of these organisms, as is evidenced by the last 40 years of steadily increasing rates of infections in healthcare that are caused be these pathogens. The problem is obvious. And such a system could in actuality serve as nothing more than blanket immunity for what is in reality bad medicine.

    There is another standard that is far more definitive than simple evidence-based guidelines. It’s called evidence-based best practices. I think it would be very hard for anyone on either side of this issue to argue against evidence-based best practices.

    If the goal is to “fix” healthcare, and not just reduce costs by redefining malpractice in a way that will create even more uncompensated victims and possibly standardize poor medicine, then evidence based best practices is what should be on the table.

  3. Jessi says:
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    I think that Obama is doing a good job in starting a dialogue about healthcare. By initiating conversation, compromises and progress can begin to be made. Here we see there are people in favor, not in favor, and hopeful about Obama’s healthcare reform. It’s too early in the game to discard what he’s saying.
    http://www.newsy.com/videos/pushing_policy_playing_politics

  4. Mike Bryant says:
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    This needs to be watched closely, it can not become a give away to insurance companies. They have made ungodly profits of the last bill they wrote, consumers need to be protected.

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    Michael: How about righting an article on evidence based best practices? I appreciate your comment and your insights.

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    Jesse: Thanks for your comment. I went to your website and it is very well done and informative. The news clip of Obama’s speech that you reference in your Comment is actually wrong on the facts. Medical malpractice lawsuits do not drive up doctor’s insurance costs. No study has ever supported that premise. I fact the number of lawsuits is minimal. Surprised? Well no one checks out these trumped up statistics that Big Insurance puts out daily. Read my article: “Tort Reform Myth: The Legal System Causes High Malpractice Insurance Premiums” at Injury Board Honolulu. http://honolulu.injuryboard.com/medical-malpractice/tort-reform-myth-the-legal-system-causes-high-malpractice-insurance-premiums.aspx?googleid=262696

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    Freudian slip: Writing not righting! Sorry Michael

  8. Thomas J.DeLuca,DO says:
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    In regards to the reality of medical malpractice reform in the US and attempts at more insurance coverage for americans–the issue isn’t as much about malpractice premiums but how much unnecessary testing can be avoided if health care providers are allowed to practice by using our knowledge,years of practice and schooling(minimum of 7 years after college)to decide what is needed to evaluate and treat a patient.NO LEGISLATOR OR ATTORNEY has this knowledge to make decisions like we do. The most expensive part of health care delivery is not physician fees–it is xray,lab and administrative costs. Americans must understand how decisions are made by their physicians and why as an example -an MRI for low back pain is an expensive test that usually won’t change the treatment of management of their condition. Their needs to be a lot of education to the public about how each person can individually help decrease health care costs. This isn’t being discussed in the press enough.
    One other key example of how to save the system cost is emergency room assessments. This is directly related to malpractice reform and saving our system BIG DOLLARS without compromising care. Currently, anyone going to an emergency room has to be seen,regardless of insurance coverage.That isn’t even the issue. The problem is, nurses are currently unable to triage people out of the emergency room —something that would save our state budgets significant cost. This can be remedied by allowing the triage nurse to do her assessment and send the patient out without getting an official emergency room visit. Currently there is no protection for the hospital and staff. DO NOT OVERLOOK the importance of these two issues. They will save everyone cost of their health insurance and increase access to health care by decreasing costs of insurance for our government plans as well as the private insurance sector. My last issue is how to save on the administrative burden of health care. Currently private insurance reviews too many patient charts to determine that providers are billing properly–this costs money obviously. Compared to a quality control system in an industrial setting,they are ridiculously overdoing it and don’t need to check on so many claims. The other and more important reality of administrative costs has to do with PRIOR AUTHORIZATION,FORMULARY and INSURANCE CLAIM FORMS. The time spent and staff needed to deal with these three issues is at least 40% of overhead in a physician’s office. As President Obama has stated -let physicians practice as physicians-this is a huge barrier to patient care.The burden to deal with these issues takes away time we have to care for and spend with our patients(nurses,office staff and physicians).
    In conclusion,there are viable ways to increase access to patient care and save costs for health insurance without compromising anything but unnecessary expense and testing. Please consider these issues when reading other articles. As a practicing rural internal medicine doctor, I practice medicine with concern for my patient population and explain why they don’t need tests adequately enough to avoid ordering them. With protection and education of the public all physicians can practice in the same way without concern of unnecessary malpractice lawsuits.

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    Thanks for the Comment Dr. DeLuca. Your claim is often made but hard to prove as you have noted. Since actual malpractice lawsuits are rare (an undisputed fact) and account for very little part of the cost of medical care, why do you suppose doctors are practicing medicine in fear of claims to the extent they do unnecessary tests? I mean if they don’t order that lower back MRI is there evidence that a large number of lawsuits arise? This is an area that data can be collected and in fact it has been collected by the medical and legal establishment. The large number of patient injuries due to negligent doctors is also well documented by the medical and legal profession. If, as you suggest, the cost of medical care can be reduced by not doing something 0 tests – that could not reduce the large number of injuries and deaths due to careless doctors. So what about the fact that only 1 out of 10 injured patients ever brings a claim at all? What about them? As an attorney who does medical malpractice cases I can tell you that _ since I must advance the costs of hiring experts and going to trial _ I would not take a case where an MRI was not performed when there was nothing wrong with the patient. Now if the MRI is not done, and the spinal cord is seriously injured because the MRI would have shown a problem, AND if the patient had signs and symptoms that they teach doctors in medical school are signs of a serious spinal cord involvement, then if you as a doctor decide not to warn the patient about the problem and decide not to do the test then I would take the case if I could find a doctor brave enough to violate the rule of medicine that has replaced the Hypocratic Oath as the #1 moral philosophy of the tort reform doctors (a small but coercive segment of medical care providers): The Conspiracy of Silence. Rather than spend your time trying to protect negligent doctors, why not make some suggestions that will help deal with the patients who are injured by the medical profession. You forget that we attorneys also are patients and we go to our doctors and we have friends who are doctors. My discussions with my doctor are not about doing unnecessary tests. He complains the the he would order more tests but that the insurance companies won’t pay for them. I would love to hear from a doctor sometime who actually cares about the amount of medical malpractice by doctors, not about using vague arguments and often false data to scare the public into granting them the morally reprehensible status as being allowed to injure people, through their deviation from the medical standard of care and leave their patients without a fair recovery – or any recovery. As long as the medical profession continues to seek this privileged status, the profession will continue to decline in the public view and in terms of doing quality work. Admit it Dr. DeLuca, your profession has a hangup about admitting when you make a mistake. Isn’t there one doctor out there who can admit to the malpractice problem in medicine? Nurses certainly will because they see it.