Quote of the week, from Charles Krauthammer (on Obamacare)

[LA Ute]

Krauthammer on Obamacare:

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that money comes from? The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Unlike too many conservatives, I recognize that the health care system's financial problems are multi-faceted, and that tort reform will not be a panacea by any means. But it is wrong, I think, that the subject of tort reform is not even on the table. Heck, it's not even in the same building as the table.

[DU Ute]

About Obamacare:

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?

When a neurosurgeon pays $200,000 a year for malpractice insurance before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients, in higher doctor fees to cover the insurance.

And with jackpot justice that awards one claimant zillions while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that money comes from? The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order for no good reason other than to protect themselves from lawsuits. Every doctor knows, as I did when I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law.

Tort reform would yield tens of billions in savings. Yet you cannot find it in the Democratic bills. And Obama breathed not a word about it in the full hour of his health-care news conference. Why? No mystery. The Democrats are parasitically dependent on huge donations from trial lawyers.

Unlike too many conservatives, I recognize that the health care system's financial problems are multi-faceted, and that tort reform will not be a panacea by any means. But it is wrong, I think, that the subject of tort reform is not even on the table. Heck, it's not even in the same building as the table.

Krauthammer always has great insights on medical issues, thanks for sharing this.

[ERCougar]

The deafening silence of attorneys scrambling to justify a corrupt and self-serving system....

[RobinFinderson]

I think heavy malpractice liability is a natural extension of a free market system to health care. How much is a lifetime of paying medical fees for one doctor's malpractice going to cost? A lot. Especially if you calculate the cost of medical care inflation based on what has happened over the last ten years.

One of the advantages of single payer would be that medical liability would decrease. Folks wouldn't have to sue as if their whole future well being depended on a huge windfall, because they would never have to worry about being able to afford quality medical care.

Without single payer, I'm not that excited about tort reform. With single payer, I would think that doctors, as public servants, would deserve more protection, and the 'bad doctors' would simply lose their patients to the good doctors, based on their reputation (rather than cost).

If doctors want to be lone gunslingers out in the wild west of a free market health care system, huge liability is part of the cost of business.

[ERCougar]

I think heavy malpractice liability is a natural extension of a free market system to health care. How much is a lifetime of paying medical fees for one doctor's malpractice going to cost? A lot. Especially if you calculate the cost of medical care inflation based on what has happened over the last ten years.

Doctors would be absolutely thrilled if malpractice awards were limited to covering future healthcare costs that resulted from the alleged error. Thrilled.

[RobinFinderson]

Doctors would be absolutely thrilled if malpractice awards were limited to covering future healthcare costs that resulted from the alleged error. Thrilled.

Right, but that can't be the extent of it. Obviously a person who is no longer able to maintain a certain quality of life, as a result of an injury sustained under the care of a negligent doctor, is going to want to include the price of maintaining the prior lifestyle. And then there is the family, who is hurt by the loss as well. It goes on like that.

The problem with a private system is that health care become just another commodity that is expected to compete the way Nintendo competes with Sony. In a free market, parties tend to over-hype and under-deliver, and this results in higher than reasonable expectations from the consumer. Consumers look to doctors to fix all kinds of things they shouldn't probably be fiddling with because the doctors, who get paid for procedures, continue to convince patients that certain procedures are going to fix everything. Doctors (seem t0) promise too much, so Americans expect too much.

[ERCougar]

Right, but that can't be the extent of it. Obviously a person who is no longer able to maintain a certain quality of life, as a result of an injury sustained under the care of a negligent doctor, is going to want to include the price of maintaining the prior lifestyle. And then there is the family, who is hurt by the loss as well. It goes on like that.

The problem with a private system is that health care become just another commodity that is expected to compete the way Nintendo competes with Sony. In a free market, parties tend to over-hype and under-deliver, and this results in higher than reasonable expectations from the consumer. Consumers look to doctors to fix all kinds of things they shouldn't probably be fiddling with because the doctors, who get paid for procedures, continue to convince patients that certain procedures are going to fix everything. Doctors (seem t0) promise too much, so Americans expect too much.

OK...but you're opening up a new discussion. I was addressing your silly contention that the reason malpractice premiums and awards are so high is that the healthcare required to clean up the mess is so expensive.

