Squaring the ledger on medical mistakes

Medicine is such a bizarre business that only now are insurance companies refusing to pay for mistakes that everyone agrees should be prevented.

As of this week, the federal government's Medicare program will no longer reimburse hospitals for 10 specific errors, including three "never events" - sponges left in a surgery patient, transfusions of the wrong blood, air injected into a vein.

Those are classified as "never events" because they are never supposed to happen if hospital personnel are paying attention.

Private insurance companies are scrambling to follow Medicare's lead, and in some cases are ahead of the government insurance program.

This isn't big bucks, as health care dollars go; Medicare expects the policy to save the program just $21 million a year. More important is the message to hospitals: Pay attention, or we won't pay you.

The nation's medical/industrial system is a mess. Care costs way too much, yet hospitals and doctors are paid too little. Insurance, and its bureaucracy, is so expensive that it often represents a family's largest bill.

Yet America - including the presidential candidates - has long been content to muddle through with this broken, expensive system. We allow ourselves to be convinced that government can somehow do worse than an insurance industry that denies care, hobbles doctors, interferes in decisions, even as it raises prices.

Change is so scary and foreign in medicine, in fact, that when Medicare makes a common-sense decision to not pay hospitals when they make unacceptable mistakes, it is splashed on the front page of The New York Times. What America needs, what each patient needs, is a restructuring that goes far beyond a simple decision not to pay hospitals when they make mistakes. That will be a story worth headlines.