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Think Tank: Medical malpractice, China and the hot new place for poverty

1) According to the Brookings Institution, poverty is rising fastest in the suburbs.

2) The three faces of work-family conflict in America: the poor, the professionals and the missing middle.

3) Medical malpractice costs and the associated increase in defensive medicine do not appear to be driving premium costs, changes in the physician workforce, or the treatments doctors prescribe.

4) Where, oh where, has the estate tax gone?

5) Harvard economist Dani Rodrik doesn't believe that re-balancing the Chinese currency will solve our global trade imbalances.

By Ezra Klein  |  January 25, 2010; 12:00 PM ET
Categories:  Think Tank  
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Hey, Ezra

I hope you'll read this sob story on TPM. It's well worth the read as it is powerful. (

Posted by: moronjim | January 25, 2010 12:47 PM | Report abuse

"Third, we find evidence that the strongest effect of greater malpractice pressure is in increased use of imaging services..."

It's as if, while looking for a smoking gun, they found this gem instead. But that IS the smoking gun!

We have a medical culture of thoroughness. Protocols dictate when doctors must image -- skip the imaging, and a doctor's on the hook for a lawsuit. Then another doctor reads the images -- overlook anything in the imaging, and then that doctor will be on the hook for a lawsuit.

It's not that we can't afford all the imaging or all the tests that our current medical culture calls for -- but we can't all afford insurance that guarantees these tests. Many of us can -- and they should be able to get them as part of their coverage.

But it should also be legal to sell insurance that does not guarantee certain tests, and without exposing doctors or insurers to risk. It should be legal for those who cannot afford such insurance to get affordable coverage and then take their own chances on some unlikely diagnoses.

I'm not saying that some "Complete Lives System" needs to ration this care to the mainstream, thereby saving some government health scheme money on "unnecessary" treatment. But the poor (and anyone with their own lifestyle priorities) ought to be able to skip the same "unnecessary" procedures if it saves them money.

People who cannot afford comprehensive insurance should be permitted to assume certain risks on their own in order to protect affordable services from doctors and insurers.

Posted by: cpurick | January 25, 2010 12:59 PM | Report abuse

I don't think you read the article Ezra. It doesn't come to the conclusion that you say it does. We already knew that malpractice premiums don't influence costs. These authors seem to be citing an older paper from Kessler and McClellan (aka Scotty's brother) about increased use of imaging. They estimate that 5% of medical spending is defensive medicine. That seems to me like a pretty significant amount, especially given that you think that doctors are "overpaid" when physician compensation is only 10% of medical spending.

Posted by: J_Bean | January 25, 2010 3:16 PM | Report abuse

Ezra, did you even skim Rodrik's paper? Your description of it is completely wrong - he expressly advocates letting the renminbi appreciate and eliminating China's trade surplus.

Ezra: "Harvard economist Dani Rodrik doesn't believe that re-balancing the Chinese currency will solve our global trade imbalances."

Rodrik: "So there is a simple solution. It is possible to let the renminbi appreciate, and hence eliminate the trade surplus, as long as complementary policies are put in place to support modern tradables more directly. Such policies, combined with macroeconomic policies targeted at the current account, can achieve both external balance and structural change in favor of modern tradables."

And that was from page 2!

Posted by: alex50 | January 25, 2010 4:01 PM | Report abuse

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