Marylanders split over health care cost issues

Survey: While nearly everyone agrees price increases are a problem, thoughts on solutions, such as limiting jury awards against doctors, break along party lines.

The Sun Poll: Malpractice

October 31, 2004|By M. William Salganik and Kathleen Cullinan | M. William Salganik and Kathleen Cullinan,SUN STAFF

On the issue of medical malpractice, Marylanders are as polarized as their politicians.

In a poll for The Sun, respondents who identified themselves as Republicans were three times as likely as Democrats to blame rising health costs on trial lawyers suing doctors for malpractice. Democrats were twice as likely as Republicans to blame insurance companies and HMOs.

As for a remedy, Republicans want to limit jury awards and lawyers' fees, while Democrats are much more likely than Republicans to support efforts to weed out incompetent doctors.

Marylanders, like their elected leaders, are convinced that the zooming costs of medical malpractice are a serious problem. The poll found that 67 percent of Marylanders believe the malpractice system needs "major change," while 25 percent support "minor change." Only 6 percent say it's fine as it is.

The sharp political split on the issue was potent in Annapolis last week, as Gov. Robert L. Ehrlich Jr., a Republican, offered a proposed remedy heavy on limits to jury awards and lawyer fees that was criticized by Thomas V. Mike Miller, the Democratic president of the state Senate, as anti-victim.

The leaders are struggling to reach consensus on a reform package for a special session in the next month or two. They're rushing to stave off an impending large increase in medical malpractice premiums that is being blamed for forcing some doctors to leave their practices or abandon some services deemed higher-risk.

No surprise

The poll findings "are not really surprising because there has been such a concerted political effort to imprint those views on the public," said Brian E. Frosh, a Montgomery County Democrat who is chairman of the Senate Judicial Proceedings Committee.

"If your hero is George Bush, and George Bush is telling you three times a day that the trial lawyers are responsible, you take it as gospel," said Dennis O'Brien, a spokesman for the Maryland Trial Lawyers Association.

The poll of 725 Marylanders was conducted during the past week by Ipsos-Public Affairs. It has a margin of sampling error of 4 percentage points.

The poll also found higher medical costs affecting Marylanders. Because of rising costs, 21 percent said they sometimes don't get prescriptions refilled and 23 percent said they are less likely to visit a doctor.

Now, Ehrlich, Miller and House Speaker Michael E. Busch, a Democrat, are searching for at least a rough agreement on a reform package that could be passed in time to block a 33 percent rate increase for doctors due to take effect Jan. 1. Most Maryland doctors were hit by a 28 percent increase in malpractice premiums this year. Several reform measures died in this year's legislative session.

While there is disagreement on what mix of reforms would work best, the consensus for action appears solid - among lawmakers and the public.

"There has been an increasing consensus in the last couple of weeks among legislators, doctors and others that there is a problem, and that it could impact access to care," said Nancy Fiedler, senior vice president of the Maryland Hospital Association, which is pressing for reforms in the court system.

Frosh, whose committee killed several reform bills in the spring, said the seriousness of the problem has become clearer with a second round of premium jumps.

"It's something most people in Maryland agree on - we've got a problem, and we've got to solve it, and we've got to solve it soon," he said. However, the choice of remedies is still subject to "quite a bit of uncertainty and debate."

Although the questions are framed somewhat differently, the results of the poll for The Sun are consistent with national findings, said Robert Blendon, a professor of health policy and management at Harvard University.

Blendon and the Kaiser Family Foundation conducted polling last year in which 68 percent of respondents (who could give more than one answer) said drug company profits were very important in pushing up health costs. Malpractice costs ranked second among things perceived as driving increases, with 60 percent listing them as very important.

While belief is widespread that malpractice costs are a major contributor to health inflation, health economists say that's not true.

Paul Ginsburg, president of the Center for Studying Health System Change in Washington, who has studies on health costs, said the share of health spending that goes for malpractice premiums is less than 2 percent.

That is consistent with Maryland data. Robert Murray, executive director of the state Health Services Cost Review Commission, told a state Senate hearing last week that hospitals in Maryland spend about $8 billion a year and that $115 million - about 1 1/2 percent of that spending - goes for malpractice coverage.

`Defensive medicine'

Those who argue that malpractice cases are responsible for inflation in health care say the threat of lawsuits adds costs as doctors practice "defensive medicine" - ordering extra tests or doing unnecessary Caesarians.

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