Doctors’ bills

Maine physicians have complained with justification about the excessive cost of medical malpractice insurance. Not only were expensive insurance premiums a major component of their office overhead, but the premiums charged by the big national insurance firms were unfair in that they did not reflect the actual malpractice experience of Maine physicians.

Doctors in Maine were handed outrageous bills for insurance based on lawsuits, litigation and levels of compensation in much more litigious areas of the country. They were being asked to subsidize insurance company losses in parts of the United States where physicians were routinely dragged into court and juries were making huge damage awards.

Good news is rare in the cost area of health care. The bottom line for services and getting well stays in lockstep with the upward march of research, technology and medical discovery. So, it was an exciting achievement when industry experience and lobbying for downward pressure on rates recently produced a drop of 15 percent in the premiums charged by the two companies that write most of the malpractice insurance in Maine.

Joseph Edwards, Maine’s insurance superintendent, three weeks ago announced a 15-percent cut in the rates of St. Paul Fire and Marine Co. of Minnesota, and followed that last week with a 14.8-percent reduction in the rates charged by Medical Mutual Insurance Co. of Portland, a physician-owned company that insures two-thirds of Maine doctors.

Combined with the 20-percent reductions imposed on both companies in 1989, Maine’s malpractice rates have taken an accumulated plunge of 37 percent in two years. Very impressive.

But one man’s cranky gall bladder is a payment on another man’s yacht, and the encouraging word on malpractice insurance brought a swift response from the legal community, where some practitioners use insurance rates as a barometer of the health of their profession. For Roger J. Katz, president of the Maine Trial Lawyers Association, the latest round of rate reductions was a sign to the Legislature to put the brakes on further efforts to reform malpractice law.

The legislative process, Katz asserts, is “chipping away” at the rights of injured people and is affording unique protection to doctors as civil defendants (a condition that makes successful medical malpractice litigation more difficult and medicine presumably less expensive).

Enough with reforms, says Katz, to which Frank Stred, executive director of the Maine Medical Association, responds, “It is difficult to envision any responsible group wanting to freeze society in the past.”

Society already has thawed on this issue. Further reforms are needed and they will be adopted, both to the tort system and to the system that delivers medical care. Despite the encouraging developments from Edwards’ office, the cost of health care remains enormous.

To bolster his case with the Legislature, Stred can help his group help itself.

Two consequences of the onerous cost of malpractice insurance premiums were that physicians were finding the expense of coverage almost prohibitive to doing business. Some doctors were baling out. Physicians also pointed to these high rates as a major factor in their fee structure. Ultimately, patients and medical insurance companies have been absorbing the high cost of malpractice insurance and litigation.

If legislation, experience and the action of the insurance commissioner has lowered malpractice insurance rates a whopping 37 percent in two years, to the delight of doctors and to the obvious irritation of the legal community, it is reasonable to ask Stred and his association when some of this good fortune will trickle down to the patients and health insurers.

It would make everyone feel better.