Increased Access to Health Care Doesn’t Require More Government
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By Joseph M. Nixon
With the reelection of President Obama it appears the question of whether ObamaCare will be fully implemented has been answered. The question still remaining is whether this massive change to our health care system will deliver as promised.
The battle over ObamaCare was really a battle over improved access to health care. While Congress made the decision to use the government to improve access, it wasn’t that long ago that Texas took a different route to achieve this.
In 2003, the Texas Legislature was finally able to break the grip of the trial bar and pass meaningful lawsuit reforms. At the time Texans were struggling with diminished access to health care. Even in San Antonio, the nation’s ninth largest city, there were not enough neurosurgeons to have one on call 24-hours a day throughout the year.
Of Texas’ 254 counties, over 100 lacked a pediatrician and more than 140 didn’t have a gynecologist. If you drew an imaginary line from Victoria to San Antonio to El Paso, there was not one neurosurgeon in practice south of that line.
Medical specialists from gynecologists to heart specialists to neurologists were leaving rural communities, restricting their practices and refusing to take complicated cases.
Lawsuit abuse led to medical malpractice premiums in Texas that equaled the rates paid by doctors in New York and were sometimes more than double those paid in California. This isn’t surprising when Texas had some counties in the Valley where doctors were being sued on average almost every year.
Add to the analysis that a statewide average of 95 percent of lawsuits against doctors failed and it becomes clear that unwarranted lawsuits were behind the reduced access to health care.
The simple question for the Texas Legislature was whether Texans wanted more doctors--and thus more access to health care--or more lawsuits. The public policy makers in the state, and then the citizens who voted on the subsequent constitutional amendment, chose more doctors.
The fix was elegant in its simplicity and utilized common sense economic principals. First, Texas required a medical report at the outset of every medical malpractice suit clearly stating that the doctor being sued violated the standard of care and that the violation was a cause in fact of real damages.
Without the report, a case must be dismissed. This reform has caused thousands of “shot in the dark” suits to not be filed.
Second, Texas capped non-economic damages at no more than $750,000, ensuring that people suffering real damages were properly compensated ,but not excessively, while blocking so-called non-economic damages for pain and suffering.
With these two reforms, medical malpractice rates in Texas have fallen more than 50 percent, resulting in 26,000 newly licensed doctors. Doctors mature in experience and trained in specialties are moving to Texas from all over the country and particularly from those states which have not adopted lawsuit reforms.
The Texas Medical Association reports that doctors are retuning to the Valley and rural Texas. Specialists in pediatrics, oncology, cardiology and neurology are again taking high risk cases and opening care facilities just for those patients.
Equally important is the expansion and development of new medical facilities. More than $15 billion has been invested in new hospitals, clinics and outpatient care centers.
All this has happened not because of new government programs or higher taxes, but because Texas reduced government involvement in the healthcare system and reduced cost of practicing medicine in Texas.
This simple yet elegant solution was rarely discussed when ObamaCare was passed. But with 17 states opting not to set up state exchanges, the federal government is going to need innovative solutions as it implements ObamaCare.
Perhaps free markets and limited government may still play a role in health care reform. It worked in Texas, why not for the rest of America?
The Honorable Joseph M. Nixon, author of Texas’ Prop 12, is of counsel with Beirne, Maynard & Parsons, LLP, and a senior fellow with the Texas Public Policy Foundation.