When Reform is Just Change
That words have meaning is too often overlooked by speakers who throw words around without regard for the consequences of their use. On the other hand, some are all-too aware of the meaning of the words they select, intending disingenuously to imbue their message with a positive glow that belies it.
As president Obama steps into the lair with the lions of the insurance, pharmaceutical and medical lobbies, we can only hope that he is not so determined to achieve sweeping "reform" of the U.S. health care and insurance systems that he forgets the difference between it and "change".
The Merriam-Webster On-line Dictionary defines "reform", in part, as:
1 a: to put or change into an improved form or condition b: to amend or improve by change of form or removal of faults or abuses2: to put an end to (an evil) by enforcing or introducing a better method or course of action3: to induce or cause to abandon evil ways <reform a drunkard>
As president Obama steps into the lair with the lions of the insurance, pharmaceutical and medical lobbies, we can only hope that he is not so determined to achieve sweeping "reform" of the U.S. health care and insurance systems that he forgets the difference between it and "change".
The Merriam-Webster On-line Dictionary defines "reform", in part, as:
1 a: to put or change into an improved form or condition b: to amend or improve by change of form or removal of faults or abuses2: to put an end to (an evil) by enforcing or introducing a better method or course of action3: to induce or cause to abandon evil ways <reform a drunkard>
The wholesome and entirely positive connotation generally attached to "reform" is why every public relations, political and advertising consultant worth a damn always packages "change" as "reform". On cue, then, the tort reformers, this year's re-packaged oldies tour. If you think dinosaur rock is nauseating, this re-issue could really make you sick!
Focus on just one of the hits the reformers are recycling: caps. Offering arbitrary, one-size-fits-all caps on damage awards by juries as a cure for their ills, the quick change artists aim to take from the most egregiously injured (and otherwise powerless) not, as they suggest, to reform a "broken" or poorly functioning system, but to change the balance of power between the victim and the perpetrators of her injury.
Let's be honest for a moment: not one of the players in this drama is entirely candid, really.
The "reformers" never address the irrationality -- and fundamental injustice -- of telling a brain-injured baby that he's a greedy little so-and-so. Of course not! They could not possibly win that battle in the court of public opinion. So, rather than pick that fight, they make it one against "the greedy lawyers." Now, there's an enemy everyone can hate without feeling guilty. Make this about the guys in the white lab coats against the dark-suited, Rolex-wearing ambulance chasers and they have a fighting chance.
Meanwhile, the trial lawyers who make their living prosecuting the claims against doctors, hospitals, and big pharma rarely -- if ever -- talk about the pure dollars-and-cents issues that are really at the heart of the change artists rationale: make taking a case unprofitable and financially risky enough, and you'll eliminate a majority of the cases.
How? It's as simple market-driven Economics 101 that comes down to two factors: time and money. Even the most routine malpractice claim requires the outlay of thousands of dollars in up-front costs: gathering records, having the records reviewed by a competent medical consultant, lining up potential expert witnesses, etc. Add to that the problem of trying to do this when most subsequent providers will not even speak with the patient's attorney (let alone cooperate with him or her) and, often, even drop the patient the instant they smell a lawsuit brewing against a colleague who is responsible for a bad result.
Typically, a case against a well-healed medical or manufacturing defendant can cost tens or thousands of dollars, and take years to bring to trial. Place an arbitrary cap on the potential recovery -- regardless of how debilitating, limiting or agonizing the injury -- and you have an economic disincentive that will cause the typical attorney to decline all but the cases with the clearest (read, easiest to prove) liability.
Doubt it? Check out the states that have swallowed the bait of caps and other arbitrary limits. How many doctors and hospitals have see the dramatic drop in their malpractice premiums? In how many states has the public seen calculable increases in the quality of care brought about because doctors are now "free of the burden and fear of being sued"?
So, what changes do we have to show for all this "reform"?
Fewer cases that can be prosecuted profitably? Check.
More victims without a remedy? Check.
Change you can believe in? Depends on who's holding the scalpel.
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Do you have some reason to believe that when Obama offers "reform" he's talking about "non-reform change"?
Your blog touches on tort reform and health care reform.
If we are doing health care reform by trying to cut out waste and excess profits, why not do that for medical malpractice too?
But actually, I believe the stats show that malpractice awards are a very small fraction of total health care costs.
June 15, 2009 7:05 PM | Reply | Permalink
As far as I know, no-one with any credibility in the debate has advocated capping total awards, but rather the non-economic portion of those, at say, $50,000 for pain and suffering. There would no similar cap on the actual costs to the patient in terms of medical expenses or loss of earning power.
I agree that such an inflexible cap may sometimes be unreasonable, but finding the right balance is not as easy as either side would make it seem.
June 15, 2009 9:59 PM | Reply | Permalink