Can The Republicans Fool Enough Of The People With This Report?

While the Republican Party might have little meaningful to say on today’s issues, you have to concede they sure beat the Democrats when it comes to showing chutzpah. They are making a lot of noise over a report (pdf here) from a CMS actuary which means far less than they are claiming.

The first point of interest is that the Congressional Republicans have event turned to a CMS actuary. During the battle over George Bush’s Medicare Part D program, the Bush administration had threatened to fire a CMS actuary if he reported to Congress about the true cost of the program.

With this report the Republicans were able to obtain the answers they want due to the limitations placed upon the data requested. The report basically says that if you ignore 1) potential cost savings and 2) any increases in any forms of taxes, then health care reform will increase government expenses. You hardly needed an actuary to tell you that.

The report makes many of the same points I have made here in previous posts. Yes, as I have frequently written, health care reform will probably cost more than is estimated. Democrats are not without blame here. They are doing what all politicians do. The Democrats are underestimating the initial costs of their program, just as Republicans underestimated the cost of the Medicare D program and of the Iraq War. It is common for politicians to underestimate the costs of their programs. At least they are not threatening to fire those who present the data as the Bush administration did.

Among areas where the report is consistent with my previous predictions, they note that it does cost more to institute preventive care programs and that the cost savings of these are not clear. As I’ve previously argued, we should spend money on preventive because of its benefits to the country. Potential cost savings are an added benefit, but not the primary reason for spending money to have a healthier population with a longer life expectancy.

The report also is consistent with my objections to expanding Medicaid to provide coverage to the uninsured, noting that patients in Medicaid programs will have difficulties with access to care. Of course the solution to this problem is to spend more money to allow everyone to have private insurance or a public plan which provides benefits comparable to private insurance. It is doubtful that Republicans will agree to this added spending.

Health care reform is largely a matter of how much we are willing to pay and how much government action we are willing to accept to hold down costs. If this was purely a matter of cost, then by far the most cost effective way to deliver medical care would be a with a single payer system modeled on the Medicare program. Republicans try to obfuscate the benefits here by citing projections of future financial difficulties for Medicare if there are no changes. Of course any projections which do not allow for changes over time mean very little. What business would remain in business indefinitely if they never made changes? In addition, much of Medicare’s financial problems come from Republicans-sponsored measures in the Part D program which would be eliminated under health care reform legislation.

Republicans certainly will not accept a single payer plan regardless of how much money it would save. The added irony of their position is that they complain about the cost of health care reform while fighting most of the measures which would bring about the greatest cost savings. They oppose the public option (while a small number of economic conservatives have made a free market argument for the plan). Republicans also oppose plans to take future decisions on Medicare partially outside of the political process, and they even voluntary attack end of life counseling as the creation of “death panels.” Of course health care reform will cost more when the Republicans block most attempts at cost savings. You hardly needed an actuary to tell you that.

The real problem here is in allowing the Republicans to frame the issue as simply a matter of cost. Republicans have so altered the political debate that any consideration of spending more money (unless it involves invading other countries or committing torture) is difficult to bring up, regardless of how beneficial increased domestic spending in some areas might be.

If we frame the issue as one of spending money, then of course the Republicans will win. There is no such thing as a free lunch. If Americans can once again look at the issues as adults, then we can look at the real issues. We have the worst health care delivery system in the modern industrialized world. Any discussion of health care should start from the perspective that the United States should be able to do what the rest of the industrialized world does in enabling all of its citizens to obtain affordable health care.

So far the Republicans have no meaningful answers as to expanding health care coverage. They essentially have two proposals: allowing people to purchase insurance across state lines and malpractice reform. The first is basically a way to allow insurance companies to avoid state regulations which is the opposite of what is needed as long as insurance companies are destroying the individual market by finding ways to deny care. Tort reform should be included in health care reform. We need to take advantage of all possible ways to reduce health care costs without reducing quality or limiting choice. While this should be included, tort reform would only have a small impact on overall health care costs and by itself it is not a solution.

We need to look beyond the question of whether health care reform costs money to  looking at the problems which must be solved. Unfortunately the Democrats also reinforce the Republican framing when they make promises which they might not be able to keep to reform health care without raising any taxes on most people. Having a country in which  everyone has access to health care, and nobody has to fear that losing their jobs or developing a serious illness might force them into bankruptcy, is something which is worth paying for. If the rest of the industrialized world can do this, the United States should be able to. Republicans are hoping that they can fool enough people with their spin on this report to avoid having to answer the real questions on health care reform.

