ORANGE COUNTY VOICES : Don’t Injure Malpractice Tort Reform : In an era of cost containment, it’s important to keep medical liability insurance affordable.

In late 1975, California physicians succeeded in getting the Medical Injury Compensation Reform Act (MICRA) passed. This California Medical Assn.-supported legislation ensured the availability and affordability of medical malpractice insurance. Since that time, a whole generation of doctors has grown up in California never having known what it is like not to have MICRA. Because of that, they might not realize the importance of it or why it simply must be protected and defended.

In real cost terms, it would be simple to say that it is better to have to pay $42,000 to insure a gynecologist here in Orange County than it is to spend $185,000 in Orange County, Fla.

But the issue goes beyond that. Doctors are not the ones who pay malpractice insurance. Patients pay it. Medicare pays it. Insurance companies pay it. In an era where cost containment is essential and where we see more and more changes to our health-care delivery system just to lower costs, we cannot lose sight of the fact that one of the best ways to contain medical costs is to reduce overhead. Liability insurance costs are one of the significant overhead items.

We need to take a look over the past 20 years to see what effect MICRA has had. Has it kept health costs from being even higher? Absolutely. Has it hurt patients? No, because two important things occur for every injured patient who is impacted by MICRA’s $250,000 limit on a pain-and-suffering award: First, all of them get to keep a larger percentage because the trial lawyer’s contingency fee is limited. Second, every payer of care, whether patient, insurance company or Medicare system, benefits by paying a lower fee than they otherwise would have.

It hasn’t really hurt the lawyers either. Even though they may be making a little less from each client, trial lawyers are still doing very well.

On this, MICRA’s 20th anniversary, what do we need to do? First, congratulate MICRA for setting the national standard as to what tort reform should be, and second, recognize that we have remaining problems in our tort system. The fact that only 42% of malpractice insurance premium dollars wind up in injured patients’ pockets and that 58% is used up in the friction of the system is unconscionable.

At this point we should build on MICRA and fundamentally change the tort system so that a much larger percentage of malpractice awards wind up going to the patients--and that the system for determining these awards becomes as efficient as it is for any other type of insurance.

MICRA is one sure way to keep health care affordable and available in Orange County and nationwide. Patients and physicians must ensure that MICRA-type tort reform is included in health system reforms that Congress enacts.