[sandworm101]

>> In the federal government and in states, there are frequent proposals to limit medical liability, but there have been no serious efforts to eliminate medical malpractice rights altogether.

Damb right. Take away a patient's right to hold doctors accountable and things go south very quickly, at least in a for-profit systems.

>>But American doctors often rail against the country’s medical malpractice system, which they say forces them to order unnecessary tests and procedures to protect themselves if a patient sues them.

The patient can only sue if the patient has been harmed. They aren't performing the extra tests in case just wakes up and decides to sue them. They perform the extra tests so that they don't miss something that could harm the patient so badly that they sue.

Doctors also forget that, again only in the US system, patients often must sue. A harm caused by malpractice isn't always covered by insurance. Patients need to find the money somewhere. Or if an insurance company does cover, the insurance company will then sue the malpracticing doctor (google "subrogation").

A few years ago several states had liability caps ready to become law (iirc $250k). Then a young woman lost both her breasts after a mixup in test results caused her doctor to recommend a double mastectomy. But at least she could still function relatively normally and the injury was not a financial burden. Imagine the costs associated with a 20yo confined to a wheelchair for the next 60+ years. Setting aside medical expenses, 250k buys you maybe four or five converted vans. While some cases are rightly suspect, many of the multi-million dollar settlements really do get spent on legitimate costs.

[dv_dt]

This is where a universal healthcare system takes some causes for inefficiency out of the system, reducing at least one source of major need for lawsuits - the need to fund future medical care.

[dsfyu404ed]

That said, government administrated systems can become just as bad or worse because you don't have meaningful alternatives or the alternatives that exist aren't practical/affordable.

[dv_dt]

The statement is more generally true if you take out the word 'government', and come to think of it, take out 'administrated' too.

[darkerside]

> Damb right. Take away a patient's right to hold doctors accountable and things go south very quickly, at least in a for-profit systems. The study cited in the article would seem to rebut that quite vigorously.

FTA: > They found that the possibility of a lawsuit increased the intensity of health care that patients received in the hospital by about 5 percent — and that those patients who got the extra care were no better off.

[mywittyname]

An side of this that most people aren't aware of is that insurance companies will refuse to pay for any medical test they deem to be unnecessary. So, while a doctor may order additional tests to "CYA," it's pretty likely that the hospital won't be reimbursed for all of them and will just eat the cost of the tests. And, while a hospital may charge thousands for a test, the actual costs might only be in the hundreds. Depending on the hospital system, this can be a win-win because the tax write-off can be worth more than the actual test costs.

The healthcare system in the US is insane.

[ryandrake]

> So, while a doctor may order additional tests to "CYA," it's pretty likely that the hospital won't be reimbursed for all of them and will just eat the cost of the tests.

What? In the USA, it’s the customer who eats the cost of the test. 1. The doctor tells you to go do all these tests. 2. Neither the doctor, the testing lab, the hospital, or the insurance company knows which ones will be covered by insurance. 3. You do the tests. 4. Insurance company, months later, says “Surprise, sucker! We won’t cover these tests so you have to pay $N,000!” 5. The lab and doctor says “You signed the paper agreeing to cover the costs. F-you Pay me.”

[FireBeyond]

Yeah, not so much. I had a bunch of tests run at the suggestion of my Provider when I turned 40. Insurer decided not all were needed in the first place. So Provider's lab (in house, attached to a hospital) just sent me a bill for $780 instead, for the balance.

[sandworm101]

Because the test only measured changes in the decisions by doctors. The doctors all work within the same medical culture, one built on the threat of lawsuits. Try telling an insurance company that they cannot be sued. See how many fewer tests get authorized when the actuaries can veto a doctor's recommendation without incurring liability.

[Retric]

As someone that lost a close family member because a doctor did not do one of those extra tests I think they are underrated. Cost vs benefit on this stuff is hard to get right, but lives are often on the line.

[noonespecial]

My condolences. But as someone whose father lost a kidney and suffered much un-needed anxiety and pain because of a false positive on one of those "extra tests" (and the general culture of treat-until-lawsuit-proof), I humbly request we meet in the middle.

[Retric]

The middle would trade X deaths for X case of pain and wasteful spending which is not a fair trade.

Trading 5-100 of your fathers cases for 1 life is IMO a worthwhile trade as we want a system heavily biased toward savings extra lives.

PS: It's the rate of false positives vs saved lives that cause wasted treatments not the number of tests.

[DanBC]

You're making the mistake of thinking that over-testing, over-diagnosis, and over-treatment saves lives, when it probably doesn't, and may well decrease length of life as well as quality of life.

The US has massive rates of testing for various stuff. It also has a lower life-expectancy than other similar nations.

[Retric]

US life expectancy rate relates to poor healthcare and poor public health more than over testing. When you let a large chunk of the population die from treatable illnesses it's hard to make up for that by treating a subset even better than average.

The US homeless population for example is 1.56 million people and they don't get good healthcare.

[DanBC]

The simple message is that over testing causes harm and does not reduce all cause mortality.

[noonespecial]

How 'bout 1000. 10000? Now were just arguing numbers. Don't forget the opportunity cost of unneeded treatments using resources that could have "saved" others as well.

We're taking many paths but ending up at some sort of rationing in the end. There's no easy answers.

