Published in Standard-Examiner, Ogden, Utah, October 17, 2009
By Vijay K. Mathur
It is disturbing to watch the news media and see our leaders make false and illogical statements on many of the policy issues facing the country. The economy is undergoing some fundamental economic changes. Unless we implement a strategy which builds our shattered financial and industrial base, our future will not be merciful on our standard of living. Disagreement over policies to stimulate growth and employment is expected in a democracy. However, abusive slogans, name-calling, and racial slurs only dissuade us from making sound decisions to solve problems collectively.
The U.S. faces the near-term problems of anemic economic growth and high unemployment rate and the long-term problems of depletion of human capital stock due to neglect in funding for education and diminished industrial base.
In the near term we face anemic and slow recovery. However, even if the economy's growth picks up at 2 percent to 3 percent in 2010 or 2011, according to some forecasts, the unemployment problem -- especially for young adults -- will be with us for some time to come. Federal Reserve Bank of Cleveland reports that in the Blue Chip survey 80 percent of the respondents predict that unemployment rate, which is close to 9.8 percent (not counting discouraged workers who dropped out of the labor market), "will not fall back below 7 percent until the second half of 2012 ...."
Government may have to address the problem of unemployment by implementing policies like investment tax credit and generous depreciation allowance to businesses (provided they promote investment in the U.S.), a payroll tax holiday (as recommended by former labor secretary Robert Reich) to small- and medium-size businesses, two-tier system of minimum wages, and permanent reduction in personal income tax rates for the middle class.
The service sector usually responds to the growth in manufacturing sector. From the long-run perspective, we have not made the required significant investments in new industries of the future to replace traditional manufacturing capacity. Therefore, outsourcing of manufacturing capacity would also lead to outsourcing of business and technical services over time.
If we wish to create an industrial base which carves out comparative advantage in order to compete in the world markets and solve the long term structural unemployment problem, our future lies in developing technologies, products and services in the fields of renewable energy, environment, information technologies, bio technologies, education and health care. And none of the innovations in the above areas will materialize without investment in the educational system to build human capital stock.
Many conservatives contend that the Obama administration is spearheading too many new initiatives: health care, education, cap and trade to limit CO2 emissions, renewable and alternative energy other than oil. But if one rationally examines the current economic situation facing the country, one would conclude that neglect of these issues now will haunt us in the future. Fiscal conservatives who are worried about the burden on future generations should support initiatives for long term investments now, so that we leave a prosperous economy for generations to come. Note, that besides the amount, efficient allocation of investment also matters for economic growth.
Fiscal conservatism is a virtue when the macro economy is growing and those who want to work have satisfying jobs. But when the economy is in shambles and we as a nation are determined to fight others' wars, fiscal balance is the main casualty. Fiscal stimulus to finance investment rather than current consumption is precisely the right medicine at this point in the economy, even with the rise in deficits, because the economic consequences of postponing such investment could be disastrous. The benefit-payoff of investments, especially in new technologies and new products' development and in education, has a long lead time. Hence, it requires patience and sacrifice of current consumption.
We are still enjoying the benefits of the innovation of electricity in 1880, investment in highway network in the 50s, public investment in Internet technology in 1969. Due to high risks involved in investments like basic science and technologies, education, renewable energy, power network, transportation systems, environment and health care, it will require a private-public partnership. In addition, a concerted effort has to be made by the private sector in partnership with the public sector to facilitate commercialization of technologies to build the industrial base.
I hope that our political leaders provide accurate information to the voters about the perils our economy faces and sacrifices they have to make to build a strong economic foundation that can support sustainable economic growth. Growth with prosperity shared by all Americans in the near term and in the future, will assure us economic, social and political stability. In addition, as Professor Benjamin Friedman of Harvard would argue, an added advantage of shared prosperity due to economic growth is that it makes a society more tolerant.
Mathur is former chair of the economics department and professor emeritus of economics at Cleveland State University, Cleveland, Ohio. He is also adjunct professor of economics at Weber State University, Ogden, Utah. He resides in Ogden.
