Friday, March 5, 2010

Tort Reform

Earlier this week I got an anonymous comment asking why Democrats don't support tort reform in the current debate about health insurance reform. In the best of times I wouldn't be able to answer such a question "for democrats" and these days, pissed as I am at the Democrat leadership I certainly don't feel qualified, even though President Obama has recently endorsed this idea for inclusion in the new plan. When George Bush was Governor of Texas he pushed for medical tort reform and it was passed into law around 2003. The result has been a massive change in the structure of law firms and a huge reduction in lawsuits. Amusingly enough with the complex requirements to attain proof of damages, the pursuit of tort lawsuits has now become the realm of the wealthy victims only. A mother on welfare has a dismal economic future anyway therefore seeking a settlement will yield very small results. You might argue this was an unintended consequence of tort reform. I'd argue it's another way the Republican myth making machine has convinced working people to argue against their own benefit. Tort reform makes it impossible for working people to get justice against...corproations! Brilliant! And furthermore I dug up this commentary from an attorney opposed (obviously) to tort reform in which Mike Ferrara points out another consequence of Texas tort reform:

Texas Tort Reform is NOT a Model for Nationwide Health Care Reform
Mike Ferrara Attorney
September 07, 2009 8:24 PM

Tort reformers like to talk a lot about how the threat of malpractice suits raises health care costs by forcing doctors to practice “defensive medicine”—the ordering of unnecessary tests, procedures, and prescriptions in an attempt to protect themselves against a possible negligence lawsuit.

In a 2008 AMA survey, they remind us, a majority of the doctors who responded admitted to practicing defensive medicine—a number that translates, the AMA calculated, to $1.4 billion more spent annually on health care. If our doctors weren’t threatened into doing this, we’d all save loads of money and our national health crisis would be over.

Are the tort reformers right? Well, let’s look at Texas. Several years ago, the state passed a stringent medical malpractice law that capped awards for pain and suffering at $250,000, and brought the number of malpractice lawsuits down dramatically.

So the cost of health care in Texas must also be down, you suppose, since doctors don’t face the same malpractice threats as the rest of the country. Eh, No. In fact, Texas is home to three of the top ten most expensive cities in the country to receive health care: McAllen, Harlingen and Corpus Christi. In each of these cities, every Medicare patient is costing the country more than $10,000 a year (a couple thousand more than the national average).

So if defensive medicine against the threat of malpractice suits isn’t driving up costs, what is?

Harvard Medical School surgeon Atul Gawande got a candid answer to this question from a general surgeon in McAllen, Texas:

“Come on,” the general surgeon finally said. “We all know these arguments are [BS]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” –Atul Gawande, The NewYorker

While tort reform like Texas' won't improve the cost of our health care, changing our charge-per-service structure just might.

So, is the high cost of health care the doctors' fault or the lawyers? I'd argue neither: it's the insurance companies. Take your pick.

700 William

William Street does a weird jog around Charlie's Groceries, one among a gadzillion inconvenience stores in Key West though this one has been around a while.
The white concrete block building marks one of the more tortured intersections in a city that struggles with right angles in streets and in construction generally. The 19th century cemetery was designed to sit on the edge of town when it was built in the middle of the island. It seemed like a good idea at the time owing to a hurricane that blew open the beach side cemetery scattering corpses and coffins. In those far off days this area was on the very limits of the urban development of Florida's wealthiest city. So they put the dead people out here and then, over time, the living caught up to them and now the dead are surrounded by a maze of awkwardly shunted streets. The seven hundred block of William is marked by this magnificent structure, the add-on to the original shown by the completely different roof line.:
Vehicles clutter the street as they always do in Key West especially in winter.
Though some few lucky souls enjoy the benefit of Off Street Parking. On an island 2 miles by four (3km x 6km Canadian) a structure this size could easily be rented for living space. I doubt the owners need to violate zoning laws to pay the mortgage.
Once you get behind the palisade of parked cars you can frequently find some lovely homes: Did I say parked cars? I should have included parked boats. This one is technically off the street but it makes for a nice botany experiment to amuse passers by. Who needs a daggerboard on dry land anyway? "We seceded where others failed" is the theme of the well worn mutiny against the Border Patrol in 1982. Conch Republic Days will be upon us soon to mark the end of snowbird season when all the unoccupied homes will be rolled up for the summer and some sort of somnolence will sink over the city until schools get out and the next wave of visitors shows up to save our city budget by spending money.
Yes indeed we could use blue skies this winter. There has been far too much rain and cold temperatures. A friend was looking wistfully out at the storm clouds mumbling about how in winter we used to be able to sit with the doors and windows open enjoying sunshine and a cooling breeze. Oh happy, lost, days!
This next picture reminds me of a saying they used to have in Marin County north of San Francisco, the county where Mercedes are as common as dirt and half the price. Conch cruisers will rule the streets again soon. Summer has to be coming.
The 700 block ends at Bill Butler Park, the open space with no benches to prevent vagrants hanging out in it. A Kermit chair would do nicely here as Cheyenne roots around in the shade.
Several months ago I noted in an essay that a stray pair of women's knickers were dangling mysteriously from a bush. Well. I am glad to report they are still there, a little sun bleached but hanging defiantly. Rubber gloves anyone?
One last view up William Street from the park.