Heath Haussamen
I found myself nodding in agreement when House Speaker Javier Martínez dropped truth during the debate over medical malpractice reform in the recent legislative session.
Our nation’s “original sin” on health care came in the early 1970s, Martínez said during a hearing on House Bill 99 before the House Judiciary Committee. That’s when our federal government started incentivizing for-profit medicine.
“Once a child’s cancer became a commodity to be traded on Wall Street, that’s the crux of the problem,” Martínez said.
The speaker supported HB99, a hard-fought compromise that caps punitive damages in medical malpractice cases and tweaks the law in other ways that are intended to help doctors stay in New Mexico.
But Martínez’s support came with a challenge: “I’m encouraged by the bipartisanship of this bill — and I sure as heck hope that next year, when I have a universal health-care bill, that same bipartisanship shows up,” he said, “…because that’s what patients need.”
Martínez has since affirmed that he is serious about enacting such reform in the coming years.
I am writing to enthusiastically amplify and echo the speaker’s words. The work isn’t done. I want New Mexico to do something really big with the time HB99 buys us — create a true single-payer health-care system.
HB99 was a critical step
I want to be clear: The handful of state House members from across the political spectrum who championed medical malpractice reform deserve our thanks and praise. Led by Rep. Christine Chandler, these folks committed to toning down the rhetoric. Even while they were under immense pressure from monied interests, they focused on their constituents who have lost doctors and are worried about losing more. Full disclosure, my spouse, Rep. Sarah Silva, was among them.
Given the state of our health-care system, HB99 was a necessary reform. This group led the House and Senate to vote overwhelmingly to send HB99 to the governor, who has said she will sign it.
It’s my hope this legislation will interrupt the exodus of doctors from our state, and I’m so proud of Sarah for her work to help doctors and patients in Southern New Mexico organize. Those folks made themselves heard in the Roundhouse, and that helped turn the tide.
Paired with other reforms like joining interstate medical compacts, I hope HB99 will chip away at our state’s doctor shortage.
The hard truth, though, is that there’s only so much New Mexico can do to regulate a health-care industry that is much bigger than us.
Insurance companies have the ability to hold our doctors hostage when we try to increase legal and financial burden for malpractice. They did exactly that when we eliminated caps on punitive damages several years ago. That forced us to move our malpractice law closer to alignment with our neighboring states.
It also highlights the stranglehold corporate medicine has on us.
The money is the problem
Proportionally, more of New Mexico’s hospitals are owned by private equity than in any other state. That’s an immense problem. Private equity exists only to liquidate everything.
During the legislative session, too many Republicans praised big health-care companies. I even heard one praise private equity, which is ridiculous.
That wasn’t the only absurdity we had to suffer during the debate about HB99.
A big hospital group bombarded us with television ads suggesting that malpractice reform would lead to new hospitals opening in New Mexico. It won’t.
On the other side of the debate, a group funded primarily by trial lawyers shouted loudly and often, “We don’t hide our donors. We celebrate them.”
The truth is they hid their donors, while exerting immense behind-the-scenes influence, until the state’s Ethics Commission busted them for violating the Lobbyist Regulation Act and forced disclosure.
There’s huge money in health care. There are good doctors, but others are trying to get rich and avoid the consequences of their mistakes, and there are also big companies looking to make their shareholders wealthy. Some lawyers are honorably defending harmed New Mexicans, but others are lobbing baseless allegations of intentional harm at doctors to negotiate settlements for their clients that also earn them big payouts.
As the speaker said, our profit-driven system is the problem. It attracts bad actors looking to make a buck. It forces the rest of us to fight for crumbs while the rich get richer.
In spite of what some attorneys claim, we can’t sue our way out of this. One prominent state senator — Katy Duhigg, a trial lawyer who works on malpractice cases — argued during the session against capping punitive damages, saying the only way to force big hospitals to behave better is to sue the pants off of them.
With all due respect, we’ve been doing that for years. Insurance companies have spiked premiums for our doctors. The billionaires behind the big corporations are still wearing their pants. Private equity is too big and wealthy to sue into being better.
Private equity is a killer
I understand the impulse to try to hold private equity accountable, but it’s impossible to regulate an industry that exists to kill things. That’s why those who identify private equity as the villain lacked substantive alternate proposals to HB99 during the legislative session.
