Guest Column: No Better Care, Thanks to Tort Reform
In 2006, Dr. Howard Marcus wrote that Texas’ 2003 tort reform statute sparked an “amazing turnaround” in which doctors came to Texas in droves, instead of leaving the state as they had before. He was doubly wrong. Texas neither lost doctors before 2003 nor gained them especially quickly in subsequent years. In fact, according to statistics published by the Texas Department of State Health Services (TDSHS), the supply of active, direct patient care (DPC) doctors per capita grew faster from 1996 to 2002 than at any time after 2003. If the pre-reform growth rate had simply continued, Texas would have ...
Comments (17)
Sue Rudd Bailey via Texas Tribune on Facebook
Per capita? Look at how fast our population has grown. Not a great way to measure this. Look at the raw numbers, and talk to the other states who have lost doctors to Texas. Tort reform has been very successful in improving access to care.
Tim Thomas via Texas Tribune on Facebook
If each person in Texas (per capita) is served by fewer doctors than how can you say it improves access to care?
Leo Tynan via Texas Tribune on Facebook
I'd like to hear his statistics on how plaintiffs attorneys fees plummeted after tort reform. You think this has anything to do with his position? He should at least include attorney's earnings statistics if he's going to state where all the money has flowed. Hospitals are currently involved in more major policy changes regarding patient safety than I as a physician ever saw before tort reform.
Thomas Prentice via Texas Tribune on Facebook
Plus the docs' premia didn't go down...they tell me premia INCREASED after Tort Reform...
Stanley Moore via Texas Tribune on Facebook
See the documentary "Hot Coffee". It deals with what a total load of BS tort reform is. Screw the working man and women is all tort reform is about and keeping Republikkkans in office.
Leesa Monroe via Texas Tribune on Facebook
The documentary opened my eyes.
John Burton via Texas Tribune on Facebook
Race to the bottom. Send us your bottom 10% Med School Grads! Love, Texas.
Stella Fitzgibbons
As both a practicing hospital-based doctor and a medical expert in legal cases, I can testify that the climate has changed. The bad news is that these changes have had almost NO effect in the longstanding medical mindset of "do that extra test because it will look better in court." The fear of lawsuits is so ingrained in our thinking that we keep on jacking up the cost of treating patients even when we know the risk of being sued is smaller now.
David Starkey
"The 2003 statute did have two demonstrable effects. First, it made doctors, hospitals and malpractice insurers millions of dollars richer by devaluing the claims of injured patients. Various sources report that premiums for liability coverage fell by half, and a study by a research group to which I belong finds that, after 2003, the number of dollars flowing to patients declined by more than 70 percent."
OMG! I TRUELY AM A PROPHET!
But, what happened to the rest of my prediction: this stupid assed law being ruled unconstitutional?
David Starkey
Here's an idea:
PHYSICIANS HEAL THY PROFESSION!
GET RID OF BAD DOCTORS!
THE GOOD OL BOY NETWORK IS COSTING YOU A FORTUNE!
mike murray
When a patient seeks medical care, he's entering into a contract with a provider. It is no different than seeking the services of a plumber or an attorney...having such services available to you is not a right. It is a privilege which one pays for. If a person can secure insurance to offset some of the costs of providing said medical care, this doesn't relieve them of the responsiblity to pay for the medical care, it simply makes it more affordable. The abillity to purchase insurance is another free market transaction and the ability to purchase insurance isn't (nor should it ever be) a right. It is, like the ability to purchase the services of an attorney, plumber, accountant, tree service, etc. a privilege one negotiates and pays for. Patients bear a large amount of responsibility for their health care...they should absolutely be responsible for who they receive treatment from and how they receive it. Unfortunately, as in many other areas of life, the average US citizen is a moron/zombie/guinea pig that spends more time on twitter and facebook than they do researching their healthcare options and blindly/stupidly allowing the system flaws to put them in harms way...then whining about it. It is similar to the mother that lets their child walk to the store at night, then whines for everyone else to search for her missing "baby". Life is tough...and it is a whole lot tougher if you're stupid and gullible.
I know two things in life, I've never met a poor doctor and I've never met a poor medical malpractice attorney. Both of these segments of our population are handsomely rewarded for their time and efforts...though those in the medical profession go through a lot more bs to get to their pot of gold than the medical malpractice lawyers. Without a doubt, medical school is a longer and tougher row to hoe than the law school/theatrics route.
There's another party involved in medical malpractice issues, that doesn't seem to get mentioned quite as frequently as medical providers and med-mal lawyers, and that is the defense bar...those high priced, pinstriped legal eagle hired to defend against the med-mal suits...they are every bit as "involved" as the other two parties. I have clients on all three sides of this issue and I've seen the effects on all...including the defense bar's inability to bill their client companies to defend as many med-mal lawsuits as prior to reform.
The medical profession should definitely clean up its act...police bad doctors, practice medicine rather than do procedures, etc., however, the legal profession has as much or more house cleaning and ethical rewiring to do in their house. Only the morons/gullible/foolish in our society believe that the vast majority of the practicioners in these professions put their hours in for any other primary reason than money. If you have a ligitimate medical malpractice case...ie. the negligence of a medical provider causes you an unneccessary injury...try finding a lawyer that will take the case. Unless you've got potentially large "losses" and a potentially large reward, you won't find an attorney to take your case. They won't enter into a fee for service arrangement unless you can prove that you can pay the bills as billed and they won't touch a contingent case unless they think they can make money off of it. The high powered attorneys who are friends of the author, won't do a pro bono case. Med-mal attorneys aren't altruistic heroes of the working man, they're hard-nosed businessmen with great bullsh*t capacity and a gullible client base.
