Our health care system is crazy

That’s a really good link, thanks. It seems I was wrong. I would say 0.5% of an inflated health system is a huge amount to pay for insurances/suits, but it doesn’t seem suing is too common at all given the US legal framework.

Just had the annual: ‘This is how much you’re boned’ staff meeting for next year’s health care plan changes. My out of pocket premiums are essentially going up $320 per month for roughly the same coverage

The thing to keep in mind whenever you hear tort reform is that a part of the reason it comes up over and over again is that it is an attack on a large (?) portion of relatively reliable Democrat fundraising. It has virtually nothing to do with the actual laws and legal processes and just about everything to do with crippling the opposition party’s access to campaign funds.

That’s not to say it isn’t necessarily a desirable thing, just that it is more about the political $ game than it is anything else.

My company is having greater “differentiation” (insurance term for “really screw some people over, but not others”). My rates are dropping ever so slightly, while a coworker’s are going through the roof.

Moreover, the article seems to be biased in weird ways. I reread it, since something feels wrong. The main study it quotes says that 1 in 25 cases lead to injuries and only 4% of them sue. That means 0.16% of medical cases (if my maths are right) result in a sue. The same article states that dealing with those takes about 0.5% of the national healthcare expenses, which is a significant increase from that 0.16% of sues. But the article avoids comparing these numbers. Frivolous claims or not, the cost of dealing with it is definitely too much.

The idea that guarding against malpractice can diminish the costs (two examples are provided) is sound. However, no mention is done of the costs of implementing those procedures. They might be significant or not, but they are a necessary part of the analysis to really judge the issue.

Anyway, the point was originally that doctors have to pay for insurance, legit or not, and that increases their expenses and is another way to justify their overpay and makes it difficult to moderate it. Doctor pays are a big chunk of any health system expenses, and at their current level they make implementing one in the US unfeasible.

Eh, there’s a lot of missing information and misleading statistics in that article. I like Klein and he’s usually pretty good with his numbers, but it gets really fuzzy if you peel back the covers just a bit.

To start with, I was a little worried that 1 out of every 25 encounters with a doctor would result in the doctor doing something to injure the patient. That’s a horrific statistic. I looked up the abstract for the Harvard study, and apparently that’s not quite what it says: it’s one out of every twenty-five people admitted to a hospital, probably involving some surgery or procedure. It doesn’t seem to cover stuff like check-ups, physicals or going to a clinic because your kid is running a fever. Although the abstract doesn’t go into much detail, I think we can also assume most of these procedures were more serious than most out-patient procedures that might be done outside of a hospital (wart removal, vasectomy, etc.).

So right there, I imagine you are skewed towards the more-expensive side of of the scale. The article doesn’t say, but I’d bet that all the 31,000 incidents reviewed for the study were significantly more expensive than the vast, vast majority of medical activities to start with.

It also sort of shows that Klein is mixing apples and oranges - the 1 in 25 and 4% deal with ONLY hospital admissions and whatever procedures the Harvard study included, while the 0.5% is system-wide. What fraction of that 0.5% went to hospital-related stuff as opposed to out-patient procedure errors? Elective (cosmetic) surgery? Mis-prescribed drugs? The answer might counter his core point; we don’t know… though there are some interesting nuggets in the abstract.

But let’s set that aside and go back to the Harvard study: It doesn’t strain credulity to assume that the cases where a doctor could “injure” a patient due to error are probably more complex than even that subset of cases that require admission to a hospital. For instance, setting a broken leg and doing an emergency amputation of a leg would both require admission, but the latter is much more complex with greater opportunity for error and complications… and likely much more expensive even if everything goes right.

And then if something did go wrong and it was the doctor’s fault, it would almost certainly require additional procedures to fix, which would then jack up the costs even further.

The tl;dr summary: the procedures studied were probably more expensive than most; the ones where the doctors screwed up were likely to be more complex (and thus expensive) than even that subset; and the costs of fixing the doctors’ errors probably raised the costs of that sub-subset. So saying that 0.16% of hospital cases accounted for 0.5% of all costs doesn’t sound too unlikely even before the lawyers get involved.

That makes sense.

Also interesting is that the 0.5% does not include the costs involved in defensive medicine (that is, the costs of procedures intended to diminish litigation but that have little effect on patient outcome). Which could be big or not. The abstract you linked says it’s very difficult to calculate, but they are likely to increase that number. I don’t even know how you even start. Compare tests done against health system of similar efficiency in other countries to weed out the unnecessary ones?

I think this is more about revenue than avoiding litigation. The financial incentives in our system boil down to, “do more stuff, get more revenue.” That obviously results in doing plenty of stuff.

It would be extremely tedious, time consuming and expensive, as it would require evaluating each case individually to determine if standard of care were followed.

While you can indeed find medical orgs that do pump up the procedures to pad the RVUs (and plenty of patients that insist on things they don’t need - antibiotics for viral infections has to be the most damaging overall), you’ll find the vast majority do follow SoC. Plus, there’s the push-back from insurance companies. They have very large rule sets about what is reimbursable under what presentations and resulting diagnoses.

Thanks! She’s doing well, though I can’t wait to get her back home by New Years. Freakin’ dogs are driving me crazy–they miss her too!