^{Posted on May 9, 2008}

Rising insurance costs may force MDs to quit

By Saul Friedman
Gray Matters
Newsday.com
2:03 PM EDT, May 9, 2008

Let’s hear it for doctors!

I know, everyone has a doctor story, including me. But most of today’s doctors are besieged, working under great pressure from insurance companies and the corporations that own or finance their practices. They are trying to keep up with the latest devices, drugs and developments in their fields, and dealing with sick patients who can’t afford all the medical care they should get.

Also, they don’t make huge amounts of money (average is $200,000). And added to that is the threat, peculiar to New York State that, beginning July 1, every doctor must cough up an average of $50,000 over the next five years to replenish the medical malpractice insurance fund, then face steep increases in malpractice insurance. On this, more later.

These are among the reasons why a new survey of 2,193 doctors by the University of Indiana School of Medicine, published April 1 in the Annals of Internal Medicine, found that 59 percent support legislation that would establish a national health insurance program; 32 percent are opposed. Authors of the study said the sample was representative of the nation’s 800,000 physicians.

The findings reflected a sharp increase over a 2002 National Institutes of Health survey of physicians that found 49 percent favored a national health insurance program and 40 percent were opposed. Dr. Ronald T. Ackerman, co-director of the latest study, said support for national health insurance has increased across all specialties.

Support was particularly strong among psychiatrists (83 percent), emergency physicians (69), pediatricians (65), internists (64), and family physicians (60). Fifty-five percent of general surgeons supported national health insurance, but that was double the percentage of 2002.

“Across the board,” Ackerman said, “more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care.” Indeed, ask your own doctor. Virtually all of mine tell me they favor national health insurance.

In December the 124,000-member American College of Physicians went further and endorsed a single-payer national health insurance program, like “Medicare for all.”

And even the once-stodgy American Medical Association is lobbying hard for a stronger, better-financed Medicare program.

We are not talking “socialized medicine,” where doctors work for the government. The excellent Veterans Administration hospitals, where doctors, nurses and lab people work for the V.A., come close to the socialist model (as do military doctors and those on the White House and congressional payrolls). But “socialized medicine,” says Yale political scientist Jacob Hacker, “is the bogeyman that just won’t die.” And it’s been “hurled at every national health plan … even Medicare.”

But as every beneficiary knows, doctors and hospitals that accept Medicare work for themselves and are paid by a public insurance system that has worked well for more than 40 years, despite efforts by this administration and its allies to starve it to death and turn it over to private insurers. If Medicare becomes the single-payer model for an American national health insurance program, doctors and patients will get the program that most of them have told pollsters they favor.

As usual, the Congress lags far behind the public. Until that changes, doctors as well as patients will live in limbo, beset by the problems of private for-profit insurance. In New York, many physicians could be driven out of their practices, according to my friend Dr. Christopher J. Beatty, a general surgeon, in East Setauket and Port Jefferson, who has been practicing for 33 years.

He asks that I warn patients that “come July 1, their doctors may be gone.” The reason: Eric Dinallo, the state superintendent of insurance, says he’s required by law to replenish the shortfall in the reserves of the state’s malpractice insurance fund. To do so, Dinallo warns, would mean a surcharge for every doctor of about $50,000, to be followed by sharp raises of 15 to 25 percent in malpractice insurance premiums.

“In my case,” Beatty wrote, “my already outrageous malpractice premium of $100,000 will go to $125,000 and adding $50,000 on top of that, you have a quarterly payment due on July 1 of $81,250. That is about half my yearly salary.” Beatty is a salaried employee of a surgical group, which may be forced by such expenses to lay off surgeons. “I did five major operations last week and assisted on five others,” he said. “Who will replace me?”

There have been similar cries of alarms among other New York doctors. And dozens of physicians have left the state or are reported preparing to leave. Dinallo has said he will impose the surcharge unless the legislature acts to relieve the crisis. Beatty and his colleagues are urging lawmakers to pass malpractice reform, which had been favored by Eliot Spitzer. But it is strongly opposed by trial lawyers, of which Assembly Speaker Sheldon Silver is one.

Critics of reform minimize the effects of malpractice claims on the crisis and oppose reforms that would put a cap on judgments. Rather, they blame the crisis on mismanagement of the fund, which Beatty says was raided to pay for other state programs.

Medicare for all may not end malpractice or the need for such insurance, although such cases have been rare in my experience with Medicare. (Medicare has refused to pay for a hospital’s errors.) But perhaps taking the profit motive and greed out of health care could help doctors as well as patients.