The governor's in a bit of a
pickle.
Nearly a year ago, even before assuming office, then
Gov.-elect Ed Rendell promised Pennsylvania doctors he would find
$220 million to help pay their malpractice costs.
He was in a bit of a pickle then, too. Doctors
throughout the commonwealth -- including more than 40 in Lackawanna
County -- were threatening to stop performing surgery or shutter
their doors completely.
Mr. Rendell, a Democrat and a lawyer,
opposed the reform they wanted most, a cap on plaintiffs' damages.
So instead, the famed can't-we-just-sit-down-and-talk- about-this
negotiator made them a deal.
He pledged hundreds of millions
of dollars and a task force to find long-term solutions. The doctors
returned to work.
But as with so many of Mr. Rendell's bold
pre-inaugural plans, the Republican-controlled Legislature has been
unwilling to fund his physician bailout.
Mr. Rendell's latest
proposal uses about $650 million of cigarette taxes and federal
money to lower doctors' malpractice costs between 15 percent and 30
percent for three years. Doctors would see the lower bills through a
reduction or elimination of their payments to the state's
catastrophic fund.
But letters sent out last week told
physicians to pay their full MCARE bills because the Legislature has
yet to approve a funding mechanism and the fund's more than $375
million in claims come due Dec. 31.
Some legislators say
they'll only talk about the governor's medical malpractice
priorities if the General Assembly's willing to talk about caps.
Others say the Legislature shouldn't be talking about subsidizing
doctors at a time when schoolchildren and libraries are going
without.
And there are the whisperings that the medical
malpractice "crisis" was never a crisis at all.
When Mr.
Rendell made his promise, the state medical society said doctors
were "fleeing the state" because of rising malpractice costs. The
threat was particularly sharp in Scranton, where orthopedists,
obstetricians, neurologists and even the region's only trauma center
had an- nounced plans to close, and in some cases, had already cut
back on services.
No state agency has a running count of how
many doctors are leaving the state. But the state Department of
Insurance tracks how many pay into the state's catastrophic fund, a
requirement for practicing here.
A recently revised count
shows more physicians are practicing in Pennsylvania now than before
premiums started to jump. The department reports 35,180 doctors paid
into the fund in 2002, 50 more than the previous year and 1,000 more
than in 2000.
The medical society says it's skeptical of the
numbers, which are often the subject of revision and do not separate
primary care doctors from the more high-risk specialists who are
typically most vulnerable to rising premiums.
Nearly all of
the local physicians who threatened to cut back are still here and
performing the same services they have for decades.
So now
Mr. Rendell is searching for money for doctors in a particularly
tight and contentious budget year while statistics are showing the
feared doctor exodus has yet to occur.
The state's health
care czar says she has another problem. The Pennsylvania Medical
Society has lacked enthusiasm for the governor's bailout proposal,
even though it would lower some doctors' malpractice bills by tens
of thousands of dollars, said Office of Health Care Reform Director
Rosemarie Greco.
Though the medical society has released
statements supporting the governor's efforts, earlier this month Ms.
Greco said she was "dismayed" and "frankly could not understand" why
the society had not been more supportive.
The medical society
and other proponents of caps on damages might be opposed to the
abatement because lowering premiums diminishes the urgency for
additional tort reforms.
And for Mr. Rendell, the abatement
allows doctors to pay premiums in line with other states, including
some with caps, without enacting a tort reform he philosophically
opposes.
Again the debate over rising medical malpractice
costs comes down to a debate over whether to change the state
constitution and limit plaintiffs' damages.
Physicians and
others in favor of caps say limiting plaintiffs' damages, at least
for pain and suffering, is essential to permanently lowering
premiums and limiting frivolous lawsuits. They point to states like
California that have both a $250,000 cap on pain and suffering
damages and lower premiums.
Attorneys say there's no proof
caps always work and they limit injured patients' ability to sue
when the real problem is greedy insurance companies.
Enacting
any cap on damages would require a constitutional amendment.
Constitutional amendments require two consecutive sessions of the
General Assembly to pass a resolution and then a statewide
referendum. Then subsequent legislation authorizing a specific cap
would have to pass the Legislature and survive any legal challenges.
Experts estimate the earliest a cap would go into effect could be
2006 or 2007.
The state House passed a bill beginning the
process earlier this year, but it has stalled in the
Senate.
The governor has found an unlikely ally in the debate
over caps. Some members of the Senate Republican caucus, including
President Pro Tempore Robert Jubelirer, R-Blair, are apprehensive
about caps, particularly the $250,000 cap on pain and suffering
damages physicians endorse.
Mr. Jubelirer thinks a $250,000
cap is unfair and the constitutional change that passed the House
does not specify the amount of the cap, said Drew Crompton, a senior
aide to Mr. Jubelirer.
"I think real people want to know a
number before they make a decision on whether to support caps," Mr.
Crompton said.
Senate Democratic Leader Robert Mellow of
Peckville said he doesn't think a $250,000 cap would ever
pass.
"If a cap ever does happen, I think it would exceed $1
million," said Mr. Mellow, a longtime opponent of caps.
For
now, Mr. Mellow said he will continue negotiating with the
Republican leadership on the budget and some abatement could be
included in their final compromise. He met with Senate Republican
Leader David Brightbill, a couple of other senators and a select
group of staff last week. They have another meeting planned for
Tuesday.
"I'm still optimistic that we'll get it done by the
end of the year," Mr. Mellow said.
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