Health Care

There is a new story on which discusses new evidence that malpractice damage caps are not a fix for high health care costs.  The argument advanced by tort reformers in the halls of Congress, as well as the halls of state legislatures all over the country, is that 1) doctors pay high premiums to insurance companies to protect themselves against malpractice suits, and 2) the cost of these premiums are passed on to consumers, which makes health care more expensive. 

Texas passed a medical malpractice lawsuit cap in 2003, limiting the amount of general damages (non-economic damages such as pain and suffering, loss of enjoyment of life, and mental anguish) to $250,000, no matter how egregious the harm done to the patient.  According to the article, the law produced a 30 percent drop in doctors’ mapractice insurance premiums.

 However that has not translated into lower medical costs for consumers.  The cost of medical insurance premiums rose faster than earnings in Texas.  According to Families USA, health care premiums in Texas rose a whopping 86.8 percent betweem 2000 and 2007.  Medicare spending in Texas increased 24 percent in the three years after the cap was passed. 

A study published in December 2008 in the journal Health Sciences Review, found that “(t)ort reforms have not led to health care cost savings for consumers.”  The study asks the question “(a)re there other benefits (from tort reform) to consumers? If these cannot be identified, it is difficult to see a justification for the loss of legal rights.”

The benefits acrue to the insurance companies who do not have to pay for the damages covered under their policies.  Those hurt are not people who have small injuries and heal up from the malpractice done to them.  Those who are damaged by the cap are the severally injured, who then become a burden on society, because the person who caused their injury is not having to pay for the damage they have done.

According to a story in the New York Times, drug maker Eil Liy, is negotiating with federal and state agencies to settle federal and state civil and criminal penalties regarding the marketing practices it employed for its anti-psychotic drug.  Zyprexa gained FDA approval for treatment of people with schizophrenia and sever bipolar disorder.  Evidence shows that Eil Lily marketed the drugs to doctors for other uses, including in people with age related dementia.  Doctor are allowed to use drugs for off label purposes, but drug companies are not allowed to promote these uses.  This fine would be the largeset one of its kind, if approved.

Eli Lily has already paid $1.2 Billion to settle lawsuits claiming Zyprexa causes diabetes in some who take it. 

The City of New York has opened two new clinics to service people who lived in the vicinity of ground zero or worked at the site and have medical problems arising from exposures at the site, according to the NY Times.  The clinics are part of the World Trade Center Environmental Health Center, which has treated 1,600 patients so far.  They expect to treat 20,000 people over the next five years.

Story on CNN about a “blackhole” in the FDA approval process which allows drugs not approved by the FDA to be sold by pharmacies to consumers without any FDA oversight.  The FDA’s process causes confusion among doctors and pharmacies as to whether a drug has been approved, allowing sometimes dangerous drugs to get into the hands of consumers.  Another good article on the FDA’s approval process problems at OMBWatch.

Doctors treating ground zero related illnesses in workers from the 9-11 site testified to Congress regarding the outlook for the workers, according to a story in the Washington Post.  One doctor testified that “respiratory illness, psychological distress, and financial devastation have become a new way of life for many” of the workers.  An OSHA employee testified that workers arriving at the site in the first 48 hours after the attack received an “incredible assault” on their systems, from all of the toxins in the air. 

A study presented at the hearing shows 70% of the workers had new or worsened respiratory symptoms after exposure to debris at the site.  The study found mental health conditions, including PTSD and depression, in 36% of the workers studied, lower respiratory problems in 40% of the workers studied, and upper respiratory conditions in 59% of the workers studied.

It is unknown how long these types of problems will last in the affected workers and whether new problems, such as cancers related to the exposures, will emerge.  Congress has not yet set up a program for long term health care and health screening for these workers.  It would be the right thing to do.

Have you ever been denied on a health insurance claim? Ever spent hours on the phone with insurance reps who seem to be looking for a reason to deny your claim. There is a great article on with tips on fighting your health insurer.

Besides giving step by step advice on how to argue your case, it also includes the story of someone who lived this nightmare. Todd Robinson’s insurer denied $200,000 worth of medical bills on his son, who suffered from adrenoleukodystrophy. Mr. Robinson spent huge amounts of time fighting the insurance company, time he could have spent with his dying son.

The Insurance Industry spokeman quoted in the article says that denials are “infrequent” and usually the fault of doctor’s improperly coding the bills. Right. The Insurance Industry spokesman said he was “surprised” to hear that an insurer denied Mr. Robinson’s $200,000 claim, but is “sure the company has learned from that experience”. I guess it is just tough luck for Mr. Robinson that he was used as a learning experience.