Thursday, October 22, 2009
Sunday, October 4, 2009
Impact negligible from malpractice cap
Published in Standard-Examiner, Ogden, Utah, October,3,2009
By Vijay K. Mathur
In the current debate on health care reform some people are critical of the Congress and the President for not paying much attention to medical malpractice tort liability reform. Some claim that we have reached a crisis in medical tort liability. Even though others dispute the crisis claim, there is no denying the fact that medical malpractice tort liability reform should be an essential part of health care reform. It must also be recognized that national caps on non-economic damage awards will neither remedy frequency of malpractice law suits nor will it solve the overall problems in health care.
Tort liability law is mainly a civil law and is based upon common law tort system. If the patient is harmed by the negligent behavior of a physician or other medical care provider, the victim is entitled to recover for all losses, both financial and for pain and suffering. Financial losses include medical and household expenses and lost earnings. Pain and suffering include loss of enjoyment of life of the patient and the family due to disability. The most heated debate is on the magnitude of claims for pain and suffering. The current law is tort-fault liability law, as opposed to no-fault liability (strict liability) law (as in New Zealand) and a very limited no-fault law applicable to infants in the states of Virginia and Florida.
Many Republican politicians, including Senator Hatch of Utah, and many physician groups argue that huge damage awards are driving the insurance cost of health care providers and the cost of health care due to the practice of defensive medicine. Therefore, to deal with this problem they are proposing a federal cap on damage awards, especially for pain and suffering, to a maximum of $250,000. California was the first to cap such damage awards to $250,000 in 1972 and now 30 other states have such caps.
Using data from National Practitioners Data Bank, the study by A. Chandra, S. Nundy and S. Seabury in the journal Health Affairs, May 31, 2005, finds that the inflation adjusted average payment amount (court judgments and out of court settlements) increased from $173,018 to $263,101 (average growth of 3.55 percent per year), and the average payment amount for top 10 percent of all payments increased from $867,792 to $1,155,031 (average growth of 2.41 percent per year) from 1991 to 2003. These estimates are not indicative of a crisis requiring Federal intervention.
Estimates also show that defensive medicine accounts for only 5 percent to 9 percent of total health care cost. This wide range indicates that it is hard to measure defensive medicine. There is a great deal of variation in procedures and medical tests among physicians, states, and regions of states and partly because of widespread variation in medical practice guidelines. Perhaps national uniformity in up-to-date guidelines would help mitigate this problem. Moreover, emphasis on diagnostic techniques based upon new but expansive technologies has substituted diagnostic skills of physicians. Emphasis on diagnostic skills in medical schools would curtail the use of tests and cost of health care.
The current tort liability system has not deterred the medical error rate. The Institute of Medicine's 2000 report found 44,000 to 98,000 hospital deaths per year due to medical errors. The consensus evidence is that medical malpractice problem is driven partly by extreme claims cost, insurance premiums driven by poor returns on investment of insurance premiums, and by poor pricing strategies of insurance companies. A cap on non-economic damage awards will not significantly reduce the cost of malpractice insurance for certain medical specialties and thus health care cost.
There are a few other issues which must also be considered. First, medical malpractice problem is concentrated in a few states; 50 percent of total paid claims in the U.S. were concentrated in 8 States in 2007. Second, the problem varies among specialties. It is more severe, for example, in surgery and obstetrics-gynecology, where insurance premiums have skyrocketed since 1960's. Third, The New York Times reported in 2005 that the study of 22 states for the years 1992, 1996 and 2001 by Professor Catherine Sharkey, Columbia Law School, found no significant difference in average damage awards among states with or without caps -- perhaps a result of change in tactics by plaintiff lawyers. Fourth, a cap on non-economic damages may discriminate against stay-at-home mothers or fathers, who have no work history, lower income people and/ or poor. In fact, lawyers may not even take legitimate malpractice cases for such people. Finally, a national cap would violate state control of tort law, thus breaking historical tradition.
States primarily regulate malpractice insurance and implement rules governing tort liability law. Therefore, a call for a national cap is unwarranted. Rather, federal guidance and help to states in handling malpractice issues would be more productive. Successful outcomes of ongoing experiments in states may show us the path to an efficient solution to this problem without national legislation on caps.
