Needed: Second Opinions 

The issue of safe, dependable, and available medical care is one that won't go away -- as two recent circumstances made obvious this week. First, the Rev. Dwight Montgomery, who is one of several Tennesseans fighting a rearguard action against significant disenrollments already under way in TennCare, launched what he termed a "health care forum."

Secondly, an ad hoc physicians group was visibly pursuing its own campaign -- to persuade the Tennessee legislature, when it convenes in January, to impose caps on the amount of damages that can be assessed in medical malpractice suits.

Both campaigns are predicated on the notion that a self-evident injustice is being perpetrated. The Rev. Montgomery and various other groups and individuals are up in arms against the ongoing TennCare cuts, which would pare some 200,000 previously covered individuals from the rolls and reduce the levels of various benefits, including those for prescription drugs. And these advocates are not bashful about suggesting the dire consequences if the cuts are not reversed by legislative action in January. The short version: People will die.

The doctors who seek state action to cap malpractice judgments suggest an equally apocalyptic future. The rising costs of medical-insurance premiums coupled with the alleged fear inspired in physicians by the threat of lawsuits are said to be causing what Dr. George Woodbury Jr., a spokesman for the group, calls "a looming loss of physicians from Tennessee." Woodbury asks rhetorically: "Will our children and grandchildren have trouble finding a doctor to deliver their babies?"

We are not indifferent to either one of these special pleadings, each of which has merit. But both arguments are also simplistic.

Few of the TennCare advocates seem to recall Governor Bredesen's more temperate proposals, back in February 2004, to leave the rolls intact on the state-run insurance program, merely trimming various benefit levels so as to bring costs under control. That proposal was forestalled by litigants, and Bredesen maintains that the delay forced his hand on the matter of cuts.

Whatever the case, there are surely remedies besides the strictly either/or scenarios of the adversary camps. Why not consider, as state senator Steve Cohen and others have proposed, a new cigarette tax that would offset costs and allow many, if not all of the dropped enrollees to be kept?

And there's a catch to the reasonable-sounding proposal for malpractice caps. The doctors seek a limit of $250,000 on "non-economic" judgments -- i.e., those awarded not for medical costs themselves but to cover the intangibles of pain and suffering. To take an admittedly extreme hypothetical case: The parents of a 6-year-old child, condemned to a permanent comatose state as a result of botched surgery, could have some confidence that her medical bills would be paid, but what about compensation for the waste of her life and their own anguish? The available sum would come to something like $4,000 a year over the course of her maimed lifetime.

Making the right diagnosis in both these policy instances is going to require skill, patience, and open-mindedness. Good medicine, in other words.

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