Posted by Bill Sandweg on 20 February 2017.
In a bid to gain support for limitations on medical malpractice cases, we have been promised savings in the order of “hundreds of billions of dollars” by those promoting limitations. These savings would come in two forms. In the first place, there would be fewer malpractice cases and their costs would not be passed on to the public in the form of doctor and hospital charges for health care. Since there aren’t that many cases to start with and since all of them put together contribute less than 1% of the amount spent on health care in this country, the big savings must be coming from somewhere else. We are told that somewhere else is “defensive medicine.”
“Defensive medicine” is the term doctors use to describe tests they order for you that they would not order if they were not afraid that you might sue them if they didn’t. In the first place, what is a necessary test and what is an unnecessary test is a difficult distinction to draw. If I am sick and there is a test that can reasonably determine why I am sick, I want that test, even if some doctor thinks it might be unnecessary. Very few medical tests are so clearly unnecessary that everyone would agree they need not be ordered.
Second, medical ethics prohibit a doctor from ordering a test for you that you do not need. The doctor is supposed to order tests for your benefit and not for his. To practice “defensive medicine” by ordering a test a patient does not need and to do so for the benefit of the doctor alone is unethical. I promise that you will not find a single doctor who will admit to unethically ordering tests for his own benefit that he does not believe his patient needs.
In the third place, we have the pernicious influence of “fee for service.” I have written on a number of occasions about the problems with fee for service. See posts here and here and here. Doctors get paid to order and interpret tests, whether the tests are medically necessary or not. Promises of savings of “hundreds of billions of dollars” are based upon the premise that doctors are ordering hundreds of billions of dollars of unnecessary tests. While it is unlikely that even greedy doctors who have no regard for their patients are ordering unnecessary tests in such staggering amounts, it is equally unlikely that by limiting medical malpractice claims doctors are going to give up that kind of revenue, just because they think it less likely you will sue.
The human condition is such that we can be fairly certain that testing will not change much, even if medical malpractice claims are drastically limited. There probably weren’t that many unnecessary tests to start with and doctors are not going to cut their income to the tune of “hundreds of billions of dollars” by doing less work just because they are less likely to be sued. Don’t be a sucker. Don’t buy what the snake oil salesmen in Congress are selling when they promise you “hundreds of billions of dollars” of savings.