A new study found no evidence that health care costs in Texas dipped after a 2003 constitutional amendment that limited payouts in medical malpractice lawsuits, despite claims made to voters by the proponents of tort reform.
The researchers, who include University of Texas law professor Charles Silver, examined Medicare spending in Texas counties and saw no reduction in doctors' fees for seniors and disabled patients between 2002 and 2009. A 2003 voter campaign in Texas, and some congressional backers of Texas-style tort reform in every state, however, argued that capping damage awards would not only curb malpractice lawsuits and insurance costs for doctors, it would lower costs for patients while boosting their access to physicians.
The findings come after a report last fall in which consumer group “Public Citizen” said Medicare spending in Texas rose much faster than the national average after tort reform. Critics of that study said that tort reform leaders never promised health care spending would decline and noted that caps on damage awards brought steep drops in malpractice rates for doctors and large increases in new doctors coming to Texas. Another study yet to be published on physician supply and tort reform, also by Silver's group, agrees that malpractice suits and payouts sharply dropped after tort reform. But that study strongly disputes claims of a mass exodus of Texas doctors before tort reform and huge increases afterward.
On the question of health care costs, Silver's group focused on the federal government's Medicare program, which makes up 20 percent of the $2.5 trillion spent on U.S. health care. That group -- consisting of two Republicans, a Democrat and a foreign national, according to the researchers -- analyzed data at the county level in Texas, said Tom Baker, author of a 2005 book, "The Medical Malpractice Myth," and a professor of law and health sciences at the University of Pennsylvania. "This is a very highly regarded study, and this team is highly regarded," Baker said. The study was paid for by the researchers' universities, Silver said, and the paper was published this month in the Journal of Empirical Legal Studies. "Their results didn't surprise me at all," Baker said.
Medicare spending up
The researchers assumed that doctors who faced a higher risk of being sued -- those in counties that had larger numbers of malpractice cases -- would perform more tests and procedures than necessary to protect themselves from lawsuits. With tort reform, which limited damage awards against doctors, the need to practice such "defensive medicine" would decline, the argument went. But in comparing Texas counties in which doctors faced a higher risk of lawsuits with counties where the risk was lower, the researchers found no difference in Medicare spending after tort reform.
"If tort reform reduces spending, it would have the biggest effect on high-risk counties," Silver said. He noted that those tend to be large and urban. "This is not a result we expected," said Bernard Black, a co-author and a professor at Northwestern University's Law School and Kellogg School of Management.
Health care spending has increased annually everywhere, the researchers said, including in the states with caps on malpractice payouts -- now at 30, counting Texas, said David Hyman, a co-author and professor of law and medicine at the University of Illinois. But, said Hyman, who worked on health policy for President George W. Bush at the Federal Trade Commission, "we found no evidence that Texas spending went up slower in comparison to all other states and may have had an increase."
Since tort reform, some Texas residents have complained that they cannot find a lawyer to pursue a malpractice case because of the $750,000 cap on payouts for pain, suffering, disfigurement and mental anguish. The limit often makes litigation cost prohibitive, patients and lawyers said. That concern was not raised in the paper, although the researchers agreed that the rhetoric used by the tort reform proponents, of “huge malpractice payouts” and rampant "frivolous" lawsuits before tort reform, were and are greatly exaggerated by its advocates.
Numbers of doctors
Jon Opelt, executive director of Texas Alliance for Patient Access, said tort reform in Texas has benefited patients by adding more physicians than can be accounted for by population growth. However, Silver and his fellow researchers' unpublished study says Texas Medical Board data that Opelt cites on new physician applications and licenses do not account for doctors who left the state or retired, creating vacancies for their jobs; physicians who don't treat patients but do research or administrative work; and physician growth compared with other states. When those factors are weighed, Texas saw the number of direct patient care doctors grow more slowly after tort reform than it did before, the study says. Afterward, Texas did slightly worse than other states in attracting doctors, the study says.
These new studies prove what the advocates of victims have been saying all along---it is not the claims or lawsuits that effect the insurance premium rates or the insurance pay rates. It is the greed to the insurance companies that control the same. But remember, these greedy corporations need to sell their ideas to the public, and they have found the easiest way to do it is to blames lawyers and “frivolous” lawsuits.
“Tort reform” merely means stripping you of your rights to seek redress or compensation when someone else harms you. It is nothing more than that. It may seem like a good idea, until it happens to you.
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