“Uniquely American tort laws” contributing to health costs

Prominent economist Uwe Reinhardt explains why health care costs are rising. Here’s how he defines defensive medicine, which is among his four identified major cost drivers:

. . . higher treatment costs triggered by our uniquely American tort laws, which in the context of medicine can lead to “defensive medicine” “” that is, the application of tests and procedures mainly as a defense against possible malpractice litigation, rather than as a clinical imperative.

I completely agree. Defensive medicine accounts to $210 billion annually in wasted health dollars, according to a PricewaterhouseCoopers analysis released earlier this year.

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  • Anonymous

    The company I work for — a toy/hobby distributor — recently held a Health Fair. An employee who reports to me won, as a door prize, a “free” heart scan at a local hospital (“a $400 value!” they said, although a nurse at the hospital admitted they only charged $90 for the procedure there).

    So yes, he gets the heart scan, but in order to understand the results he has to schedule an appt. with a doctor, who recommends a stress test, a physical, and a colonoscopy.

    Bear in mind that this man, although in his mid-50s, had no health complaints. He was just taking advantage of his “prize”.

    That’s not malpractice-related; it’s pure capitalism at work, opportunistic bait-and-switch. How much of this conduct is improperly categorized as “defensive medicine,” I wonder.

  • drneelesh

    This is soooo funny. Americans dont want to consider health care as a right for the needy. But they are comfortable giving health care as a “Prize” in a fair!! :)

    No offense, but doesn’t anyone else get the preposterous-ness of this proposition?

  • Anonymous

    Kevin, I think it's time for you to close-up your propaganda shop. Wow, Reinhard the socialist (given his nationality maybe national socialist . . ) of course will knock any individual approach to medical care.

    The POINT IS that there is no evidence that defensive medicine exists, i.e., fear of lawsuits cannot be shown to increase the number of procedures and may be indistinguishable from cautious medicine.

    For a few recent rigorous analyses of the issue, see http://www3.interscience.wiley.com/journal/117994350/abstract?CRETRY=1&SRETRY=0 (showing POSITIVE effect of fear on lawsuits on mortality) and http://www.journals.uchicago.edu/doi/abs/10.1086/587430?journalCode=jls (finding no effect of increase likelihood of being sued on likelihood to perform caesarians)

    It's times the aspiring-goebbels of medicine stop their big lies about defensive medicine and let evidence, not self-interest guide their rhetoric,

  • Anonymous

    Reinhard analysis convincingly shows that we spend “too much” for health care–but is seriously flawed in that he just takes his basic parameters as a given–they are not. GDP is not a function of natural forces but os economic system and culture. He utilizes the fact that Canada’s per person GDP is about 85% of the US without asking why.

    Is Canada’s lower economic vitality completely unrelated to the socialist attitudes and economic system that created their socialized health care system?

    Is their more extensive system of entitlements, defined primarily by their “right to healthcare”, promoting lower economic activity and passivity in it’s population?

    Is the American’s greater emphasis on personal responsibility for taking care of oneself and greater personal risks if one fails to do so the reason that we are more productive?

    Doesn’t that greater productivity more than exceed the greater health care costs? His chart shows that it does!

    Health care is a commodity, a service, not a right and is as appropriate a door prize as a new TV. People are perfectly free to live out their natural lives without health care if they don’t want to work and pay for it. A lot of them would live longer if they did. That attitude towards personal responsibility is what makes us so productive dispite all of our social liabilities (which are much greater than Canada–and still we out produce them).

    BTW, malpractice may be unfair sometimes in it’s application, but the basic notion of holding doctors personally responsible to the patient for their care is also part of that foundation of ownership of responsibility.

  • Anonymous

    I viewed, maybe too cynically, the heart scan "prize" as gimmick to "get a customer in the door." Today I opened the newspaper to find a 1/2-page, full-color ad from the Heart & Vascular Institute of another local medical clinic. Headline: "After age 40, studies show the risk of developing coronary heart disease is 49 percent for men and 32 percent for women. What's your risk?" It then promotes a ten-minute calcium scoring test/CT scan — just $99. Call your doctor for more details…

    The argument I often see here is that exhorbitant health care costs are driven by defensive testing which is driven by malpractice fears. But in at least two recent situations, I have seen our clinic actively marketing its tests to the general public. There's nothing "defensive" about it — the clinic is on the offense, pursuing profit.

    I'm not even remotely knowledgeable enough about medicine to know how valuable these tests are to good ol' Joe Sixpack. I'm just tired of seeing the blame finger always pointing at the stereoptyped litigious patient. There's a whole lot more going on here than that.

  • Anonymous

    There is no bigger canard in the health care debate than “defensive medicine.” It’s a made up term encompassing literally anything the physician discussing it wants to apply it to.

    The one good thing about universal healthcare is that physicians will no longer have anyone to blame but themselves for their predicament.

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