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Don't Forget the Patients

March 06, 2003

President Bush was playing to the crowd Tuesday when he told a meeting of the American Medical Assn. that the nation's health-care crisis "doesn't start in the waiting room or the operating room -- it starts in the courtroom." Reeling under steep insurance premiums and lottery-like malpractice awards, the assembled doctors cheered and put their hands together.

The president's speech would have been more on point and powerful if it had instead emphasized besieged emergency rooms -- such as the one at Los Angeles County-USC Medical Center, where patients wait an average of seven to eight hours before feeling the first cold slap of a physician's stethoscope.

Yes, doctors are under siege. In Florida, for instance, insurance premiums have soared by 30% to 40% in general surgery and obstetrics in the last two years alone. So Bush was right to embrace a bill by Rep. Jim C. Greenwood (R-Pa.) that would put a national cap on pain-and-suffering damage awards for medical negligence.

With 107 co-sponsors, the bill is expected to breeze through the House as early as next week and then head to the Senate. There, lawmakers need to scrutinize it more closely. As is, it sets the cap at $250,000. This is the amount California set 28 years ago. Given inflation, that amount has become too small to motivate most lawyers to take on even the most valid case of malpractice.

Greenwood's bill describes itself primarily as a way to "improve patient access to health-care services." Let's get real. Nearly one out of every three nonelderly Americans -- 11 million in California -- went without health insurance for all or part of 2001-02, according to a report released Wednesday by the Robert Wood Johnson Foundation. Limiting how much doctors can be sued for won't do much for people who can't afford prompt treatment in the first place.

What's needed is a complete overhaul of America's health-care system. But even a few less-revolutionary changes would help a lot -- if Bush would just show as much concern for impoverished sick people as he does for rightfully angry docs.

In urging the privatization of Medicare, Bush repeated that he is adamantly opposed to ideas "in which the federal government decides care, the federal government rations care, the federal government dictates coverage."

But what's wrong with the government "dictating" that Medicare programs cover essential treatments like emergency-room visits for seriously ill people and preventive screening for cancer and diabetes?

Helping Medicare patients obtain prescription drugs also would be good. But Bush asked Congress to offer a prescription-drug benefit only to seniors willing to leave traditional Medicare and enroll in health maintenance organizations -- again demanding no guarantees from the HMOs.

Bush is on to something in devoting so much attention to health care. Now he and Congress need to make sure that reforms offer at least as much help to downtrodden patients as they do to well-heeled healers.

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