Medical Malpractice Reform: Truth in Advertising Needed
Guest post by Michael Halasy, Practicing Emergency Medicine PA, Health Policy Analyst, and Health Services Researcher
Medical Malpractice Reform: Truth in Advertising Needed (Part One of Three)
Medical malpractice liability reform (Tort Reform) has been a hotly contested item for years, as the GOP, with physician support, has continued to market this as a health reform measure that can contain costs.
I think to start, we need to examine results in states where tort reform has already been tried. We need look no further than Texas.
Politicians tried to claim that Texas was a success, Rep Bachmann stated ““The state of Texas did a wonderful job of lawsuit reform and actually saw medical costs come down. We know it works.” Others have touted the Texas experiment as a success..but empiric data is a powerful thing, and as we will see, contradicts this sentiment.
In 2003, they passed the most aggressive tort reform measures in the country by placing a 250,000 cap on malpractice awards. It is true that this reform, after 2003, lowered malpractice premiums. But malpractice settlements and awards have dropped even farther than premiums, suggesting that the main benefactors so far, have been insurance companies. (See Table 1).
Also, the same report found that Medicare spending per patient had doubled between 2003 and 2007, in contrast to the decline in Medicare spending that was noted prior to the laws enactment. (See Table 2)
Additionally, one of the strongest arguments that tort reform supporters claim is a reduction in “defensive” medicine expenditures, or unnecessary testing… unfortunately, between 2003 and 2007 testing expenditures per Medicare enrollee grew at 50% greater than the national average…
They also found that Texas has the highest rate of uninsured patients in the country, both prior to the law, and accelerating after the law was passed.
The additional physician presence has only increased because of an increasing population as well, and when it was analyzed, there was only an increase of 0.4 (correction…0.4%) physicians per capita after the law was passed.
These tables and data were all obtained and detailed in this study HERE, and there is much more information at the link. (enclosed link: http://www.citizen.org/documents/Texas_Liability_Limits.pdf).
The short version is that medical malpractice reform should be a topic for discussion, but we need to be honest about this. In this article we reviewed what actually happened in Texas after the most aggressive tort reform measures were created. Costs (outside of settlements, payments, and premiums did NOT go down), and healthcare spending was at best unaffected, and may have even increased.
The next article will focus on the effects of reducing defensive medicine practices on patient mortality. The final article will focus on the association between medical malpractice premiums and healthcare spending.
Of course costs won’t go down with “tort reform”.Much unnecessary testing is ordered not because docs fear malpractice suits;rather it’s because they get paid for doing the extra testing and especially procedures. Until we do away with fee for service,costs will not go down,
Michael, thanks for bringing up this contentious subject. A question for those willing to fight Tort Reform so strongly, why? It, coupled with a solution to Jack, M.D.’s point, would be hugely popular, and at least modestly successful at lowering costs.
Finally, a side effect of Texas’ Tort Reform in Michael’s words was a 40% increase of available Dr.s. That’s a significant increase, but would not happen if it was implemented nationally.
Where did modestly successful at lowering costs come from Corev?
Jack, you are correct. This was highlighted in the Gawande article on McAllen. As far as payment reform, and getting rid of fee for service, one of the recent health policy symposia I was at, this was voted as the number one priority for the healthcare community moving forward…
Moving to a system like Prometheus, or perhaps, some variation therein.
CoRev,
I’m not completely opposed to malpractice reform, as a practicing clinician, I wouldn’t mind it for mostly selfish reasons. What I was interested in, after I saw the initial CBO projections, was “will it actually decrease costs?”
ALSO, it’s 0.4%, not 40%….but I realize that that’s NOT what I said, and the above is a typo. Please note the correction though.
Thanks!
Dan, modestly successful = increase in Drs for Texas and some assumptions on the demographical differences shown in the article’s charts.
Lower costs = lower insurance rates for Drs. I assume they, like the insurance companies passed some of those savings back to their patients. 😉 Don’t you?