Health Care Bill Helps Trial Lawyers

Jazz Shaw points out that the House health care reform bill not only fails to meaningfully address tort reform but also makes it less likely that caps will be placed on claims for non-economic damages as many advocate. The bill provides for incentives for states to consider tort reform–as long as they don’t limit attorney fees or place a cap on damages. While conservatives greatly exaggerate the impact of malpractice on health care costs, this is still a cause of unnecessarily wasted money and those serious about reducing health care costs should address this problem.

This provides one example of why it is difficult to get anything done in this country. On one side we have the Republicans who are in the pocket of the insurance industry and will fight any reform, while on the other side the Democrats are unwilling to cross the trial lawyers (as well as being influenced to some degree by the insurance industry).

This is also why I continue to consider myself an independent as opposed to a Democrat despite voting exclusively for Democrats the last several years other than in local elections where everyone is a Republican. While I have a far greater degree for contempt for the GOP since it has been taken over by the extreme right and and has lost touch with reality, voting for the opposing party in a two-party system is not the same as totally embracing them.

Congressional Budget Updates Estimates on Savings From Malpractice Reform

The Congressional Budget Office has updated their estimates with regards to the economic effects of tort reform. (Hat top to Ed Morrissey). A summary of the full report is on their director’s blog:

Today CBO released a letter updating its analysis of the effects of proposals to limit costs related to medical malpractice (“tort reform”). Typical legislative proposals for tort reform have included caps on awards for noneconomic and punitive damages, rules allowing the introduction at trials of evidence about insurance payments and related sources of income, statutes of limitations on suits, and replacement of joint-and-several liability with a fair-share rule.

Tort reform could affect costs for health care both directly and indirectly: directly, by lowering premiums for medical liability insurance; and indirectly, by reducing the use of diagnostic tests and other health care services when providers recommend those services principally to reduce their potential exposure to lawsuits. Because of mixed evidence about whether tort reform affects the utilization of health care services, past analyses by CBO have focused on the impact of tort reform on premiums for malpractice insurance. However, more recent research has provided additional evidence to suggest that lowering the cost of medical malpractice tends to reduce the use of health care services.

CBO now estimates that implementing a typical package of tort reform proposals nationwide would reduce total U.S. health care spending by about 0.5 percent (about $11 billion in 2009). That figure is the sum of a direct reduction in spending of 0.2 percent from lower medical liability premiums and an additional indirect reduction of 0.3 percent from slightly less utilization of health care services. (Those estimates take into account the fact that because many states have already implemented some of the changes in the package, a significant fraction of the potential cost savings has already been realized.)

Enacting a typical set of proposals would reduce federal budget deficits by roughly $54 billion over the next 10 years, according to estimates by CBO and the staff of the Joint Committee of Taxation. That figure includes savings of roughly $41 billion from Medicare, Medicaid, the Children’s Health Insurance Program, and the Federal Employees Health Benefits program, as well as an increase in tax revenues of roughly $13 billion from a reduction in private health care costs that would lead to higher taxable wages.

A previous CBO report had minimized the impact of tort reform on health care costs. In evaluating this report it must also be considered that the process the CBO uses to estimate savings might very likely underestimate potential savings from tort reform (as they have also likely underestimated  potential cost savings from the proposed health care reform proposals). On the other hand, I also fear that even if the fear of frivolous malpractice suits was immediately removed, doctors would still be slow in changing habits which include increasing costs due to defensive medicine.

The report concludes by looking at contradictory evidence as to whether there would be any adverse impact on patients’ health from limitations on malpractice suits. While the evidence is certainly not clear, I lean towards those studies which show minimal if any adverse impact. The current malpractice system is so flawed that we have both a tremendous number of suits filed which lack merit while those who truly suffer from negligence are unlikely to benefit under the current system. As I’ve argued in the past, rather than the limited reforms being considered, I would prefer to remove the process compensating those injured from the legal system and establish new bodies to handle this.

In the past Barack Obama has expressed willingness to consider tort reform. Malpractice reform was also a component of John Kerry’s health reform plan during the 2004 election. So far we are not seeing this in current legislation. Hopefully the fact that these new estimates were requested indicates that there now is some interest in including tort reform in the final health care reform legislation.

