Physician Burnout and Medical Malpractice

 

There is no doubt there is a physician shortage that is getting worse. The reasons for this trend include early retirement, physician burnout, declining wages, decreased independence, electronic health records (EHRs), and government intrusion into the practice of medicine.

According to the Association of American Medical Colleges in 2018, there will be a shortage of 120,000 physicians by 2030. That’s an increase of 14% over last year’s estimates.

By some estimates, doctors now spend half of their time on EHRs – and barely 25% of their time seeing patients. As recently as 2000, doctors spent 60% of their time with patients. This has led to two-thirds of doctors today who describe themselves as burned out, depressed, or both. If we ever see single-payer healthcare in this country, as many progressives want, those numbers will surely increase.

What is the impact of medical malpractice on physician burnout?

As discussed above, there are many reasons for physician burnout. But certainly an important one is the threat, real or imagined, of medical malpractice litigation.

In 2011, Batch et al. surveyed 7,197 members of the American College of Surgeons and found 24.6 percent had been sued during the previous 24 months. Compared to members who were not recently sued, those who were had higher rates of burnout, symptoms of depression, and suicidal ideation.

The authors addressed the question of causality: “Since burnout can contribute to poor decision making, less compassion, and diminished dedication to safe, optimal care, it is reasonable to suggest that these physicians were more likely than their nonsued counterparts to be at risk for error.” A study in Oregon would seem to prove the point when they found the risk of receiving a second malpractice claim, after a first one, doubled in the following year.

The impact of a malpractice claim on a physician’s life was estimated in a study of 41,000 doctors by Seabury et al. They found that during the course of a mean physician career of 40 years, the average doctor spent 50.7 months, or more than 10 percent of that time, with an unresolved, malpractice claim.

Does burnout increase the risk for malpractice or does malpractice increase the risk for burnout?

Eeric Truumees, M.D., writing in AAOS Now, says we don’t know the answer to that question yet. We do know that the risk of medical malpractice has several other impacts on the healthcare system.

  • Increases the practice of “defensive medicine” – ordering unnecessary tests
  • Increases the cost of healthcare
  • Influences the movement of physicians to lower-malpractice-risk states
  • Influences the decisions physicians make in “high-risk” patients

 

What can be done to lower the risk of medical malpractice while maintaining high standards of healthcare?

A recent interview of several health policy experts by The New York Times reporter Margot Sanger-Katz revealed several suggestions:

  • Shielding doctors if their care adhered to accepted standards
  • Using administrative courts in lieu of juries to determine liability and damages
  • Implementing no-fault systems – currently widely used in worker’s compensation systems and in vaccine litigation.

 

The solutions are not clear – but the problems of physician burnout and physician shortages are not going away. Something must be done soon or we face a future with inadequate numbers of physicians to take care of our growing and aging population.

How to Reduce Health Insurance Premiums

 

It’s no secret health insurance premiums are rising. What can be done about it?Reminds me of the old saying, “Everybody talks about the weather but nobody does anything about it!” But there actually is a way to lower health insurance premiums.

Avik Roy, healthcare economist writing in Forbes, says the answer is to eliminate the health insurance tax. Wouldn’t that be a nice Christmas present?

What is the health insurance tax?

A bit of history is needed here. When President Obama proposed the Affordable Care Act (ACA) in 2010, now known as ObamaCare, he insisted it be “budget neutral”, which means it would not increase the federal deficit. This made it politically acceptable – even if it required some subterfuge and “accounting creativity” to make it possible.

To make the $2 Trillion price tag for insurance subsidies possible, the ACA required huge cuts in Medicare spending ($716 Billion) and a long list of tax increases (21).

These tax increases harmed economic growth and contributed to the slow economic recovery after the 2008 recession. The Tax Foundation estimated the 3.8% net investment income tax alone cost the economy 133,000 jobs and restrained wage growth.

But Roy gives the blue ribbon for the Dumbest Tax in ObamaCare to the tax on health insurance premiums (HIT). The HIT is a tax assessed on every health insurance premium sold. The tax is assessed on the health insurance provider but the cost is paid by the one who purchased the policy since it is incorporated into the premium. The Joint Committee on Taxation estimates it will raise $161 billion in revenue between 2019 and 2028.

Actually, it’s worse than that – consultants have estimated that for every dollar the government raises in taxes, the premiums go up by around $1.27. If you do the math it translates into an annual premium increase in 2020 of $196 per person for buying coverage through ObamaCare; $458-$479 for those who obtain their coverage through their employer; $241 for enrollees in Medicare Advantage; and $147 for enrollees in Medicaid managed care plans.

Adverse Selection

The bad news is not over. Health insurance premiums go up even more for related other reasons.

First, as health insurance premiums get more expensive due to the tax, more healthy people drop out of the insurance market. As more healthy people drop out, premiums must increase even more to pay for the sick patients that remain.

