TW: This Leonhardt piece focused specifically on malpractice reform as a component of overall health care cost reform. To avoid clipping the entire article I will sum up his angle- "malpractice is expensive but overall a small expense relatively speaking, it greatest impact in incenting defensive medicine. Defensive medicine leads to more tests, more treatments etc., just like about every other aspect of the American system".
Malpractice reform may be a component of overall reform but again it is no panacea (posted on the topic last month here).
From David Leonhardt at NYT:
"...The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits.
So the most promising fixes are the ones that don’t treat the malpractice system as an isolated issue.
Imagine if the government paid for more research into which treatments really do make people healthier — a step many doctors don’t like. Such evidence-based medicine could then get the benefit of the doubt in court. The research would also make it easier to set up “health courts,” with expedited case schedules and expert judges, which many doctors advocate.
Similarly, you would want to see more serious efforts to reduce medical error and tougher discipline for doctors who made repeated errors — in exchange for a less confrontational, less costly process for those doctors who, like all of us, sometimes make mistakes.
A grand compromise along these lines may be unlikely. But it’s a lot more consistent with the evidence than narrower ideas. The goal, remember, isn’t just to reduce malpractice lawsuits. It’s also to reduce malpractice."
http://www.nytimes.com/2009/09/23/business/economy/23leonhardt.html?scp=9&sq=david%20leonhardt&st=cse
2 comments:
It seems that what is never factored into the costs of malpractice is the savings from implementing changes to practices to avoid repetition of errors. For example, having the patient sign their right knee before surgery to avoid the doctor accidentally performing surgery on the left. Good has and does come from malpractice lawsuits but noone seems interested in pointing that out or quantifying it.
Awul Gawande wrote a great article a couple of years ago
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
about "checklists" and their subtle but profound impacts.
If you read the Leonhardt piece I think you will find he is pretty balanced. Some on the right think malpractice litigation is a plaintiff's attorney game, it is not (at least not most of the time). And most malpractice cases a shame to be eliminated, it is not. That said those of us on the left should not be oppposed to legitimate reform of all aspects of our system.
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