The sequestration that is about to take effect imposes too much austerity too soon, does so in a nonsensical way, and yet does little to improve the long-term U.S. fiscal picture.
Far more beneficial would be to make sure that the deceleration in health costs we have been enjoying continues. This is why medical-malpractice reform, although far from a panacea, is worth trying.
Most of the costs in the U.S. health care system are incurred in a small number of expensive cases. The top 25 percent of Medicare beneficiaries ranked by cost, for example, account for 85 percent of total spending. And the expenses in those cases are driven significantly by the recommendations that doctors make to pursue one treatment path and not another.
In making these choices, doctors are influenced by various things, including medical-school training, traditions among their peers, financial incentives (which are distorted by fee-for-service payments) and, yes, the medical-malpractice system. Improving the criteria for what constitutes appropriate care could significantly change doctors' behavior and also save money, recent research by Michael Frakes of Cornell Law School suggests.
Most proposals to amend medical-malpractice law would limit liability in cases where doctors are found to be at fault. But they neglect to address the more important issue of how guilt is determined in the first place. The malpractice laws are generally based on "customary practice" — that is, a doctor can be considered guilty of malpractice if he or she fails to follow such practice. This is a nebulous concept, however, that only pushes doctors to look around and mimic what their peers seem to be doing.
Other doctors, however, vary widely in their practice of medicine. And just because one treatment or diagnostic procedure dominates in a particular situation doesn't mean it is the most medically effective one.
Many states have, in the past few decades, altered their customary-practice standard to base it on national medical practices rather than local ones. And the change has had a stunning effect, as Frakes's study shows. Since 1977, he found, the differences in the medical practices he studied between the 16 states and the nation as a whole diminished by 30 percent to 50 percent.
And this suggests, as Frakes says, "that standardization in malpractice laws may lead to greater standardization in practices." What's more, this can bring down the cost of medicine without making it any less effective, because the more costly procedures are often not the best ones.