While there is certainly room to question the exact amount of savings which this might represent, and the amount of likely savings is often exaggerated by conservatives, tort reform does present an area where real savings are possible without needing to limit necessary health care. Tort reform is certainly not the sole solution to health care costs as some conservatives claim but should be included in any efforts to reduce costs and pay for more comprehensive health care reform. Other reforms which are not considered by the Congressional Budget Office but which would be tremendously beneficial to society include shipping all the lawyers who run those tasteless commercials to drum up business to Gitmo.

The Cost of Defensive Medicine

David Leonhardt reviews research on malpractice and finds what I have been saying. Malpractice does not have the effect on health care costs which many conservatives claim and even the total elimination of malpractice would only have a modest affect on costs. However,  malpractice, primarily due to defensive medicine, does result in unnecessary expenses which we still should try to recover to attempt to pay for the current health care reform measures. Leonhardt writes:

The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.

The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.

At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action…

Medical errors happen more frequently here than in other rich countries, as the Robert Wood Johnson Foundation recently found. Only a tiny share of victims receive compensation. Among those who do, the awards vary from the lavish to the minimal. And even though the system treats most victims poorly, notes Michelle Mello of the School of Public Health at Harvard, “the uncertainty leads to defensive behavior by physicians that generates more costs for everyone.”

It should also be noted that often errors are not addressed because medical institutions are afraid that admitting errors will subject them to suits. Reforming our current system would be helpful in reducing true medical errors.

While I agree with Leonhardt’s general findings on malpractice, I would caution the exact amount spent on defensive medicine is very hard to measure. There will be honest disagreement as to what tests are legitimate and which are examples of defensive medicine. Habits also die hard. Studies based upon a reduction in defensive medicine after changes in laws will not be exact as it will take time for physicians to change their habits even if the threat of malpractice is removed. Unfortunately this also means that, while we should pursue such savings, they might not amount to as great a number in the short run as many believe.

The New York Times Reports on The Edwards Scandal

The New York Times story on John Edwards’ affair with Rielle Hunter yesterday  didn’t really contain anything more than I’ve noted in previous posts. Perhaps just appearing in the Times gives this story more prominence as it remains highly ranked on Memeorandum and has received numerous blog links. The story reports on the grand jury investigation into whether the hush money paid to keep the affair quiet violates campaign finance laws and states that “he is considering declaring that he is the father of Ms. Hunter’s 19-month-old daughter.”

While this is all material which has come out earlier, for those who have not been following the story, here’s the juicy parts:

Wade M. Smith, a Raleigh lawyer who represents Mr. Edwards, declined to comment on the paternity issue directly, but said in a statement that “there may be a statement on that subject at some point, but there is no timetable and we will see how we feel about it as events unfold.”

The notion that Mr. Edwards is the father has been reinforced by the account of Andrew Young, once a close aide to Mr. Edwards, who had signed an affidavit asserting that he was the father of Ms. Hunter’s child.

Mr. Young, who has since renounced that statement, has told publishers in a book proposal that Mr. Edwards knew all along that he was the child’s father. He said Mr. Edwards pleaded with him to accept responsibility falsely, saying that would reduce the story to one of an aide’s infidelity.

In the proposal, which The New York Times examined, Mr. Young says that he assisted the affair by setting up private meetings between Mr. Edwards and Ms. Hunter. He wrote that Mr. Edwards once calmed an anxious Ms. Hunter by promising her that after his wife died, he would marry her in a rooftop ceremony in New York with an appearance by the Dave Matthews Band.

I’ve heard of the promises to marry Hunter before, but the promised appearance of the Dave Matthews Band is a trivial but new point to me.

Not surprisingly many conservative blogs have linked to the story. When this story first broke it often seemed like Liberal Values was the only liberal blog following it. As Edwards’ initial denials were admitted to be untrue, even many liberal  bloggers are now discussing this, sometimes denying the full extent of the scandal. Talk Left complains that the Times story “mixes factual reporting and hearsay from a tabloid-type.” The fact of the matter is that, from the start of this story, the information has first come from the tabloids, and the tabloid accounts have later been shown to be correct.

