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Comment by danielweber | Hacker News Reader

Richard Thaler just had this op-ed in the NYT on ways to reduce costs, talking some about tort reform: http://www.nytimes.com/2013/02/24/business/overcoming-obstac...;

I'm skeptical about tort reform as a panacea. However, lawsuits are incredibly expensive, and so doctors take steps that we would otherwise call economically unreasonable to avoid them.

The amount of tort reform I think is really necessary is whatever would allow me to set up a private equivalent to the UK's NHS here. If someone thinks they are getting denied care that they deserve to have, the decision needs to be very cheap to adjudicate.

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Yes. Malpractice insurance isn't super costly, but knowing many doctors (my father was a doctor as well), the adversarial relationship that malpractice suits sets up is a heavy burden. We know that overtreatment is a huge source of the cost overages we have in the US relative to other countries with the same health outcomes, and malpractice threats are a significant contributor to that, although it is obviously very hard to measure.

Personally, I think there could be some advantages in making a more patient-responsible system. The most expensive healthcare we have is ongoing (chronic) stuff, and most people with issues like that end up being experts on their own conditions. Why not allow them to get their own medicine and equipment directly rather than be forced to visit the doctor every N weeks to refill a prescription? Or be severely inconvenienced by being somewhere where it is difficult to obtain the right prescription for the medication they know, any sensible person knows, they need? That's silly and inefficient.

It's not a panacea. It's a part of the very complicated system that is providing and paying for healthcare. How important are insurance premiums relative to other factors? It depends. But there are costs to having uncapped settlements, and lack of tort reform.

Also, insurance premiums effect practices of different sizes differently. I personally think you can attribute the shift away from smaller private practice groups towards larger groups and hospitals are for other reasons. Insurance premiums are somewhat to blame, but I think the bigger driver is that many of the government mandates are too expensive (n.b. this doesn't mean it shouldn't be done) to take on for most smaller private practice groups.

I'm not sure how to respond to your comment about tort form if it get's us to an NHS like system, because I disagree that's the best way forward. But that's a topic for another day.

Most opposition to tort reform comes from the left, and fans of European-style health care also come from the left, so saying that we couldn't set up a European style because of the legal climate is intended to cause cognitive dissonance.

(I'm not advocating putting everyone into a government system run NHS-style system. Surely, though, me and a few thousand of my friends ought to be able to get together and attempt to emulate it if we wish.)

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