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Comment by hardcandy | Hacker News Reader

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

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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?

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