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Health Care BS pointed out (“Medical Malpractice Caps Work“) that the New York Times has, in at least one case, not published any. Instead, they published a story about Texas medmal situation after tort reform. While there is debate over how much of the new increase in doctor immigration into the state is due to the tort reform, there seems to be a (reluctant in some cases) consensus that it is at least in part responsible and that the increase is long-term, not simply a “spike.”
I couldn’t get the HCBS link to work, but I found the NY Times article through the google news search. Here it is: “More Doctors in Texas After Malpractice Caps.” I have read about Texas before but one detail I had somehow missed and/or forgotten was that the caps were put in place through a state constitutional amendment. I think that is important to understand the dramatic result: there is little or no fear that the law will be thrown out by a judge. Other states have implemented tort reform through the legislature. While the worsening of the situation has slowed down or stop, those states haven’t always seen the dramatic decrease in the medical malpractice insurance rates or some other obvious improvement. This is probably because people are still living in fear that the caps won’t be allowed to cap anything.
This just in: As I’m writing this I notice that the Wall Street Journal’s Health Blog just posted a piece, “After Texas Caps Malpractice, Doctors Move In.”
I recently covered a previous entry by Rangelmd.com on defensive medicine, and he has posted another one that is really good. I think this is especially relevant in light of the opposition to tort reform that I quoted yesterday. Keep it in mind: “To take away the incentive to make it [medicine] safer is the wrong way to go.”
But who is safer getting unnecessary treatments? Read the story and ask if the high pressure of medical malpractice liability is really doing anything for patients beside raising the price of medicine.
The practice of emergency medicine (among other high risk specialties) has become so regimented and infused with defensive medicine tactics that many ER docs are not even aware of how this has changed the way they think. It seemed as if this ER physician could not fathom the concept that we would send home a patient who could easily have just had a heart attack despite the fact that we were going to do absolutely nothing different for her then if she went home. Even though the possibility of litigation in this case was remote it was the constant and overall threat of litigation that has fundamentally changed the thinking of physicians and how they practice medicine.
This change in thinking has had significant consequences. Ever wonder why we spend so much on medical care? Part of the answer lies in this example. This ER doc was about to turn an $800 ER visit into a $4,000 hospital admission. Now imagine this happening all over the country in multiple variations and degrees of absurdity tens of thousands of times EVERY DAY.
Of course, tort reform doesn’t deny people compensation for real harm. But the idea that unreformed fear of unlimited medmal liability is really motivating any improvement in medicine sounds farfetched. It simply doesn’t match the evidence.
