Saul Ain’t Gonna Like This by Pat Conrad MD

Move over Kate Upton, I’m offering the sexiest S.I. issue for 2014.  Both the White House and the congressional supporters of the Affordable Care Act claim that it will result in cost savings, and will not consider any curtailing of the expansive legislation.  Pres. Obama famously said last week that he was open to ” any good idea” that will help the program succeed, and politicians on both sides of the aisle repeatedly vow to protect and strengthen Medicare and Medicaid.  By way of qualifiers, let me note that I am neither a math whiz nor economist, and I probably have not Googled or Bing’d THE definitive studies…but these will do, so let’s ponder…

In 2009 the Washington Post quoted a Harvard University study that put the low side of defensive medicine cost at $60 billion annually, while “other research places the yearly cost at roughly $200 billion.”  I quote Medical Economics magazine” which recently quoted a May 2011 DefensiveMedicine.org who quoted Jackson Healthcare and Gallup polling “that defensive medicine costs the United States $650 billion to $850 billion annually.  “In December 2010, the American Academy of Orthopedic Surgeons cited estimates that, by reducing defensive medicine, liability reform could result in yearly savings from $54 billion to $650 billion.”

In 2009 US News & World Report stated that an estimated 50 million, or 42 percent, of the 120 million visits made in 2006 to U.S. hospital emergency departments were billed to the Medicaid and Medicare programs.  So if we wildly extrapolate the 42% figure to all of health care, we precisely divine potential defensive medicine savings for the government patients to be anywhere from $21 billion to $273 billion…or more.  Look, our elected masters have legions of economists and actuaries at their command, all engaged in troublesome meddling that add to the cost of daily living, so certainly some of them may be spared for this project.  And how do I accomplish my grandiose savings?

Sovereign Immunity.  If S.I. is good enough for so many academics that prescribe policies daily for the rest of us, then it should work out here amongst us little people.  I propose to achieve massive savings by declaring that any Medicare or Medicaid patient be barred from ever bringing suit for malpractice as a condition of receiving taxpayer-funded care.  Their quality of care may still be guarded by peer review.  Access will be improved by allowing speedier, less costly care; said savings could be passed back to the hospital (which could be audited to pass on a portion to reduce cost-shifting), or used to fund the large Medicaid increases in the offing.  In addition to the direct savings from reducing unnecessary testing, there would be reduced malpractice premium costs passed along to the hospitals, groups, and private providers, helping to offset the losses due to EHR’s, sequestration, and any other inflicted cost saving measures.  Yes, the trial lawyers, med-mal carriers (perversely), sanctimonious pols, and do-gooder groups all will swarm out to defeat this idea.  But it has the merit of sound philosophy wedded to practicality:  if someone else pays your way, you should not be able to sue him for it.