An unholy alliance

I received my medical insurance renewal quote the other day: up a whopping 20 percent. When I called the insurance company, I was told — in the middle of hints that “Obama-care made us do it” — that the real reason was that malpractice claims are up: “Doctors have more claims made against them.” In other words, it is the doctors’ fault. Said another way, this is like “the devil made me do it.” Here are a few facts:1. There are 25,000 new lawyers in this country every year. Lawyers retire late (if at all), meaning that there are over 1,440,000 lawyers in this country at any given moment, according to the American Bar Association (ABA) — roughly 1 percent of the workforce. As many as 98,000 of them are in the personal injury business, according to the American Trial Lawyers Assocation in Washington, D.C.2. The fee you (or your insurance company) pay to a doctor is divided up before taxes (and his food bills): At least one-third goes to insurance premiums, and sometimes a premium of 5 percent goes to the affiliated hospital for their insurance costs.3. The insurance person who checks on the payments and need for payment with local hospitals (sometimes one man per 100-bed hospital) gets a salary deep into six figures. Mind you, this person does nothing to help medical procedures or help provide health care. His or her job is to “keep the hospital honest.” Said another way, this job is to lean on the hospital to keep down costs by extorting a reduction in testing and patient care. Overnight stays for major surgery are even frowned upon now. And nurses are being laid off (but not bean counters, of course).4. A lawyer who gets a small, perhaps frivolous, claim for malpractice can file a lawsuit (filing fee? $50 or less) in local court and receive, within the week, a settlement offer from the insurance company. If the claim is “just below the threshold of necessary defense” (to quote a source at the ABA), a check is cut by the insurance company within the month. No trial, no discovery, no meetings, if the claim is just small enough, it’s not worth the bother to go through the motions. Thirty percent or maybe 50 percent go to the lawyer(s) for a $50 out-of-pocket cost. It is obscene.Now, you may ask why, since some of these undefended claims are for as much as $150,000. The answer is simple: The insurance companies charge doctors premiums based on the number of malpractice claims they have to process and pay, not the amount, but the number of claims. Additionally, the insurance companies charge you and I based on the amount of payments they have to make to doctors and hospitals. Hospitals and doctors have to charge us more because they are paying the insurance companies more. It is a great scam, they charge us more and we believe (because we are told doctors and hospitals charge too much) that it is the medical profession that is overcharging, profiteering. The medical profession points to the underhanded lawyers who file suit for a hangnail. The lawyers’ associations say nothing because they know which side of the bread their butter is on: The more they win in “under the wire” lawsuits, the more profit the insurance companies will make. And here is the point: Every time insurance companies pay out for a false or “under the wire” claim, they know they will get it all back, with a small mark-up of course, in increased premiums.Why would you expect the insurance companies to go after the lawyers? They are essentially their allies. The insurance companies are adamant they are not to blame. It is the bad doctors, surely. Doctors who are forbidden under the terms of their insurance policy to defend themselves or ever explain publicly. It is in the fine print. If a patient makes a claim, the doctor is never allowed to defend himself. To you and me, a malpractice payment is proof of a doctor’s wrongdoing; to the insurance company it is a way to make profit, to hell with the doctor’s reputation.Remember that insurance adjuster who covers a regional hospital for just one company? I saw one 10 years ago at Sharon hospital in his mid-20s. He drove up in his shiny new Cadillac. I watched as an eight-year student, now a doctor in ER, left the hospital in his beat-up old Honda. The fine print in an insurance policy coupled with an over-abundance of unscrupulous personal injury lawyers results in a business that has only one aim: Squeeze more money from innocent people: you and I and the doctors. This money would be better spent for health care, as it was intended. Peter Riva, formerly of Amenia Union, lives in New Mexico.