Really Affordable Medical Care

Everyone wants to make medical care more available and more affordable.

Many people believe that Shakespeare had the solution to an important aspect of the affordability problem: “The first thing we do, let’s kill all the lawyers.”

Not literally, of course. But still, Shakespeare was prescient beyond even his imagination.

It should go without saying, but during the public debate about Obamacare, few mainstream media outlets addressed the issue of malpractice reform. Since trial lawyers are an integral part of the Democratic party, one understands that the hyper-partisan media would have ignored their influence on the cost of medical care.

Now, however, that the Supreme Court has ruled in favor of Obamacare, reputable professionals are now addressing the malpractice issue.

Among them, Dr. Sanjay Gupta, of CNN. Writing in The New York Times, Gupta explains the different aspects of the problem.

First, American physicians prescribe a “staggering number of tests and procedures” when compared with other nations.

Second: they do so because they need to protect themselves against “potential lawsuits.”

Third: the more physicians prescribe tests, the more they increase risk to the patient. In and of themselves, procedures expose patients to risk.

Fourth, when procedures yield “false postives” physicians prescribe treatments that are unnecessary or even harmful.

This means that the mania about malpractice is not only increasing the cost of American medicine but is indirectly making people sick.

In Gupta’s words:

But a reasonable estimate is that medical mistakes now kill around 200,000 Americans every year. That would make them one of the leading causes of death in the United States. Why have these mistakes been so hard to prevent?

Here’s one theory. It is a given that American doctors perform a staggering number of tests and procedures, far more than in other industrialized nations, and far more than we used to. Since 1996, the percentage of doctor visits leading to at least five drugs’ being prescribed has nearly tripled, and the number of M.R.I. scans quadrupled.

Certainly many procedures, tests and prescriptions are based on legitimate need. But many are not. In a recent anonymous survey, orthopedic surgeons said 24 percent of the tests they ordered were medically unnecessary. This kind of treatment is a form of defensive medicine, meant less to protect the patient than to protect the doctor or hospital against potential lawsuits.

Herein lies a stunning irony. Defensive medicine is rooted in the goal of avoiding mistakes. But each additional procedure or test, no matter how cautiously performed, injects a fresh possibility of error. CT and M.R.I. scans can lead to false positives and unnecessary operations, which carry the risk of complications like infections and bleeding. The more medications patients are prescribed, the more likely they are to accidentally overdose or suffer an allergic reaction. Even routine operations like gallbladder removals require anesthesia, which can increase the risk of heart attack and stroke.