The Half-Vast Right Wing Conspiracy

See this article from a German, recounting European appeasement efforts. Note that he is writing about Europeans. Americans unfortunately often do the same thing. Appeasement is tempting but nearly always wrong.

This was an inspiring visionary speech. Post is in Adobe Acrobat (.pdf) format.

Came across this posting from a trial lawyer, who does not like tort reform policies. As I see it, the arguments are:
1. Even though the award is reduced first by expenses, then by 30-40%, that's perfectly reasonable given how hard your lawyer works to represent you.
2. It doesn't make sense to put limits on noneconomic damages because then some hurt people can't make a lot of money off of their injury.
3. We have to give trial lawyers lots of incentive to bring cases or ordinary people just won't have access to the courts.
4. Tort reform just doesn't lower malpractice premiums anyway. I guess all those doctors who think it does are just stupid.
5. The federal government limiting access to courts is not a conservative position; the states should do this.

My responses:
1. As a doctor, if I had the miserable success rate that lawsuits against doctors has I'd be out of business. (Docs win 70-80% of malpractice cases that go to trial. I don't know how many get settled early.) Plaintiffs only win about a quarter of the cases brought against physicians. Lawyers are doing a lousy job of screening cases. What DA would be reelected with a 25% conviction rate? And, no, I don't think paying an attorney 40% of the settlement, AFTER taking out expenses, is reasonable.
2. Again, as a doctor I see a lot of people suffering from their diseases. I don't see anybody rushing in to give them money to compensate them for their suffering. Suffering has no monetary value. It seems pretty apparent to me that "pain and suffering" has as its main value paying higher attorney's fees and accentuating the idea that if my life isn't good, it's somebody else's fault and they should pay me. Call me cynical. Money just doesn't make everything all better.
3. If attorneys would screen their cases more carefully, they wouldn't have to push so many cases to court. In medicine, we tell people if a treatment is likely to help more than hurt.
4. This is a truly interesting argument. Why on earth would organized medicine be pushing tort reform if it doesn't help with malpractice insurance? I guess we're idiots. Of course, the fact that in some states it costs $98,000 per year for an obstetrician to get insurance while in others it is $9800 for the same coverage...
5. I agree that this is not a "conservative position." Neither is Medicare, which basically controls all of healthcare in this country with its byzantine complexities and internally inconsistent regulations. What we now have is a healthcare system that has lost most of its free market aspects, but is still treated as if it were a business.

There are things he did not address.
For those of us who are not attorneys, getting sued is worse than undergoing most medical procedures. It ruins our lives for more than a year. It costs tens of thousands of dollars to defend the suit. It takes hundreds of productive hours away from our practices. We have the choice of settling and basically admitting guilt, or defending the case, likely winning (docs win 70-80% of malpractice cases in court) but ruining a year of your life. And there is NO downside to the plaintiff. There should be. Otherwise it's just a lottery.

Malpractice is not a good system for regulating medicine. Fear of lawsuits prevents reporting of medical problems, and so systematic issues never get addressed. The Institute of Medicine (hardly a conservative organization, by the way) recommended in their report on medical errors that wholesale changes were needed in reporting. Won't happen while we doctors see ads on TV from carnivorous lawyers. If we as a society want to have healthcare as a "right", and want to pay less for it, and have it be better, one of the necessary costs will be to eliminate the "right" to sue at will.

He did not address defensive medicine. Doctors in fear order too many tests. I don't have good data for this; nobody does. But every test ordered has risks and inaccuracies. Ordering too many tests does harm, and not just economic harm. But nobody ever gets sued for ordering too many tests, and they might for not ordering what some attorney feels in retrospect wasn't enough. Again, this drives up healthcare costs.

You see, we know how random, capricious, and unfair the tort system is. We know a few docs that we wouldn't refer to never get sued, and we know the best ones sometimes are. We watch the horror they go through with endless depositions, changes in trial dates, and having to listen to hired "experts" willing to claim whatever their attorney wants. When we hear you attorneys use high-sounding words about people's right to justice, we ask about our right to be free of legal terrorism.

And the thoughtful among us know that the current legal system will not allow us to improve healthcare for the great mass of Americans. Fear of lawsuits will kill any effort at systematically investigating problems, analyzing root causes, and making improvements. Fear of lawsuits makes peer review and self-policing impossible. Most of the physicians I know are excellent human beings trying to make a difference, trying to help the sick and injured that come in their doors. The excesses of trial lawyers are interfering, in ways that do not appear to improve health care.

The Federal Government has extended the tax year to the end of January for contributions to tsunami relief. Be sure and document what it's for. World Vision is a good organization to contribute to. Beware of scams, there are lots.

Take a look at this blog from Chrenkoff. Is Iraq dangerous? Absolutley. Is it destroyed? Absolutely not. Why don't we hear this on our media? One might guess that they want the US to fail!