Issue Summary:  Health Care Performance and Liability Reform
DRAFT Revised 1/25/2004

Detailed Issue Summaries contain a quick reference to Centrists.Org policy ideas.

Outline:
Liability Issues
Performance-Based Medicare and Health Coverage Proposals

Liability Issues.  The malpractice crisis may not be widespread or affect all specialties, but even the most die-hard defenders of trial lawyers have to admit that the U.S. health care liability and compensation system is a disaster.  Ideally the system should prevent errors and encourage health providers to install reliable error-prevention systems.  It should weed out mistake-prone or inept providers.  It should create a database of knowledge that prevents the same mistakes from being made over and over again.  It should quickly and fairly compensate the injured and their families.  It should not inhibit the practice of medicine or nursing in certain locations because of locally-different legal climates.

The U.S. medical-legal system does none of those things.  Jackpot justice fails to prevent errors; instead it encourages health providers to cover them up.  The system fails to discipline bad doctors, hospitals or other health providers.  Patients have difficulty finding information about which providers are best-- the  system is both mysterious to patients and their families, and despised by health providers.  The only real beneficiaries are the lawyers.

Centrists.Org supports the concept of "health courts," with rapid, expert medical reviews of errors or problems.  Patients who aren't satisfied with the decisions of the specialized health courts could still sue, but the findings of the health courts would be admissible in any courtroom.  There should be a special, national compensation system for families suffering from bad health outcomes that result from chance (and which inevitably occur even under the best care) rather than poor medicine.  

One of the most thoughtful proponents of tort reform in health care is Philip Howard of the group Common Good.  Howard's work has been criticized by consumer advocates (generally the "rage for justice" crowd), but on its face Common Good's health care proposal seems reasonable and should move the debate forward. 

Links:
Congressional Budget Office Limiting Tort Liability for Medical Malpractice Economic and Budget Issue Brief (January 8, 2004)
Troyen A. Brennan and Philip K. Howard Heal the Law, Then Health Care Washington Post (January 25, 2003)
Common Good (Ideas for Legal Reform, including tort reform in Health Care)
Centrist Policy Network Enzi Reliable Medical Justice Act (S. 1518)

Performance-Based Medicare and Health Coverage Proposals.  The main components of health reform proposals by the center-left Progressive Policy Institute (PPI) are a de-centralized bureaucratic structure coupled with strong performance incentives and accountability measures and elements of consumer choice.

This performance-based structure could be used in Medicare, with localized system of improving care for beneficiaries with costly long-term or chronic illnesses.  Local programs would be rated on their ability to improve Medicare benefits, and the best ideas would be adopted by programs nationwide.

This system could also be used to spark improvements in health coverage for the non-Medicare population.  PPI has also proposed a system of grants to states, which would be tied to improvements in health coverage rates and indicators of good health care.  Again, states could learn from local systems and experiments that succeeded or failed.

Links:
Progressive Policy Institute A Performance-Based Approach to Universal Health Coverage by David B. Kendall and others (November 15, 2002)
Progressive Policy Institute An "ABC" Proposal to Modernize Medicare by Jeff Lemieux and others (February 14, 2003)
Centrists.Org Helpful Chronic Care Initiatives in the Medicare Bills by Megan Burns, Jeff Lemieux, and Matt Alpert (July 22, 2003)
Centrists.Org Issue Summary Chronic Care and Medicare
Centrists.Org:  Stuart Butler and Henry Aaron' A State-By-State Approach to Universal Health Coverage (July 6, 2003)