I’m with Machi. Frank’s comment makes no sense.

Machi, your comment is a bit like suggesting, “I don’t understand how they can say that inflation is under four percent, when gas prices went up by 25%.” It’s self-evident, isn’t it? More goes into health care costs than physician salaries.

This discussion is going on as if there’s no empirical data.

There are states that have caps.

Do those states have less healthcare costs?

If yes, then they work. If no, then they don’t.

Seems very easy to end the debate if you want to.

Hey Aaron, here’s how defenive medicine works.
I’m an OB/GYN. I see an 18 year with a lump in her breast. It’s most likely a fibroadenoma which is benign. She has a 1 in 10,000 chance that it might be breast cancer, which at her age is usually an aggressive form.
I order an ultrasound which her insurance pays for because she has a lump. The radiologist reads it as a probable fibroadenoma cannot exclude breast cancer. She gets this result and wants the lump out. She is sent to the general surgeon who agrees that it is probably a fibroadenoma, but she wants it out. So its taken out and 9,999 times out of 10,000 its a fibroadenoma and we just wasted a huge amount of money.

But if she’s the 1 in 10,000 with breast cancer, and rather than do the above, we engage in watchful waiting and it spreads…well my ass is grass….so everyone gets the $100,000 work up rather than the 3 month $65 follow up visit.
In the real world we should all do the follow-up, but none of us wants to get sued even when we do the right thing.

And all of the above was paid for because it was indicated no matter how unlikely the risk of breast cancer is.
I have had at least 2 patients per year over the last 10 years who followed this scenerio and none of them choose watchful waiting even when they knew their risk of cancer was one in ten thousand

“Anonymous coward – no wonder you are afraid to stand behind your words.”

A large fraction of my income is from government contracts. I or my colleagues could very well end up in front of a Congressional committee to justify our line items in the budget. It would not do to be seen in public telling the truth about lawyers.

“Obviously damages caps are directed at meritorious cases…”

Non-economic damages are not meritorious by definition. The jury comes up with them by rolling the dice.

It is also difficult to see what the trial lawyers’ obsession with jury selection has to do with merit. The most fair and accurate assessment of merit would be by highly-educated, intelligent professionals. Yet the torters bend over backwards to load juries with the dull and uneducated. I am reminded of the line ‘The more he talked of his honor, the faster we counted the spoons.’

“Obviously, the notion of limiting attorney fees, also, has the greatest impact with the most severe, most meritorious cases.”

Venture capitalists make a good living playing very long odds. If there were really that much merit lying around waiting to be plucked, the trial lawyers would have been disintermediated long ago.

Everyone reasonable can acknowlege that malpractice costs as a share of health care spending (as opposed to malpractice premiums as a share of some providers’ business expenses) are pretty low–well under 1% ($4billion is one oft quoted number). It’s the “defensive medicine” part that costs so much–6-8% or about $100 billion depending on which McLellan study you believe. But if we’re spending $100bn a year on defensive medicine, that’s $100bn that provders across the health care system are collecting.

Can anyone with a straight face tell me that if we got rid of all malpractice suits overnight, health care spending would go down $100 billion? Go ahead I dare you!

MJL, your allegorical “$100,000 workup” is fascinating, but how many “real world” dollars are we talking? (Or are you suggesting that the cost of “defensive medicine” as advanced by “tort reform” insurance lobbyists is premised upon the notion that any “defensive medicine” procedure costs $100,000.00?)

Matthew, granted it is easier to “make stuff up”, but how is that figure ascertained?

Evan, nobody here wants to address the fact they yawn at – that 10 – 20% of every health care dollar goes to pure bureaucratic waste. That’s about three times as much as the highest total cost for “malpractice”, including the made up “defenisve medicine” figure. The concern here is *not* about keeping health care costs down – it is about keeping physician income up.

Besides, if we “follow the bouncing ball” and accept the latest argument that 6-8% of health care costs are “defensive medicine”, we’re brought right back to the fact that damages caps are about recovery in the most meritorious cases with the most severely damaged victims of malpractice – and won’t have any effect on “frivolous” or unsubstantiated claims, and thus won’t have any impact on “defensive medicine”. But perhaps that’s okay, because as MJL noted, when he practices “defensive medicine” he gets paid.

I think that even in states with caps defensive medicine exists because nobody wants to get sued. It is a significant emotional as well as finacial burden for the doctor who is sued. I don’t know how to get around that.

MJL,

If, as you admit, defensive medicine exists because “nobody wants to get sued,” then you are admitting that caps don’t work.

As a practicing doctor, I’m not worried about getting sued at all … I am worried about keeping the patient.

If I’m a dick and I keep saying “no you don’t need that” in a way that puts the patient off, I’ll soon spend very lonely days. Now sometimes I can convince a patient that a test is not just not necessary but a bad idea … whole body CT scanning for example.

But the young girl with the breast lump … she’s gonna get tested by almost every doctor almost every time … not because they’re afraid of getting sued I hope, but because they’re afraid of her having breast cancer and not doing anything about it.

To tell her she doesn’t need a test that she wants in a case like that is radical indifference to the needs of your patient.

So lets stop the smoke and blather about the “costs of defensive medicine.”

The only thing caps can do is decrease the average award from jury trials and settlements (which by the way are cases where both sides agree that something indefensible took place).

So the purpose of the cap is to keep awards down for people with legitimate cases as determined by juries and insurance companies.

Woo hoo!

MJL,

That’s really not the point of my argument.

My point is that (a) malpractice caps don’t decrease defensive medicine, and (b) in an environment where patients getting good service often determines how much business a provider does, a provider who routinely denies reasonable tests to patients that they themselves wish done will probably see fewer patients.

The science is all well and good. I agree with you on the science … but so what.

If the patient is understanding of the low risk and comfortable with it, then fine she doesn’t need a workup, but if she isn’t, then she’s going to get tested in our system in any state in the union. Not because of defensive medicine but because doctors want to stay in business.