Health Care Mess Should Be Topic One

by Molly Ivins

I suppose I could come up with some dramatic metaphor for the crumbling, tottering, greed-rotted structure, but hey, why don't you check out your health insurance premiums and see how you're doing? Up by 12 percent, 22 percent, 40 percent?

Larger premiums, higher deductibles, increased payments for prescription drugs? Employer dropping your coverage? Are we having fun yet?

Our money-corrupted political system isn't about to address the systemic problems. I think it's almost self-evident that a single-payer system is the best answer to all the problems, but since we have to deal with political reality, let's shelve that plan for now. Last time anyone tried to do anything about the whole system -- Hillary Clinton with a not-very-good plan back in '93 -- she was shouted down by $10 million in insurance company ads, still the record for the most money spent ever to defeat a single bill.

Now, we've got 41.2 million Americans with no health insurance -- 14.6 percent of us -- which ends up costing us more than it would to pay for their insurance. We pay the world's highest health-care taxes. Our government spends $2,604 per capita, the highest of any nation, including those with national health insurance, even though only a quarter of our population is covered by government insurance.

We spend 13 percent of our GDP on health care, the highest in the world. The average in the European Union and in other developed countries is 8 percent. According to the Organization for Economic Cooperation and Development, we spend a total of $4,600 per capita for health care, more than twice the average of other countries. We ain't getting much bang for our buck, either. Forget the "we have the finest health care in the world" claims. In both life expectancy and infant mortality, we're below the median for developed countries.

If you stand back and look at the fiscal crisis in the states and cities, you will see that almost all of it is driven by health-care costs. Naturally, the strapped states and cities can't think of anything to do except start knocking people off Medicaid and the new Children's Health Insurance Program (CHIP). That just means they wait and get sicker before they finally end up in the emergency rooms, costing us all more money in the long run.

One chunk of this insanely complicated system the politicians are now preparing to tackle is medical malpractice costs. "Med-mal," as it is known in the trade, is currently the subject of a particularly fruitless pissing match between Republicans and Democrats over whether the trial lawyers or the insurance companies are to blame for astronomical increases in premiums. This is complicated by the fact that trial lawyers give money to Democrats and insurance companies give money to Republicans.

We've all heard of ridiculous lawsuits by trial lawyers looking for a buck. The insurance companies have well-funded campaigns to publicize idiotic suits -- they do not publicize it when the suits get thrown out of court. Of course, we've all heard of ridiculous medical mistakes, as well.

It has never been clear to me why the American Medical Association goes along with blaming trial lawyers rather than insurance companies when their malpractice rates skyrocket. The fact is, malpractice is committed by a tiny percentage of doctors -- 5 percent according to Public Citizen -- and the AMA could save itself and everyone else a lot of trouble by getting rid of them. In Texas, we've had zero doctor's licenses revoked because of medical errors since 1997, despite 6,038 medical malpractice claims reported to the state, including 150 times surgeons operated on the wrong part of the body.

Of course, trial lawyers do drive at least a part of med-mal costs, but if you examine the competing claims (under the Bush administration, you have to be wary of government data because it increasingly uses only insurance industry figures), the insurance industry is the primary villain. (If this were a lawsuit, the trial lawyers would figure out how much blame to assign to each of the parties to the last decimal point.)

According to The Wall Street Journal, the insurance industry is jacking up prices not just because their investments in the stock market have fallen dramatically, but also because they fouled up their pricing practices in the early ‘90's. They seriously underpriced med-mal and are now trying to recoup, and for this they blame the trial lawyers.

California is an interesting case in point. The state passed a tort reform bill, limiting what one can recover in a lawsuit, in 1975 and waited expectantly for insurance premiums to go down. They nearly tripled in the next 12 years, finally leveling off in the early '90s. And, amazingly enough, California just happened to have passed strict insurance regulations in 1988.