Getting serious about health care access

Rep. Verla Insko's straightforward bill to study how the state can expand health care was approved in committee yesterday, but not before skeptics of the legislation bogged it down with amendments.

 Instead of creating a health care policy council, as originally proposed, the statute will now charge the North Carolina Institute of Medicine with studying ways to create a more integrated health care system and report annually to the General Assembly.

 But even in its pared down form, the bill proved threatening enough to some lawmakers that they felt compelled to trot out tired arguments against expanding health care access.

 The official purpose of the council to make recommendations "for moving from the current fragmented health care system to an integrated system of public and private health care" concerned Rep. Joe Boylan from Moore County. He thought the language sounded too much like an endorsement of universal health care.

 What was perhaps more disturbing was Gaston County Rep. Wil Neumann's addition, over Insko's objection, that the task force study how much medical malpractice lawsuits add to the cost of health care in the state. During committee debate Neumann said, "A lot of doctors are being forced to practice defensive medicine in order to avoid lawsuits."

 The first problem with Neumann's insertion is that Insko's bill does not call for the specific study of any other topic. The original intent of the legislation was to keep the charge broad and give the Institute of Medicine room to examine a variety of access issues.

 The second problem is that we already know how much medical malpractice lawsuits add to the cost of health care: not much.

The worldwide leader in business consulting – McKinsey Global – has weighed in on the malpractice cost issue.  Their report last year on health care costs was clear: "While the US malpractice system is extraordinary, it is only a small contributor to the higher cost of health care in the United States."

The nonpartisan Congressional Budget Office has concluded:

Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending-private or governmental-because malpractice costs account for less than 2 percent of that spending.⁽³⁾ Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

A recent study in the respected journal Health Affairs found, "tort reforms' overall impact appears to be extremely limited." Even more damaging, the study is referring to the impact of reforms on physician malpractice premiums – the costs at which most reforms are directly targeted.

We can only hope that lawmakers will stop playing politics and start studying ways to expand health care. We will see what happens today when the House votes on the bill.