My interview with a doctor about Prop 46 (part 1)

Politics are something I rarely chat about with others, as it can be such a volatile thing. I've seen it cause fights in my extended family, Facebook wars and instantly add tension to an otherwise happy group. Though I've never used my blog to share my views about politics, I've decided to break that self-imposed rule just this once.

Health care is something that's very important to me. Even with private insurance through my husband's employer, I feel like medical bills become a battle ground. Rarely is there any service beyond an office visit which I don't end up having to make calls to the insurance company, pharmacy, lab, billing office, etc. etc. to get the information delivered correctly and covered as it should be. So, I pay pretty close attention to changes in health care policy - especially those that will affect the standard and/or cost of care.

I was recently given the opportunity to interview a local doctor about his from-the-trenches thoughts on Prop 46, and what its passing would do to health care. He basically gave me a pass to ask what I wanted to relative to the topic, and he was wonderfully thorough in his responses. I tried my best to ask the types of questions I believe the average person would want answered, so hopefully you will find this interview helpful and informative. I've decided to break this post into two parts, the second of which I will post tomorrow. (I'm going to highlight a few key points where I felt I learned things specific to the Prop.)


No on Prop 46: An Interview with Dr. Mario Martinez, Family Physician at UCSF Fresno, Part 1




Q: Prop 46 sounds very convoluted - like it’s three separate ideas shoved into one proposition. I understand the goals of the proposition to be as follows:

1. Increase medical malpractice lawsuit limits, up to 4 times as high as they currently are in California
2. Mandate drug & alcohol testing for physicians
3. Mandate the use of government run CURES database for all patients
A: You’re not the only person who has noticed that Proposition 46 looks a lot like three unrelated propositions in one. The main goal of Prop 46, which is funded by trial lawyers, is to make it easier to file medical malpractice lawsuits against health care providers.
In fact, the proponents of Prop 46 have acknowledged that they tacked on two additional provisions, one related to a prescription drug database and the other to require drug- and alcohol-testing of physicians, to hide the lawsuit provisions.
Under current law, called MICRA (Medical Injury Compensation Reform Act), an injured patient can receive unlimited economic damages for past and future medical expenses, unlimited economic damages for lost income and future earning potential and unlimited punitive damages. Subjective non-economic damages are capped at $250,000 which provides a disincentive for trial lawyers to file meritless lawsuits. The trial lawyers who are funding the Prop 46 campaign want to quadruple the non-economic damages cap. That would increase medical lawsuit payouts and increase the amount of money they can earn by representing injured patients.
Q: My first question is related to understanding the expenses associated with medical malpractice insurance. Can you give the average person like myself without medical background an idea of the existing costs for medical malpractice insurance in California, perhaps related to your total office overhead or just in numbers like typical premiums, so we have an idea of what the expense is like currently?
A: Like any kind of insurance, the cost of medical malpractice insurance varies based on a number of factors. Key to keeping medical malpractice rates low in California is MICRA. High-risk specialists like obstetricians, emergency room physicians and surgeons tend to pay significantly more for medical malpractice insurance than internists. Yet because of MICRA, California’s rates are reasonable compared to some other states. For instance, in Los Angeles, an obstetrician can expect to pay about $71,250 per year in medical malpractice insurance premiums. In New York’s Nassau County, a state without any limits on medical malpractice lawsuits, medical malpractice insurance for OBGYNs is $176,000 per year. Because of these astronomical medical malpractice insurance rates, 19 counties in New York are without obstetricians and several hospitals in NYC are partially or completely without liability insurance due to the high cost of liability premiums.
But providers aren’t the only ones hit with higher costs from Prop 46. The California Legislative Analyst, whose office reviews every single ballot measure for impacts to the public sector, state and local government budgets, found that the lawsuit changes in Prop 46 will cost state and local governments “several hundred million dollars annually.”  If you look expand that analysis to include the public and private sector, the costs balloon to $9.9 billion, or about $1,000 for a family of four.
Q: How would an increase in these premiums affect you in your practice personally?
A: I am currently completing my third and final year of my Family and Community Medicine Residency Program at UCSF Fresno. I work at the Selma Community Clinic and Selma Community Hospital, about 20 minutes south of Fresno.
More lawsuits and higher payouts would lead to higher medical malpractice premiums. That would make it more expensive to provide care to our patients. Those costs would have to be absorbed somehow, either by raising the cost of services or cutting back on services for patients. For many clinics, especially those that treat low-income Californians, patients will lose access to care.
Q: How do you see this affecting the overall local medical landscape in the San Joaquin Valley?
A: There’s no question that Prop 46 will increase health care costs significantly. That will translate to every single patient in California.
I’m sure that for some people paying an extra $1,000 a year in higher health care costs will be a problem, but not an insurmountable one.
But none of my patients fit that category and higher heath care costs will impact them dramatically. Nearly all my patients are from Spanish-speaking, low-income families that have difficulty getting the care they need. Though I’m a family-medicine physician, I also provide OB-GYN services because there are so few OB-GYNs in the community. I treat all ages, from babies to seniors.
The patients I serve struggle paying even $5 or $10 a month on medications. The community clinics where these patients get their care often struggle financially.
Prop 46 would increase lawsuits against doctors and hospitals and increase health care costs. That would threaten community clinics and make things even harder for low-income patients.
This is the absolute worst time to limit access to care and to increase health care costs. I got into the practice of medicine to help people, especially underserved populations. Proposition 46 would take California in the wrong direction.
Read Part II

Note: This post is completely my own interview and Dr. Martinez's responses. I have not been paid by the campaign in any way to blog about this issue - it is just something I care about. Also, I will not be posting comments on either post, parties on either side of Prop 46 are passionate about their beliefs, and in some cases offensive and hurtful, and I do not publish rude or attacking comments on my blog. I encourage everyone to always do their research and become as informed as possible on any issue, then get out and vote on election day. At the end of the day, there are parts of this Prop I can understand, but it's an all or nothing pass or not - which means enacting three major changes, as they are. Food for thought...


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