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Unpleasant Wonkfact: Tort Reform Won’t Affect Health Care Costs

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From the Wonkfile Archives, here’s an oldie but goodie link from August.

Tort reform (more precisely, restricting patient redress) is just a way of croaking the trial bar for overwhelmingly contributing to Democrats.

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  1. If tort reform were in fact the ticket to lower health care costs, then we’d all move to Texas because their cap has significantly reduced the number of suits and has capped awards at a quarter million dollars.

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    p>Quoting the article:

    McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average – although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

    The reason McAllen, Texas is so expensive is that the medical profession there has turned itself into a business.

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    p>Gawande’s article gives the example of gallstones. The recommended means of handling gallstones is diet. With appropriate dietary changes, most patients overcome them. However, three things about that:

    • Some patients are more comforted by having a procedure and will pressure the physician for one.
    • There’s a lot more business in gall bladder removal than diet advising.
    • There’s also a lot more risk in gall bladder removing than diet advising.

    In a sense, the business/customer relationships do not align with the best medical practice. Unless there is a strong professional ethic (and possibly rewards to reward it), then one ends up with McAllen, Texas healthcare. Patient as ATM machine.

    • …which is a variation on the same theme.

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      p>I still remember the circus over the privatization of Boston City Hospital.  Basically an eight-hundred million dollar equity-transfer from the City to B.U., despite the fact that the old BCH returned millions to the City treasury every year and B.U. Hospital lost millions per annum.

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      p>…and every major “progressive” group in the City sucked up to B.U.

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      p>Your last point is the key: the old professional ethic have come down with terminal corporate rot; hell, there used to be a time when HMOs worked.

    • a patient with good health insurance is regarded as an ATM machine. You wouldn’t believe the maladies that I have been tested for on all the latest medical machinery.(or the unknown doctors who pop up at your bedside out of nowhere to give you a ten minute consultation and later bill you $800.00 or more for that privilege.)

      • That amazed me when I got the bills for my weekend hospital stay. Some doctor would appear, look at my chart while saying something or other in justification of his presence, then disappear forever. All I was left with to remember him by was his bill.

    • It’s got to do with physicians becoming business people and yes a system that is broken there. The New Yorker article is linked below.

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      p>http://www.newyorker.com/repor…

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      p>I like the end of the article you cite.

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      p>”But Mello, who has advised the Obama administration on malpractice reform, doesn’t expect to see such proposals coming out of Congress or the White House anytime soon. “Trial lawyers don’t embrace proposals that would remove their role in the malpractice system,” she said. And they have a lot of influence with Democrats in Washington.”

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      p>Personally I’ve got a real problem with a lawyer second guessing  a doctor’s split second judgment. Sometimes the doctor is going to make a mistake,  and there does have to be  some type of compensation system, but the current one doesn’t work.

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      p>

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      p>
      Some of these trial lawyers make income off doctors that would make wall street blush. In the big economic picture, who should be paid more – a doctor who has trained 15 years and can perform heart surgery on a infant, or a trial lawyer who may sue him/her over  an operation that was a long shoot to begin with.

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      p>

        • I cannot find the quotation from the cited article. Perhaps you mean this which I don’t recall reading.
        • Yes, yes, our criminal justice system runs on the guessing of lawyers. That’s how cases are decided.

      • The GOP has made the argument that unnecessary tests are due to medical malpractice and torts getting out of hand. The McAllen example makes it clear that unnecessary tests can have a rather different origin.

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        p>After decades of weak and ineffective regulation, trial lawyers don’t look so bad.

        • If Mass Health caused the cost of health care to double in Westfield  – would we say Massachusetts Health Care has failed. It’s just a part of larger problem of health care costs.

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          p>

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          p>

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          p>Doctors and  businesses (and you should be) are  scared of frivolous lawsuits. Trial lawyers drag  everyone they think of into a lawsuit and then you have to disengage.  Even if you have nothing to do with the suit, you still have to pay your attorney, nobody will  reimburses your costs.

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          p>Simple solution, loser pays.

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          p>

      • Often conservatives say states should be laboratories to test out if laws work.  Texas tried Tort Reform because Bush promised it would keep down costs.  Now McAllen, Texas, has the highest per person medical costs in the country.  

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        p>Simple logic dictates that Tort Reform did not lower costs.  If it did, McAllen would not be #1 in high costs.

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        p>It does not matter what lawyers want.  The conservative idea became law and it failed to control costs.  

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        p>roarkarchitect is probably too intelligent to disbelieve the evidence, so he or she is mis-directing the readers, skipping the whole point to say “lawyers are bad.”

        “Personally I’ve got a real problem with a lawyer second guessing  a doctor’s split second judgment. Sometimes the doctor is going to make a mistake,  and there does have to be  some type of compensation system, but the current one doesn’t work.”

        But whether lawyers were bad or good doesn’t matter–Texas did tort reform, and lawyers can’t make millions there anymore on medical malpractice, and costs are still out of control in McAllen, Texas.

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        p>By the way, the law itself has always had a real problem with lawyers suing doctors over malpractice, and so the law puts the burden of proof on the plaintiff, thereby favoring the doctor in any lawsuits.  

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        p>Most likely roarkarchitect knows all this. He or she must be saying whatever it takes to get what the conservatives want. And for that, I can’t blame him or her because saying whatever it takes worked when the conservatives got the war they wanted in Iraq.

      • Given the necessity for corroborating medical opinion, it’s not as easy as conventional wisdom would have it for plaintiffs to win malpractice cases.

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        p>The costs to doctors result from these factors among others:

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        p>The relative lack of self-policing within the medical profession, coupled with an “us versus them” mentality within and without the larger health professions as a whole. (Talk to any nurse about this!)

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        p>The relative lack of public access to MD disciplinary histories.

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        p>The rise in the size of judgements, as opposed to the number sucessfully litigated.

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        p>The disinclination of insurance companies to base malpractice premiums commensurate with the doctor’s training, experience, and history; instead charging what the traffic will bear.

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        p>Corporatized medicine, where fiscal interests take precedence over medical necessity.

        <

        p>This is IMHO just another symptom of cultural collapse, as applied to elite professionals.  If, as your nickname suggests, you’re a libertarian, I would have thought you would be the first to support the market-based redress offered by the contingency fee tort bar.

  2. Single-payer has proven results wherever it has been adopted.
    Granted the Republicans must take much of the blame for a national single-payer system being killed…again.

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    p>But here in MA there is hardly a Republican in sight to kill single-payer. Grace Ross has pointed out that single-payer in Canada was passed province by province.  All that’s needed is a little Democratic will power.

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