Sunday, January 09, 2005

What I'm Reading 

Competition of Rules
This article argues against doing something about tort reform at the Federal level, and I absolutely agree.

Hayek for the 21st Century
Great interview with one of Friedrich Hayek's biographers.


Malpractice vs. "Malresult"
Keeping this entry entirely devoted to Reason articles, they just published another article dealing with the tort reform issue. I'll have to think for a while about what exactly I think about this, but I like his recognition of the difference between malpractice due to doctor negligence and bad outcomes that are out of any doctor's control.

I've also read a figure that said medical malpractice raises costs by only 1%: that doesn't sound like a crisis to me.

Excellent point about states versus the federal level: adjusting tort is just one solution to the problem, after all, and it's more a pound of cure instead of an ounce of prevention. I'd like to see some more states try Massachusetts's plan: if three malpractice payments are made by a doctor, he or she will be investigated and formally reviewed. The figure was that only 0.25% of all MA doctors accounted for 13% of all malpractice payments. (Read more here.)

I think the medical association, and not just the states, should address the problem too: they gotta kick out of the medical association their worst, instead of protecting them.
Macneil, I suspect this is one of those cases where the two sides are talking past each other. No one who wants tort reform is trying to protect crappy doctors who really make serious medical errors and don't deserve to be practicing (actual malpractice). I think that they are talking about something different (I know I am).

The problem is more like the very expansive notion of what malpractice is, and how that can affect the decisions doctors make. Juries are notorious for siding with sympathetic defendants, and often don't distinguish between what is the doctor's fault, and a bad result that is out of the doctor's hands. When this leads to large jury rewards, it causes everyone's malpractice insurance premiums to go up, not just the crappy doctors'. Furthermore, it can lower the quality of healthcare, by scaring doctors into performing medically unnecessary tests.

For example, a patient under 40 who developed glaucoma sued her doctor for not giving a screening test in 1974, even though professional custom was to only screen people over 40 (due to the exceptionally low glaucoma risk to those under 40). The test was cheap and accurate, but it does come with risks of its own; when I took Law and Economics, we calculated that screening only those over 40 was actually more efficient from a cost/benefit angle. Yet in an informal survey, many students in my class had had glaucoma tests at some point. The case is Helling v. Carey.

Another article about how fear of lawsuits can affect the quality of medical care is here: http://www.slate.com/id/2111499 I guess you could read that and think you'd rather go with the policy doctors are following because of their fear of lawsuits. I personally think that I'd prefer to do what the doctors would recommend if they weren't afraid of getting sued.

In any case, I don't know what your uncited number comes from, and if it's taking all that into account. I do know that you can usually phrase things of that nature so that it sounds small. After all, our current deficit is only 4 percent of GDP. Doesn't sound like a crisis to me. I'm not sure what is a good level of senseless waste, in any case.
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