Many liberal bloggers are primarily disappointed that Edwards was willing to run for the nomination despite the risks that this scandal would break during the 2008 campaign, likely allowing the Republicans to remain in office if Edwards had won the Democratic nomination. MyDD writes:

John Edwards is a persona non grata in the Democratic party. This sad and sordid episode continues to devolve simply because John Edwards cannot admit to the truth. Instead, Mr. Edwards choses willfully to save whatever grace he may yet possess. It is not as much the affair nor the child out of wedlock, though there is that, but the hubris with which Mr. Edwards has acted since the allegations were proven to have a certain validity. Moreover, how does one even contemplate a run at the Presidency given a personal life in disarray?

That is true, but I continue to think that the real moral of the story is that there is a need to recognize that there are dishonest and opportunistic politicians on both sides of the aisle. I had described John Edwards as one of the slimier politicians around well before the Rielle Hunter scandal surfaced. There has been plenty of evidence of this throughout his career. This began when he was an attorney who made his fortune by convincing southern juries that birth defects were caused by medical malpractice and was again seen at multiple points in his political career (which I’ve mentioned in several previous posts).

Obama Speech Strengthens Prospects For Health Care Reform

Barack Obama’s speech before Congress (full text here) keeps health care reform alive , reversing the gains made by Republicans with their campaign of distortion which dominated the news in August. While Obama kept the door open to working with Republicans, he directly confronted them:

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Obama  addressed several of the lies being spread by the right wing about health care reform. He also responded to the idea held by some on the left that health care reform is not worth supporting without a public option:

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.

Besides those aspects of health care reform which has frequently been discussed on the left, Obama also expressed support for malpractice reform. While conservatives greatly exaggerate the effect of malpractice on health care costs, this does remain an area where we can achieve some meaningful cost savings without compromising medical care.

Obama noted that those supporting health care reform include some who were opposed to it in the past:

Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors’ groups and even drug companies – many of whom opposed reform in the past.

Demonstrating the support for health care reform among doctors, the American Medical Association sent out an email expressing their support (copy here).

A CNN/Opinion Research poll found, “Two out of three Americans who watched President Barack Obama’s health care reform speech Wednesday night favor his health care plans — a 14-point gain among speech-watchers.”

It comes as no surprise that liberals are praising the speech. While the conservative movement will undoubtedly repeat their usual lies about health care reform, at least one more sensible conservative has expressed support. Andrew Sullivan concluded his live blogging by writing:

A masterful speech, somehow a blend of governance and also campaigning. He has Clinton’s mastery of policy detail with Bush’s under-rated ability to give a great speech. But above all, it is a reprise of the core reason for his candidacy and presidency: to get past the abstractions of ideology and the easy scorn of the cable circus and the cynicism that has thereby infected this country’s ability to tackle pressing problems. This was why he was elected, and we should not be swayed by the old Washington and the old ideologies and the old politics. He stands at the center urging a small shift to more government because the times demand it.

And he makes sense. And this was not a cautious speech; it was a reasoned but courageous speech. He has put his presidency on the line for this. And that is a hard thing to do.

Earlier Sullivan wrote, “It is a defense of limited but strong government. It is not anti-conservative” and “This is a liberalism most centrists can live with.”

With these comments Sullivan demonstrates the difference between rational conservatism and the anti-intellectualism dominating the conservative movement. The conservative movement takes a knee-jerk opposition to any government action which does not involve killing, torture, or imposing Christian fundamentalism. There are some functions which the market cannot handle without some government action or oversight, and this is a centrist program, not any form of socialized medicine or a government take over of health care.

The Congressional Budget Office And Cost Savings

Conservatives have an amazing skill for picking and choosing which facts to use to support their beliefs, and have absolutely no difficulty promoting contradictory claims if it supports their cause. Conservatives ignore the predictions of the Congressional Budget Office which show that the public plan would not be a threat to private insurance companies. They had no concern about their predictions as to the cost of the Iraq war.  They certainly don’t pay any attention to their predictions that tort reform would not significantly reduce health care costs. On the other hand they promote the report which says that savings will not fund health care reform.

Besides the contradiction of picking and choosing which CBO reports to pay attention to, conservatives fail to realize that one reason the CBO minimizes savings is that the bill does not give the government all that much power to lower costs. In other words, endorsing the CBO report contradicts conservative claims that the proposed health care reform would amount to a government take over of health care or socialized medicine. Conservatives oppose those measures which would lead to greater savings.

