Ernie's Rx for healthcare

According to an A. P. story that appeared in Sunday’s Appalachian News-Express, Governor Ernie Fletcher has as a goal in 2006 the passage of a constitutional amendment “on medical malpractice lawsuits…in Kentucky”. Well, you don’t have to be Jeanne Dixon to interpret the Governor’s intentions. It’s pretty plain the Governor means to reduce monetary awards that arise from malpractice cases. According to Fletcher, this would help to reduce “Kentucky’s soaring health care cost and…the increased cost of employee insurance”.

With all due respect, this is a specious argument at best. Medical malpractice lawsuits are hardly the primary cause of rising health care in the Commonwealth or the U. S. As a one-time practicing physician, the Governor should know that one of his former patrons, the tobacco industry, does more to run up medical bills in the Commonwealth than malpractice suits ever could. Kentuckians are avid consumers of tobacco products, and as a consequence, a great number are afflicted by preventable tobacco-related illnesses, a fact that is reflected by the large deficit in the state’s Medicaid program.

I will grant that the Governor seems to have been enlightened on this subject since the tax on cigarettes was increased from the miserly rate of three cents a pack. The new rate, unfortunately, does not cover the cost of treating sick smokers. The estimated true cost of this ranges anywhere from $8.00 per pack, up to $43.00 per pack, depending on what you charge off to smoking. The later, higher estimate includes loss of productivity due to sick days taken by smokers.

Still another factor in the high cost of medicine in Kentucky and elsewhere in the U. S. is the nature of the health care system, itself. Those uninsured among us, for instance, get little in the way of preventive health care, and as a result require much more medical attention when they do seek help. This is something that our health-care system has not yet grasped.

Take the matter of dental care, for instance. In an article written for the New Yorker magazine, writer Malcolm Gladwell cited the work of two Harvard researchers who interviewed uninsured Americans to find out how they dealt with untreated medical problems. The most common problem, it turned out, was with teeth. Dental care in America has always been treated as an added luxury, even to those who have basic health insurance, so certainly to those who don’t have health insurance, dental care is indeed a luxury that they simply cannot afford. Dental problems that go uncorrected tend to keep sufferers in poorer paying jobs because of the appearance of their teeth, and the problem continues to go uncorrected due to a lack of funds.

The writer then tackles what he sees as an enduring mystery: Why is it that Americans, who seem to demand efficiency in every aspect of their lives (they have deserted domestic car makers for the better-made foreign brands, and left Mom and Pop stores for the cheaper prices of Wal-Mart) seem so intent on keeping a health-care system that costs on the average some two and a half times more than the world’s median, yet which comes with fewer doctors per capita than most Western countries, fewer visits to these doctors, and fewer instances of hospitalization? The mystery only deepens when you consider that Americans are also less satisfied with their health-care system than the citizens of other Western countries.

Finally Gladwell describes a reason for rising health care costs for businesses in America by looking at how health insurance pays. Health insurance has traditionally been “social insurance”. By that, it is meant that the cost is distributed equally among all users. So, say, those who are younger and healthier accept a larger cost to help provide coverage for those who are older and sicker, in the hope that, when they, too, are older and sicker, someone will help them.

The latest trend, however, has been to make health insurance “actuarial”, where the user pays only for those costs he or she incurs. In this system, the younger, healthier worker pays considerably less than an older employee who would likely need more in the way of medical services. The downside of such a system is this; those industries that employ more of the older workers have seen much higher costs associated with heath care.

So, it is not likely that, should the Governor succeed in his aim of limiting malpractice awards, health care costs in Kentucky would even be slowed down, let along be reduced. There are simply too many factors that are driving health-care costs for this simplistic approach to work, and too many are outside the Governor’s ability to affect them.

What is needed as much as anything is a comprehensive overhaul of a system that has grown unresponsive to the needs of its users. To suggest that limiting malpractice awards would reign in health care costs is to underestimate completely the scope of the problem.