On February 25th, 2010 at 3:58 pm, chapoutier said:

Doing some quick math, the metro areas in the article represent almost 60% of the entire population of Texas. So suffice to say, even if the reduction in number of suits were significantly lower in the rest of the state, overall it would still be an impressive number statewide.

Sorry, I didn’t notice the link.

Yes, I don’t think a 50% drop is enough. But I think that even a 50% drop in filings will help cut costs over time.

I provided a link showing four of Texas’s largest population areas in terms of population showed a 50% drop.

Doing some quick math, the metro areas in the article represent almost 60% of the entire population of Texas. So suffice to say, even if the reduction in number of suits were significantly lower in the rest of the state, overall it would still be an impressive number statewide.

How often is the key. Do you have data for Texas other than that one county?

I provided a link showing four of Texas’s largest population areas in terms of population showed a 50% drop. I can’t imagine why any other part of the state would show a dramatically different rate.

I don’t think “pretty soon” is accurate. I think there’s still quite a bit of room.

You think over half of all med mal claims are junk? And I am not talking about cases where there is a legitimate question of whether or not there may have been malpractice, but the doctor is ultimately exonerated. I think you would agree that someone can sincerely and legitimately believe they have a claim, but ultimately lose.

On February 25th, 2010 at 2:45 pm, chapoutier said:

The threat of lawsuit is twofold. How often and how much.

How often is the key. Do you have data for Texas other than that one county?

Because pretty soon you are talking about eliminating entirely legitimate claims.

I don’t think “pretty soon” is accurate. I think there’s still quite a bit of room.

If defensive medicine is caused by the threat of a lawsuit (even a dismissible lawsuit – regardless of the potential damage award) then the threat of a lawsuit needs to be reduced in order to reduce the cost of defensive medicine.

The threat of lawsuit is twofold. How often and how much. If you think there is a significant difference between the reduction of one as opposed to the other, fine, I won’t argue. Because regardless, both parts of the equation have been significantly affected by tort reform in Texas. Here is another source saying that claims have been reduced by half.

By half. And I have seen studies estimating the reduction in payouts ranges from 27% to 67% (let’s go with the 27%)

Half the claims and at least a quarter of the monetary liability. And yet Texas went from ranking 33rd in the country in 2002 in terms of insurance premiums costs to ranking…33rd in 2008, five years later and well after the effects of reform had taken hold.

I am just wondering what numbers you think we’ll need to hit before we see tort reform significantly reflecting health reform. Because pretty soon you are talking about eliminating entirely legitimate claims.

On February 25th, 2010 at 12:15 pm, chapoutier said:

Whether or not you go by it with respect to reduction in overall lawsuits or reduction in payouts for suits that are brought, the end result is the same, no?

No. That’s like saying that any reduction of prostalglandins is the same end result as reducing pain.

If defensive medicine is caused by the threat of a lawsuit (even a dismissible lawsuit – regardless of the potential damage award) then the threat of a lawsuit needs to be reduced in order to reduce the cost of defensive medicine.

Overall, I think you’ve given up on legal reforms too quickly.

Btw, have you done any analysis of removing state specific regulations for health insurance? What do you think? Any cost savings there?

No. That is a bit too much “in the weeds” for me. I assume you are referring to doing this so that you can open up interstate competition. I’ve no doubt costs would be at least somewhat controlled if someone in Rhode Island had more of a choice than between United and Blue Cross.

You just admitted that you don’t have any data regarding a drop in lawsuits. You only have data regarding healthcare costs.

No. I also have data showing significant reductions in overall jury awards. Whether or not you go by it with respect to reduction in overall lawsuits or reduction in payouts for suits that are brought, the end result is the same, no? An overall reduction in the risk (in monetary terms) a doctor faces.

But in any case, just quickly checking The Google, I found that in the year after tort reform was passed in Texas, lawsuits in Harris County (i.e., Houston) dropped by well over half.

Malpractice lawsuits in Harris County have dropped to about half of what they were in 2001 and 2002. There were 204 cases filed in 2004, compared with 441 in 2001 and 550 in 2002. There were 1,154 lawsuits filed in 2003, attributed to attorneys trying to file before the new law took effect (Houston Chronicle, 5/17/05).

So my point remains that Texas say a profound reduction in med mal costs (both in terms of direct payouts) and in terms of malpractice insurance premiums. And no corresponding effect on health care premiums. Admittedly, looking at premium costs is a bit of a blunt tool. I would much rather see some data on direct heath care costs incurred. But 1) premiums are the cost most people are most directly affected by; and 2) if we are to believe the insurance companies, there should be a direct relationship between the two.

If it is the case that tort reform significantly reduced the rate of health care spending in Texas while at the same time premiums rose by almost 100% in a decade, then I will become the biggest champion of severe tort reform there is so long as the right doesn’t complain about equally severe restrictions on the obviously predatory and disingenuous private health companies.

On February 24th, 2010 at 12:05 pm, chapoutier said:

Advil works by impairing the production prostalglandins . . . Even with a small dose of advil, you can measure a drop in prostalglandins.