The other problem with the report is that the methodology used by the CBO under-estimates savings because they can only include savings which clearly can be measured and coded. Jon R. Gabel, a senior fellow at the National Opinion Research Center of the University of Chicago,  has reviewed the track record of the CBO and has showed that their methodology routinely underestimates savings. After giving some examples he concludes:

The Congressional Budget Office’s consistent forecasting errors arose not from any partisan bias, but from its methods of projection. In analyzing initiatives meant to save money, it helps to be able to refer to similar initiatives in the past that saved money. When there aren’t enough good historical examples to go by, the estimated savings based on past experience is essentially considered to be unknown. Too often, “unknown” becomes zero — even though zero is not a logical estimate.

The budget office has particular difficulty estimating savings when it considers more than one change at once. For example, last December the office reported that it found no consistent evidence that changes in medical malpractice laws would have a measurable effect on health care spending. It also reported that increased spending on studies comparing the effectiveness of different drugs and medical treatments would yield no net savings for 10 years. Yet if both malpractice reform and comparative effectiveness studies were instituted simultaneously, they might work together to yield substantial savings; doctors would gain more confidence in the effectiveness of less aggressive treatments and, at the same time, could use those treatments with less to fear from lawsuits.

The budget office’s cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects. This, in turn, forces Congress to believe it can pay for reform only by raising taxes, which then makes reform legislation more difficult to pass.

The most likely reality is somewhere between the CBO report and the overly optimistic claims of the Obama administration. The CBO’s methodology has prevented them from considering health care savings from the proposed legislation–just as their methodology prevents them from recognizing savings which might come from tort reform–as there is no way to accurately measure the savings at this time. The proposed measures will ultimately save money, but it will also be necessary to spend more at first for measures like expanding preventive care and promoting computerization of medical records. Health care reform will probably save money, but I do not believe the savings will pay for the proposed measures.

Taxation and The Battle over Health Care Reform

While it is still difficult to predict the final outcome, momentum for passing health care reform has slowed. Republicans have launched their typical misinformation campaign to scare voters. They continue to confuse the fact that the real changes are over how insurance coverage is handled. This is not a “government takeover of health care” or anything resembling “socialized medicine.” It certainly does not help matters when Republican politicians make uninformed and dishonest statements such as  claiming reforming health care coverage is comparable to placing health care under FEMA as Bobby Jindal does today in The Wall Street Journal.

Besides the endless number of dishonest Republican claims, there are also real concerns about the complexity of the plan and the cost. First Read points out a major problem in passing health care reform:

One of the bigger, but more under-reported, sea changes in American politics is how any kind of tax increase — whether in war or peace, good economic times or bad ones — has become absolutely unacceptable. After all, Ronald Reagan raised taxes. So did every modern American president involved in war, until George W. Bush. But not anymore. Indeed, as one of us pointed out on Nightly News last night, only 29% (or 157) of the 535 and House members and senators serving in Congress were around the last time — 1993! — the federal government raised taxes, and that was on gasoline. Think about that for a moment: Congress hasn’t really had a TOUGH vote in 16 years, if one defines a “TOUGH” vote as the government asking for a financial sacrifice from the American people. This is the political climate that President Obama faces in trying to pay for health reform. Republicans and some Democrats are opposed to a tax on the wealthy, and unions and Obama’s political strategists are against taxing health benefits.

While I am generally not a fan of big government programs and opposed HillaryCare, the situation with health care coverage has deteriorated to the point where government action is necessary. This is also something which costs money despite the claims of the Obama administration that health care reform can largely pay for itself. It costs money to provide coverage to those who cannot afford it, increase the delivery of preventive care, and improve health care information technology. We will not see the savings from improved preventive care and information technology for many years.

As I’ve noted before, reforming health care coverage is something which benefits everyone, not only the near one hundred million who are currently uninsured or under-insured. Having a society in which nearly everyone has health care coverage and nobody has to fear losing coverage due to developing a serious illness, losing a job, or desiring to change jobs is worthwhile but we must be willing to pay for it.

The chances of raising enough money to both achieve these goals and avoid the types of restrictions on care which Americans would not want to see imposed is greatest if the money for this can be raised by a broad based tax as opposed to pretending we can get all the money by taxing the rich alone. Unfortunatley this probably is not politically feasible as there would be protest over a tax increase on the middle class, even if it would be largely offset over time by both lower insurance premiums and ultimately lower costs from a more efficient health care system.

