Original links are included though some may have expired.

In This Issue:

1.) Blame Government Week
2.) Whither Malpractice Reform?
3.) Health ID Cards: Another Piece of the Puzzle
4.) Googling Your Health

1.) Blame Government Week

Senate Republicans are calling it Health Care Week. Far from solving American's health care problems with practical solutions, however, they are merely acting out a skit they know too well: how to blame government for what ails society.

That's the core of the Republicans' argument about the medical malpractice system and health coverage for small businesses. They believe the malpractice system lets trial lawyers use the judicial branch of government to drive doctors out of business through countless lawsuits. And they argue that small businesses cannot afford health care coverage because state governments mandate insurance companies provide costly benefits.

As in past years, the GOP hasn't made any progress on malpractice reform. They've stuck to their old proposal of capping the damages patients can receive for injuries caused by substandard medical care, although they have increased the proposed cap from $250,000 to $750,000. Earlier this week they couldn't muster even a majority of the Senate to support a procedural motion over how to debate their bill, let alone the 60 votes needed to prevent a filibuster.

It turns out that Democrats may be partly right about the lack of a national urgency to cap medical lawsuits. (See the next item below.) Nonetheless, serious problems with the current malpractice system continue to hamper medical justice and patient safety. With GOP failures should come Democratic initiatives for real reform.

Democrats have joined the debate on health care coverage for small businesses with a constructive alternative to the GOP approach. Rather than simply trying to restrain the excesses of states that have mandated too many benefits as Sen. Enzi (R-WY) has proposed, the Democrats would offer small businesses a better marketplace to purchase coverage based on the Federal Employees Health Benefits program (FEHB). This model has already proven affordable for federal workers while providing comprehensive benefits. Specifically, Sens. Richard Durbin (D-Ill.) and Blanche Lincoln (D-Ark.) have proposed the Small Employers Health Benefits program (SEHB).

The Durbin-Lincoln bill would change how both the government and the marketplace works for small businesses. It would create a marketplace for small businesses to affordably purchase the same type of comprehensive coverage that large employers offer their employees. Large employers can often efficiently provide the same benefits that state governments mandate because they spread the costs over a large group of people.

Another solution to the mandated benefits problem is to require mandates to past muster with scientific evidence on the effectiveness of the medical care being mandated and economic evidence on the need for the benefit. For example, the California Health Benefits Review Program gives legislators a thorough analysis of the cost and benefits of mandated benefits before they are enacted.

As the drama unfolds in the Senate, the outcome is fairly certain. The Democratic alternative will likely fail, but so will the GOP bill because it won't have the 60 votes to survive the threat of a filibuster. But that may be just fine with some GOPers. They would get to blame Democrats for blocking what they call progress.

Let's hope that assessment is wrong and Congress moves beyond the limited ideology of blaming government and proceeds with the business of real reform.

For more information:

"Association Health Plan Bill Advances in Senate; Democrats Say They Have Not Ruled Out a Filibuster,"
Daily Health Policy Report, Kaiser Family Foundation, May 10, 2006:
http://www.kaisernetwork.org/daily_reports/
rep_index.cfm?DR_ID=37160

Small Employers Health Benefits Program Act of 2005,
S. 637, 109th Congress, 1st session:
Sens Richard Durbin and Blanche Lincoln:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?
dbname=109_cong_bills&docid=f:s637is.txt.pdf

California Health Benefits Review Program,
University of California, Office of the President:
http://chbrp.org/

2.) Whither Malpractice Reform?

Just as Senate Republicans tried yet again to limit malpractice lawsuits and respond to the "crisis" of doctors being put out of business by their insurance costs, two new studies find that the problem is less severe than it seems. An analysis in Health Affairs finds that malpractice insurance was less expensive (relative to doctor's income) in 2000 than it was 15 years earlier and that lawsuits are simply not a cause for physicians being driven out of business en masse. A second study done by Harvard researches reveals that the legal system does a fairly good job at sorting out legitimate claims from numerous groundless ones, since most claims are dismissed without payment.

Surely, the malpractice system presents a challenge for lawmakers -- most injured patients don't even file claims and the legal system does little to prevent medical errors -- but presenting this issue as a crisis of runaway lawsuits is simply wrong. Furthermore, the Republican approach, which puts all the blame on trial lawyers and seeks to limit malpractice claims, would accomplish little. Any cap on legal damages that doesn't account for the severity of a patient's injuries does not solve the problem; it just punishes the victim.

What would solve the problem, and what congressional Democrats should offer as an alternative, is a new system of health courts, which PPI has outlined in a detailed policy report. Civil courts are not appropriate for malpractice cases. Health courts, which would have expert judges and professional witnesses as well as limits on non-economic damages determined by an independent commission based on the severity of a patient's injury, would be able to distinguish real cases from bogus ones and process claims expeditiously.

The raging feud between doctors and trial lawyers, with partisans playing to their favored constituency, is unproductive. Instead, policymakers should assess the real challenges of medical malpractice and seek out the most prudent approach to a just system. Health courts would be a good place to start.

