Today's exercise in euphemistic oratory before the AMA was just that: an exercise. Our leader failed to ingratiate himself with the nation's health providers despite an opportune moment to do so. So what, you ask? Mr. Obama was faced with a choice to confront a major source of rising health care costs, but chose instead to sidestep the matter by contravening an earlier campaign position: During his campaign, it will be remembered, Mr. Obama betrayed a sentiment inimical to many of his party by siding with the rising demand for tort reform. More about that later.
Providers include hospital administrators struggling to keep their doors open at a time when rising demands on ER and L&D facilities show no sign of abatement, broken Medicaid programs fail in their meager attempts at reimbursement, and staff physicians threaten to bolt for fairer venues. Providers obviously include those physicians, most of whom are frustrated by an environment of contention between and among insurers and litigators, on the one hand, and the public, their hospitals, and physicians, on the other. Anyone familiar and conversant with the ingrained mechanics of tort litigation has been conditioned to accept the reality that insurers and litigators prefer the status quo. Insurance companies employ hundreds of defense lawyers whose job it is to litigate and/or settle out after negotiating with their counterparts, the plaintiff attorneys. And too many plaintiff attorneys, despite their sanctimonious rhetoric on public forums, care less about justice than reward, as they seek to cash in on the booty contained in defense funds deposited regularly by physicians who are required to do so in order to maintain hospital staff privileges.
The system was supposed to be self-sustaining, providing a target for fledgling law students in their early days in Torts class. And that was supposed to be true whether they chose to represent plaintiffs or defend providers. Few apparently were prepared to cope with the malignant, volcanic eruption of costs reverberating throughout the system, felt so acutely by consumers seeking only to purchase enough health insurance to cover their families...and by providers caught in the vise. Providers must buy liability coverage or lose their hospital privileges, at the minimum limits imposed by the hospital. And such coverage typically is of sufficient cost that it cuts deeply into anything that used to be considered income.
Medicine is no longer attractive to the best and the brightest of our youth. They need only ask those providers, many of whom will lament and rue the day they chose to enter the noble profession of healing. Tort reform must not be ignored, as it looms ever larger on the horizon of change. That subject is next.
Howard William Singer, MD FAAP JD
physician and attorney