Big Brotherism...........

John A. Quayle blueoval57 at VERIZON.NET
Tue Feb 10 16:46:16 MST 2009

Free Congress Foundation Commentary: Defensive Medicine: Burden in Billions 
and in Care

By Marion Edwyn Harrison, Esq.
February 3, 2009

It is unclear what the Barack H. Obama Administration, the cognizant 
leadership of the recently convened 111th Congress, or both, will propose, 
or what will be enacted into law, with respect to Medicare, Medicaid, 
medical or health insurance and/or the full gambit of the American medical 
profession and our health care.

The subject affects every human being in this country - lawful resident, 
business visitor, student visitor, tourist or otherwise.  Perhaps above any 
other subject, it deserves careful, comprehensive, objective and realistic 
consideration.  Any measure of consideration short of that risks 
aggravating the availability and competence of medical care, which 
unquestionably is the highest in any large country and perhaps any country 
at all. (For example, Swiss medical care also is exemplary.  However, 
Switzerland is a small, growth-restrained, comparatively homogenous 
population, hardly relevantly comparable.)

There are hints - perhaps more than hints - from informed sources in or in 
touch with the new Administration, and arguably some (possibly 
campaign-type) statements from the top,  that sweeping change is to be 
proposed.   Some such statements appear to engulf a measure of even further 
Federal governmental influence and control, perhaps even dominate "big 

Medicare and Medicaid undoubtedly are at best mixed blessings, to use the 
trite phrase (in lieu of a phrase more condemnatory). No available figure 
necessarily is fully accurate. However, one realistically can treat most 
such figures as reasonable approximations. In that milieu, present average 
American household medical expenditure is said to be about 23% of average 
household income, steadily rising, projected  by the (very competent) 
outgoing Secretary of Health and Human Services, former Utah Governor 
Michael Leavitt, as 41% within 20 years. More definitively, longevity has 
increased dramatically since 1965, when a version of Medicare was enacted 
into law.  Risking labeling as some kind of Malthusian, one might say we 
are becoming - maybe have become - a nation of old folks.

One statistic shockingly reveals that about 30% of Medicare dollars are 
expended upon care for patients in the final year of their lives.

So much for some introductory statistics.  An often overlooked and more 
often minimized cost of medical care is tort-generated.  The John Edwards 
of the country are a threat to and burden upon the entire practice of 
medicine.   Not surprisingly, the so-called "trial lawyers" - that is, 
plaintiffs' contingency-fee malpractice lawyers - generate the practice of 
defensive medicine. One expert study finds that 5% - 9% of medical 
expenditures result from defensive medicine - that is, hospitals, 
physicians, nurses, medical assistants and the like taking extra steps not 
medically necessary but prudent as medical-liability defense. Not 
surprisingly, as any physician or medical-cost statistician call reveal, 
medical liability insurance is frightfully expensive. For an 
obstetrician-gynecologist in Florida it can rise to $ 200,000.00 annually.

The USA is the only major country - probably the only country - which 
infects its medical care with the costly and difficult burden of punitive 
damages, a burden which limits  professional income and materially 
increases  patients' and taxpayers' cost of  medical care.   The United 
Kingdom tolerates so-called "exemplary" damages.  However, they are nominal 
and infrequently are afflicted upon medical caregivers.  This column 
previously has discussed the excesses of our American tort law, columns 
reprinted herewith.

The possibility, probably likelihood, of more statutory and regulatory 
assaults upon medical care remains to be seen.  One should be more 
defensive than optimistic. The status quo already is far more than we can 
afford or otherwise justify.

Marion Edwyn Harrison is President of, and Counsel to, the Free Congress 

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