The health care crunch

BY THE TIME the presidential campaign ends Nov. 2, the candidates will have spent hundreds of millions of dollars trying to convince voters that their team is most able to tackle the tough problems ahead.

Hundreds of hours of speeches will have generated thousands of commercials. Countless meals of chicken and coleslaw will be consumed as the candidates commiserate with potential supporters. Some of the issues will be simple; others will not. Health care is one of those that are most difficult.


The problems facing our ailing health care system - which is being stressed beyond its limits - are not simple. Health care costs driven by expensive new technology and a reliance on miracle drugs have grown at a rate far exceeding inflation, and the aging baby boom generation further imperils it.

Efforts to control costs by the government and other payers over the last 10 years have ratcheted down payments to physicians so that they now represent less than 17 cents for every dollar spent on health care. The same aggressive constraints have been applied to hospitals, forcing them to choose among hiring nurses, maintaining buildings or investing in new technology.


Today, the most visible and immediate threat to health care is the skyrocketing increase in malpractice liability premiums being charged to doctors and hospitals. The average jury award or settlement undertaken to avoid a capricious jury has increased in Maryland to more than $425,000 a case this year.

The company that insures over 75 percent of Maryland's doctors paid over $75 million in 2003 alone.

The insurance companies pass on these losses in the form of premiums charged to doctors. Many hospitals, because they are self-insured, must take the money from daily operating funds. The tragedy of the current situation is not just that physicians are curtailing services, retiring early or leaving the state, but also that the current malpractice system doesn't identify truly bad doctors and doesn't result in better health care.

While it is imperative that malpractice reform be enacted to preserve access to needed health care, the significance of this crisis is even greater than our politicians - state and federal - understand or acknowledge.

The fundamental problem is that through decades of dictating reimbursements to the providers, regardless of their costs, and of defining the circumstances in which the services can be delivered, the government and other third-party payers have created in the minds of the public a system of socialized medicine. It is a system in which health care is felt to be an entitlement - expected to be available on demand in a convenient location and free of cost or risk to the consumer.

The flaws in these perceptions are obvious. The first is that though all of us in medicine strive for a good outcome for our patients, this cannot always be achieved. The second is that because providers of health care exist in a capitalist world, ever-increasing expenses must be met if providers are to remain financially viable and in business. Regardless of their competency, the rising cost of malpractice liability insurance is putting doctors out of business.

No other business in America subjected to these realities would be expected to survive. No health care entity - doctor, hospital, nursing home - can exist indefinitely under the current system that dictates reimbursement regardless of the costs incurred to provide the service.

Today, for doctors and hospitals, that critical cost is the medical malpractice liability premium that reflects our dysfunctional medical malpractice system. If our state and federal lawmakers, and those who seek to replace them, really want something tough to chew on in the next couple of months, let them chew on these realities.


Marylanders - in fact, all Americans - are desperate to see what our leaders will come up with.

Dr. Scott E. Maizel is president of the Maryland chapter of the American College of Surgeons.