Earlier in the year polls did show that voters were willing to accept a tax increase to pay for health care reform. We are not seeing as many support this now. Some of this is for unavoidable reasons, such as belt tightening during a time of economic crisis and due to the scare tactics of the right wing. This is also due to a missed opportunity by Barack Obama to show true leadership.

If Obama had proposed a health reform plan and honestly discussed both the costs and benefits, he might have received support for the taxes needed to pay for this. Obama has done an excellent job of receiving support from groups which opposed health care reform in the past such as the American Medical Association. He could have further demonstrated a willingness to respond to the crisis by going beyond traditional partisan concerns by taking an even stronger position on malpractice reform. While Republicans do greatly exaggerate the role of malpractice on health care costs, the fact remains that reducing costs on defensive medicine does remain one of the easier ways to reduce costs without negatively impacting quality or patient choice.

Obama Not Following His Doctor’s Advice On Health Care Reform

David Scheiner, Obama’s internist from Chicago, says Obama is on the wrong track with regards to health care reform. No, he is not a doctor opposing health care reform but is recommending a single payer system. From Forbes:

Scheiner, 71, was Obama’s doctor from 1987 until he entered the White House; he vouched for the then-candidate’s “excellent health” in a letter last year. He’s still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. “I’m not sure he really understands what we face in primary care,” Scheiner says.

Scheiner takes a few other shots too. Looking at Obama’s team of health advisors, Scheiner doesn’t see anyone who’s actually in the trenches. “I have a suspicion they pick people from the top echelon of medicine, people who write about it but haven’t been struggling in it,” he says.

Scheiner is critical of Obama’s pick for Health and Human Services secretary–Kansas Gov. Kathleen Sebelius, who used to work as the chief lobbyist for her state’s trial lawyers association.

“He doesn’t see all the pain, it’s so tragic out here,” he says. “Obama’s wonderful, but on this one I’m not sure if he’s getting the right input.”

What should the president be focused on? Scheiner thinks that a good health reform would be “Medicare for all,” a single-payer system where the government would cover everyone and pay for it by cutting out waste in the system. “A neurosurgeon gets paid $20,000 for cutting into the neck of my patient. Have him get paid $1 million a year instead of $2 million or $3 million. He won’t starve,” Scheiner says.

Conservatives apparently loved the title of the article (Obama’s Doctor Knocks ObamaCare) and the beginning, but then had to change the tone after reading of Scheiner’s support for a single payer plan. Gawker noted:

After first quoting approvingly, the National Review‘s Mark Hemingway actually updated his post on Schneier. He had initially quoted the first three paragraphs and concluded “Ouch.” But then he read all the way to the sixth paragraph and discovered Schneier spouting Maoist propaganda. Like we said, whatever. The headline’s out there. Take it away, Hannity.

Scheiner also said that the proposed public plan doesn’t go far enough, and that Obama isn’t doing enough on malpractice reform:

Scheiner, like most others in his profession, thinks that it should be harder to sue doctors and that awards should be capped. He says that he and other doctors must order too many tests and imaging studies just to avoid being sued.

While conservatives often exaggerate the significance of malpractice when they sometimes claim that solving this problem will end most of the cost problems, the fact remains that this is probably the largest area where health care expenses can be cut without lowering quality. It makes little sense to talk about saving small amounts of money in other areas, or to spend large amounts of money on computerization of medical records in the hopes of future savings, without doing anything about money wasted on defensive medicine.

Malpractice reform will provide a test of whether the Obama and the Congressional Democrats are more concerned about lowering health care costs or appeasing the trial lawyers who typically support them.

Obama Offers To Consider Malpractice Reform To Obtain Support From AMA

Obama is looking like a smart politician, in the occasional good sense of the word, as he tries to obtain the support of the American Medical Association for health care reform. The New York Times reports that Obama discussed malpractice reform:

The American Medical Association has long battled Democrats who oppose protecting doctors from malpractice lawsuits. But during a private meeting at the White House last month, association officials said, they found one Democrat willing to entertain the idea: President Obama.

