President Obama Launches Medical Malpractice Reform Proposal

President Obama’s budget, discussed at a press conference yesterday, launches a new presidential focus on professional liability laws as they apply to medicine.   He intends to revamp state medical malpractice laws and curb the practice of so-called “defensive medicine.”  The budget specifically calls for $250 million in Justice Department grants to help states rewrite malpractice laws that are consistent with the recommendations made by the bipartisan debt reduction commission last year.  Health and Human Services Secretary Kathleen Sebelius told the Senate Finance Committee yesterday that her agency would advise the Justice Department on grant awards. 

The president’s proposals for professional liability reform include:

• Establishing health courts to deal with medical liability cases.  Health courts would use specially trained judges instead of juries to decide medical malpractice cases.  Awards would be made according to a set schedule.
• Creating a “safe harbor” for physicians who adhere to guidelines for best clinical practices. 
• Creating some protections for physicians who demonstrate acceptable use of an electronic medical record. 
• Providing protections for hospitals and physicians that employ early apology and compensation for medical errors.
• Changing proportionate share laws such that instead of each defendant being held liable for the entire amount of an award in a malpractice suit, each defendant is liable for a percentage proportionate to the responsibility for the harm.  

NOT covered in the president’s proposal is a cap on jury awards.  President Obama has long said that he would not entertain caps as a solution to the professional liability insurance crisis, but has said that he would entertain other options as outlined in his proposal.

President Obama’s debt reduction commission estimates that implementation of the recommendations could save government programs $17 billion by 2020.  Although the cost of defensive medicine is widely debated, conservative estimates start at around $50 billion per year.  The president’s budget does not include any actual savings from the new proposal.   

Am I A Traitor To Shake Hands With President Obama?

Photo courtesy of Dr. Andrew Bern

Yesterday I had the great pleasure of attending an event at the White House at the invitation of President Obama. I was surprised to learn that my attendance at the recent Presidential address in the East Room has caused some members to threaten to leave ACEP. It is of concern to me that some members feel this way, in spite of the existence of a well-publicized advocacy agenda that focuses on improved access to health care for all Americans. Being invited to and attending an event at the White House in no way implies wholesale endorsement of the President’s health care reform proposal or any other proposal.

Let me say that being invited to attend an event at the White House, being able to have a few words and shake the hand of the President of the United States, being able to have a short conversation with Secretary Sebelius, and having the opportunity to meet and discuss strategy with my counterparts in the major specialty organizations in medicine was a unique and productive opportunity. I think it important that representatives of the college be able to take advantage of such opportunities without fear of members quitting the college over the action, not the substance, of the visit.

A dose of reality is needed here. We are a 28,000 member organization. It is a matter of pride that we have developed a respected and requested voice in Washington D.C. health policy. However, declining an invitation to the White House would gain nothing for our patients and for our members. Hopefully, our members will understand and respect that fact.

Lastly, attending the President’s announcement of his new health care reform plan and applauding his request that Congress take action sooner rather than later does not imply that the American College of Emergency Physicians endorses carte blanche every aspect of that proposal. We will continue to work tirelessly to ensure that health reforms include provisions that improve the health and well-being of our patients and our member physicians.

It is a challenge to lead an organization as diverse and as divided as ours is at this moment in time. We are a representative organization, and I ask those of you with concerns about the policies of the college to speak up, get involved, make your perspective known to your Chapter president, the Council, your Board of Directors, and to me. One opinion will not have the opportunity to be heard in the density of Washington politics, but many voices joined together to promote better emergency care for all can change the course of history.

Please join me in that pursuit.

What Brown's Election Means for Health Care

Oh how I miss you Ted! The senate seat that was filled for so long by one of the biggest, if not THE biggest, supporter of healthcare reform is gone. State Sen. Scott Brown's (R-MA) win and takeover of Mr. Kennedy’s seat has huge repercussions. This seat has been Democratic for 50 years. That is a huge momentum swinger for the Republicans.

What does this mean? The Democrats 60-vote filibuster-proof majority in the Senate is gone. Mr. Brown has been campaigning on the message that he would be the 41st vote in the Senate AGAINST passage of the Democrats' plans for health reform. In all likelihood, the Dems need all 60 votes to pass meaningful healthcare reform.

Backup plans??

1.) Democrats are contemplating trying to pass the bill before Mr. Brown’s seat gets confirmed. That takes about 15 days, so it isn’t very likely. Plus, rushing a bill through could look bad to the public and give the Republicans ammunition to eventually overturn whatever is passed.

2.) Another option on the table is to have the House pass the Senate bill, and then use a procedural rule known as "budget reconciliation" to amend it later on. This is not a great option because reconciliation is a long and complicated problem that lawmakers would rather avoid.

3.) Get the vote somewhere else. Who will be the brave Republican to step up to the plate and save the country of a reform blockage.....which when you break it down is saving lives. Many more than I could ever imagine saving in my career...in one simple vote. Come on Olympia Snowe...the country needs you.

What I hope comes out of this is for the Republican’s to step up and start helping fix the problem of healthcare reform. Right now they have done a good job of "Just say NO.” We all know the current system cannot be sustained. I don’t believe the public will allow for a complete blockage of healthcare reform. As one of my mentors always says, “Knowing the answer is the easy part, making it happen is the hard part.” Maybe it all starts with tort reform...I don’t know. Now that they have the seat...It’s time for them to bring something to the table.

David Darrigan, DO

Ed. Note: Dr. Darrigan’s post reflects his personal opinions, and not necessarily those of the American College of Emergency Physicians.

George Stephanopoulus spoke with President Obama today, and reports that the President was not “waving the white flag,” but seemed focused on finding a “peaceful” solution to controversy about health care. AFG

Obama's address to the AMA

In the wake of President Obama’s remarks to the American Medical Association on Monday, it seems that everyone has an opinion about what should be done with the healthcare system in America.  Unfortunately, there is no consensus , even within the house of medicine.  The president was very clear about his intent, and very little of it surprised those in the audience.  The president led with a condemnation of the status quo, complete with touching stories of patients struggling with tragic circumstances, both medical and economic.  His arguments were the standards in the healthcare debate – providing medical care is too expensive, too complicated, and too poor in quality to continue.  He did stop short of blaming the current state of affairs entirely upon the physicians, perhaps in deference to the audience.

 

President Obama followed his indictment of the status quo with a description of elements of the reform package that he has long championed:  the electronic health record, comparative effectiveness research, dissolution of healthcare disparities, and universal coverage.  He assured the audience that anyone partaking of a private health insurance plan who was satisfied with that plan would be able to keep it.  However, as he stated long ago on the campaign trail, he supports a government-supported public plan, now called the Health Insurance Exchange.  The president believes that a public option would provide an alternative for Americans who currently cannot obtain affordable health insurance.  He also stated that the public plan would provide “healthy competition” for private insurers. 

 

There were two things that I noticed today that were a change from the president’s usual discourse on health system delivery.  First, he stated today that all Americans would be required to purchase health insurance of some kind.  In the past, especially during his campaign, he only espoused a requirement  for insurance for children.  Secondly, he stated that he is opposed to caps on damages recovered in malpractice litigation, but that he is “open to consideration of” any number of other methods to  appease physician concern over professional liability.  He said that he has drawn criticism from members of his party over his willingness to consider any changes to the tort system. 

 

No doubt the president is looking to trade vague, lukewarm promises to consider changes in the tort system for some Republican support of his health system reform plans.  Will it be enough?