Is There Another Way to Deal with Medical Malpractice? (Winner of Last Week's Reader's Challenge!)

Note from Joshua Holland: Last week, in a fit of extreme laziness while trying to come up with innovative ways to engage our audience, I asked readers to send in their takes on a (meaningless) poll that found a lot of support for tort reform, among other things, among a population ill-informed of the underlying debate. I got lots of varied reactions, many of which were worthy of publication. Here's the winning post submitted by Scott Bidstrup -- who gets an AlterNet t-shirt for his troubles!

Ah, it's the oldest dilemma one hears about in the debate over American medicine - one that goes back decades.  Even before the debate over such things as public options and single payers.  How much are the doctors that are getting sued ending up costing the rest of us in increased professional fees and insurance premiums?

Well, not all that much, if you accept the results of studies quoted in Slate.  Or, if you hear the physicians themselves tell it, the costs are huge.  So what's the reality?  Well, they're both right.  Physicians are paying a lot more than they should be paying for covering them from a rather low professional risk.  Such is the nature of the private insurance industry - charge the victim... er, client, as much money as it is possible to extract from his wallet, and pay out as little in claims on his behalf as you can possibly get away with.  But gee, isn't that the capitalist way?  No wonder the physicians are carping about a relative non-problem.

Bad incentives.  That is why physician tort liability insurance doesn't work - it is rife with perverse incentives, lack of accountability and transparency, and all those other problems that are becoming increasingly obvious in the capitalist model in general and the insurance industry in particular.

So maybe a little socialism might be in order here.  Why not try this: incentivize physicians to be responsible for their own members' behavior by having them pool their tort insurance premiums and liabilities into a single physician-run insurance cooperative - which would give them the incentive to review the tort claims successfully levied against their fellow physicians.  If a physician is being sued successfully in far excess of the norm for his region and specialty, say, five times the average, he gets booted out of the cooperative - and has to go bare, facing the cold, cruel world of tort liability for the quality of his own practice.  And finds himself pretty quickly looking for honest work.

Fixing the incentives here is the only way to solve this relative non-problem in a way that will make both physicians happy and will fully preserve the public's right to be made whole by suing a bad apple.  And if the incentives are properly structured, it can do us all a favor by improving the quality of medical care in the process.  This might be one way to do that.


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