Back in the days of the eight-track tape, our health care system seemed to spin in greased grooves. A person went to work for a big company, a small business or the government and had health care benefits for the family. Doctors and hospitals gave good care at a reasonable cost, and the insurance company paid the bills. Except in rare cases, not a trial lawyer was to be seen. Today that once-efficient system is a train wreck.
Costs are rising four times as fast as wages. Nearly 700,000 Marylanders now are without health insurance, and Maryland has the second-fastest-growing uninsured population in the country, a situation that is costing the state about $800 million a year. And a more immediate mess looms.
Last year medical malpractice insurance rates in Maryland increased 28 percent. This year the state's largest malpractice insurance carrier has announced its intention to raise rates another 41 percent. Doctors have begun to close their practices, and hospitals and nursing homes are diverting funds from patient care to pay soaring premiums.
Gov. Robert L. Ehrlich Jr. (R) has appointed a 19-member panel to try to head off the impending crisis, but at its first public meeting, things rapidly turned dogmatic and ugly. Before the coffee had finished brewing, Democratic leaders from both houses of the General Assembly accused Ehrlich of packing the panel with doctors and insurance executives.
Senate President Thomas V. Mike Miller Jr. (D-Calvert) called the panel "biased" and "embarrassing." Miller, a trial lawyer, was offended that more of his brethren were not appointed to the panel.
"If the governor and his right-wing staff want to take off their Republican hats for one minute and find a real solution and avoid partisanship and name-calling, there are solutions to this problem," Miller said. He refused to send any lawmakers to fill seats reserved for them on the panel.
Ehrlich fired back. "This is a tough legislature," he said. "I feel as though I've been trying to run against a train. But you know what? I have a hard head."
The panel has a lot of tough bark on it too. Various members have deep ties to the medical establishment, the health insurance industry or the trial lawyers' association. Membership also is heavy with major contributors to both political parties.
Judging from the panel's efforts so far, tossing angry wolverines into a phone booth could not have produced a worse start. About the only point panel members seem to agree upon is a deeply held belief that only doctors, trial lawyers and insurance executives have the right and the ability to control the final outcome. Their argument appears to be about which of these groups will prevail.
In the end, it all may be for naught anyway. Given the panel's membership, in a Miller-controlled Senate, whatever work it completes will be dead on arrival.
Theoretically, Ehrlich's idea of having a panel is a good one. But to succeed, the panel needs to be open to knowledgeable people who aren't lawyers, doctors or insurers. A much more inclusive panel would make it difficult for Miller to reject its work out of hand.
Give doctors, lawyers and insurers a half-dozen seats on the 19-member panel. If lawmakers want to participate, they can occupy the four seats already allotted to them. But the remaining nine panel slots should go to other people who also have a big stake in the outcome.
Start with some patients. They seem to have been forgotten.
What about appointing a patient whose life was saved by a doctor? That would give the trial lawyers on the panel an example of just how valuable good doctors and quality care are. Add a patient who was badly harmed by a negligent doctor. That would give the physicians on the panel the prompt they seem to require in regard to their failures to protect victims from bad doctors.
And why not a small-business owner who, say, can't afford to offer employees health care coverage anymore? Or a nurse? No one knows the health care system and its flaws better than a good nurse. The panel might include a hospital administrator or a person whose monthly health care premium is as large as her car payment, or a person who has lost coverage or a person who never has been covered. These individuals would remind the panel that the results of its work will affect many people, not just a few special interest groups.
The point is that thousands of citizens could ably serve on this panel and could help it craft solutions that would stand up to the hard legislative bargaining that will follow.
Time is not the governor's ally on this issue, as more doctors threaten to pull up stakes and leave Maryland. The central questions for Ehrlich now are:
How much time does he have left, and what is he going to do with it?