In his essay on high-risk medical specialists leaving the state ("Cost of malpractice insurance forcing doctors to leave high-risk specialties," Monitor Forum, March 13), Dr. Michael Lynch cited the lack of OB/GYN services in the North Country as evidence.

First, the Weeks Medical Center in Lancaster will no longer deliver babies because that area has one of the highest populations of low-income patients who rely heavily on Medicaid. New Hampshire's Medicaid reimbursement rate (one of the lowest in the nation) pays only 36 cents on the dollar for the cost of health care delivered. That, coupled with the declining birth rate in the northern counties, led to the decision to close the Weeks birthing practice.

But the argument that doctors are leaving the state is commonly used by the medical industry to further its cry for reform. The intent is to limit doctors' responsibility for the errors they commit by either giving them immunity for their errors or reducing victims' rights of recovery.

However, if specialists are leaving the state, what states are they flocking to? The U.S. General Accounting Office has determined that such claims "could not be substantiated." Two recent studies reported in the March 2008 Journal of Empirical Legal Studies found that "the supply of OB/GYNs in a state has no relationship to either a doctor's malpractice premiums or a state's liability laws." Those arguments sound scary, but they are inaccurate.

The argument that malpractice premiums are rising because of increasing malpractice litigation and rising verdicts is also false. A July 2005 study by Jay Angoff, former Missouri insurance commissioner, found that the payout on malpractice claims over the preceding five years was essentially flat, but that the U.S. malpractice insurance carriers raised doctors' premiums 120.2 percent over the same period.

Reviewing the 2004 filings alone found that the "insurers took in approximately three times as much in premiums as they paid out in claims." What did they do with the rest of the money?

During this same period, 12 of the larger malpractice carriers collectively increased their reserves up to a staggering $3.81 billion, which the National Association of Insurance Commissioners reported as excessive. While the industry told the regulators that they needed to increase their reserves to cover "possible future claims" the footnotes in their filings stated that "their projected claims losses are likely materially inaccurate and in the past have also been materially inaccurate." You have to question where all this surplus money is then going.

As reported on MSN a few months ago, most CEOs of major insurance companies also gave themselves lofty pay raises, incentives and bonuses over the past five years.

Complicated system

Two years ago New Hampshire capitulated to the industry and instituted a complicated special court system by now requiring two trials in a malpractice case, once before a board of three court arbitrators and then before a jury. Has any New Hampshire doctor seen a decrease in malpractice rates in the two years since? In fact, the industry admitted nationally that it would not correspondingly reduce the premiums it charges doctors even if their "reforms" are instituted. The American Tort Reform Association reported in its own trade journal Liability Week that "we wouldn't tell you or anyone else that the reason to pass tort reform would be to reduce insurance premiums."

The American Insurance Association has also said that its "reform" won't reduce insurance rates. But while crying for "reforms" they continue to gouge the doctors, pad their own pockets and put aside huge sums in their investment portfolios. Why aren't we calling for an investigation into the insurance industry and calling for insurance reforms? (next page »)