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Can't judge a policy by its price tag

This argument from Charles Krauthammer is really very weird:

The final act was carefully choreographed. The rollout began a week earlier with a couple of shows of bipartisanship: a Feb. 25 Blair House "summit" with Republicans, followed five days later with a few concessions tossed the Republicans' way.

Show is the operative noun. Among the few Republican suggestions President Obama pretended to incorporate was tort reform. What did he suggest to address the plague of defensive medicine that a Massachusetts Medical Society study showed leads to about 25 percent of doctor referrals, tests and procedures being done for no medical reason? A few ridiculously insignificant demonstration projects amounting to one-half of one-hundredth of 1 percent of the cost of his health-care bill.

Reasonable people can disagree with whether state-run demonstration projects are the best way to figure out an effective medical malpractice system (they can also disagree with Krauthammer's number, which is eye-poppingly high, and bears no relationship to the demonstrated gains from tort reform. Many states have imposed harsh tort reforms and their medical system is barely any different. Texas is one of those states, yet McAllen is the national poster child for unnecessary care).

But whatever tort reform you attempt, it's not going to be expensive. Tort reform is a series of regulations that change the way lawsuits are handled. Saying that the experiments come to only "one-half of one-hundredth of 1 percent of the cost of his health-care bill" is saying exactly nothing about them. If they made all malpractice lawsuits illegal, they'd actually have a negative cost to the federal government, but by Krauthammer's logic, they'd be a total slap in the face to reform advocates.

By Ezra Klein  |  March 5, 2010; 5:47 PM ET
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I guess that your colleague is being deceptive as usual.

Look at the sentence "What did he suggest to address the plague of defensive medicine that a Massachusetts Medical Society study showed leads to about 25 percent of doctor referrals, tests and procedures being done for no medical reason."

There are two interpretations of that sentence. One is that he claimed that the Massachusetts Medical Society demonstrated that all (100%, 13 out of 13, 17 out of 17) un-necessary referals, tests and procedures are due to defensive medicine.

This can't possibly have been shown. Also it is not conceivable.

Or did he just claim that 25% of referals etc were shown to be un-necessary and asserted that defensive medicine has something to do with that. That without defensive medicine it would be maybe 24%.

Or, for that matter, maybe 26%. It could be the effect of fear of malpractice suits is that there are fewer un-necessary procedures because some doctors are afraid of being sued when un-necessary procedures have adverse consequences. I mean defensive procedures ? How many physicians have been sued for not performing a procedure ?

Doesn't the similarity of the estimates for referals and tests on the one hand and procedures on the other provide near proof that fear of malpractice suits is not a major factor ?

So what does he assert is the fraction of procedures that are -necessary procedures caused by defensive medicine ? It could be 25% or 1% or -1%. You consider the number 25% definitely an estimate of the effect of defensive medicine. I think you fell for his trick.

I just re-read my opening sentence and I wish to retract the claim. I can't be confident it is true. I said he is usually deceptive. That implies that I can think of an honest argument made by Charles Krauthammer. None comes to mind, so I can't rule out the possibility that he is always deceptive. I apologize for my careless wording, which is inexcusable in a comment which contains the numbers 100% etc. I couldn't swear that I know that Krauthammer is deceptive less than 100% of the time.

Posted by: rjw88 | March 5, 2010 7:30 PM | Report abuse

Yeah, let's ignore the actual results of tort reform. And ignore the fact that doctors get *paid more* to *do more.*

Must be nice working with such fine, upstanding individuals.

Posted by: AZProgressive | March 5, 2010 7:36 PM | Report abuse

This Krauthammer person doesn't sound very smart, or very honest for that matter. It's hard to imagine that any respectable newspaper would publish what he writes. Where did you find this stuff?

Posted by: eb53 | March 5, 2010 7:58 PM | Report abuse

In the Mass Med Society poll they just asked doctors how much they think they spent on defensive medicine. That is bound to produce an overinflated figure, and 25% is much higher than what most other studies have shown. I seem to recall that if you actually look at the expenditures, the actual amount is about 0.5-1.0%.

And states that have put a limit on malpractice settlements have not seen a major drop in health care expenditures.

Ironically, a national health care system might be far better for tort reform than what the Republicans are proposing. First, national care standards could be established and doctors could practice medicine without worry of frivolous lawsuits and patients could be assured that physicians meet standards. Second, if people knew they were guaranteed care if there were a poor outcome, they may not feel a need to sue for large amounts of money, or sue at all in the first place.

