Except “defensive medicine” is not the issue. The whole “defensive medicine” claim exists solely as a creation of insurers trying to reduce their risk.

You say the “tort reform” was not strong enough, but the only tort reform seriously proposed is “reform” designed to either a) make it more difficult to file a claim by making it more expensive; and b) designed to keep people who are found to have a legitimate claim from receiving the full measure of damages.

There is no movement to reduce costs. Why? Because tort reform as an issue arises from corporate America trying to reduce its exposure to individual claims and class actions. Not improve medicine or save money on healthcare. That’s why all the legislative proposals, when you read them, are only guaranteed to benefit insurers. The proponents promise ancillary benefits to physicians and patients, but despite decades of these promises they have never materialized.

Physicians have told us in the recent past there was too much defensive medicine and thus we needed tort reform. Some states passed it. Yet healthcare hasn’t improved or gotten cheaper in those states.

Citing us to surveys of physicians doesn’t tell us much other than what they believe. They’re not lying, per se, I’m sure they do believe it. The truth is, though, they really can’t agree what is or is not defensive medicine when applied to particular patients or procedures. You’re “defensive medicine” is another physician’s necessary and proper test. But even assuming we could define it accurately, and assuming it wasn’t just a lobbying phrase, you have literally proposed nothing to curb it.

Now you’re telling us we need more of the same things that haven’t worked in the past? You sound like the President telling us the stimulus will get unemployment below 6%, and when it doesn’t do anything, saying we just needed a little more.

And I’m sure you’ll say “well, the insurers proposals aren’t what I want to do.” But what you want to do never gets proposed as legislation – what THEY want does. Because they put their money where their mouths are. And their money doesn’t go to support individual, Constitutional rights.

The above comments are the exact “tug of war” that I describe in the article, which does nothing but distract from the issue, very conveniently so. Such are attempts to shift the discussion away from the effect of defensive medicine on patient health and towards “costs” and other issues. Another is the argument that since in states where tort reform has been enacted health-care costs and medical testing have not decreased sufficiently, therefore defensive medicine was never really a problem and tort reform was never really needed. This is a fallacy and proves nothing more than the fact that the tort reforms in such states were not strong enough. We all know where physicians and attorneys stand on the issue. What is most important is what patients think about the issue.

You can mock the examples, you can mock the article, and you can twist and spin the data in whatever way you want. However, physicians are saying and writing over and over again, in print, online, on TV, in private and in scientifically performed surveys that they practice defensive medicine, that they see colleagues practicing defensive medicine, and believe that it is bad for patients.

What it really comes down to is this: you can either choose to believe them, or not. If you think physicians are simply lying about the issue for self-serving reasons, okay, that is one view point. Make that argument. Otherwise, if you prefer a more “scientific” explanation, I would refer you to the Archives of Internal Medicine: “Physicians’ Views on Defensive Medicine: A National Survey Arch Intern Med. 2010;170(12):1081-1083″

http://archinte.jamanetwork.com/article.aspx?articleid=416067

But #4 is the best: you’re arguing no less than “CTs should be banned from medicine.” That’s the only way to interpret that example. Is that really what you think?

If the AMA is not the primary physician lobbyists, then they have an excellent marketing department because if you ran a poll I bet you’d find the public thinks otherwise. Isn’t the AMA chiefly responsible for setting reimbursement rates of Medicare through a committee with some unwieldy name?

” Because, as the article shows, fear is killing people.”

Actually, the article doesn’t show that at all. It makes a number of assumptions, and I’m surprised to see you make such leaps, although I expect confirmation bias explains much of it.

” to insure uniform standards are applied, and we don’t end up with the judicial hellholes like Florida.”

How does one determine a “judicial hellhole”? Sounds like a lobbyist term, rather than anything with a particular meaning. I agree with you that federalization is coming, but the conservative in me is in no hurry to further reduce the rights of individuals.

And you’re absolutely right about next steps. I’ve said many times, malpractice will soon be governed by some byzantine regulatory process to both compensate victims and punish physicians. No one will like it.

“Most of the state you cite have the support of your lobbyists”. Actually it is personal observation. Can you tell me who my “lobbyists” are? (and don’t say the AMA – they represent academics and students. ACEP and other groups are too busy eyeballing their own sphincters to be effective lobbyists). I do agree, Matt, that my profession has invited the abuse, and now it’s time to suffer the abuse. We should have hired the ATA to lobby for us.

“But should we pass laws based on fear, regardless of rationality” So much for the argument against legislating our way to good health. I have outlined a couple of steps to alleviate the fear. Because, as the article shows, fear is killing people.

“Why do you want to federalize everything?” .. to insure uniform standards are applied, and we don’t end up with the judicial hellholes like Florida. That whole environment is just toxic. And, federalization will come anyway, it’s a matter of time (regardless of single payer).

“you know who really won’t like them? Insurers.” Maybe. Granted, the next logical step of federalization is to federalize malpractice insurance. And when the malpractice lawyers go after the government, the government will pass legislation like Feres doctrine in response. Deems ridiculous

And unless you’re sitting in the office with the patient, you have no idea how many other lawyers they saw or what they were told.

And spare me the “insurers going to settle because they’re scared of a jury” line. It’s particularly strange to hear that nonsense out of a physician. Your profession Should know better than any how hard it is to squeeze money out of insurance companies. Why you think liability carriers are different than any others is beyond me.

But let’s assume you are right. Where can I find your solution?

And I didn’t say everything was not true. I said some of it was. I agree with igloo that single payer renders this all moot. Hope that works out for you physicians though.