[...] Commentaries on malpractice …DB’s Medical Rants [...]

Let’s put aside whether we can define defensive medicine, and what would or would not diminish it, or whether physicians practicing defensive medicine actually reduces their risk. Let’s even put aside the difficulties in estimating the costs of so called “defensive medicine”, and the fact that one physician’s defensive medicine is another’s necessary care. Or even the fact that without the profit motive, certain tests may not be as likely to be ordered in a single payer system. Put aside all that.

I think the problem with comparing other legal malpractice systems is that you also have to compare the healthcare system in conjunction. The need for pursuing a claim for future medical bills and lost wages and your overall decline in the quality of your life is not as urgent in countries with a deeper social safety net than that provided by the US. Even things like the relatively inexpensive availability of public transportation in places like that matter. If a person injured in the US is looking at a lifetime of specialized care, and mountains of past medical bills, that’s an expensive proposition, which becomes less expensive in single payer systems.

I say less expensive, but let’s be clear, the cost is the same overall, the paying party is just changed. In Canada, it’s the taxpayer that picks up the tab for malpractice. In the US, it’s the responsible party if the victim does not have the means to pay them themselves. So do we want the responsible party paying for the harm they caused, or do we want all us taxpayers sharing that cost? It’s a philisophical question. Just because Americans FILE claims more often than Canadians doesn’t mean health care is any cheaper there. It may mean simply that the injured party isn’t responsible for the direct cost of resulting damage so the incentive for filing isn’t there. And remember, filed claims don’t equal paid claims.

So simply to say, well, any cost savings is solely attributable to one thing is dangerous. If physicians go that route, they will eventually find people looking at the salaries of Canadian and US physicians and wondering why the difference and perhaps some money could be saved there as well.

You say you think “malpractice reform” would change things, but there are myriad proposed reforms out there now, so without being more specific it’s hard to say. It’s like saying that healthcare reform would save money. Without knowing the specific proposed reform, how can you make that determination?

And while you may be a fan of “health courts”, even if they were not a backdoor version of arbitrary caps, they still have a cost. You’re creating a whole group of experts, judges, staff, etc. at least one in every state if not more, to be paid by the taxpayer rather than the parties to the litigation. And the injured victim and the other party are still going to have lawyers, still going to have insurance, etc. So if you haven’t analyzed those costs, you aren’t being honest about the cost comparison.

In my area there are at least two doctors who have lost priviliges at both local hospitals for negligence and have been sued at least 6 times each. Both of them have set up their own surgery centers in the their offices and maintain an outpatient surgery setting. If something goes wrong, they send the patients to the ER of hospitals where the primary care physician is on staff to take care of the injured patient.
On the flip side, I have never been sued, yet my malpractice insurance for primary care for 09 is $32,000 with no surgery or ob, payable in 4 installments with a low interest loan, read 7%, available through a firm that contracts with my malpractice insurance company.
A way to decrease malpractice premiums and suits would be loser pays the legal fees. Both sides would have to put at least $100,000 in an escrow account. Since most injured patients do not have this, the lawyer would have to pony up the money and risk losing money for baseless suits. Legal costs to defend baseless suits can make up over 70% of the premiums.
How about getting rid of some these “expert” witnesses that often have not seen a patient in private practice in years, if ever. These expert witnesses have no clue what the local standard of care is.
What about patient responsibility? Is it the doctor’s fault that the patient does not take the BP or diabetic meds daily? I get faxes from the mail order companies about my noncompliant patients, where a 90 day BP med supply lasts 110 or more days. Who is responsible for the patient who does not exercise, won’t quit smoking, and won’t quit drinking, yet has an MI at 50 and dies?
Finally, in Canada and many countries with socialized medicine, any suits go through the government. The taxpayers get to pay the malpractice premiums and any payouts to injured patients.

Do they want to improve health care and decrease costs or win political points?

I think you know the answer to that one.

[...] for those who have not read this entry I present – Commentaries on malpractice. Our malpractice environment likely has a major influence on costs. Trial lawyers will deny it, but [...]