Medical malpractice

There is nothing thinly veiled about my comments. Advocates of health care reform regularly trot out the canard that health care "costs" the United States "17% of GDP" but we rank behind nations that "spend" less in GDP in various health care metrics. This sort of comparative analysis based on GDP is incorrect, for all the reasons I have tried to patiently state in my previous posts (i.e. GDP does not measure costs, efficiency of spending, quality of goods and services purchased, or any other measurement by which a person could evaluate the quality of the U.S. health care system). Despite this, you seem to be stuck on this point and don't appear to understand it at all. As the old saying goes about leading horses to water, I will leave it to you to puzzle over how to drink from this particular well.

LexHumana,

Stop it with the thinly veiled insults. Who said that GDP is a measure of efficiency? People use GDP as a major factor, a baseline of sorts, in determining efficiency within the system. Are you sure you're not trolling?

jayxray wrote: Sep 10th 2010 6:00 GMT "Should I clarify and say that percentage of GDP is a major factor in determining efficiency within a system? Even if you have trouble with my previous statement I would have thought the following comments would have clarified, e.g. '17% is not necessarily too much; however when you compare the treatments and the percentages with other countries it becomes apparent that we spend too much.'"

No, this analysis is completely off base (and I'm beginning to wonder if a basic ECON 101 lesson would be completely wasted on some people).

GDP does not measure efficiency. Percentage of GDP does not measure efficiency of anything either. In the case of healthcare, it only measures how much of our economic activity is generated in that particular industry. You cannot simply look at percentage of GDP and assume that if the U.S. consumer loves to buy a lot of something (i.e. healthcare) that they will automatically be the healthiest people on the planet.

The "heathcare industry" covers a lot of products, treatments, and procedures that have nothing to do with longevity, death rates, or any other metric that people love to trot out. For example, annual sales of Viagra in the period 1999–2001 exceeded $1 billion, with a huge portion of those sales occurring in the United States. Viagra does not improve your life expectancy, does not reduce mortality rates, or cure any communicable diseases, yet it is considered part of the healthcare GDP. Every boob job and nose job done in the United States counts towards "healthcare" GDP, even though it does not improve life expectancy or reduce mortality rates. There are countless other procedures (hair implants anyone? LASIK anyone?), that fall into this category, and consumers in the United States are enthusatic purchasers of them all.

GDP measures economic activity only. Using it as a proxy for determining what we like to buy is imperfect at best; using it as a proxy for determining whether we are spending our money efficiently or wisely, or whether a particular industry is too expensive or inadequate, is a foolish non sequitur.

Coloradojack,

I would certainly hope that in cases that actually come to trial in Federal court, some arguable issues exist. If this were not the case, the attorneys and judges would be completely incompetent.

But that of course is not the question anyway. Most cases, especially the nuisance ones, do not come to trial at all, and as noted in my previous post, there are huge costs involved in dealing with these disputes, whether they make it to trial or not. The rinky-dink economic analyses done by dufuses at law schools and public policy drones are, of course, incapable of dealing with such subtleties.

And no, the major explanation for defensive medicine is not that doctors sometimes invest in medical testing facilities. This is the kind of common-sense canard that is blindly repeated without supporting statistical evidence.

How about the costs these amateurs did not look at, like for example the extensive records retention (on paper, no less), time spent on discovery requests, time wasted in depositions, time wasted in court, mental distress suffered by doctors, nurses, and other medical workers, money spent on expert witnesses, time wasted by jurors like me who have to take a day or two off work with trivial compensation to ourselves or our employers, the cost of the archaic and inefficient court system itself (paid for by me and other taxpayers), settlements made in cases where a lawsuit is never filed, etc?

Nope, too hard to look at those things, so these econometric amateurs just pretend they don't matter.

As for defensive medicine, which is really the major cost driver, it is at least encouraging that Ms. Mello acknowledges that she doesn't have a bloody clue of how to analyze the problem. Rather than make an ignorant guess, it might be better for her and her colleagues to turn the matter over to people at the University of Chicago, Michigan or Stanford who understand how to handle such analyses.

Or perhaps they could take their skills in producing innumerate blather and go work for the CBO, where they would fit in splendidly.

"Tort Reform" is just another Republican red herring. In all my years of defending medical malpractice cases in Federal court in California, I never saw one that wasn't arguably justified. The real problem was the failure of the medical profession to police the small percentage of over-aged, or burned-out or simply incompetent practitioners who practice medicine.
Defensive medicine is often practiced because the same doctors own the MRI machines or other labs or equipment or services which may be in question. Real medical care reform in the form of single payer, instead of the Obama sellout to the insurance companies, would make a real difference in cost containment.
The tort system exists largely because the legislatures, state and federal, have been bought off by the special interests, so they decline to pass appropriate regulatory laws and try to duck responsibility by passing it on to the court system. I won't deny that there are some excesses, but how much do you think it costs to provide the needed care for an infant who was born seriously deformed and/or impaired due to the negligence of the attending doctor or hospital, who is going to live for 70 + years with the need for round the clock nursing care? Clean up the medical profession, clean up the legislatures, and torts will be an even smaller part of the problem.

Lex,

Should I clarify and say that percentage of GDP is a major factor in determining efficiency within a system? Even if you have trouble with my previous statement I would have thought the following comments would have clarified, e.g. "17% is not necessarily too much; however when you compare the treatments and the percentages with other countries it becomes apparent that we spend too much."

jayxray wrote: Sep 10th 2010 4:33 GMT "Come on LexHumana, why is it that you find comparisons to GDP difficult to understand? It is the standard measurement for determining efficiency within a system."

No it isn't. GDP doesn't measure the efficiency of anything. I challenge anyone to pull up the official definition of GDP, and coherently explain how it measures efficiency.

