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Comment by Newgy | Hacker News Reader

A major driver of U.S. costs that isn't discussed in the article is our parasite lawyer class, who drive up the cost of insurance for doctors and lead to widespread over-testing or "defensive medicine". Few Americans are proud of our litigious society.

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Regarding the so-called "parasite lawyer class", you might be interested in reading "Blocking the Courthouse Door: How the Republican Party and Its Corporate Allies Are Taking Away Your Right to Sue"[1]

From a Booklist review of the book:

  By demonizing trial attorneys and exaggerating high-profile litigation
  awards -- the famous McDonald's hot-coffee case -- campaigns for limiting
  damage awards threaten to jeopardize the American right to civil jury
  trials guaranteed by the Bill of Rights. Investigative reporter Mencimer
  examines the Republican campaigns for tort reform that would protect
  large corporations from "frivolous lawsuits." The campaigns carry the
  dual benefit of supporting the interests of corporations that are major
  Republican campaign contributors and hurting trial lawyers, who are part
  of the contribution base of Democrats. Mencimer criticizes the media for
  their lack of understanding about civil litigation, willingness to
  swallow reports of litigation abuses, and failure to understand that
  Republican tort reform will also limit the ability of news organizations
  to sue for information. Drawing on national data and scrutiny of
  individual cases, Mencimer defends the civil justice system and its
  reliance on jurors, average citizens who are the same people who vote.
  This is an eye-opening look at an important issue for readers concerned
  with the civil justice system.

also, "The Lawyer Myth: A Defense of the American Legal Profession"[2]

From the Booklist review:

  However disliked lawyers have become, they have played an essential role
  in the development of the American democracy, assert legal scholars
  Strickland and Read. Taking aim at media critics -- left and right -- who
  blame lawyers for a host of social ills, Strickland and Read debunk
  several popular myths about lawyers. They begin with the notion that
  there are too many lawyers and lawsuits, citing statistics to put things
  into perspective, and they point to the benefits that have come from
  lawsuits, including increased consumer protection from faulty products.
  But they concede the need for reform in a chapter that calls for major
  research into alternative legal mechanisms. Finally, Strickland and Read
  look toward the next generation of lawyers and outline the
  characteristics most essential for the practice of law: competency,
  responsiveness, and integrity. They emphasize that it’s not what lawyers
  bring to the law but what they give that makes a difference. This book
  is not likely to stop lawyer jokes, but it is an insightful look at a
  much-maligned profession.

[1] - http://www.amazon.com/Blocking-Courthouse-Door-Republican-Co...

[2] - http://www.amazon.com/The-Lawyer-Myth-American-Profession/dp...

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.

I am a physician, and I teach in a medical school. Although they are 2% of total costs, they drive up the cost in unnecessary procedures that patients demand without medical indication. Those $1080 MRIs are often ordered to avoid a lawsuit. That adds up to a lot more than 2%.

My dad is a surgeon, so that's my appeal to authority and anecdote. In my country litigation isn't a problem, but unnecessary treatment is. People go doctor shopping to find one that gives them the treatment they want. Same problem, different cause.

You aren't French are you? I seem to remember that being considered a big issue with the French medical care system.

I'm a doc based in the UK. I know that we order fewer useless investigations than you do in the US. Thankfully we don't have a litigation heavy medical culture yet. Although, I think it's slowly heading that way.

As I understand it now, doctors have largely invested in testing companies. When they (not all doctors obviously) - I probably thinking primary doctors - order tests the test is a money maker for the doctor.

Wouldn't a calculation of the effect of litigation include the scenario you mentioned? Otherwise it would seem to be a bad calculation. Do you have any studies that show how often a test is ordered simply to avoid a lawsuit?

Even if many testing companies are owned by doctors, the overwhelming majority have no stake in one.

Citations re: excess testing:

http://www.ncbi.nlm.nih.gov/pubmed/15928282 http://www.ncbi.nlm.nih.gov/pubmed/10136689

I only read the abstracts, so correct me if I'm wrong, but both of those links fail to compare the US with other countries. I.e they don't show that costs in America are higher than other countries due to defensive medicine. It could be that all countries have higher costs due to defensive medicine, we wouldn't know from these studies.

The second link hardly endorses your view. It says

Although our estimates delineate a wide range of potential savings, systemwide savings from aggressive malpractice reform could approach $41 billion over five years.

According to one source [1] the U.S. spent $2.6 trillion in health care in 2010. An $8 - $9 billion dollar savings per year from eliminating defensive medicine hardly adds up to "a lot more than 2%".

[1] http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/...

I agree that the second link is saying more about the effects from malpractice reform. I have seen the Kaiser study, and what I think they are not taking into account is the culture of defensive medicine that may physicians don't even think about. For example, an MRI is more likely in a US Emergency Room than in a UK Emergency Room. UK practice is (in general) evidence based, and they won't order it unless it makes sense to do so. May US physicians would not identify this as "defensive" because the practice is so widespread, although the root reason for ordering it stems from that cause. I am not aware of an analysis that takes this into account.

Yeah but 2% of a very high cost is higher than it would be if the cost is lower (obviously). Of course you won't cut the costs much by targeting those 2% at first, but if you ever get to reasonable prices those 2% would transform in 7% and 7% is starting to be notable.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there.

The cost to avoid lawsuits adds up with a lot of tests that are not needed. Doctors end up doing whole batteries of tests on everyone to avoid the 1:1000 or higher chance that the person in their office with a headache really had an aneurysm and get the doctor sued for negligence when he sends them home.

Another side effect of all these tests is that many are extremely dangerous. CT scans in particular are ordered way too often and can does people with levels of radiation that lead to problems later in life.

Do you have data to backup these claims?

I have anecdotal evidence to back up these claims: my mother is in internal medicine and my father is a surgeon. both have practiced defensive medicine and my father has complained about how common an occurrence it is on a regular basis.

Many tests, drugs and treatments have been applied in the name of defensive medicine.

The followup question is, how much defensive medicine is necessary? If there's a 5% drop in that practice then do the costs from lawsuits go up to compensate? Are we at an equilibrium point, or are doctors doing defensive medicine because the myth of the power of a lawsuit is so strong?

I believe there to be a more concrete cause of US healthcare costs: collusion between insurance companies and healthcare providers. "Insurance" includes both health insurance and malpractice insurance, as well as "providers" being hospitals/doctors and manufacturers of equipment and drugs.

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