Maybe or maybe not. An adequate dose is need to trigger mechanisms.

But in order to gauge a drop in prostalglandins one would need to collect data on prostalglandins levels.

You just admitted that you don’t have any data regarding a drop in lawsuits. You only have data regarding healthcare costs. That’s the same only collecting data on Advi’s effectiveness to reduce pain.

So, again, you don’t know enough to make this determination.

I certainly support relatively radical reform.

I believe you do, and I believe you truly don’t think it will reduce healthcare costs.

I appreciate your sincerity, but I do think there’s a good chance to reduce healthcare costs via legal reform. However, I don’t believe it’s the silver bullet some might believe it is. Your points about doctor incentives are germane.

Btw, have you done any analysis of removing state specific regulations for health insurance? What do you think? Any cost savings there?

Ten reasons why America’s health care system is in better condition than you might suppose.
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Just so it isn’t lost in the discussion of whether or not I think –any– tort reform is effective in controlling costs, I certainly support relatively radical reform.

Regardless of whether it would save a single penny on health care costs, there are intrinsic reasons why doctors should not work in constant fear of being second guessed by a 23 year old high school drop out on a jury, or be saddled with really expensive malpractice insurance.

As I said, I think we need special courts preferably paneled and judged by doctors, and knowledgeable lay people to make determinations of medical liability. The average person is not intellectually or emotionally capable of consistently knowing the difference between malpractice and an unfortunate result.

At the least, I would propose a panel that would automatically review any med mal case for threshold levels of evidence before it was sent on to our normal court system.

Caps, however, are wrong. They affect those who are most injured and aggrieved. Sometimes a doctor or hospital does deserve to pay through the nose. Look at Rhode Island Hospital, which performed surgery on the wrong side of the brain THREE times. In one year.

The mechanism of action is obvious.

No, it really is not.

What evidence? The only evidence you provide is that weak reform hasn’t been a great solution.

It’s inappropriate for you to extrapolate your evidence to apply to stronger reforms.

That’s the same as claiming Advil can’t relieve pain simply because a quarter tablet hasn’t demonstrated effectiveness. Try taking two tablets and see what happens.

My initial reaction is that what you are proposing vis a vis what current tort reform measures are on the table is akin to comparing a quarter tablet of advil to fentanyl.

But, I’ll go with it….okay. Advil works by impairing the production prostalglandins, which are the cause of pain and inflammation. The causal connection between prostalglandins leads to inflammation leads to headache is firmly established. Even with a small dose of advil, you can measure a drop in prostalglandins. It may not be enough to stop the swelling and thus kill the headache, but it is at least working.

A better analogy to your two advil solution is that you are pushing Pill X, which has never been proven to cure headaches. When the patient complains that he is still hurting, rather than investigating whether Pill X actually reduces prostalglandins, you admonish him for only taking a quarter tablet instead of 2.

We have in the US dozens of states with varying levels of tort reform. Some levels are so weak as to be almost useless. Some are quite strong in the sense that they have had a real significant impact on malpractice payouts. None have shown to be effective in reducing health care costs significantly. I suppose that, rather than an inverse relationship between risk and defensive medicine, it is possible there is some quantum level of tort reform that will suddenly open the flood gates, so to speak. But reaching that level is certainly not without its own inherent cost, and certainly pretty risky when we don’t even know if it will ultimately have the desired effect.

That’s fine, but don’t claim that you can back that opinion up with data. More effective reforms can still be tried and might be successful.

I guess that depends on one’s definition of “tort reform.” There is plenty of evidence that tort reform, as is currently being understood and debated, is ineffective. If you are talking about something more radical, like a special court, then I am not aware of any relevant data because it hasn’t been tried out in the US. But, in my opinion, if so called “defensive medicine” is a significant factor in health care costs, there are still several issues that are still present, no matter what particular form tort reform takes:

1) it is difficult to say, except in hindsight, whether a particular test or procedure or prescription is truly unnecessary, except in hindsight. If a doctor is ordering a test that he absolutely KNOWS is unnecessary because it has no chance of revealing anything of significance, then he is committing malpractice. But how often is that truly the case? Far more often the doc is pretty sure he knows that headache is just a headache, but can’t beyond all certainty, rule out a tumor. So…out comes the MRI machine. Of course, that test was unnecessary for the 99.99% of folks that will come back clean, but it certainly was not for the other .01%, and none of it is known until after the fact. If you want to promote a culture where people simply have to be more accepting that the outliers may not get caught as often, that is fine (and I would probably agree), but that is a cultural issue with Americans who insist on the best and most, no matter what the cost.

2) ordering these tests, procedures, or scrips is, at best, cost free to a doctor. And in fact he often will have financial gain (through self referral practices, which are becoming more and more common). When there is zero cost, and even the tiniest bit of potential reward for an action, who in their right mind would NOT do it? Are you expecting doctors to voluntarily stop acting rationally in their own self interest? Even removing all liability, a doctor, assuming he cares about professional reputation, would have incentive to order “unnecessary” tests for no other reason than he would probably prefer his patients not die, even if the chance of them doing so is small.