So back in the debates, our President brought up "defensive medicine" when asked about the cost of healthcare. I was sort of surprised, since it's been years since physicians have been using the defensive medicine excuse. (Later, I found out that the President was using data from the mid-90s, which is about the last time I heard anyone talking about defensive medicine.)
In the debates, the President was all into tort reform, rah rah, get rid of the lawyers, they're bad for health care, once the lawyers are gone, everything will be all right, etc. And Kerry was dumbly nodding his head and saying something about yeah, tort reform, but...*
What bugs me about all of this, though, is a
pesky report that came out in 1999 from the
Institutes of Medicine**. Five years ago, the IOM released a report estimating that between 44,000 and 98,000 Americans die each year because of preventable medical mistakes. From time to time, health care providers fuck up and people die.
All of this could be a nice little historical tidbit, and the Bush administration could point and laugh and say "hey, that happened on Clinton's watch." But, with the exception of the 80 hour rule (which is a ACGME rule, not a rule that the government had anything to do with),
not much has been done since the report came out.
The IOM specifically reccomended that Congress should create a Center for Patient Safety housed at the already existing Agency for Healthcare Research and Quality
"starting with $30 million to $35 million per year and growing over time to at least $100 million annually--modest investments relative to the consequences of errors and to the resources devoted to other public safety issues." The budget for the agency this year is at about $60 Million, and there is no Center for Patient Safety. (ETA, there is a
Patient Safety Task Force)
Health care providers are fucking up in the delivery of health care, and sometimes patients die when that happens. It's also expensive when a provider fucks up, because that adds to the health care costs for treating the patient. Providers don't want to be overseen by regulatory agencies.*** They want to be immune from law suit in tort reform. They're not particularly good at policing themselves in peer reveiw.
Medical errors happen, and unless they can be reduced significantly, patients should have some recourse. This is an area where government oversight is appropriate because it is a public health issue, not simply a healthcare administration issue. It's the 8th leading cause of death. I'm dissapointed that no one brought this up at any point during the election or for that matter in the public debate about health care in the last five years, because it's inexcusable to know we have a problem in the country with medical errors and little has been done about it. I think that we cannot have such a high rate of medical errors and then point fingers at the trail lawyers and claim it's their fault health care costs so much.
*I find it fascinating that no one in these arguments goes after the malpractice insurance companies. Doctors AND lawyers hate insurance companies, and it's pretty clear that a lot of the "malpractice crisis" exists today because of poor investment decisions by the insurance companies. That said, as soon as tort reform passed here in Texas last year, one insurance company gave an across-the-board drop of premiums to all of its covered phsyicians of 13%. Of course, it's now almost impossible to bring a malpractice lawsuit in Texas.
**"The nation turns to the Institute of Medicine (IOM) of the National Academies for science-based advice on matters of biomedical science, medicine, and health. A nonprofit organization specifically created for this purpose as well as an honorific membership organization, the IOM was chartered in 1970 as a component of the National Academy of Sciences. The Institute provides a vital service by working outside the framework of government to ensure scientifically informed analysis and independent guidance. The IOM's mission is to serve as adviser to the nation to improve health. The Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large." It's a well-respected, non-partisan body.
***Watch what the TMA (which some argue is the strongest physician lobby in the country) does this legislative session when the Texas State Board of Medical Examiners is under Sunset Review. That agency will be evicerated, and it's a fairly weak Medical Board as it is. 
