In two separate threads recently discussing single-payer health care systems, comments have been made that tort reform is essential for single-payment to be adopted in the US.
First, in the Ben Carson thread in the Pit, adaher said:
Then, in the thread in GD about adopting the Canadian system in the US, Shodan said:
Perhaps I’m obtuse, but I’m not seeing what tort reforms are envisaged as being necessary to make single-payer work in the US.
I’m not aware of any tort reforms in Canada that are related to health care costs, in the ~50 years since single-payer was adopted.
Can someone enlighten me on this point?
(I’ve put this in GD because all health care threads seem to end there, although it may have more of a factual inquiry to it.)
Part of it is blatantly political, in that personal injury lawyers and malpractice lawyers tend to vote and donate to Democrats, so the Republicans sort of like to beat up on them. But if you’re looking for an actual argument, it’s that medical malpractice lawsuits and the fear of medical malpractice lawsuits lead doctors to perform unnecessary tests that raise the price of health care.
People like doctors and hate lawyers. It also provides a simple, easy, and wrong solution to a very hard problem. And finally, it’s a solution that only truly effects a small number of people.
For a long time tort reform has been the reflexive conservative answer to fixing U.S. healthcare. It’s a dodge in this case, since AFAIK neither of the cited posters would ever be interested in UHC.
Texas has had tort reform since 2003. I’ve looked at some articles published for its tenth anniversary. The lawyers say it doesn’t lower health care costs but make no mention of malpractice insurance costs. The insurance companies say it reduced malpractice cases but make no mention of healthcare costs.
Beats me.
If it’s of any relevance, I don’t think there were any significant changes to the law on negligence and so on affecting doctors in the UK. AFAIK they have personal insurance through their professional organisations, but more importantly the NHS has a single Litigation Authority that deals with cases on behalf of NHS doctors and services, which may help come to an earlier resolution of cases and compensatory payouts where necessary. Current total costs of compensation, litigation and so on come to around £1.2bn a year (which, roughly speaking, would be a fraction of a penny per patient interaction, or 2p a head for every person in Britain).
It may be that there’s a different attitude as to what defines negligence, or to the principles underlying compensation, or indeed in deciding whether to sue through the courts or go for mediation/arbitration as a route to compensation. But certainly doctors have on occasion faced criminal charges of manslaughter for gross negligence.
I have no idea, but the malpractice law in Canada is a bit different that in the US. (although even in the U.S., plaintiffs prevailing is a rare event)
I thought the idea was that doctors had to pay half their salary each year in malpractice insurance premiums, and if you capped the payouts malpractice victims could receive, the insurance premiums would go down, resulting in those savings being passed on to the customer, I mean patient. Not sure I buy it entirely, but it seems like a plausible connection. I do think it’s a very small part of the problem, though. You can’t blame absurdly high healthcare costs on malpractice lawsuits completely, though they might be 1% of the problem.
You see the two flaws in the reasoning. 1) even with caps the insurance company doesn’t want to reduce the cost, and 2) even if the cost of insurance goes down, the doctor will just pocket the difference.
The “real” argument is that the fear of lawsuits is causing doctors to practice “defensive medicine” and do a lot of expensive tests that aren’t necessary. What has been found, however, is that hospitals and doctors make money off of MRIs, etc., so they have no reason not to order everything that might be helpful.
I don’t know how many doctors consciously think “this test is completely unnecessary but I’m going to order anyway just in case I get sued”. But the underlying danger biases them in that direction. And on a broader level, at the national level, it changes the prevailing standards as to what level of risk justifies tests and other intervention. These standards influence individual doctors even beyond their specific self-interest.
Point of all of the above is that a change in defensive medicine resulting from tort reform will be slow to develop, and will also be more limited if it’s a local change.
[This is all assuming that the study is valid to begin with (I’ve not looked at it).]
If you think about it from a human nature standpoint, it’s hard to imagine that doctors, human beings like all others, are not influenced by the fear of lawsuits. So I think the claim that this is incorrect needs a pretty high standard of evidence before it’s accepted.
The consensus of the experts is otherwise. (It’s actually one impetus for the “cadillac tax”)
And in the countries which have socialized medicine, which the US is constantly being unfavorably compared to, they do a lot less of all sorts of tests and procedures.
[Note this is not only due to defensive medicine in the US. But it makes sense to think this is also a big part of it.]