For more information:

"Malpractice Premiums And Physicians' Income: Perceptions Of A Crisis Conflict With Empirical Evidence,"
Marc A. Rodwin, et al., Health Affairs 25 (2006): 750-758
http://content.healthaffairs.org/cgi/content/abstract/25/3/750

"Malpractice suits often groundless, study says: Harvard analysis finds that many dubious claims are weeded out,"
by Associated Press, May 11, 2006:
http://www.boston.com/business/globe/articles/2006/05/
11/malpractice_suits_often_groundless_study_says/

"Health Courts,"
Nancy Udell and David B. Kendall, Progressive Policy Institute, 2005:
http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111
&subsecID=138&contentID=253178

3.) Health ID Cards: Another Piece of the Puzzle

Why is it when you go to the doctor, the office clerk often makes a copy of your health care benefits card? Imagine the piles of paper banks would create from copying your ATM card every time you withdrew cash. Preventing such waste in health care is part of the promise of infusing health care with proven information technology like a swipe card.

If your health care card had a magnetic swipe, doctor's offices would immediately know that your health care coverage was current and how much to charge you. It could eliminate months of bills from providers and benefit notices from insurance companies. That's how it already works for members of most HMOs, but there's no reason why the rest of health couldn't work the same way.

That's the focus of a new Kansas initiative. The Kansas Governor's Health Care Cost Containment Commission wants to promote the use of electronic health ID cards because one-third of every health care dollar goes to administrative overhead. The commission has found that one of every five claims filed with insurance companies by health care providers are rejected because the information about the patient's coverage is inaccurate or incomplete.

As Kansas Lt. Gov. John Moore said, because "health insurance cards aren't electronic ... that means more time spent doing paperwork, and more money being diverted away from patient care."

Health care ID cards could also serve as a way for patients to authorize the transfer of their medical records. Such information would no longer be stuck in an isolated computer system. Patients could protect their privacy by determining the information they wanted to share. Health information technology initiatives in Kansas and many other states show much can be done to eliminate wasted from health care.

For more information:

"Electronic health cards can lower health costs, says Lt. Gov Moore,"
press release, Office of Kansas Governor Kathleen Sibelius, May 1, 2006:
http://www.ksgovernor.org/news/docs/
news_rel050106a.html

"KC Group Staffs Medical ID Card Task Force,"
Kansas City Business Journal, May 2, 2006:
http://www.bizjournals.com/kansascity/stories/
2006/05/01/daily11.html

4.) Googling Your Health

Anticipating an announcement at Wednesday's Google Press Day, the blogosphere was abuzz with rumors of a new "Google Health" search tool. As it turned out, what Google actually unveiled Wednesday was a beta version of "Google Co-op," an engine that caters to health as well as other specialized search types. According to Andy Beal at webpronews.com:

Google Co-op beta is a community where users can contribute their knowledge and expertise to improve Google search for everyone. Organizations, businesses, or individuals can label web pages relevant to their areas of expertise or create specialized links to which users can subscribe.

Health information happens to be particularly well suited to this style of search engine. Google Co-op, at www.google.com/coop, offers patients information about conditions (symptoms, tests, treatments, risk factors) and about drugs (uses, side effects, warnings). It offers doctors information about new research, practice guidelines, patient handouts, and clinical trials. Additionally, it provides resources for alternative medicine and support groups.

The Google co-op health feature will likely gain popularity quickly, and compete with the three other prominent health search engines, MSN Health and Fitness, Yahoo! Health, and WebMD.

While these search engines do wonders for patients who insatiably seek answers to their health questions, the engines are limited by the knowledge of lay web-surfers. Search tools are only as powerful as the information they are given. Google in particular, which relies exclusively on keywords, is most helpful to people who know, very specifically, the kind of information they are looking for. And most people are just not capable of providing that kind of information. It's the difference between Googling "blister" and "Autoimmune Thrombocytopenia."

The usefulness of health search engines could be maximized if patients had Personal Health Records (PHR) in their hands. PHRs -- secure, digitized, patient-controlled health records -- bring the convenience of modern technology to the arcane health world. They facilitate better organization and therefore a safer health care delivery system. But PHRs would also give patients ready access to information about their conditions, allergies, and treatments. Equipped with their detailed health profiles, patients could conduct more accurate and helpful Internet searches. As of now, searching the web for health queries generates overwhelming results, which brings out the inner hypochondriac in too many of us. PHRs could make health web searches substantially more useful to millions of patients.

For more information:

"Google Health Actually Google Co-op,"
Andy Beal, WebProNews, May 10, 2006:
http://www.webpronews.com/blogtalk/blogtalk/
wpn-58-20060510GoogleHealthActuallyGoogleCoop.html

Google Co-op Health:
http://www.google.com/coop/topic?cx=health_devel

Other Health Search Engines:

WebMD:
http://www.webmd.com/

MSN Health and Fitness:
http://www.health.msn.com/

Yahoo! Health:
http://health.yahoo.com/

Newsletter compiled and written by David B. Kendall, PPI's senior fellow for health policy and Eitan Hersh, Dutko fellow.