[Retric]

I doubt they would have removed a liver if the risks where that low.

So, really it's saving lives at the cost of a fixed but low number of false positives and a lot of wasted tests not a 10,000 extra removed livers per life saved.

[conanbatt]

> he patient can only sue if the patient has been harmed. They aren't performing the extra tests in case just wakes up and decides to sue them. They perform the extra tests so that they don't miss something that could harm the patient so badly that they sue.

Unfortunately this is not how good medicine is practiced. Medicine is not a straightforward hard-science. Tests are expensive, patients dont follow through, they have personal consequences, chances you got something are 100% but chances you got something specific are 0.0001%.

It is digestible for a doctor to have liability but compare it to other professions: does a web developer that botched a UI for a bank transfer and introduces some consequence go to jail for robbery? Doctors have too high a burden. And a decision or an oversight that makes someone die could be as stupid as a misprint on a paper.

[malcolmgreaves]

A patient can sue for any reason. They can be wrong and sue.

It's then up to the physican to pay costs for legal defense (i.e. medical malpractice insurance). If the patient is wrong, then the physican can counter-sue. This whole dance is very expensive and, worse, time consuming (which, for a doc, is the ultimate resource). This cost ends up on the patient ad the doc must raise prices to account for the new insurance.

[mywittyname]

Patients normally sue a hospital system though. My partner has been involved in dozens of malpractice lawsuits over the years because every person who interacted with the patient during their stay is named in the lawsuit, not just the doctor(s) who treat them.

Hospitals have staff lawyers whose job it is to deal with lawsuits. So it's not terribly time-consuming for doctors outside of depositions.

It's safe to say that this is one of the reasons that doctors move from private practice into working in a hospital system. But it's also not a major one (dealing with insurance companies is the major factor).

[todd8]

Hacker news readers may not realize that joint liability exists in many states. Under this doctrine, the plaintiff can collect all awarded damages from even very peripherally involved people. A person with deep pockets can end up paying for others mistakes.

For example, a plaintif’s attorney might drag everyone into a lawsuit they can over a disappointing surgical result. The jury could be persuaded that an operating room nurse is 1% liable for a failed operation and the surgeon 99% responsible. If the surgeon can’t pay their part of a two million dollar judgement (brand new doctor perhaps) the nurse may end up paying the two million (maybe the nurse is married to a software engineer).

[forapurpose]

> the doc must raise prices to account for the new insurance

As I understand it, the portion of additional costs that the doctor eats and the portion that they charge to their patients actually depends on the elasticity of the market for the doctor's medical services. I can't comment on the market for the hypothetical doctor's medical services (in the U.S. AFAIK that market is very complex and opaque, and it probably depends on the doctor, location, and the specific service), so speaking generally about sellers and buyers:

The portion of a cost increase that is eaten by the seller or charged to the buyer depends on elasticity. Computer memory is highly elastic: If your costs go up and you try to increase your price $10/DIMM, then I'm going to buy my DIMM someplace else (unless your DIMMs are very special); a small change in price causes a large change in demand. Superstar developer salaries are highly inelastic: If the developer's costs increase (a new baby!) and they ask for more money, I probably have to give it to them because I'm not going to find a replacement. You see that more publicly with superstar athletes: Cristiano Ronaldo is irreplaceable; the market for his services is at the extreme of inelasticity; he can almost name his price for running around in shorts, playing games.

[grasshopperpurp]

No idea why this is being downvoted. Maybe they missed the qualifier?

> . . . at least in a for-profit systems.

[pc86]

Probably because it's flat out wrong and shows a shockingly incorrect view of how things actually work.

> The patient can only sue if the patient has been harmed.

No, the patient can sue for whatever reason they want to. The doctor's malpractice insurance is going up regardless. Even a completely frivolous lawsuit will cost the physician real money out of his or pocket for years to come, not to mention the cost (if they choose to pursue it) of counter-suing the patient.

[mywittyname]

A frivolous lawsuit costs the patient (or patient's lawyer) a lot. Hospitals get sued all the time and they have an entire legal department staffed and ready to handle subpoenas.

You still have to prove damages. Which means getting treatment from another hospital for whatever mistake was made, then proving that the mistake was caused by the treatment you received at another hospital.

As stated elsewhere, my partner has been named in dozens of malpractice lawsuits and every one she was deposed for she felt was legitimate. There were a few where she told me privately that she hopes the people win.

[grasshopperpurp]

That part is incorrect; however, the overall message of the post is correct. In a for-profit system, it's the patient's only recourse. Don't like it? Fight against for-profit healthcare.

[pc86]

Whether healthcare is for-profit or non-profit does not change how the legal system works.

[sandworm101]

But it does change the math. Where patients do not have to pay for their own injuries, ie under a national health service, they don't need to collect in order to pay for later care.

[sandworm101]

>> No, the patient can sue for whatever reason they want to.

Check your rules of civil procedure. Patients cannot just invent reasons to sue. The case must hit several benchmarks before a doctor ever has to respond, let alone be deposed. Dismissal for failure to state a claim deals with the truly junk lawsuits.

[mywittyname]

I don't get it either. People outside of healthcare probably aren't aware of how ridiculously common it is for medical mistakes to be made. Dozens of overworked people are coordinating with one another to take care of you.