Our host, James Joyner put his finger on two fifths of the problems we face, to wit:

Health care is too expensive and the costs are rising at an unsustainable rate.

It is not that hard to figure out. If we pay more per capita than other industrialized countries for health care, if the rate of increase is faster, and health care outcomes are worse, and one out of six Americans do not have health insurance, and 35% are believed to be under insured, the money must be going down some rat hole.

Now then, if you are tired, and your significant other looks at you and says you have a pasty complexion and are (cough, cough) underperforming, your local doc will probably find out you are anemic. If he / she looks at your stool, and finds some Proglottids, your doc will look at you and say you have a tape worm, and that sucker (pun intended) is bleeding you dry.

Now then, tape worms are parasites, they contribute nothing to our well being and can cause significant health damage. Our health care system is riddled with tape worms, folks who contribute nothing to the actual practice or delivery of health care, but are sucking money out of the system and putting it into their own pockets.

Get a grip on yourself mon, we have a problem that impacts our manufacturing and intellectual base. We either solve it, or go down the drain to join other banana republics.

You may have to go against the grain of the libertarian/conservative camp which views health care as a commodity from which anybody with smarts can make some money off.

I agree. First, all Doctors will now make "minimum wage". After all, their "smarts" shouldn't earn them any extra money...

The cost of medical mal practice insurance to the docs is trivial in the over all per capita health care costs is less than 1% to my recollection. The cost to the individual doc is another matter.

The impact of medical malpractice suits is diffuse, as it influences health insurance rates and a variety of other related and non related costs centers (see Steve). One thing every doc will tell you. Insurance companies will negotiate with a plaintiff and will only go to trial if the cost benefit ratio (cost of trial vs potential pay out) is sufficient. It is not uncommon that Insurance Companies will settle out of court when they could “win” in court. See here and here, and of course our fountainhead of knowledge, Wikipedia has a section on Medical Mal Practice Insurance.

Steve (July 13, 2009 | 10:39 am) is correct in his analysis of Emergency Room medicine. It involves not only an over use of tests, but also of a variety of consultants and procedures. You will never overcome the Emergency Room dilemma until you provide adequate care to the poor and non-insured population.

James, devote yourself the problem you have identified: Health care is too expensive and the costs are rising at an unsustainable rate. You may have to go against the grain of the libertarian/conservative camp which views health care as a commodity from which anybody with smarts can make some money off.

In the past, I pointed out that one had to identify those who were parasitic and those that were saprophytic within this system. Cut, or limit the parasitic group, and your save money. Arnold Relman, former Editor of the NEJM, has a similar but more (cough, cough) socialistic view, and with less inflammatory rhetoric.

R. Paul Miller, M.D.

Sam-CBO estimates put the direct costs at 2-3%. The difficult part to determine is the defensive spending part. How often do we order tests and studies just because of fear of a suit. This is a difficult study, as you cannot go anywhere that it does not exist in the US. I do know that when I have met docs from other countries we sometimes chat and the topic of malpractice comes up sometimes. They find it odd that I order tests I know will be negative just because of fear of suit.

Just as an example, if you show up at most ER's in other countries with belly pain, they look for the biggies and if there is nothing obvious going on, they will likely send you home with instructions to follow up with your internist or come back if it gets worse. In the US, you will probably get a CAT scan +/- consult or two. That is necessary from the physician POV because if that patient EVER has another complication related to the abdomen, the typical trial attorney goes back and names everyone who ever saw or treated that patient for an abdominal issue. If you do not have that CAT scan, it may be difficult to convince a jury (of people who could not get out of jury duty) that what you saw the patient for 20 years ago had nothing to do with the current problem.

Steve

That with tort reform

I suppose you mean medical malpractice. Can you supply some figures for the impact of medical malpractice premiums and malpractice suits on the total cost of health care in the United States? Thanks.

Maybe this post by John Cole, where he implies that Kaus is a "contrarian concern troll" -- and directly accuses him of "contrarian wankery" -- got under Kaus's skin.

Kaus reads Balloon Juice? I wonder what he thinks about Tunch...