Health Insurance

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.

Story on CNN about a new treatment strategy in the war on lung cancer. The process of staging tumors previously relied on a sampling of 5,000 tumors from M. D. Anderson Cancer Center in Houston, which was put together decades ago. Doctors use staging to guide treatment and predict odds of survival. It looks at the size and shape of the tumor, as well as where the tumor has spread.

Doctors have come up with a new way to stage, that uses 100,000 tumor samples from around the world. Doctors say the plan will move a good number of people from the non-operable category to the operable category. It appears that the new staging will refine the treatment options and give more aggressive treatment options to those who had little options before, and could give more targeted treatment to those with smaller tumors. Hopefully this will increase survival rates for all.

As a side note, the American Cancer Society has announced a change in their advertising strategy for the next year. The focus of their ad campaign will be the effect of the health care crisis on cancer mortality rates. Studies have shown that the lack of insurance leads to delays in detecting malignancies, which results in more cancer deaths. There is no doubt that improvements in the way we handle health insurance in this country will lead to less cancer deaths. People who can’t afford to go to the doctor often find out they have cancer too late. The ACS is doing a great thing.

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.