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  • Is Orszag Proposing Medical Malpractice Reform or Something Else?

    White House Director of the Office of Management and Budget Peter Orszag

    Former Office for Management and Budget Director Peter Orszag recently wrote an opinion piece in The New York Times on the need for medical malpractice reform. Well, kind of.

    Orszag’s approach has more to do with creating stricter mechanisms to enforce physicians’ compliance with evidence-based guidelines than with reforming the tort system to better protect doctors and patients.

    Orszag writes, “What’s needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.” He describes malpractice reform as a way to “encourage doctors to adopt new evidence more quickly.”

    Medical malpractice reform should not be used as a guise to implement policies that would standardize medicine and limit physicians’ autonomy. Orszag’s plan would require comparative effectiveness research (CER), which looks at “what works and what doesn’t,” to determine guidelines. CER is a useful tool to aid physicians in determining the best treatment option for a patient. But using findings to compel physicians to act according to “best practices” would diminish the role of patients’ personal preferences and physicians’ training and experience in decision-making. If physicians could escape legal liability for following evidence-based guidelines, they would surely feel significant pressure to act based on the evidence far more and on their best judgment far less.

    Moreover, evidence-based guidelines do not have the capacity to dictate the best course of treatment for every case. In the Huffington Post, Joanne Doroshow of the Center for Justice and Democracy writes:

    The reality is that no matter who writes them, it is impossible to develop single authoritative guidelines for every medical condition, let alone to trust any entity to suddenly become the sole arbiter of acceptable medical practice. It is estimated that more than 1,400 sets of clinical practice guidelines exist today. While some standards, such as those in anesthesia, are clear and easily complied with, others, such as in obstetrical cases, are complicated and can be contradictory. Moreover, as they are written for “average patients” and cannot encompass the huge variation in how patients present, there may be good reason to vary from a guideline’s recommendation for a patient.

    Strong financial incentives for doctors to adhere to guidelines are already included in the Patient Protection and Affordable Care Act (PPACA). As Director of the Congressional Budget Office, Orszag testified before the Senate Finance Committee that “to alter providers’ behavior, it is probably necessary to combine comparative effectiveness research with aggressive promulgation of standards and changes in financial and other incentives.” Under the PPACA, Medicare will penalize hospitals through reduced reimbursement rates based on their performance on quality measures. Introducing the use of guidelines to medical malpractice reform would have an even stronger effect on patients and practitioners.

    Orszag’s article does not do justice to the very real need for medical malpractice reform. To solve the medical liability crisis, former Heritage health policy fellow Randolph Pate explains that states should reform their malpractice systems in order to best address the critical demands of each:

    Options for states include rationalizing and refocusing malpractice awards to compensate quickly for economic losses like lost pay and medical bills, reserving punitive damages for the small number of warranted malpractice cases, and limiting attorneys’ fees to guarantee that patients get the highest possible proportions of awards in medical malpractice cases. … States may also wish to consider creating patient indemnity insurance, a new breed of insurance that would compensate for injuries at a level chosen by the patient. States should mix and match the solutions presented in this paper, tailoring reforms to meet specific challenges.

    Medical malpractice reform is necessary to reduce unnecessary spending in the health care system and ensure that patients safely receive the care they need while concurrently protecting physicians and their practices. Orszag’s proposal instead treats malpractice reform as an avenue to achieving the broader goal of standardizing the practice of medicine.

    Posted in Obamacare [slideshow_deploy]

    3 Responses to Is Orszag Proposing Medical Malpractice Reform or Something Else?

    1. Leon Lundquist, Dura says:

      The Deny Healthcare To More Americans Act (they mislabeled it as Healthcare Affordability) is the perfect example for duplication of layers of Government to hide what is really going on. The Best Practices Bureau will do for Healthcare what has been done everywhere else Obama and his gang touch. "Necessarily skyrocketing costs" and it will kill more Americans than Hitler. There is no size that fits all. Look at all the crazy TV Medicine ads (followed up with Lawyer ads)! This is all about attacking Americans and controlling them, making them vulnerable to Progressive schemes.

      Genuine Third Generation Communists wrote this Legislation. It has nothing to do with Healthcare! It is the follow up to the bad policies put forward by the American Medical Association (which if you didn't know, was taken over by the Communists decades ago!) They don't focus on curing disease anymore! They 'manage' disease. They 'manage' symptoms. They manage Syndromes, Immunodeficiencies and Disorders and refuse treatments that work. The Doctors have discredited the AMA! Only the Government listens to them!

      The CER replaces the AMA (which once infiltrated, was run into the ground). No, my friends, this is all about Junk Science invading Medicine and corrupting it (Government gets its slice of the pie while Americans are dying!) There are Doctor Shortages as far as the eye can see coming out of the CER. They will be fleeced and fined, denegrated and demonized on the way down. Their assets and businesses will be stolen. I read the Bill. That's what is in it!

      The PPHCA (Obamacare) was designed to destroy the best Medical System in the World. The part I find most offensive is how Mental Health Treatments (barbaric and horrible) will be imposed on more Americans and paid for by the Government! (Mental Health Parity) Yes! Against your will! They did exactly that in Russia to the Loyal Opposition. I will note that Constitutionalism, belief in God and belief in Communist Conspiracies are all actual AMA approved symptoms of mental illness!

    2. Kris G says:

      Mistakes sometimes happen in medicine, so insurance is a good idea. However, when you have individuals who make a living suing or sitting at home making babies their suits should be tossed out. I am all for placing a cap on monetary settlements. It is time to protect the provider and question the motives of many claiming damages. Notice I didn't say all claims.

    3. william reichert Atl says:

      I have been a medical expert in several malpractice trials. Sad to say but

      the situations presented in nearly all of them address issues of medical care not addressed by any guidelines. Medical practice itself requires decisions to me made

      that guidelines address only some of the time. The media and the public find very appealing the idea that guidelines are "out there" and if only doctors would follow them everything would be wonderful.This is not the case. I would be happy to expand on this idea with concrete examples if you want to know more.

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