Furthermore, the amount of the reduction in payouts passed back in insurance rates is a business decision, lags, competitive positioning… for the insurance companies as well as the Drs. (Another winking smiley face needed here!)
I hope you are getting my point here re: what actions are needed to actually reduce the costs, and what amount it might end up being. Pointing at only one player (insurance companies) while ignoring the govt’s role of limiting payments in the game is a little naive.
Thanks for the post. My understanding is that frequency of medmal claims is highest in neurosurgery, ob-gyn, anesthesiology, and emergency practice. Is there something endemic about those specialties that attracts doctors more likely to be negligent than, say, derm or orthopedics?
And sponsoring legislators don’t mind if they have a conflicting experience in their own pst performance. Just this AM in the NY Time, http://www.nytimes.com/2011/02/09/health/09malpractice.html?_r=1&ref=business
“The money was paid in 2007 to settle a medical malpractice lawsuit brought against several doctors, including Representative Phil Gingrey, who worked for three decades as an obstetrician before he was elected to Congress in 2002.”
“Until we do away with fee for service,costs will not go down,”
And until we do away with selecting elected officials on the basis of corporate advertising the quality of government will not go up.
The September 2010 issue of Health Affairs (healthaffairs.org) lays to rest most of the main myths about malpractice and contains the most up-to-date and sophisticated analyses available, including the findings that caps on damages, etc., do not affect physician behavior, as you see in the Texas data, and also does not affect physicians’ perceptions of the prevalence, cost and frequency of malpractice claims (which suggests that most physicians are irrational and slightly hysterical when it comes to this issue). One thing you never hear is that only 1.53% of those people injured during their care ever file law suits — and most do so because, due to the lack of honesty and transparency by docs and hospitals, filing suit is the only way to get access to hospital and physician records and witnesses that can shed light on what actually happened during their care and why. And another thing you won’t hear is that a careful study of such suits and the resultant awards and outcomes finds that fully 75% of the awards to injured patients were justified and congruent with the level of their injuries. The fact remains that the medical profession has yet to live up to its professional obligations to understand and practice safe medicine and “First, do no harm.”
One final point: Republicans are especially keen to pass a federal law that would cap non-economic damages, among other things. Someone explain to me why Repiblicans, who oppose Federal intervention and regulation of just about everything, are so anxious to create a new federal law, that, like all other federal laws, will interfere in this area that has always been state-controlled (and some states’ constitutions, for example, prohibit caps on damages), and that will then become subject to political and interest-group whims and tinkering by whatever party happens to be in power.
Jonsax, is this what you really meant to say? “…also does not affect physicians’ perceptions of the prevalence, cost and frequency of malpractice claims (which suggests that most physicians are irrational and slightly hysterical when it comes to this issue).” Are you actually trying to attack a group’s beliefs? Tamping down the emotions might be more possible than an actual change, and above all changing a belief via hyoperbole and sarcasm is expected to be successful? Dunno, just wondering.
As to your last point, Republicans have an issue they believe in. If thatdifficult to understand for a liberal, then it is just as diffcult for a Republican to understand the liberal beliegfs that gund kill people and that SUV’s cause accidents, and not their users. Outlawing the things involved in accidents do not change the behaviours of those who caused the action.
Some information:
What Are All These Lawsuits For?
Demand for legal services is increasing across the board, but particularly in such areas as health care, intellectual property, venture capital, energy, elder, antitrust, and environmental law.
The largest jump in lawsuits has been seen in the health care industry, where doctors have been paying significantly higher liability premiums to defend against potential litigation. While some say the increase in health care lawsuits may provide a safer environment for patients, opponents believe they are keeping patients from receiving the best care. Some interesting facts:
Over 16 million civil cases were filed in state courts in 2002.
79 percent of doctors report that they’ve ordered more tests than they would based only on professional judgment due to litigation fears, according to a Harris Interactive Poll.
The American Medical Association lists 21 states as being in a “medical liability crisis.”