As for your other points, I really don't think doctors are responsible for patients wanting a pill for everything. Personally, I can't stand it when patients come in, asking me to solve stupid problems that any normal person could take care of by themselves. Doctors respond to demands of patients. Part of that is the free market at work--they know that if they don't cater to the demands, they'll go somewhere else to find a doctor who will. So I agree in that there are disadvantages to the free market's involvement in healthcare. But it's unfair to throw this on the shoulders of doctors; in the end, we all really want to heal disease, not baby the worried well.

[LA Ute]

Doctors would be absolutely thrilled if malpractice awards were limited to covering future healthcare costs that resulted from the alleged error. Thrilled.

Yep. All providers would be. Way back in the 70s CA passed MICRA by ballot initiative (the Legislature never would have passed it - the trial lawyer lobby is too powerful). There was a malpractice insurance crisis resulting from whacked-out jury awards for pain and suffering. MICRA limits those to $250K. This means an injured patient can still get compensatory damages - the cost of life-long care, for example - but no real pain and suffering award. Juries were giving huge awards, which made insurance underwriting impossible. The awards were too unpredictable.

Anyway, $250k is probably too low now, after 30+ years, but no one will touch MICRA for fear it will be abolished altogether. There have been efforts to do something similar (cap pain and suffering) on a national/federal level, but the national trial lawyers are scarily powerful. I think some states have adopted similar limits.

A couple of years back Florida OB/GYNs all dropped malpractice coverage altogether because it was unaffordable. I'm not sure how that story has ended, if it has.

[UtahDan]

There is room for disagreement on this issue, but as people drink the insurance lobby's Kool Aid, they should also take a few sips of the advocacy on the other side:

http://www.abanet.org/media/docs/mmqa.pdf

I'm too tired to argue about this, but that link contains some of the salient points.

[RobinFinderson]

Courts exist to resolve disputes between private parties. Juries exist to help resolve disputes between private parties. Juries are not the government. When a jury decides to award a huge settlement for pain and suffering, this reflects the society's expectations at large, and those expectations are a byproduct of the existing health-care system (see ER? I'm laying blame at the feet of the system now, and not just the doctors). The system is capitalist.

So, how is tort-reform not a form of government meddling with the free market?

[UtahDan]

Anyway, $250k is probably too low now, after 30+ years, but no one will touch MICRA for fear it will be abolished altogether. There have been efforts to do something similar (cap pain and suffering) on a national/federal level, but the national trial lawyers are scarily powerful. I think some states have adopted similar limits.

That 250K number has been around forever as you know. $250,000.00 in 1970 in today's dollars is $1,371,465.28.

[LA Ute]

That 250K number has been around forever as you know. $250,000.00 in 1970 in today's dollars is $1,371,465.28.

I think the limit should be $1 million. Increasing it would be just like throwing chum in the water for plaintiff's attorneys, but it would be fair to keep up with inflation. (I know you are more sympathetic to the plaintiff's bar than I am. That's OK, as long as you are not passionate about the subject.)

[RobinFinderson]

That 250K number has been around forever as you know. $250,000.00 in 1970 in today's dollars is $1,371,465.28.

I think the limit should be $1 million. Increasing it would be just like throwing chum in the water for plaintiff's attorneys, but it would be fair to keep up with inflation. (I know you are more sympathetic to the plaintiff's bar than I am. That's OK, as long as you are not passionate about the subject.)

I'm a little surprised that you two are such great advocates of government meddling between private parties with disputes that arose from their interacting in a capitalist market. The government should just keep out of the market, no?

[UtahDan]

I'm a little surprised that you two are such great advocates of government meddling between private parties with disputes that arose from their interacting in a capitalist market. The government should just keep out of the market, no?

No. I am guided by the 7th amendment. The jury is the backstop of the legal system and I would not interfere with it except to the extent that well established common law principles allow. Essentially the framers view. You will have to ask my conservative friend LA which he is such an enemy of the constitution.

[RobinFinderson]

No. I am guided by the 7th amendment. The jury is the backstop of the legal system and I would not interfere with it except to the extent that well established common law principles allow. Essentially the framers view. You will have to ask my conservative friend LA which he is such an enemy of the constitution.

I totally agree. LA is such a communist.