Mathur is former chair of the economics department and professor emeritus of economics at Cleveland State University, Cleveland, Ohio. He is also adjunct professor of economics at Weber State University, Ogden. He resides in Ogden. His articles also appear at vijaykmathur.blogspot.com
By Vijay K. Mathur
In the current debate on health care reform some people are critical of the Congress and the President for not paying much attention to medical malpractice tort liability reform. Some claim that we have reached a crisis in medical tort liability. Even though others dispute the crisis claim, there is no denying the fact that medical malpractice tort liability reform should be an essential part of health care reform. It must also be recognized that national caps on non-economic damage awards will neither remedy frequency of malpractice law suits nor will it solve the overall problems in health care.
Tort liability law is mainly a civil law and is based upon common law tort system. If the patient is harmed by the negligent behavior of a physician or other medical care provider, the victim is entitled to recover for all losses, both financial and for pain and suffering. Financial losses include medical and household expenses and lost earnings. Pain and suffering include loss of enjoyment of life of the patient and the family due to disability. The most heated debate is on the magnitude of claims for pain and suffering. The current law is tort-fault liability law, as opposed to no-fault liability (strict liability) law (as in New Zealand) and a very limited no-fault law applicable to infants in the states of Virginia and Florida.
Many Republican politicians, including Senator Hatch of Utah, and many physician groups argue that huge damage awards are driving the insurance cost of health care providers and the cost of health care due to the practice of defensive medicine. Therefore, to deal with this problem they are proposing a federal cap on damage awards, especially for pain and suffering, to a maximum of $250,000. California was the first to cap such damage awards to $250,000 in 1972 and now 30 other states have such caps.
Using data from National Practitioners Data Bank, the study by A. Chandra, S. Nundy and S. Seabury in the journal Health Affairs, May 31, 2005, finds that the inflation adjusted average payment amount (court judgments and out of court settlements) increased from $173,018 to $263,101 (average growth of 3.55 percent per year), and the average payment amount for top 10 percent of all payments increased from $867,792 to $1,155,031 (average growth of 2.41 percent per year) from 1991 to 2003. These estimates are not indicative of a crisis requiring Federal intervention.
Estimates also show that defensive medicine accounts for only 5 percent to 9 percent of total health care cost. This wide range indicates that it is hard to measure defensive medicine. There is a great deal of variation in procedures and medical tests among physicians, states, and regions of states and partly because of widespread variation in medical practice guidelines. Perhaps national uniformity in up-to-date guidelines would help mitigate this problem. Moreover, emphasis on diagnostic techniques based upon new but expansive technologies has substituted diagnostic skills of physicians. Emphasis on diagnostic skills in medical schools would curtail the use of tests and cost of health care.
The current tort liability system has not deterred the medical error rate. The Institute of Medicine's 2000 report found 44,000 to 98,000 hospital deaths per year due to medical errors. The consensus evidence is that medical malpractice problem is driven partly by extreme claims cost, insurance premiums driven by poor returns on investment of insurance premiums, and by poor pricing strategies of insurance companies. A cap on non-economic damage awards will not significantly reduce the cost of malpractice insurance for certain medical specialties and thus health care cost.
There are a few other issues which must also be considered. First, medical malpractice problem is concentrated in a few states; 50 percent of total paid claims in the U.S. were concentrated in 8 States in 2007. Second, the problem varies among specialties. It is more severe, for example, in surgery and obstetrics-gynecology, where insurance premiums have skyrocketed since 1960's. Third, The New York Times reported in 2005 that the study of 22 states for the years 1992, 1996 and 2001 by Professor Catherine Sharkey, Columbia Law School, found no significant difference in average damage awards among states with or without caps -- perhaps a result of change in tactics by plaintiff lawyers. Fourth, a cap on non-economic damages may discriminate against stay-at-home mothers or fathers, who have no work history, lower income people and/ or poor. In fact, lawyers may not even take legitimate malpractice cases for such people. Finally, a national cap would violate state control of tort law, thus breaking historical tradition.
States primarily regulate malpractice insurance and implement rules governing tort liability law. Therefore, a call for a national cap is unwarranted. Rather, federal guidance and help to states in handling malpractice issues would be more productive. Successful outcomes of ongoing experiments in states may show us the path to an efficient solution to this problem without national legislation on caps.
Mathur is former chair of the economics department and professor emeritus of economics at Cleveland State University, Cleveland, Ohio. He is also adjunct professor of economics at Weber State University, Ogden. He resides in Ogden. His articles also appear at vijaykmathur.blogspot.com
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