Posted by: rlplant | March 5, 2010 8:36 PM | Report abuse

eb53, i was planning on coming up with something clever but then i read your 7:58 - brilliant!

and rlplant, you remind me of all the people who think that foreign aid is why the budget isn't balanced....

Posted by: howard16 | March 6, 2010 12:48 AM | Report abuse

Trial Lawyers suck out almost exactly as much money from USA's healthcare system as Shareholders in Private Insurance Companies do!

This is a FACT Democrats always choose to ignore!

Posted by: FastEddieO007 | March 6, 2010 9:23 AM | Report abuse

My comment only about Paul Krugman mistakes.
He took mistakes of scientists, who advised Al Gore as true things and create mathematical model, which confirm that mathematic is good only is suggestions are good. "Put garbage in model and you will receive garbage".
Dear Mr. Krugman and Ezra Klein:
Of course GHG are reasons to heat the atmosphere, but properties of water actually cool the air, despite water vapor is also greenhouse gas. "Economy and climate change or KGB agent"

Posted by: mioffe | March 6, 2010 1:24 PM | Report abuse

Charles Krauthammer is a very smart guy who understands exactly the misrepresentations of the Obama administration. He knows America is screwed if Obama maintains his "progressive" agenda! None of us have healthcare as a right....we must earn and pay for our healthcare! The CBO reports that Obama's budget deficits in the next 10 years will be almost $10 TRILLION! Wake can't be stupid enough to drink this kool-aid!


Posted by: my4653 | March 6, 2010 6:14 PM | Report abuse

The article about McAllen is most illuminating in that it exposes the complete failure of a government run healthcare system to address the problem of overutilization. It would be interesting to see if McAllen is equally expensive for private insurers.

Posted by: bgmma50 | March 6, 2010 7:25 PM | Report abuse

Krauthammer has obviously stung the trial bar with the truth-you can tell by the vitriolic and personal attacks they resort to when exposed. Yes, we need a trial bar, but we need to put a medical review panel and arbitration process inplace before a lawsuit can go forward. Of course, the trial bar will fight that furiously and with significant lobbying dollars and any suggestion that a "loser pays" rule would reduce frivilous lawsuits and cut medical costs due to defensive medicine by 20%. The trial bar owns the Democrats and some Republicans will bow to the mighty political $'s as well. The walking around public stands no chance in that fight.

Posted by: mrtro | March 7, 2010 3:45 PM | Report abuse

Texas instituted very severe tort reform in 2003. At that time, it ranked 33rd in health care insurance premium costs.

7 years later, and tort reform has really, really worked. Lawsuits are down by about 50% and total malpractice payouts (both settlements and jury awards) are down at least 25%.

And guess where Texas ranks now in health care insurance premium costs?

33rd!!! Just once, when someone like McCain is rattling off all the statistics about how since tort reform, there are more doctors, lower malpractice premiums, fewer lawsuits, etc... someone would just stop them and ask, "That is all well and good, but what is the bottom line? How were health care costs affected?" Then watch them stammer for some nonsense response.

Fact is, tot reform is not a new, exotic idea. It has been tried in dozens of states and there is no appreciable connection between tort reform and lower health care costs or decreases in so called "defensive medicine." There are many good reasons to support tort reform external of hoping it will lower health care costs. But for this to literally be the cornerstone of the Republican plan shows they are either grossly ignorant or intellectually bankrupt.

Posted by: chapoutier | March 8, 2010 8:39 AM | Report abuse

Krauthammer's playing rope-a-dope here with people who are actually interested in arguing about tort reform and medical costs. Republicans don't give two sh*&ts about medical costs. All this is about is sticking it to the trail lawyer lobby which heavily favors Democrats. What they want is tort reform that ends the big paydays for malpractice firms -- whether or not it actually results in better or more affordable health care is utterly beside the point.

Posted by: jonas6 | March 8, 2010 12:13 PM | Report abuse

So, the Massechussets Medical Society is saying that 25% of the work being done by doctors and hospitals is fraudulent?

What else do you call it when an auto mechanic, construction worker -- or doctor -- performs unnecessary work and then tries to bill for it?

However, the situation with the doctors is more serious. Merely billing for unnecessary work is merely fraudulent. Performing unnecessary procedures is assault at best, and murder where those procedures have unfortunate results.

Some medical licenses need to be yanked.

Posted by: HighPlainsLawyer | March 8, 2010 4:34 PM | Report abuse

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