What Do You Mean by the Word "The"?

 Clouds Rest - photo by JoAnn Sturman

by Scott Sturman

Last November in Hawaii a Canadian pediatric cardiologist, an attorney practicing in California, and I sat down after dinner to sort out the American health care system.  Presumptuous by all means, but how could we could do a worse job than the politicians who have made a career running the wagon train off the cliff?  All on the panel prefer to simplify problems, so it wasn’t long until we settled on two topics to resuscitate another leadership failure.  Fraud and waste seemed like a good place to start.
 
The FBI estimates health care fraud costs $80 billion per year, while the New York Times put the value at $100 billion for Medicare alone and $250 billion for health care in the aggregate.   The latter value represents nearly 10% of the annual national health care outlay.  For Democrats that translates into a lot of food stamps and delta smelt and for their colleagues on the other side of the aisle plenty of tanks and airplanes.

When a television announcer proclaims, “If you’re on Medicare or Medicaid, this product won’t cost you a dime.  In fact we’ll fill out the paperwork for you, and XXX will be delivered to your door at no cost,” one should envision wheel barrows full of $100 bills leaving the U.S. Treasury and into the pockets of entrepreneurs.  Vendors must feel no small comfort that the odds of a customer examining an invoice with zero balance is virtually zero.

Solution #1: Whether its seeking health services or purchasing medical merchandise, even a modest financial obligation encourages patients to use them sparingly, peruse bills for accuracy, and report fraudulent activity. 

Our committee disagreed on the extent and cost of defensive medicine, but the attorney was out numbered, and victors write history as they see it.  As doctors, it has been our experience that tests and procedures frequently are ordered, which have as much to do with fending off potential lawsuits than being thorough.  What is the scope of these expenses?  Estimates reported in the Wall Street Journal range from $270-650 billion per year with potential savings of $2.6 trillion over the next ten years.   

Did you have sex with Ms. Lewinsky?”  a reporter asked Bill Clinton, while trying to extract information at a press conference about Monica and a cigar.

“What do you mean by the word ‘have’?” Clinton, the Georgetown University and Yale Law School graduate, responded.

At the time Clinton’s retort sounded ludicrous, but he simply reverted to his lawyer mantle, where even the definitions of basic words are contested.  Plaintiff attorneys thrive in this environment, and carefully chosen words translate into cash and a lot of it.  No where are these linguistic skills more lucrative than when used to tie dull jurist’s minds in knots to the point they actually wonder what the word “the” means.

 Last August my wife attended a seminar in Las Vegas on “Malpractice and Fetal Monitoring,” where both defense and personal injury attorneys discussed jury selection.  Suffice to say, each side is in the market for a different product.  A cynic could conclude the facts of the case are secondary, if a juror’s primary attribute is mental malleability.  

By its very name the Affordable Health Care Act purports to place a priority on financial prudence.  It stands to reason if medical malpractice costs and defensive medicine are a major contributors to excessive health care expenditures, then they should bear no less scrutiny than any other component.  That tort reform was deemed off limits by politicians who wrote the law smacks of obscene cronyism which places special interests ahead of the welfare of the country.

Solution #2:  Tort law is a major contributor to the unacceptably high cost of health care.  Loser pays, protection from frivolous law suits, and relying on a panel of experts rather than gullible juries would help rein in the reign of terror being waged by personal injury attorneys against the medical establishment.

It took us a couple of hours to save the country half a trillion dollars a year without reducing patient access to health care.  It is really not all that difficult if the primary motivation is solving the problem rather than trying to get reelected.