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 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.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Saul Ain’t Gonna Like This by Pat Conrad MD

  1. Jeanne
    December 27, 2013 at 7:55 pm

    And the chances for this brilliant idea being accepted are .. oh .. zero. My husband, a neurologist newly forced into early retirement due to MediCare reimbursement cutbacks, and I have long agreed that nothing will change until there is tort reform. In the meantime, doctors have to retire early (several in the past six months in our small town alone) or take a job with the V.A. or Kaiser in order to survive. The general public has no idea just how bad this is going to get.

  2. Frank
    December 26, 2013 at 8:37 pm

    What a wonderful idea. Of course, as you said, it will never work because too many people…oops, I mean, lawyers…would never allow it.

  3. Ricky
    December 26, 2013 at 2:27 pm

    Pat you hit the nail on the head. I worked in a very high percentage medicade practice 80%+. And all they ever wanted was to sue someone so they could finally hit the lottery and recieve what they were entilted to. I say lets go a step furthur and if you dont work and pay taxes then you should not be allowed to vote on how those tax dollars are spent! I am always in favor of spending someone elses money if it gets me something for “free”.

  4. Sir-Lance-a-Lot
    December 20, 2013 at 8:04 am

    You nailed that one, Doug!

    I would only add the creation of local non-judicial panels of medical experts to review claims and provide reasonable payment in the event of actual malpractice (which could include… Yes, federal Disability payments).

    • Doug Farrago
      December 20, 2013 at 6:14 pm

      That was by Pat Conrad

      • Kurt
        December 26, 2013 at 5:13 pm

        Yeah, but you agree Doug? 🙂

        • Doug Farrago
          December 26, 2013 at 6:38 pm


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