A major problem with the "defensive medicine" argument
We all know or know of someone who had to fight with his or her insurance company to get a medical treatment approved. And there have been more than a few lawsuits alleging that insurance companies were improperly denying treatments just to save money. The harsh reality of managed care is that insurance company administrators have more of a say over which treatments a patient receives than do that patient's own doctors. Yet the "reform" crowd wants us to believe that doctors are routinely running unnecessary tests because they're afraid of being sued. They call this practice "defensive medicine." Check out this article from the New York Times and see if you think it's likely that insurers are approving unnecessary tests:
Not long ago, fed up with what he perceived as a loss of professional autonomy, Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens.
“I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.” [Somehow, I think "I want this MRI because I'm afraid of being sued," wouldn't get an MRI approved. - JCL]
When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.
“But managed care is like a magnet attached to you,” he said.
He continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ”
There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.
Another is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners. [The "reform" movement prefers to argue that the real reason there's a shortage of primary care physicians is that they're afraid of lawsuits. Ironic, since the "reformers" tend to be economics guys; they should understand that doctors aren't going to flock to a field that doesn't pay well. - JCL]
As long as insurers have say-so over whether they'll pay for tests and procedures, "defensive medicine" will be more myth than reality.