# Why does tort reform keep getting mentioned in healthcare debates? **URL:** \ **Category:** Great Debates\ **Created:** [November 11, 2015, 2:38am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248 "2015-11-11T02:38:23Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 11, 2015, 2:38am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/1 "2015-11-11T02:38:23Z")
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: > [@Ben Carson: Abolish medicare and medicaid, replace them with $2000 vouchers](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/37): > > Too much testing and over prescribing of drugs is definitely an issue, although that’s a tort problem as well as a profit motive problem. Single payer systems deal with that issue as well by not allowing big settlements. **Tort reform and single payer go hand-in-hand.** Then, in the thread in GD about adopting the Canadian system in the US, **Shodan** said: > [@Wouldn't Switching US healthcare to a Canadian system lower the debt faster than anything else?](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/50): > > … > Combined with tort reform, rationing is the only realistic option to reduce health care inflation. > … > > Regards, > Shodan 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.) ---
**Author:** ![Captain\_Amazing](https://avatars.discourse-cdn.com/v4/letter/c/6de8d8/32.png) [@Captain\_Amazing](https://boards.straightdope.com/u/Captain_Amazing)\ **Post date:** [November 11, 2015, 3:25am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/2 "2015-11-11T03:25:40Z")
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. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 11, 2015, 3:33am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/3 "2015-11-11T03:33:44Z")
Recent study: > [@](#): > > The last bubble to burst was the idea that doctors, fearful of getting sued, practice “defensive medicine,” prescribing unnecessary and costly tests and procedures. That myth was dispatched by the recent publication of a major study in the New England Journal of Medicine. A team of five doctors and public health experts found that tort reform measures passed in three states—specifically designed to insulate emergency room doctors from lawsuits—did nothing to reduce the number of expensive tests and procedures those ER doctors prescribed. > > This latest study follows numerous others that deflated other tort reform myths: that making it harder for victims to file medical malpractice lawsuits would reduce the number of “frivolous” suits that “clog the courts”; that imposing caps on the damages victims could receive would reign in “out of control” juries that were awarding lottery-size sums to plaintiffs; and that malpractice insurance premiums would fall, thereby reversing a doctor shortage caused by specialists “fleeing the profession.” > > None of these promised benefits became reality. That’s because the alleged problems were themselves non-existent. ---
**Author:** ![Alpha\_Twit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alpha_twit/32/265_2.png) [@Alpha\_Twit](https://boards.straightdope.com/u/Alpha_Twit)\ **Post date:** [November 11, 2015, 3:38am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/4 "2015-11-11T03:38:55Z")
> [@Procrustus](#): > > Recent study: Please cite your source. ---
**Author:** ![Alpha\_Twit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alpha_twit/32/265_2.png) [@Alpha\_Twit](https://boards.straightdope.com/u/Alpha_Twit)\ **Post date:** [November 11, 2015, 3:49am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/5 "2015-11-11T03:49:30Z")
Sorry, never mind. Just a random moment of being me again. Carry on Procrustus. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 11, 2015, 3:53am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/6 "2015-11-11T03:53:50Z")
> [@Alpha\_Twit](#): > > Please cite your source. Here’s [one](http://www.nejm.org/doi/full/10.1056/NEJMsa1313308) [Here’s](https://cardozo.yu.edu/fallacies-medical-malpractice-tort-reform) another good article. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [November 11, 2015, 3:59am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/7 "2015-11-11T03:59:30Z")
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. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 11, 2015, 6:44am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/8 "2015-11-11T06:44:37Z")
> [@Procrustus](#): > > Here’s [one](http://www.nejm.org/doi/full/10.1056/NEJMsa1313308) > > [Here’s](https://cardozo.yu.edu/fallacies-medical-malpractice-tort-reform) another good article. Thanks **Procrustus** - they look like good reading. ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [November 11, 2015, 7:05am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/9 "2015-11-11T07:05:59Z")
> [@Northern\_Piper](#): > > Thanks **Procrustus** - they look like good reading. Just keep in mind that a plaintiff’s med-mal lawyer is not a neutral source. Question: How do malpractice premiums in Canada compare to those in the US? ---
**Author:** ![marshmallow](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@marshmallow](https://boards.straightdope.com/u/marshmallow)\ **Post date:** [November 11, 2015, 8:15am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/10 "2015-11-11T08:15:57Z")
> [@Northern\_Piper](#): > > Can someone enlighten me on this point? 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. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [November 11, 2015, 8:28am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/11 "2015-11-11T08:28:18Z")
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. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [November 11, 2015, 8:41am UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/12 "2015-11-11T08:41:03Z")
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. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 11, 2015, 4:23pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/13 "2015-11-11T16:23:07Z")
> [@Tom\_Tildrum](#): > > Just keep in mind that a plaintiff’s med-mal lawyer is not a neutral source. > > Question: How do malpractice premiums in Canada compare to those in the US? I have no idea, but the malpractice law in Canada is a [bit different](http://www.theglobeandmail.com/life/health-and-fitness/health-navigator/patients-odds-of-winning-medical-malpractice-suits-in-canada-arent-good-says-new-book/article10812604/) that in the US. (although even in the U.S., plaintiffs prevailing is a rare event) > [@](#): > > From 2005 to 2010, only 4,524 lawsuits were filed against Canadian doctors. During that five-year period, 3,089 claims were dismissed or abandoned “because the court dismissed the claim or the victim or the victim’s family quit, ran out of money or died before trial,” according to McKiggan. > > And out of 521 cases that went to trial, only 116 led to a judgment that favoured the patient. And the median damage awarded was just $117,000, he noted. > > “Of more than 4,000 lawsuits filed against doctors from 2005 to 2010, only 2 per cent resulted in trial verdicts for the victim.” ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [November 11, 2015, 4:45pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/14 "2015-11-11T16:45:44Z")
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. ---
**Author:** ![lance\_strongarm](https://avatars.discourse-cdn.com/v4/letter/l/87869e/32.png) [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)\ **Post date:** [November 11, 2015, 5:27pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/15 "2015-11-11T17:27:04Z")
The idea is that lawyers suing for malpractice is driving up health care costs. It is a myth that has been debunked. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 11, 2015, 5:35pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/16 "2015-11-11T17:35:00Z")
> [@DrCube](#): > > 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. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 11, 2015, 5:42pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/17 "2015-11-11T17:42:38Z")
> [@Procrustus](#): > > Recent study: 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. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 11, 2015, 5:46pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/18 "2015-11-11T17:46:05Z")
> [@Fotheringay-Phipps](#): > > 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. On the other hand, maybe the additional treatment and tests are saving a lot of lives. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [November 11, 2015, 5:48pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/19 "2015-11-11T17:48:57Z")
> [@Procrustus](#): > > Recent study: That study seems to be limited to emergency room care, and the tort reform laws similarly limited to emergency room medical malpractice only. Is that correct, or am I missing something? ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 11, 2015, 5:50pm UTC](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248/20 "2015-11-11T17:50:08Z")
> [@Procrustus](#): > > On the other hand, maybe the additional treatment and tests are saving a lot of lives. 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.] [Next page](https://boards.straightdope.com/t/why-does-tort-reform-keep-getting-mentioned-in-healthcare-debates/737248.md?page=2)