Isn't there a significant flaw (by omission) in the "cost listing" made?

I would suspect that physicians pay an immense amount to insure themselves against malpractice. Of course, these costs are handed down and end up bloating the patient's bill for medical care.

Could the Economist please try to estimate and include this (possibly dominant) contribution in this otherwise very well targeted article?!

Come on LexHumana, why is it that you find comparisons to GDP difficult to understand? It is the standard measurement for determining efficiency within a system. 17% is not necessarily too much; however when you compare the treatments and the percentages with other countries it becomes apparent that we spend too much.

What measure for health care results? How about more babies dying at birth than other modern countries? How about the average citizens not living as long as citizens in other countries?

actually, your government has spent lots money on healthycare.
do you konw the conditions on other countries in the world.
like China, the common people should afford all the costs...

Aligning economic incentives? SOCIALISM!!!!

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If you eliminate Fee-for -service the only alternative is to put doctors on a salary. Every aspect of the system will be owned by someone else.The doctor will have no incentive to work hard i.e. treat patients. Trust me after a few years most do not work endless hours for the good of their neighbor. Putting doctors on a salary will be the equivalent of paying them not to doctor. If your goal is to reduce spending this may work but if your goal is high quality available health care it is not likely to work. Which is worse; to do unnecessary procedure because you get paid for it or not to do a necessary procedure because you don't get paid for it? The power company etc. won't leave the power on if they don't get paid. If people are paying for their own medical care they will ask "Doc, do I really need this?" and "is this the cheapest way to do it?"

I have always been amazed that the doctor who after 11 to 16 years of post high school training, who doesn't begin to make a living wage until age 30 to 35 is pilloried for making a decent living. There is however no criticism of the exorbitant earnings of entertainers of all kinds. Be careful of what you wish for. It will likely have unforeseen consequences. The forty hours a week, long lunch breaks and absolute immunity for mistakes that judges get actually doesn't sound so bad.

I don't believe the low estimate of medical malpractice costs that the authors report. The people that make such estimates are not in the trenches with everything they own at risk not because of a mistake or error but because of a bad result. If there wasn't big money in medical malpractice how did John Edwards get so filthy rich? Your are not serious about any medical system reform if you are not willing to drastically change the tort system. You are simply a shill for trial lawyers and power hungry politicians.

How about if people want to be compensated for a "bad result" they be required to buy "bad result insurance" ? Insurance companies could very easily develop a product. If you don't see how this could simultaneously address other issues you have no business commenting on the issue. If you don't buy homeowners insurance and your house burns down you are out of luck. This is no different.

Is it not obvious that "fee for service," taken by itself, tends to reduce overuse of health care rather than encourage overuse.

The Mello study estimate of 2.4 percent of health care cost being defensive medicine is incredible. It seems obvious that it is greater than 50 percent.

In our area it is common for accident victims to be helicopter airlifted to a hospital at a cost of over $20,000. They are then treated for minor injuries and released.

I assure you medical liability issues represent more than 80% of the cost of medicine here in the USA--congress by avoiding this issue has done nothing to cap the cost of medical care---i have provided medical care throughout the USA for 30 years--remember that all medical records can be subpoenaed --we are very aware of it --computerizing the records so anyone can read the medical record really is scary--there is a database where every physician that is sued is kept regardless of winning the case--hospitals have to document that they have searched it when you are hired--imagine what a burden that is

Hedgeson, said unpopularity is what makes America not Europe which has looked to us to care for them when most in need. Socialism doesn't work - ask the Greeks. Obviously, semi-capitalism as we have in the U.S. isn't working either, suggesting some model with a bit of both perhaps. While I wouldn't mind some of the policies of Europe, vis-a-vis French healthcare, we Americans must never accept the european idea of socialism and equality of outcome. It is equality of opportunity, not outcome which prompted DeTocqueville to say "Democracy and socialism have nothing in common but one word, equality. But notice the difference: while democracy seeks equality in liberty, socialism seeks equality in restraint and servitude".

Hedgeson wrote: Sep 9th 2010 8:50 GMT "Only in America could you become unpopular for trying to get free healthcare for something like 46 million people? Coming from an English perspective, how many countries have that privilege?"

That is because nothing is ever "free". This public healthcare initiative is not "free". The doctors and nurses are not working for free. The drugs are not free. The hospital buildings don't spring magically out of the ground for free. These costs must be paid for by someone, and that someone is the taxpayer.

If a person remembers only two bits of wisdom in his life, the two should be: "there is no such thing as a free lunch" and "you get what you pay for".

Only in America could you become unpopular for trying to get free healthcare for something like 46 million people? Coming from an English perspective, how many countries have that privilege?

jayxray wrote: Sep 9th 2010 6:53 GMT "The issue is that health care is much more expensive in the US than elsewhere, yet the results are below average. We spend more but get less. We overpay and to such an extant that households can be ruined from debt."

More expensive by what metric? Certainly not by GDP, as I have pointed out as clearly as I can that this is not a measure of "expensiveness". The way to determine "expensive" is to measure the cost of procedures, taking into account the actual availability and frequency of procedures (for example, the U.S. may regularly use certain treatments that are not widely used elsewhere, and vice versa).

Results are "below average" by what metric? Again, it cannot be based on GDP, since that is not a measure of efficiency or effectiveness. Moreover, comparing various quality of life metrics is dependent on culture, habits, and geographic location, as well as a variety of other social factors that are independent of healthcare spending.

There are a great many throwaway arguments being bandied about in the healthcare debate, and most are based on nonsensical comparative data (like GDP comparisons) or deliberately ignore the presence of other contributing factors.