The battle is lost. The lawyers, politicians and insurance companies have won. You just might not realize it- yet. My solemn advice for any physician under the age of 45: get out while you can still build a new career.

Where? That does not even make sense, because of the typical 4 year tail on claims. And, before caps become effective, a number of cases are filed that would normally be strung out over a longer period of time so the insurer is going to need a larger reserve for the next 2-3 years. So unless your insurer was overestimating its losses in the first place, it makes no sense for them to immediately decline following passage. Plus, many insurers will tell you they’re waiting to see if the caps survive legal challenges.

Rates go up and down with the economy. Recently, as interest rates and the stock market have gone up, rates have gone down in both capped and non-capped states.

Defensive medicine = quality services? In that case, what’s the complaint about? Isn’t that what we’re paying for – quality services?

Actually, you cannot prove any of the above. I can prove that premiums were immediately and significantly reduced after caps passed. I agree the quality of services was already high to begin with, excessive defensive testing being the reason, and probably not affected by caps.

This claim is simply false. Caps have not added to the number of physicians in rural areas, reduced premiums meaningfully, or increased the quality of services to the public. Unless you’re defining “effective” as increased the profitability of insurers and reduced their risk, that is. But then you have to believe that the insurance industry should be exempt from the rules of risk, the very thing you pay them to insure!

“There is no doubt in my mind that there is significant abuse and manipulation of our legal system in general.”

There being no doubt in your mind doesn’t equate to it being true, anymore than someone who says there is no doubt that doctors just are in it for the money’s belief is true.

Is it a “cost of doing business”? Perhaps, but even without the current system, we’d still want people to pay when they breach their contracts and negligent injure another, and unless you want the taxpayer to pick up the tab, there will always be a system to do that which requires time and money. But it’s also a benefit to business, because unlike, say Russia, our legal system allows businesses to enforce their contracts, protect their patents, keep employees from revealing trade secrets, employers from breaching their agreements with employees. And one doesn’t have to worry if the politician who nominated the judge is against them, because you’ve got 12 people, not some lobbyist, deciding your case.

As for caps on noneconomic damages, from someone with an underprivileged background, those ought to be the most offensive of all to you, because they disproportionately effect the poorest and weakest members of society when they are injured the worst. Those caps don’t effect the person in the fender bender, they effect the person who can’t walk, who cannot live without significant pain. Essentially, an insurance lobbyist, without hearing a bit of evidence, has decided the value of your pain and suffering. Who lobbies for the injured people? It’s not like they have a lot of spare cash.

As a medical practitioner from an underprivileged nonmedical family background who has lost at least two family members to alleged medical negligence, I have well founded opinions. The sweeping generalizations two posts up aside, there are two sides to every coin. Doctors are patients too.

There is no doubt in my mind that general liabiliy reform is needed, that caps on noneconomic damages have been proven to be effective in California and Texas, and that this is not strictly a matter affecting physicians. In fact, the legislation promulgated involves noneconomic damages on all sorts of nonmedical cases. There is no doubt in my mind that there is significant abuse and manipulation of our legal system in general.

The amount of space devoted on this blog to legal matters is out of proportion to the relative impact of such matters on medical practice and economics. It is the emotional impact and the fact that doctors take it personally that makes legal matters loom so large. One person I know has perhaps a most practical perspective, regarding such matters merely as a cost of doing business. This may be the only rational way to view such matters with our present adversarial system, and we must work to be fair while reducing costs of doing business with limited economic resources. A good start is to reduce the take of the middle-man and transactional costs, whether by insurance company, attorney, high cost triage provider, or unscrupulous physician.

Actually, that is most of what we ALL want to do.

“Do you all all need some lithium?”

No, but you could use a dose of truth serum.