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Comment by Dr_tldr | Hacker News Reader

And yet, when Texas put a cap on medical malpractice awards, the cost of medical care didn't go down at all. Surely you have a good explanation for that and you're not just repeating discredited talking points for personal gain.

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Personal attacks are not allowed on HN. Your comment would be a fine one without the second sentence, which (apart from a personal attack) carries no information.

Suggesting that someone's material interests may interfere with their objectivity and cause them to pass on incorrect information uncritically is now a personal attack? This was my initial concern and it's been profoundly confirmed by subsequent dialogue.

If I'm a PHP dev and I say (without any good evidence) that all security problems come from not using PHP, contradicting me is not a personal attack. Or is it, in your world?

Talking about conflict of interest in general is fine, but making it be about one person is almost never fine. Egregious cases might be different, but to use it as a routine device in an argument is a personal attack and doesn't belong here. This is important because people on the internet are much too quick to jump to such conclusions about people they disagree with. See https://hn.algolia.com/?sort=byDate&prefix=true&page=0&dateR... if you want to read about our thinking on this; there's a lot of material there.

> contradicting me is not a personal attack.

You've moved the goalposts though. If I contradicted you by saying you were lying for personal gain, that would be.

Argh, I see your point, and I'm wrong.

Even if I think that misleading-statement A stems from personal-interest/experience/bias B, bringing B into the discussion is a form of personal attack.

That's a great way of putting it that I'm not sure I've heard before. Thanks!

You're incorrect, the cost of medical care is measurably lower as a result of tort reform in Texas. And maybe more importantly, accessibility of care has increased. You see price reflected in at least two places: 1) the variable in the formula for medicare reimbursements that reflects practice environment costs, and 2) more visibly, in Obamacare rates for the State of Texas, which would be significantly higher in the pre-2003 med mal environment.

Here's an interesting read on the financial impact of various State medical malpractice environments:

http://epmonthly.com/article/the-medical-malpractice-rundown...

http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Your first link claims that "doctors have flocked to [Texas]," but -- if physician supply is a key metric of the success of tort reform -- the evidence shows that there was no net effect on supply[1]. On the other hand, we have had high-profile if anecdotal cases, such as the Duntsch case (a neurosurgeon who left a trail of mutilated patients in his wake and was called a "sociopath" by a colleague who filed a formal complaint against him, and yet who kept his hospital privileges), in which tort reform made patient recovery effectively impossible. While there were certainly reasonable corrections to be made to the medical tort system to protect providers against inappropriate damages, the post-reform landscape appears to indemnify providers and institutions against even the most grotesque abuses of medical ethics.

[1] http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2047433

That second link is interesting since it claims that the perception of malpractice risk is overestimated among physicians since doctors are sued a fair amount (leading to a high perception of risk), rarely do they ever actually lose a case (leading to low actual costs). I don't see where it says that malpractice caps have any substantial reduction in the prices of medical care.

Further, your first link actually disputes your claim, not supports it.

> Theoretically, states that have enacted special laws to reduce unreasonable litigation (expert witness reform, case certification requirements, and medical review panels) and curb excessive rewards (damage caps) should have the most favorable environments, with physicians paying the lowest annual premiums. However, this is not always the case. The relationships between tort reform, malpractice costs, and medical liability environment favorability are complex and nonlinear.

Read the whole post (it's worth it). The part you quoted refers to states which have damage caps >$1m (versus Texas at $250k). The author writes about his own experience going from Illinois to Indiana and then Texas. My uncle was a surgeon in Texas pre and post tort reform and I saw first hand how much of a difference it made. It's anecdotal of course, but his malpractice dropped from $150k to $50k solely as a result of that law. He reaped the gains for a couple years and then reimbursements were lowered to compensate. Those lower reimbursements are used to calculate premium costs which then also benefited from the reduced med mal costs. The emergency physician correctly points out that med mal functions largely as a transfer of wealth from people with health insurance (which is now, in theory, everyone) to trial attorneys. Lastly I'd point out, again from my uncle's experience, that being sued is an extremely stressful experience even if the eventual financial outcome isn't very impactful. I couldn't relate to it until I went through the same experience myself.

Neither link you posted corresponds to your claim about a drop in costs, and this report also contradicts what you're saying: http://www.citizen.org/documents/Texas_Liability_Limits.pdf

Do you have any other sources for your belief?

Whoa, calm down now. No need to resort to an ad hominem and speculate on someone's personal motivations.

I don't really see it as pure ad hominem; it's a demonstrable fact that malpractice insurance rates are not tied to malpractice award amounts, and that capping malpractice awards does not rein in the absurd ballooning of malpractice rates.

Malpractice insurance rates are not tied to malpractice award amounts? Unless rates were fixed by law and financially guaranteed by the Government, how on earth would that even be possible. Are you just a troll?

Malpractice awards tend to grow at a rate slightly higher than inflation. Malpractice insurance premiums, however, grow at a far higher -- sometimes double-digit -- rate, and do so even when malpractice judgments are capped by law.

If the premiums were simply rising because of the amount of money given in a malpractice judgment, we would not see that. Therefore, malpractice premiums are not -- in any meaningful sense -- tied to malpractice award amounts. Typically, the gigantic spikes in premiums seen over the past couple of decades are attributed to other factors in the insurance industry, including the need to make up for investment losses and for losses from other sectors of insurance (i.e., market crashes + 9/11 were not kind to insurers).

Do you realize that many hospitals and surgical specialties self-insure themselves? e.g. large groups of orthopods and neurosurgeons will get together and form a co-op with a few attorneys and operate as a self-insurance vehicle, because they are able to gauge risks better than others. Premiums and judgments are way more connected than you are implying.

Premiums and judgments are way more connected than you are implying.

There is a belief on the part of many people that massive, bank-breaking, out-of-control, $BIGNUM malpractice judgments are common and that this is the reason why premiums have skyrocketed.

This belief is not borne out by the facts, which are that malpractice awards increase, on average, about 3% more than inflation, and that even in states with "here's a nickel, sorry we killed your spouse"-type caps on judgments the premiums have continued to rise far out of proportion to the amounts of the judgments.

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