Malpractice Myth and reality in SOTU

One of the most frustrating things about Bush's presidency for those of us who study public policy is the utter disdain that Bush shows for smart and sensible policy in obeisance to his ideological beliefs.  His proposed caps on malpractice are a case in point.  What this plan does is limits the redress for legitimate victims of medical mistakes.  It does nothing to reduce medical errors or actually limit medical costs.  In a terrific book, the Medical Malpractice Myth, by Tom Baker puts the lie to these malpractice cap policies.  The problem is not that jury awards are too high, it is that there is way too much malpractice.  Furthermore, the evidence suggests that malpractice (including so-called “defensive medicine”) makes up an incredibly trivial portion of our overall health care spending.  Consumers Union (publisher of Consumer Reports) nicely summarizes:

Furthermore, the President is expected to call
for a controversial plan to limit the legal damages awarded to patients
in medical malpractice cases. Putting caps on such damages will not
solve the problem of rising malpractice insurance rates. Such limits
are not only ineffective; they are unfair to the patients who are
injured and to the families of those who die because of grossly
negligent behavior by health care providers. There is no guarantee that
this plan will lower rates. It does nothing to enhance patient safety
or reduce medical errors, and it puts an unfair burden on innocent
victims of malpractice.

Every ten years or so, we hear about a medical malpractice insurance
“crisis,” eventually followed by an evening out and lowering of medical
malpractice insurance rates. The reason is that insurance companies
rely on both premiums and investment earnings to pay claims. When the
stock market is doing well, insurance companies often lower premiums to
the point where they are unprofitable, simply because they can invest
those premium dollars in the market and make money. When the stock
market falls, as it has in the last two years, premiums go up.

Rather than support this proposal, Congress should help doctors by
forcing insurers to better manage malpractice premiums, spread risk
among doctors for the high cost of insuring high risk specialties, and
force insurance companies to make public their insurance practices.
Congress should look at repealing the insurance industry's special
exemption from antitrust suits and consider creative ideas such as the
possibility of a fair and equitable no-fault system for malpractice


Open Ended

Time for a little commentary on English.  One thing that has bugged me for a while is that President Bush says that our commitment in Iraq is not “open-ended,” yet at the same time we cannot stop fighting until we win.  Sounds like the definition of “open-ended” to me, yet rarely is called on this absurdity.  Fred Kaplan, who as readers of this blog know, writes great stuff about Iraq and military policy, calls Bush on this and several other absurd features of his Iraq policy in his latest column.  Highlights…

What is most head-shaking of all is that, after four years of this war,
the president once more fell short of making its case. As in the past,
he said that it's very important ?”a decisive ideological struggle,” he
called it, adding, “nothing is more important at this moment in our
history than for America to succeed.” And yet he also said that
America's commitment to the war is “not open-ended.” How can both
claims be true? If nothing is more important, it must be open-ended. If
it's not open-ended, it can't be all that important…

He then said, “Americans can have confidence in the outcome of this
struggle because we are not in this struggle alone. We have a
diplomatic strategy that is rallying the world to join in the fight
against extremism.”

This is mind-boggling. The largest
“coalition” partner, Great Britain, plans to pull out by the end of the
year. Most of the others have long since vanished. There is, clearly,
no “diplomatic strategy,” no “rallying” to recruit others to the fight.
A diplomatic strategy and energetic leadership are precisely what
everyone is waiting for. They are what President Bush once more failed
to offer tonight.
(emphasis mine).

What I REALLY thought of the State of the Union

If you read carefully, you can see what I really thought about the State of the Union here.  And, if you are coming across this a couple days from now, sorry, but Slovaks apparently don't believe in keeping their links active for a long time. 

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