71,000 drug lawsuits have been filed in federal courts since 2001 — and have outnumbered asbestos, tobacco and auto safety lawsuits since 2002.
45 percent of U.S. hospitals reported that the liability crisis has caused a loss of physicians and/or reduced coverage in emergency departments.
61% of doctors over age 55 have been sued.
How many of these mecial law suits were frivolous? How many of these specialty lawyers advertise? On TV? Or even show up in Google searches re: medical lawsuits? It’s an unregulated business.
So whey do liberals want to regulate every other phase of the medical business and not this?
Jonsax, is this what you really meant to say? “…also does not affect physicians’ perceptions of the prevalence, cost and frequency of malpractice claims (which suggests that most physicians are irrational and slightly hysterical when it comes to this issue).” Are you actually trying to attack a group’s beliefs? Tamping down the emotions might be more possible than an actual change, and above all changing a belief via hyperbole and sarcasm is expected to be successful? Dunno, just wondering.
As to your last point, Republicans have an issue they believe in. If tha’s difficult to understand for a liberal, then it is just as diffcult for a Republican to understand the liberal beliefs that guns kill people and that SUV’s cause accidents, and not their users. Outlawing the things involved in accidents do not change the behaviours of those who caused the action.
Some information:
What Are All These Lawsuits For?
Demand for legal services is increasing across the board, but particularly in such areas as health care, intellectual property, venture capital, energy, elder, antitrust, and environmental law.
The largest jump in lawsuits has been seen in the health care industry, where doctors have been paying significantly higher liability premiums to defend against potential litigation. While some say the increase in health care lawsuits may provide a safer environment for patients, opponents believe they are keeping patients from receiving the best care. Some interesting facts:
Over 16 million civil cases were filed in state courts in 2002. – 79 percent of doctors report that they’ve ordered more tests than they would based only on professional judgment due to litigation fears, according to a Harris Interactive Poll. – The American Medical Association lists 21 states as being in a “medical liability crisis.”
– 71,000 drug lawsuits have been filed in federal courts since 2001 — and have outnumbered asbestos, tobacco and auto safety lawsuits since 2002.
– 45 percent of U.S. hospitals reported that the liability crisis has caused a loss of physicians and/or reduced coverage in emergency departments.
– 61% of doctors over age 55 have been sued.
How many of these medial law suits were frivolous? How many of these specialty lawyers advertise? On TV? Or even show up in Google searches re: medical lawsuits? It’s an unregulated business.
So why do liberals want to regulate every other phase of the medical business and not this?
So why do liberals want to regulate every other phase of the medical business and not this?
Because trial lawyers are big Dem contributors?
“Additionally, one of the strongest arguments that tort reform supporters claim is a reduction in “defensive” medicine expenditures, or unnecessary testing… unfortunately, between 2003 and 2007 testing expenditures per Medicare enrollee grew at 50% greater than the national average…”
Yes. Yes. Yes!
I dearly hope that when the full three-article series is posted, someone manages to forward it to Obama. He’s ready to jump on the “tort reform” bandwagon in the same manner that he so often jumps on sound-bite truism Republican bandwagons: hook, line and sinker, rather than arguing the actual facts to the public. Obama doesn’t seem willing, or he’s simply unable to, argue points to the public using statistics and analysis.
Hmm. Now that I think about it, I guess it won’t make any difference whether he reads this series of articles or articles like them, or not.
Kudos, Dan, for getting this article series for AB.
“Additionally, one of the strongest arguments that tort reform supporters claim is a reduction in “defensive” medicine expenditures, or unnecessary testing… unfortunately, between 2003 and 2007 testing expenditures per Medicare enrollee grew at 50% greater than the national average…”
Yes. Yes. Yes!
I dearly hope that when the full three-article series is posted, someone manages to forward it to Obama. He’s ready to jump on the “tort reform” bandwagon in the same manner that he so often jumps on sound-bite truism Republican bandwagons: hook, line and sinker, rather than arguing the actual facts to the public. Obama doesn’t seem willing, or he’s simply unable to, argue points to the public using statistics and analysis.