The problem will be solved by patients taking responsiblity first...relying on doctors, hospitals, insurance companies, and lawyers to protect you is naive and stupid.
Steve Hirsch via Texas Tribune on Facebook
Sue Rudd Bailey, you have it exactly backwards. Per capita is the best way to measure. Looking at raw numbers would lead precisely to the problem Charles Silver identified. If you had 10 new doctors in a community you could say you've come out ahead. If the population grew by 100,000 though, you're behind.
mike murray
Steve,
When Mr. Silver uses the "net" number of doctors practicing to "show" that tort reform hasn't had the effect that Dr. Marcus claimed...he's misrepresenting the facts. It is hypocritical for him to do that while attacking Dr. Marcus for what he claims is misrepresentation of the facts by choosing another set of statistics.
Mr. Silver's choice of net figures (ie. gross number of doctors practicing per 100,000 people at one point in time, less the gross number of doctors practicing at a later date) doesn't relate to the number of new Texas doctors (those who chose to practice in Texas versus another state). All it shows is that the number of new doctors hasn't outstripped the numbers who are leaving the practice of medicine.
In order to judge whether Dr. Marcus' numbers accurately reflect his assumptions (and what he wants the readers to believe) or whether Mr. Silver's numbers are an accurate reflection of his assumptions (and what he wants the readers to believe) will take a lot more information than is in play in either article.
When a reader draws a conclusion that Mr. Silver's assumptions are correct, they aren't doing it from a point of knowledge...but are doing it because his assumptions reinforce their existing bias. This is human nature (the Apostle Paul told Timothy that 'there will come a time when people gather unto themselves "teachers" who tell them what their itching ears want to hear'). Selective perception is a tool that manipulators use to manipulate their intended audience.
It is ironic that many who believe themselves to be intellectually superior to others draw conclusions rooted in preconception and bias...neither of which are hallmarks of an educated mind.
David W. Hodges via Texas Tribune on Facebook
Sue Rudd Bailey - President of TMA. How about you choose ONE facebook account from which to post, doctor? Can you cite to me any peer reviewed literature that supports your claim that access to care has improved in Texas post 2003? Oh, and Texas has the WORST access to care in the country btw.
Kendrek
In “No better Care, Thanks to Tort Reform,” the author incorrectly asserts that medical lawsuit reform is a partisan issue. It isn’t. It is an access to care issue. Democrats and Republicans supported the 2003 reforms, which have remained intact through bipartisan support. The vote for Proposition 12 was a statewide referendum on tort reform. Democratic-leaning areas of the state such as San Antonio, El Paso, and here in the Rio Grande Valley favored Proposition 12 because those voters recognized that having more doctors providing more care was in the best interest of their respective communities.
mike murray
Steve Hirsch,
You wrote:
"Sue Rudd Bailey, you have it exactly backwards. Per capita is the best way to measure. Looking at raw numbers would lead precisely to the problem Charles Silver identified. If you had 10 new doctors in a community you could say you've come out ahead. If the population grew by 100,000 though, you're behind."
Stating net numbers per capita, and claiming that those numbers indicate that tort reform hasn't increased the number of doctors choosing to practice in this state, is a lie for the ignorant to swallow. Your explanation is prima facia evidence of bias or the state of our education system. No one has claimed that the total net number of doctors has increased...or that the number of doctors per 100,000 residents has increased...what was stated is that there was a measurable increase in the number of doctors applying for medical licenses to practice in the State.
Your simpleton view of the per capita measure doesn't take into account the growth of the population or the number of doctors leaving the practice of medicine that have nothing to do with tort reform.
If the number of new doctors applying for license to practice in this State has increased in a statistically significant way, the total or net or per capita numbers are moot in relation to whether tort reform has made it more likely for doctors to stay in Texas or relocate to Texas. At the rate that Texas is growing and with the largest segment of our population (of which are a huge number of doctors) reaching retirement age, the net number of doctors practicing (total existing and new less those leaving practice) can hide a significant increase in the doctors staying in practice (that would otherwise have quit practicing) and those who've chosen to open a practice in the State (newly minted mds or those fleeing from another state).
I would assume that the lawyer who wrote the article is intelligent enough, and has sufficient education, to determine where his use of statistics proves the old adage that, "figures don't lie, but liars figure". He can't claim ignorance which eats up so many in our society, so the only alternative motivation for his blatant misuse of statistics is that he's intentionally lying so that he can feed the preexisting bias and ignorance of his target audience.
Craig Purcell
Just google "inflation Adjusted Physician Incomes" if you want to see how much money is flowing into physician pockets in Texas or any other state. Most practicing specialties have flat rates of income over the years. We aren't hurting, but considering most of us are 30+ years of age before we draw a real paycheck, I feel no guilt about pulling in a nice income for the stressful work I do helping patients, 30% of whom pay me nothing for the care I give them. Also, as an Emergency Medicine doctor, I cannot write off my free care as a business loss, whereas any other specialty can, or can even sue for "theft of services" Also, a patient who pays me nothing for the care I give them can still sue me for the whole farm if they have a bad outcome. "Give me free stuff and I sue you if your free stuff is not perfect" - sounds like a viable business model to me.