Thursday, August 20, 2009

Grading papers: exactly what is the quality of the "Research Reports" published by the Caesar Rodney Institute?

Consider this a first superficial look.

Tonight I perused Thinking Logically About Health Care Reform, authored by Garret Wozniak and James Patterson and published by the Caesar Rodney Institute.

Aside from being more of a thinly sourced philosophical document than any sort of research report, the shallowness of the research is ... disturbing.

Let's take a single, but important example: Medical Malpractice and Tort Reform.

Medical Malpractice Reform

Even without excessive mandates, health care may still be too expensive for a great many Americans. One of the least cited, but according to the Government Accountability Office most costly, areas of price-increases in health care includes torts and medical malpractice suits. In 2003, the GAO released a report entitled, “Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates” attributing a large, albeit numerically indeterminate, proportion of rate increases over the preceding years to medical malpractice suits. In response to extremely costly threats of litigation, doctors must perform redundant tests and procedures to avoid the stigma of negligence which can result in multimillion dollar malpractice suits. The same doctors must further purchase medical malpractice insurance, raising the costs associated with everyone’s typical doctor’s visit. As the report concludes, “Multiple factors have combined to increase medical malpractice premium rates over the past several years, but losses on medical malpractice claims appear to be the primary driver of increased premium rates in the long term. Such losses are by far the largest component of insurer costs, and in the long run, premium rates are set at a level designed to cover anticipated costs.”

Innumerable options for torts law reforms are possible, such as setting up a special type of court with specialized medically trained judges (similar to bankruptcy or tax court) to assess malpractice cases. Such a system would ensure that only the most obviously negligent or egregious medical errors could result in exorbitant monetary damages, cutting both the total cost of payouts and the likelihood of frivolous suits and thereby saving the insured a great deal of money per doctor’s visit.

The GAO report is the only source cited by Wozniak and Patterson, which makes the first sentence I placed in bold especially significant:

In response to extremely costly threats of litigation, doctors must perform redundant tests and procedures to avoid the stigma of negligence which can result in multimillion dollar malpractice suits.

Why significant? Because the placement of the sentence would lead even the most diligent reader to assume that unwarranted defensive medicine [all those redundant tests and procedures] actually appear as a factor in the GAO report.

They don't. The GAO Report [please go read it for yourself] only deals in purely economic terms with the fact that more malpractice suits have meant higher malpractice insurance premiums.

The report does not examine, nor claim to examine, whether such suits were in fact justified by poor quality or negligent care. Nor does the report discuss a consequence of higher malpractice insurance rates being a factor in defensive medicine.

Yet Mssrs. Wozniak and Patterson, speaking officially for CRI, would have you believe that their sentence is supported by the GAO report.

In fact, were the authors either conversant with, or intellectually honest enough to acknowledge, the state of research in the field, they would have discovered that Tom Baker's The Medical Malpractice Myth has substantially demolished any potential correlation between malpractice premiums and unnecessary tests and procedures. Baker exhaustively examines the statistical basis of the previous studies on which such claims were made and debunks them point by point. Many law schools across the country now use Baker's book to teach torts and medical malpractice; it has never been successfully confronted by the insurance industry, let alone refuted.

Baker's conclusion is clear [as cited here from a shorter article; the link above will allow you to examine a substantial portion of the book]:

What do we know?

First, we know from the California study, as confirmed by more recent, better publicized studies, that the real problem is too much medical malpractice, not too much litigation. Most people do not sue, which means that victims—not doctors, hospitals, or liability insurance companies—bear the lion’s share of the costs of medical malpractice.

Second, because of those same studies, we know that the real costs of medical malpractice have little to do with litigation. The real costs of medical malpractice are the lost lives, extra medical expenses, time out of work, and pain and suffering of tens of thousands of people every year, the vast majority of whom do not sue. There is lots of talk about the heavy burden that “defensive medicine” imposes on health costs, but the research shows this is not true.

Third, we know that medical malpractice insurance premiums are cyclical, and that it is not frivolous litigation or runaway juries that drive that cycle. The sharp spikes in malpractice premiums in the 1970s, the 1980s, and the early 2000s are the result of financial trends and competitive behavior in the insurance industry, not sudden changes in the litigation environment.

Fourth, we know that “undeserving” people sometimes bring medical malpractice claims because they do not know that the claims lack merit and because they cannot find out what happened to them (or their loved ones) without making a claim. Most undeserving claims disappear before trial; most trials end in a verdict for the doctor; doctors almost never pay claims out of their own pockets; and hospitals and insurance companies refuse to pay claims unless there is good evidence of malpractice. If a hospital or insurance company does settle a questionable claim to avoid a huge risk, there is a very large discount. This means that big payments to undeserving claimants are the very rare exception, not the rule.

Finally, we know that there is one sure thing—and only one thing—that the proposed remedies can be counted on to do. They can be counted on to distract attention long enough for the inevitable turn in the insurance cycle to take the edge off the doctors’ pain. That way, people can keep ignoring the real, public health problem. Injured patients and their lawyers are the messengers here, not the cause of the medical malpractice problem.

Baker could be wrong; it's possible. But his work represents the generally accepted standard treatment of the subject, and one that cannot be ignored by any individual organization or author who expects to be taken seriously on the topic of medical malpractice.

My conclusion: you cannot take Wozniak and Patterson [and thereby the Caesar Rodney Institute] seriously on this subject because they are either consciously erecting a straw-man argument or simply have not researched the subject thoroughly enough to know what they are talking about. [Unfortunately, the same lack of depth and quality can be found throughout this report, but to detail it would render this post even longer than my normal over-writing allows.]

This is unfortunate. There is plenty of room for quality research and free-market analysis on health care, education, and other topics. But the production of poorly sourced material that ignores major scholarship does not represent a good start.


Anonymous said...

Is there something you can be outed for? I'd watch out if I were you :-)

Nancy Willing said...

oh snap.

LiberalGeek said...

Hmmm. Doesn't sound like the FoC (Friends of Charlie) are getting their moneys worth. Nice job, Steve.

I think that it is hilarious that the spam-thwarting word that came up for me was "outor". Misspelled, but the implication was clear. :)

Mark H said...

Tough Grader :)

Anonymous said...

too bad nobody reads this blog

word verification = gonaski