I, of course, think this is just dandy. I am, after all, a doctor. However, I think it's dandy because I really do believe it will lower health care costs in America.
During my morning commute the next day, they were fact-checking the speech on Morning Edition. Among the things they questioned was how much malpractice costs contribute to health care costs overall. The take-home lesson is that tort reform would save very little money. A similar argument was made a while ago in the Times, and the amount that could be saved was described as a "rounding error" because it would be so small.
I think this misses the mark. Buried in the Times piece is this exchange:
But it’s not just the cost of premiums and litigation. What about the charge that it causes doctors to practice “defensive medicine,” ordering tests that are expensive and unnecessary?A.
A 1996 study in Florida found defensive medicine costs could be as high as 5 to 7 percent. But when the same authors went back a few years later, they found that managed care had brought it down to 2.5 to 3.5 percent of the total. No one has a good handle on defensive medicine costs. Liability is supposed to change behavior, so some defensive medicine is good. Undoubtedly some of it may be unnecessary, but we don’t have a good way to separate the two. [italics in original, but emphasis added]
In other words, nobody really knows how much so-called "defensive medicine" (or "CYA medicine" -- you figure it out) really costs. Allow me to suggest that it costs a whole hell of a lot.
I defy you to find a medical provider who has never ordered tests he or she knew to be unnecessary in order to placate an anxious or irate or demanding patient or parent. This is not to say that anxious/irate/demanding health care consumers do not sometimes have real medical problems that are discovered because they pressed for further testing; medical providers are fallible, and sometimes the tests prove to be more important than initially suspected. But there are, I guarantee, innumerable instances when tests or consultations are ordered with low suspected yield, and with little or no useful outcome.
Speaking merely for myself, I try like the dickens to avoid ordering unnecessary tests, and I go to great lengths to explain why I don't think they are indicated. I try to do this in a way that addresses parents'/patients' concerns, so as to avoid making them feel ignored or dismissed. But sometimes the demand persists, and it's a hard call whether it's better to acquiesce or have a pissed-off patient.
Nowhere is there a box to check "I am ordering this to appease a demanding mother" or "This test is to cover a plausible number of obscure diagnoses, thus creating the appearance of due diligence and limiting potential liability." No provider is going to put any indication of this reasoning in the medical record. In fact, just the opposite is likely, with physicians and other practitioners making an effort to explain why they did what they did in case the chart is ever audited by insurance carriers. These costs are, and will remain, hidden.
How much of an impact would tort reform have? I have no idea. But I suspect it is much greater than any study would be able to determine a priori.