Hmm. Now that I think about it, I guess it won’t make any difference whether he reads this series of articles or articles like them, or not.
Kudos, Dan, on getting this article series for AB.
“Additionally, one of the strongest arguments that tort reform supporters claim is a reduction in “defensive” medicine expenditures, or unnecessary testing… unfortunately, between 2003 and 2007 testing expenditures per Medicare enrollee grew at 50% greater than the national average…”
Yes. Yes. Yes!
I dearly hope that when the full three-article series is posted, someone manages to forward it to Obama. He’s ready to jump on the “tort reform” bandwagon in the same manner that he so often jumps on sound-bite truism Republican bandwagons: hook, line and sinker, rather than arguing the actual facts to the public. Obama doesn’t seem willing, or he’s simply unable to, argue points to the public using statistics and analysis.
Hmm. Now that I think about it, I guess it won’t make any difference whether he reads this series of articles or articles like them, or not.
Kudos, Dan, on getting this article series for AB.
Dan let me also add, that tables in the paragraph titled: “Health Insurance Premiums Soaring” actually show the opposite as the title. HC Premiums in Texas are diverging (lowering) from the national averages. those numbers are now two years out of date. Did the trend continue? Are they even lower today?
Tesas in some instances can be an example of the bad things Govt HC legislation can provide. Fewer Drs accepting medicare, a higher number of uninsured, slower growth in Drs, etc. Dan, with the exception of fewer insured is it similar in MA?
CoRev, Yes, I meant to say what I said about physician perceptions, because I was merely reporting on a study of that in the issue of Health Affairs that I refered to. You might want to go read that issue, which debunks all of your yelling points above. And yes, liberals and most others with any sense of balance want to regulate this area too, and states have done so for almost a century. The fact is that physician and hospital caused injuries are the 8th leading cause of death (Institutte of Medicine Errors Report 1999). And that doesn’t count the hundreds of thousands who are injured unnecessarily. Until the health care industry starts to take patient safety seriously, we should all be thankful that we have a robust legals system to police this and to seek justice for those injured and killed by poorly run and regulated health systems.
And by the way, guns DO kill people. Why do you think they give soldiers guns instead of having them just point their fingers at someone and say BANG!
Michael,
Thanks for the guest post. Please bring more!
But, The last three charts you posted do not support your conclusions that Tort reform had any effect on them. Charts 2 & 3 clearly show the trends happening before the Tort reform and the 4th chart just looks like a straight line with normal noise. Unless there was a large lag in the effects it doesn’t look like Tort reform had any effect on the measures these charts provided.
All the actual changes look to have happened in 2006 (two years after Tort reform). So I don’t see how you jumped to your conclusions. They don’t follow from the data.
On the other side, your first chart shows that Tort reform had the desired effect. Less payouts and a reduction in the number of lawsuits.
Lastly Texas has been one of the fastest growing states in the Union this past decade. The DFW area, alone, grew more in this last decade than Ohio and Michigan combined. We also have a very large first generation immagrant population and a rather large number of illegal aliens here also (compared to the national avaerages).
Islam will change
Yep.
Thanks for the reply Buff, and I agree with your assessment. I was only speaking to overall spending, and the growth in uninsured was minimal, although it did increase.
I agree that there was some trending starting really in 2002, and I don’t have any data, although I did look, to explain the change in 2006.
The problem with analyses like these at times, is, as you point out, there are a large number of exogenous variables to try and control for. The rapid growth in population somewhat mitigates the growth in the physician workforce, and might explain higher earnings per capita, which would explain the slight decrease in growth of health insurance premiums as compared to earnings (compared to the national average)…
I think the take home message, at least for me, is that tort reform in Texas did not really alter or change healthcare spending, might have caused it to increase slightly, did not benefit patients, did not reduce the rate of uninsured patients, and really only benefitted physicians (although only to a small degree) and the insurance industry which benefitted the most.
