From the president

Mar. 29, 2010 – Now that ObamaCare is law, we can begin to examine the effect it will have on orthopedic surgeons and their patients. The recently passed healthcare legislation did not address medical liability. Unfortunately, this legislation is absent any measure of tort reform. The final bill did offer a watered-down allocation of $50 million to states looking to experiment with alternative ways to try cases or improve patient safety. In addition to the amount of this funding being inadequate, the law allows an exemption – enabling plaintiffs to back out and file malpractice claims at any time.

This message has not been lost on the well-organized lobby of trial lawyers. There have been two recent setbacks to surgeons in the past few months. In February, the Illinois Supreme Court eliminated the established cap on malpractice damages saying it was not legal under the state’s constitution. This past week, the Georgia Supreme Court struck down a law limiting non-economic damages to $350,000. This has been in response to the full-court press of the American Association for Justice, a lobbying group for trial lawyers. Over the past several years, non-economic damage caps have been enacted in Texas, Florida and California. The changes in Texas have been dramatic with a now positive influx of new doctors into the state and a decline in malpractice insurance rates. Now that ObamaCare has been signed into law, we can expect the trial lawyers to continue to press their cause and attempt to reverse the laws in other states that have enacted reasonable caps on damages. Although the malpractice climate here in Minnesota is currently tolerable, this could change and we should work with our colleagues in other states to protect the access of our patients to quality orthopedic care.

ObamaCare was pushed by Nancy Pelosi and the current majority in Congress as a way to stem the spiraling costs of health-care. But unfortunately, it only increases the overall costs of medicine. It significantly increases Medicaid spending by adding 15 million new recipients and takes away from Medicare $500 billion in cuts and tax hikes (a rise in the Medicare tax from 1.45% to 2.35% for households over $250,000)

Unfortunately, we did not need an attempt at a complete overhaul of our health-care system. The vast majority of the citizens of Minnesota are happy with their health-care. There are, however, significant areas where reform is needed, but the current bill did not address them. It adds new taxation and regulations which will increase health-care costs not control them. An incremental approach to health-care reform would have won broad congressional (and not partisan) support.

A few simple changes could have been enacted and the response to these measured and the next steps more carefully crafted. Health savings accounts could have been expanded. Permitting patients to purchase health insurance across state lines would increase competition among insurance companies. Allowing health-care expenses to be tax deductible, not just for employers, but also for individuals would be a start.

But perhaps most importantly, individual patients should be aware of the real cost of medicine. We currently spend 17% of the GDP on health-care, but for the vast majority of citizens with health insurance, out-of-pocket expenses are only 12% of total health-care spending. In Switzerland where a significant percentage of the GDP is also spent on health-care, out-of-pocket expenses are about 30% of total medical spending. How many of your patients know the real cost of the total knee implant that you used last week? Once patients spend more sums from their own pockets and begin to learn the true cost of medicine, then they will begin to shop around and ordinary market forces will begin to come into play.

The first demonstration of the true cost the new law was seen quickly this week when ATT announced a $1 billion write-down due solely to the health bill. The tax increases on companies such as ATT and John Deere who offer prescription drug benefits to their employees rather than shifting them to the taxpayer expense of Medicare part D makes little sense, but is one example of the true increased cost of the new law. Those in Congress who pushed through the current legislation hoped for a delay in the public’s recognition of the adverse consequences. A delay might have allowed voters to not recognize the connection between the inevitable future tax increases and current policy. As Joe Biden would say, this is a big, err, deal.

Scott Steinmann, M.D.