Second, the federal government is subsidizing the cost of health insurance for nearly everyone. Premiums in Medicaid and Medicare Advantage are heavily subsidized by federal and state governments. The same is true for ObamaCare. Even employer-provided insurance is subsidized through the tax code (that doesn’t recognize this as income).

That leaves us with government at its worst: The federal government imposes a tax (HIT) that leads to higher premiums. Higher premiums lead to higher levels of subsidies of premiums paid by the same government.

The consulting firm Oliver Wyman believes the premium tax will result in $58 billion in additional spending on Medicaid premiums between 2020 and 2029. Premiums will rise $72 billion in Medicare Advantage, $103 billion for employer-sponsored coverage, $29 billion for individual –market coverage, $4.7 billion for Medicare drug plans, and $3.8 billion for federal employees.

That’s a grand total of $211 billion in premium hikes over ten years. Therefore, the HIT tax will raise $161 billion in revenue and cause premiums to go up $211 billion over the same ten years.

Roy says its time to repeal the HIT tax and there’s no better time than now during the “lame duck” session of Congress. It’s the perfect Christmas present for all Americans.

The Democratic Healthcare Plan

 

What is the Democratic healthcare plan? Democrats retook control of the House of Representatives in the recent mid-term elections largely based on their promises to improve your healthcare. They spent over $90 million on healthcare advertising alone. So what is their plan?

That’s the question John C. Goodman, healthcare economist writing in Forbes, asks in a recent post. What exactly do the Democrats plan to do?

Senate Democrats maintain a website called A Better Deal which purports to outline their plans. But here is what Goodman found when reviewing the site:

  • They have no plan to insure the 28 million Americans currently uninsured.
  • They have no plan to address the ObamaCare premiums that are 2 – 3 times higher than they used to be.
  • They have no plan to reduce the sky-high deductibles that cause people to avoid seeing their doctors.
  • They have no plan to address the narrow networks that exclude the best doctors and hospitals from these networks.
  • They have no plan to address the problem that half the counties in this country offer only on insurance provider.
  • They have no plan to address pre-existing conditions protections though most of their ads focused on this issue.
  • They do have a promise to stand up to pharmaceutical companies – whatever that means.

 

We have all heard that about half the Democrats in the House of Representatives, and many Democratic senators preening for a presidential run, have advocated “single-payer” healthcare, often referred to as Medicare For All. But the Democratic leadership in both chambers are avoiding this discussion and it is not mentioned on their website.

Goodman also examined the writing of economist Paul Krugman, a reliable apologist for Democratic thinking. He found an editorial entitled How Democrats Can Deliver on Health Care, which proposed two ideas the federal government should implement:

  • Allow individuals under age 65 to buy into Medicare
  • Allow Medicaid to be a public option competing in the exchanges

 

Goodman thinks Krugman, and most Democrats, believe Medicare and Medicaid are government programs that are fundamentally different from private insurance. In fact, both programs have been so extensively privatized that these “reforms” might not involve much change at all. Here’s why:

Conventional Medicare today is less attractive than most people think. Although the government pays for Part A (hospital coverage), the individual must purchase Part B (doctor coverage), Part D (drug coverage) and Medigap insurance (supplemental to cover what Medicare doesn’t cover). It is hardly a government give-away. Even after all that there is no catastrophic coverage.

As a result of all that, Medicare Advantage is growing in popularity. More than one-third of all seniors choose Medicare Advantage plans which are offered by private companies such as Humana, Cigna, and United Healthcare. These plans are less expensive and offer broader coverage. Their only real drawback is a limited choice of primary care physicians.

If Medicare were offered to younger people, it is likely most would choose a Medicare Advantage plan. But private plans like these are already available. The difference is seniors are heavily subsidized. They pay only about 20 percent of the cost of their insurance out of their own pocket. But if we’re going to subsidize young people we don’t need Medicare. We could just subsidize private insurance directly.

Goodman says no one in Congress is advocating spending more money to subsidize insurance that people already have access to. Yet a Medicare buy-in would amount to little more than that.

The same problems exist in extending Medicaid availability. About two-thirds of Medicaid enrollees nationwide are in private-sector health plans. The private insurance providers who operate these plans have been more successful than others in the ObamaCare exchanges. Centene, one of these, covers about one-fifth of all ObamaCare enrollees in the country.

However, quality has been a problem. The plan Centene offers in the exchanges is little more than Medicaid with a high deductible. There have been numerous complaints of patient abuse in the Texas Medicaid program and Centene was the contractor with the most complaints.

Goodman says these cheap, low-quality plans on the exchanges essentially are already a “public option.” But they don’t solve real healthcare problems. Democrats may be making promises to solve your healthcare issues but they don’t have any meaningful plans yet to do so.