Sunday, September 27, 2009

Malpractice, defensive medicine and politics of reform

The News and Observer has a front page story today on medical malpractice and tort reform. Several points from my perspective. [note, I wrote about this in N and O on Aug 7, but the 'new and improved' online version appears to not link to past articles....trying to work this out]

*I think defensive medicine likely raises the cost of the health system by 1-3%. 5% would be $125 Billion per year (this year total spending will be around $2.5 Billion, the $2.1 B the article notes is last year). The biggest estimate I have seen is $168 B per year (Charles Krauthammer wrote $200 B per year in a column this past summer, but I think he was just rounding up; will dig it up later).

*The article shows that rates of suits have been dropping. Several lawyers have written me saying so based on stuff I have written in the past saying we needed tort reform, mostly as a political tool to bring the docs along (and to respond to their true obessession with getting sued, even if the rate of such is dropping).

*Even if the data show that we won't save much money from tort reform (I don't think we will), if ONE doctor gets up wearing white coat and says defensive medicine is key cost driver, most folks will put more credence in that than they will the testimony of 100 lawyers plus 100 health policy guys.

*So, we need tort reform to (1) get the docs to be able to focus on providing care; (2) ease the way into a patient safety system in which errors are looked into to learn from; (3) docs will use this as 'escape clause' for any cost saving efforts in the system.....they retort will be 'what about malpractice?'

*And given that it is apparently quite hard to sue anyway, we aren't losing much by way of a deterrent for errors and poor quality.

Again, if you think docs are money grubers only (I don't), then heavy tort reform will be the only way to call their bluff. If reform comes about and defensive medicine doesn't drop, it will be something else. And tort reform could be the lead into a real patient safety approach that will improve quality in a way that tort law hasn't been able to do.

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