Access to quality care must come first in overall healthcare reform. That is what it is all about, after all. And ensuring patient access to care means acting now to fix our critically ill medical liability system.”
With these words James R. Bean, the 2008—2009 AANS president, concluded his testimony on March 24 before the House Energy and Commerce Subcommittee on Health. It was the last of three hearings on “Making Health Care Work for American Families.”
Most hearings of Congressional committees are not heavily publicized, broadcast or webcast. They can go on seemingly forever as a series of speakers hold forth before their bored audience of elected officials and public observers. In other words, they resemble committee meetings anywhere. When Congressmen are there at all they may use the occasion to posture for their constituents. Yet this is where much of the business of governing happens, where bit by bit information is gathered and where it is possible to influence the creation of policy that affects us all.
The date of this hearing coincided with the 2nd Joint Surgical Advocacy Conference, during which surgeons from various specialties converged on Capitol Hill to advance our common interests. Conference attendees were visiting with Congressmen or staffers while the hearing was being held. For much of the hearing there was a standing-room-only crowd. Chairman Frank Pallone opened the meeting and laid out the goal of hearing the speakers propose ways to improve patient access to care.
Of the speakers, Dr. Bean was the only surgeon. Others were internists, healthcare economists, a pediatrician, and a neurologist. They addressed such issues as training more primary care physicians and paying them better, increasing the number of doctors in rural America, and eliminating disparities in healthcare delivery among different ethnic groups.
Dr. Bean spoke on the need for medical liability reform, and he was the only speaker to address this issue. He explained, with supportive evidence, that the defensive medicine that arises out of the fear of being sued costs as much as $170 billion a year. The example of Texas, which experienced a dramatic improvement in physician recruitment and access after voters passed an amendment that limited noneconomic damages in malpractice cases, was made plain. Dr. Bean noted other potential reforms, including use of an “early offer” model, under which plaintiffs are held to a higher burden of proof after rejecting a settlement that pays economic damages and lawyers’ fees; specialized health courts with real authority to issue binding judgments; and the protection from legal action by practitioners who follow evidence-based guidelines.
The presentation by Dr. Bean was compelling, especially in comparison to some of the other speakers, in ways that are instructive to anyone planning to make their case with Congress. Stay focused on your message. If your goal is to discuss liability reform, don’t dilute the presentation by bringing up other topics, however worthy (such as avoiding surgical fee reductions to pay for other needs in the healthcare system). Be concise—don’t take 20 minutes to state your case if you can do it in half the time. Keep graphs and charts simple and easy to read. Know your audience and stay clear of jargon: for instance, after one speaker discussed the “GME” (graduate medical education) system for some time, one of the representatives made clear his confusion between medical student and resident education. And back up your assertions and your proposals with facts.
Members of Congress are busy dealing with many people with many different concerns, and with their own ambitions and lives. Even the whole of healthcare reform is only a part of the Congressional agenda, and to be sure the territory occupied by neurosurgery is a very small fraction of that. That is why it is vital to state your case clearly, briefly, and forcefully before Congress, as Dr. Bean did so well.
Michael Schulder, MD, is co-associate editor of the AANS Neurosurgeon. He is vice chair of the Department of Neurosurgery and director of the Harvey Cushing Brain Tumor Institute at the North Shore Long Island Jewish Health System, Manhassett, N.Y. The author reported no conflicts for disclosure.