In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

It is a position that could hurt Mr. Obama with the left wing of his party and with trial lawyers who are major donors to Democratic campaigns. But one Democrat close to the president said Mr. Obama, who wants health legislation to have broad support, views addressing medical liability issues as a “credibility builder” — in effect, a bargaining chip that might keep doctors and, more important, Republicans, at the negotiating table.

On Monday, Mr. Obama will go to the annual medical association meeting to face a group that has come out against a central component of his broader health care proposal — his call for a new public insurance program that would compete with the private plans. The White House says he will make the case that “reform is the single most important thing we can do for America’s long-term fiscal health,” and how important it is to have the cooperation of doctors.

But whether he can get them on board is an open question. The speech comes as the president’s ideas on health reform are facing mounting criticism — not only from the A.M.A. and Republicans, who also vehemently oppose a new public plan, but also from the hospital industry, which is up in arms over a proposal Mr. Obama announced on Saturday to pay for his health care overhaul in part by cutting certain hospital reimbursements.

Medical liability is an important component of the debate, but that, too, is controversial. White House officials said Mr. Obama was likely to refer to the issue in his speech to the medical association, but would not offer any specific proposal.

Mr. Obama has not endorsed capping malpractice jury awards, as did his predecessor, President George W. Bush. But as a senator, he advanced legislation aimed at reducing malpractice suits. And Dr. J. James Rohack, the incoming president of the medical association, said Mr. Obama told him at a meeting last month that he was open to offering some liability protection to doctors who follow standard guidelines for medical practice.

“If everyone is focused on saying, ‘How do we get rid of unnecessary costs,’ ” Dr. Rohack said, recounting the conversation, “if we as physicians are going to say, ‘Here’s our guidelines, we will follow them,’ then we need to have some protections. He listened and he said, ‘Clearly, that concept is worthy of discussion.’ ”

Health care experts estimate that preventable medical errors kill more than 100,000 Americans each year, yet doctors and hospitals, fearing lawsuits, do not openly discuss their mistakes — an impediment to improving quality of care. At the same time, doctors complain that “defensive medicine” — ordering tests and procedures out of fear of being sued — drives up health costs.

Many liberal bloggers are protesting any action by Obama to limit malpractice suits, but limiting frivolous suits and ultimately reducing money wasted on defensive medicine should be in the interest of those supporting malpractice reform. Steve Benen isn’t as upset about this as some other liberal bloggers (such as here), seeing room for compromise which can be beneficial, but also points out that Republican claims of a “lawsuit crisis” are “patently ridiculous.”

Steve is right that many conservatives have exaggerated the role of malpractice suits, greatly exaggerating the potential savings if malpractice suits were to be eliminated. While their impact is exaggerated, frivolous lawsuits do remain a real problem and this is a concern to the American Medical Association. The more the claims of a “lawsuit crisis” are “patently ridiculous,” the easier it will be to take actions to reduce malpractice suits without such actions being harmful. Obama is doing the smart thing in trying to seek the support of the American Medical Association by offering support for a reasonable goal which is supported by physicians. Compromise is possible as many physicians do support changes to provide greater access to health care and reduce unnecessary costs.

Obama does not go along with capping malpractice awards which many physicians want. While I can see where some liberal bloggers would object to caps which limit the awards of those who are truly injured, there is no reason not to take other actions which will reduce frivolous suits (unless one’s primary goal here is preservation of income for trial lawyers). Personally I’ve always seen more benefit from actions to make it more difficult to file frivolous suits than to cap awards. Certainly the potential for tremendous awards will motivate some trial lawyers, but lawyers also file many suits knowing they will not receive a huge award, and are just rolling the dice hoping they can con a jury into paying out more than what it costs them to take a case.

While conservatives often exaggerate the costs of malpractice suits, defensive medicine does add to medical costs and it is to the benefit of supporters of health care reform to reduce such unnecessary expenses. Health care reform can also be of benefit to physicians who are concerned about malpractice suits. Patients who suffer adverse results, which may or may not be due to actual malpractice, often see a law suit as the only way to ensure they will have coverage of their medical expenses in the future. Universal health care would eliminate the need for malpractice awards to be able to afford future health care. Ideally we should separate payment for medical problems, whether or not due to malpractice, from the court system. Compensation to patients who suffer adverse outcomes should be more based upon their legitimate needs as opposed to whether they can prove malpractice and win a court battle, and evaluation of the quality of medical care should be handled separately from malpractice suits which do a poor job of evaluating the quality of medical care.