If malpractice system continues as is, availability will suffer

Palm Beach Post Letters
http://www.palmbeachpost.com

Fifteen years ago, one health-care policy expert described health insurance choices for society as containing three key components: quality care, inexpensive care and quick care. The choice for society was that it could have two of the three components. For example, Canada has a system that is thought to have quality and (relatively) inexpensive care, but at the expense of timely care. The United States (in general) has quality and timely care, but at a tremendous cost.

I submit that the health-care malpractice situation has a similar three-component system: unlimited access to the tort system (i.e., no limits on malpractice suits); inexpensive to society (the cost of coverage is placed primarily on providers, hospitals and physicians); and broad availability of physicians and specialists. Our system has essentially unlimited access to the tort system and financing primarily through providers. The downside is that availability will be limited.

We should not forget that once a physician leaves, it is very unlikely that market forces will bring the physician back. There is also the problem that when a critical number of physicians leave, the limited number of remaining physicians in a specialty become overwhelmed and subsequently cut back on services, further exacerbating the problem. In other words, availability of physicians and specialists is not a fluid component of the system, and when other areas of the three-component model change, availability will follow very slowly.

If people, such as the writer of “Immunity for ER doctors removes one incentive” (Feb. 12 letter), do not want to limit access to the tort system, and presumably do not want limited access to care, then society will have to bear the cost of malpractice insurance. This would have to be through taxes, fees added to current medical bills (similar to a hotel surcharge or airline landing fees), or through user insurance.

Perhaps individuals who want to have malpractice insurance coverage for the health care they receive ought to purchase their own policy, similar to the optional coverage one buys for traveling or the extended insurance you have an option of buying when you purchase a refrigerator. If this is not popular, individuals could purchase “underinsured” or “uninsured” physician coverage, similar to what we buy with our automobile insurance (i.e., uninsured motorists insurance).

If society and policymakers continue with our current system, it is inevitable that availability will suffer, and then we all will be left without physicians to care for us when we are ill.

RICHARD W. POMERANTZ, M.D.

Jupiter

Editor’s note: Dr. Richard Pomerantz is board-certified in pulmonary and critical-care medicine. He is chief of staff at Palm Beach Gardens Medical Center.
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