Dear John Stossel Doctors Cause Wasteful Medical Expenses Not Their Victims

A second open letter to John Stossel of Fox News:

So you talked with one doctor at one hospital who told you that the “indirect costs (of lawsuits) are far higher because suits force doctors and hospitals to practice defensive medicine and do unnecessary tests.” And you believed that ONE doctor in ONE hospital is the final source, the definitive word, on the costs of lawsuits to all medical patients. That’s a piece of shoddy, biased journalism, with not even 30 minutes devoted to (a) some simple internet searches to find objective studies, or (b) a few phone calls to find different viewpoints and establish some objective credibility to your reporting.

If you cared about doing objective reporting, you would have found real studies cited in one article in the New Yorker in 2009, The Cost Conundrum, by Dr. Atule Gawande. He investigated why the border town of McAllen, Texas has become the country’s most expensive place for health care, even after significant tort reform in Texas. Dr. Gawande found that such high costs are due, not surprisingly, to the profit motives of medical practitioners and inefficiency, and not liability. Some cogent points from that article:

• When asked whether lawsuits increased costs, “a general surgeon responded, ‘We all know these arguments [malpractice arguments] are bull***. There is overutilization here, pure and simple.’ Doctors, he said, were racking up charges with extra tests, services, and procedures…Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’… He knew of doctors who owned strip malls, orange groves, apartment complexes–or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had ‘entrepreneurial spirit,’ he said. They were innovative and aggressive in finding ways to increase revenues from patient care…. he had often seen financial considerations drive the decisions doctors made for patients–the tests they ordered, the doctors and hospitals they recommended–and it bothered him.”

• “In a few cases, the hospital executive told me, he’d seen the behavior cross over into what seemed like outright fraud. ‘I’ve had doctors here come up to me and say, ‘You want me to admit patients to your hospital, you’re going to have to pay me…The amounts–all of them were over a hundred thousand dollars per year.'”

• “General surgeons are often asked to see patients with pain from gallstones… If there aren’t any complications – and there usually aren’t – the pain goes away on its own or with pain medication…But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.”

John, that article cites case after case (none of which you cared to find and read) with the same conclusion: Eliminating unnecessary but profitable procedures and changing incentive systems will reduce medical costs and enhance the quality of medical care. It worked at the Mayo Clinic and in Grand Junction, Colorado, and had nothing to do with giving doctors immunity from their accountability to their patients.

John, try serious reporting based on real research, not anecdotes from one doctor.