Malpractice and Healthcare

I am very disappointed that there has been so little discussion of the importance of malpractice liability in the discussion of the cost of healthcare. It may be anecdotal, but my impression is that malpractice liability adds significant costs to medical care. It may be a relatively small percentage, but it’s a small percentage of a huge number. The CBO says malpractice costs are only 2% of overall healthcare costs. It’s hard to know where to go to get unbiased information because tort lawyers are such important donors to the Democratic Party.

My main anecdote is former senator and presidential candidate John Edwards, who became obscenely wealthy as a lawyer suing doctors for malpractice. There is no doubt that the doctors were at fault and that the victims should be compensated, but did the system have to pay for multiple mansions for John Edwards in addition to helping the victims? I think John Edwards is just one of many lawyers becoming rich off malpractice suits. Just watch the TV ads for lawyers trolling for clients who have been injured in various ways as a result of medical conditions.

The only people I’ve heard mention this issue, however, have been Susan Eisenhower on Bill Maher’s show and Mort Zuckerman on “Morning Joe.” I found a transcript of John McCain on Hannity’s Fox News site; so, maybe I just don’t watch enough conservative talk shows. McCain said a neurosurgeon’s liability insurance could cost $200,000 per year. I think ob-gyn insurance is about the same; they are people that John Edwards used to sue.

A 2004 Congressional Budget Office report on the malpractice tort suit issue was non-committal. Its conclusion was:

In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency. Thus, choices about specific proposals may hinge more on their implications for equity--in particular, on their effects on health care providers, patients injured through malpractice, and users of the health care system in general.

It also says that around the time of the 2004 report there were about annually about 5 successful malpractice claims for every 100 doctors, and the average judgment was $320,000, up from $95,000 in 1986. It further says that the evidence is not clear on defensive medicine, the practice of requiring many extra tests to confirm diagnoses. CBO believes that a greater driving factor for extra tests is the extra profit made by the doctors.

It seems to me that it would be better in a reformed healthcare system to go to a system like workmen’s compensation for malpractice claims, and to do more to drive out poor doctors. Even the CBO says it is a relatively small subset of poor doctors who really drive the costs of malpractice insurance through the roof. First, the government should do more to monitor doctors’ performance and eliminate under performing physicians. Secondly, the government could set price for the most common types of malpractice: X dollars for cutting off the wrong let; Y dollars for leaving a clamp in a patient after surgery, etc. Incidents not specifically listed could be arbitrated based on guidelines, rather than litigated by high priced lawyers for contingency fees.

Another Op-Ed on Israeli Settlements and Iran

Alan Dershowitz had an op-ed in the July 2 WSJ saying there has to be some flexibility on Israeli settlements so that people already living in them can have babies. It's a specious argument. Why don't the settlers start out in larger houses? Or why can't they move to a new town if they have lots of children? People in American do it all the time, although the housing crisis has somewhat affected Americans' propensity to move. But what really sets Dershowitz off is linking the settlement issue to Iran. If Israel were to spit in America's eye over the settlements issue, there are hints that America might be less aggressive in stopping Iran's nuclear program. He says, "If the Obama administration were to shift toward learning to live with a nuclear Iran and attempt to deny Israel the painful option of attacking its nuclear targets as a last resort, that would be troubling indeed. Thankfully, the Obama administration's point man on this issue, Dennis Ross, shows no signs of weakening American opposition to a nuclear-armed Iran." He thanks God for Dennis Ross because Dennis Ross is Jewish, and therefore not exactly unbiased on this issue. It's pretty clear reading between the lines that what Dershowitz really wants is to kill some Iranians. Dennis Ross has a long history of working on Middle East issues at the State Department under Democrats and Republicans; hopefully he will be more responsible than Dershowitz gives him credit for being.

I Don't Blame McNamara

I don't blame Robert McNamara for the US failure in Vietnam, although he certainly played an important role in it. As Secretary of Defense, he was not powerful enough to lose a war single-handedly from the Pentagon. The real culprits were the presidents -- Kennedy, Johnson and Nixon -- the Congress, and the American public. McNamara was an official under orders, and he carried them out to the best of his ability. He was more like the generals who worked for Hitler; he could have been guilty of war crimes, but not for the overall conduct of the war. That his obituaries are not claiming that he was guilty of war crimes probably speaks well of his character. Today, we have wars in Iraq and Afghanistan that the country more or less ignores, but in which they have been quicker to perceive war crimes, particularly in places like Abu Ghraib and Guantanamo.

I blame the country, the United States, rather than McNamara. Despite protests, the leadership of the country let the war go on. I think from some of the obituaries I read, more GIs died in Vietnam after McNamara left as Secretary than during his tenure. The NYT obit says "Half a million American soldiers went to war on his watch. More than 16,000 died; 42,000 more would fall in the seven years to come."

As long as the rich and connected -- Bush, Cheney, Clinton, Wall Street types -- could avoid fighting, they were content to let the war go on, but in order to cover their cowardice they reviled those who fought the war, whether McNamara in the Pentagon, or some poor private just out of high school. The criticism heaped on McNamara in his obituaries taints every soldier who fought in the war. I'd like to know more about how the Germans treated their low ranking veterans of World War II. Did the German soldiers experience more shame and hatred from their fellow citizens than Vietnam veterans did?

UK Foreign Secretary Miliband is Jewish

I was surprised while watching Fareed Zakaria's GPS on CNN to learn that British Foreign Secretary David Miliband is Jewish. About 19 minutes into the interview, he made a point of saying that he is an atheist, but that his grandparents and his parents went through the Holocaust. So, he's an ethnic Jew, if not a religious Jew. It's no big deal, except that it's another indication that Jews run a lot of the world.

It's not unusual. In the Bible, Jews were advisers to lots of gentile leaders, starting with Joseph advising the Egyptian Pharaohs on how to avoid their seven years of famine. Later, you have Daniel advising Persian King Darius, ironic in light of today's Israel/Iran tensions. My only question is whether Jews are more loyal to the countries where they live or to Israel. The only example I can think of in the Bible is Nehemiah, the king's cup bearer, who persuades the king to let him rebuild the wall around Jerusalem.

We have not had a Jewish President. It would be interesting to know whether Al Gore's picking Joe Lieberman to be his vice president helped or hurt his campaign. Certainly it looked odd for Lieberman to support John McCain in the last election. Some new book says that Henry Kissinger is responsible for America surviving the Watergate scandal. Kissinger certainly spent a lot of time working on Israeli issues, but, perhaps mistakenly, I think he was pretty even handed. I think he was committed to Israel's existence, but was willing to press Israel to make concessions to the rest of the world. Although Barak Obama is certainly not Jewish, he is surrounded by a lot of Jewish advisers, starting with Rahm Emanuel and Larry Summers, whom I find suspect. For some reason I have no qualms about Paul Volker or Ben Bernanke, who for some reason I consider totally American, even more trustworthy than Kissinger.