Private equity and corporate greed murdered my industry, journalism, in recent decades. It took down democracy along with our nation’s newspapers.
I lived through this death by a thousand cuts. Each time, I thought they’d finally reached bone and had to stop.
They never stopped.
Private equity never builds something good. Contrary to slick corporate messaging, there’s no partnering with it to improve systems. There are no new hospitals coming in a system dominated by private equity, just like there weren’t new newspapers. There will only be a steady stream of deaths.
No reform to tweak our profit-driven system will force a focus on quality and humanity. The best our lawmakers can hope for as long as they’re trying to regulate the existing system is negotiating a less painful death.
We have our own money
There is an alternative.
New Mexico has a relatively small population and the second-largest sovereign wealth fund in the nation. We have the money to buy health-care facilities, replace our corporate insurance system, and let independent doctors join a network of providers within that system.
For those who are exhausted by how difficult it was to reform our malpractice law, I realize I’m suggesting a monumental task. No U.S. state has successfully created a single-payer system. Only a handful have tried. There are political, financial and logistical challenges.
The special interests that fought each other over medical malpractice reform might unite against such an idea because it wouldn’t be as lucrative for them.
But the prospect of raising taxes to pay for such a system is often one of the biggest hurdles. We don’t have that problem.
Long, difficult work
I’m certain such a system wouldn’t be perfect. We’d have to commit to coming back regularly to make adjustments as we learn by doing. This would be long, difficult work.
We need to do it.
Our current system is fatally flawed. It takes our money while limiting or denying treatment. It provides substandard care. It limits doctors’ ability to make decisions and protects bad ones from consequences.
It will never stop doing those things, but it will keep us busy trying to mandate better behavior.
We reformed our malpractice laws in 2021. We did it again in 2023, we were at it once more in 2026, as a visibly frustrated Martínez pointed out at that Feb. 11 House Judiciary hearing.
“I really hope that in 2029 we’re not in the same situation trying to fix something again,” he said, “…but I’m not going to hold my breath.”
As it stands, we will be back in 2029. Maybe not because of our malpractice law, but because of another crisis in our profit-driven health-care system.
We’ve already begun
We can keep tweaking the current system to increase the number of providers in our state, and we’ll eventually get there. HB99 is a step in that direction.
But that legislation can be so much more. It can be the stopgap that gives us time to create a revolutionary health-care system.
This should be a multi-year effort. I’d start with a task force to consider how to build such a system, then bring a proposal back to lawmakers. We can implement it in phases.
Our flagship medical facility, the University of New Mexico Hospital in Albuquerque, is already publicly owned. Lawmakers just approved funding to dramatically expand its capacity. The state also owns Miners’ Colfax Medical Center in Raton.
Perhaps we’ve already begun the work.
Make New Mexicans the focus
Building a new system is meaningless if it doesn’t do more to protect patients than our current system and make them whole when they are harmed. That has to be a critical component of a new system. It’s possible if we make New Mexicans the focus, rather than profit.
We’re capable of doing big things in this state. Let’s stop believing rosy claims that our profit-driven system will build us more hospitals, or that we can sue those hospitals into treating people better.
House Bill 99 bought us some time. Let’s use it to create a different reality.
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DISCLOSURE: If you didn’t read carefully enough to catch it in this column, Rep. Sarah Silva is my spouse. I’m expressing my opinions alone. I do not speak for her.
This is a fine article Heath, with an important and noble goal. Single payer began in Canada in but one province.
Single payer, Medicare for All is an essential program, but as critical as it is it cannot achieve its promise unless two adjoining issues are also effectively addressed: 1. The huge shortage of health professionals across all categories, and 2. The grossly skewed geographical distribution of existing health care providers. In other words, far too few providers overall, concentrated in urban areas. Leaving rural areas nationwide doubly cursed.
Not generally addressed is the fact that the federal Medicare for All bill sponsored by Bernie Sanders and Pramilla Jayapal does not address either of these critical ancillary issues. Thus, in the still unlikely event it became law it could not possibly provide health care services to everyone in the nation that required them. The federal bill must be amended to include provisions to ameliorate those problems.
And if New Mexico is going to take up a single payer plan those issues of adequate provider numbers and rational geographic distribution should be part of it from the git go.
Thanks, Max! This is good feedback.