Fixing Health Care The Smart Way: at the state level, starting with Arizona

With the very questionable and incredibly expensive and poorly though out presidential health care initiative appearing to be in trouble, one state among others remains in a high cost medical environment.  Arizona doctors, especially primary care physicians are leaving for more conducive legal environments.  One state, Texas, has had great success in attracting both primary care physicians and specialists, since it enacted wide-ranging medical tort reform.  Tort reform, however, is only part of the solution. 

What is wrong in Arizona?

1. A shortage of primary care physicians exists – patient to doctor ratio is and has been rising for some time.
   1. Too many Arizona trained doctors opt to leave Arizona.
   2. Too many opt to go into specialties.
2. Health care costs in Arizona and the nation continue to dramatically outpace inflation.
3. Too many tests ordered, too few primary care physicians, too many expensive specialists, too many frivolous malpractice suits, too many dollars awarded as punitive damages.

Why is it wrong?

• Two medical schools in Arizona.
  1. University of Arizona, turning out only 110 doctors per year.
  2. A University of Arizona location in Phoenix will not significantly add to number of physicians output – output may be only and additional 24 doctors per year.
• A.T. Still University School of Osteopathic Medicine in Phoenix will have its first graduating class next year and produce only about 110 each year.
• The cost of medical malpractice insurance forces primary care physicians to order too many tests to protect themselves from malpractice claims.
  1. Damage Caps
     “Arizona does not place a cap on the amount of damages recoverable in a medical malpractice action. Article 2, § 31 of the Arizona constitution prohibits the enactment of any law limiting the damages one may recover for personal injury or death.”
  2. Statutory Cap on Attorneys’ Fees
     “Arizona does not place a limit on the fees recoverable by an attorney in a medical malpractice action.”
         Source for damage caps and attorney fees is McCullough, Campbell, and Lane LLP, attorneys: http://www.mcandl.com/arizona.html
• Physicians opt to become specialists seeking higher income to repay crushing student loans and cope with malpractice insurance premiums.

How does Arizona fix it?

1. Arizona should spend $500 Million annually to pay for the operation of “free” medical training for M.D.’s and D.O.’s.  This should allow for the doubling of doctor output from the 250 per year to 500 per year.  “Free” is not really free.  Doctors agree to work in primary care or community health care for 10 consecutive years in Arizona after becoming doctors.  Each year worked, eliminates 1/10th of the student loan made to the student who attends an Arizona medical school.
2. Quality of enrollees sours.
3. Double the output capacity for the two medical schools in Arizona, an initial expense of $200 Million.
4. Address tort reform in Arizona by seeking to amend the state constitution to:
   • Limit damage caps to actual damages, less contributory negligence from the patient.
   • Cap attorney fees.
   • Require mandatory initial medical arbitration, before referral to the courts.
5. Provide for a loser pays all cumulative attorney and court fees – if partial damages, then partial reimbursement of fees.  No one gets rich on malpractice.

Why will this work?

1. Costs across the board will be reduced.  Health insurance rates drop.
2. Malpractice premiums will drop in Arizona.  Health insurance rates drop.
3. Malpractice suits and awards will be diminished in Arizona.  Health insurance rates drop.
4. The number of new primary care physicians will reduce the current patient load.  More primary care physicians per capita means better health care.  Health insurance rates drop.
5. A higher percentage of D.O.’s become primary care physicians, than do M.D.’s.  More D.O.’s means more primary care physicians.
6. New doctors will not have crushing student loans to repay.
7. Fewer specialists, due to the better financial situation of new primary care physicians, as they no longer need to become specialists to increase earnings to repay loans and pay malpractice insurance.
8. Less need for specialist patient medical referrals to protect against malpractice – fewer higher cost specialists per capita needed.  Health insurance rates drop.
9. Fewer costly tests will be ordered in Arizona, lowering medical costs.  Health insurance rates drop.
10. Tort reform brings even more physicians to Arizona just as the tort reform in Texas has brought physicians to Texas. Supply and damand – Health insurance rates drop.
11. More primary care physicians actually doing hands-on medicine instead of being gate keepers will lower health care costs.  Health insurance rates drop.
12. Health care insurance becomes substantially more affordable to all in Arizona.  Many more people will be covered.
13. More small businesses in Arizona can now afford to provide health care insurance.
14. Small businesses migrate to Arizona, creating Arizona jobs.

Issues to overcome:

1. Malpractice attorneys are unhappy and fight the changes.
2. Progressives and liberals who want to control the population via health care are unhappy.
3. Coming up with the initial $200 Million to increase the capacity of medical schools and $500 million annually to fund the student loan / waiver program.  This equates to $30 per head and $77 per head respectively based on Census 2008 population estimates for Arizona.  Actually if  the federal government gave each state $500 million each year to cover this cost, it would cost only about $2.5 Billion annually and not the Trillions projected by out dysfunctional federal government.

Also included is a link to McCullough, Campbell, and Lane LLP, malpractice attorneys http://www.mcandl.com/arizona.html and a link to the School of Osteopathic Medicine web page explaining the difference between D.O.’s and M.D.’s http://www.atsu.edu/soma/programs/osteopathic_medicine/index.htm.