Jonsax, oh, the trigger is pulled without someone’s action?
Jonsax, I might have gone to the article had its URL been provided. Otherwise you get what I find on a Google .
Michael, Buff expanded on my reference to demographic changes. Furthermore, my reference to lags may explain some of the failure to fully pass through the insurance price cuts in liability insurance. Or the charts you didn’t show of the health insurance price cuts may be where some of those savings showed up when the companies cover both sides. BTW, who says there must be a 100% give back anyway?
You didn’t bite on my Dr pass through of savings. 🙂
On the other side, the first chart shows that Tort reform had the desired effect. Less payouts and a reduction in the number of lawsuits, Buff?
What an admission! The purpose of Tort reform is simply to reduce the number of lawsuits, not to make healthcare more affordable!
Sorry, Buff, but how exactly is the goal of reducing the number of lawsuits, in and of itself, even an appropriate objective of governments? Has Texas considered simply disbanding its civil litigation courts completely? That would reduce the number of lawsuits, after all.
Michael,
Could you please send this statement to all the guys at AB who post numerical analysis:
“The problem with analyses like these at times, is, as you point out, there are a large number of exogenous variables to try and control for. “
Yes, there are. Yet many on this board, for years, will argue insanely at times that that is not the truth. We see it mainly in all the ‘D Presidents are better for growth than R Presidents.’ Which starts with the wholy unjustified and unsupportable assumption that Presidents are the only effect involved in GDP growth and that their effect can actually be quantified. Stay around or just scroll down. Its has become almost comical at times.
My take-away was that Tort reform accomplished just what it was meant to due – Less payouts, less stress on doctors due to reduced lawsuits, and less money in the hands of lawyers (always a good thing). And we are keeping up with growing doctors as our rapidly growing economy and population conitnues to surge.
BTW, it was not meant to reduce the rate of uninsured patients and not much has changed the rate of healthcare spending (or its increase) anywhere in the US. From your own analysis it transferred money from lawyers to doctors and the insurance industry – sounds like a win to me). So on the whole I thing tort reform was a success. Not a great, game-changing event or even close, just another improvement on the system.
But thanks for posting…
Islam will change
Beverly Mann, did you notice the charts
“In contrast to claims that health insurance has become “more affordable” in Texas since 2003,
premiums in Texas have increased by 114 percent for individuals and 144 percent for families.
Health insurance premiums in Texas grew at about the same rate as the national average from
2003 to 2008 (120 percent for individuals and 148 percent for families), and Texas occupied the
same rank – 33rd highest premiums – at the beginning and end of the period.
So we have reduction of 6% for individuals and 4% for families when compared to the national average. I won’t make the claim that its due to Tort Reform, but I also will not rule it out as you have.
CoRev,
This took less than 30 secs on Google
http://content.healthaffairs.org/content/29/9.toc
You find what you honestly look for. Try that some time. The honest approach I mean.
“So we have reduction of 6% for individuals and 4% for families when compared to the national average.” CoRev
That’s a ridiculous statement if the reference is the quote that precedes it. There was no reduction in costs of any premiums. At best one might point out that Texas rates increased by a lesser degree than the national averages. Even that comparison is tenuous without citing a measure of error of the measure of central tendency. Keep trying Co. You’re batting 1.000 on the statistical distortion scale.
http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=22327
Medical costs and insurance premiums trend upward significantly since 1995. In MA in the two years hospital costs have increased a lot by %, and physician costs and the like have flattened. Uninsured is about 3-4% instaed of Texas 15%.
MA has had some of highest insurance premiums in the US for many years. Gov. Romney, the hospital association, the two major insurance companies leading up to passing the Romneycare bill could not agree on cost containment strategies in 2006, which was quite evident at the time. As far as I know they still cannot and go their own ways.
There was little agreement how to contain costs. However, mandated kinds of coverage make apples to apples hard…there is no simple ‘catastrophic’ event kind insurance, basic plans are demonstrably better in coverage than other states.
Jack, Yup! You got the point. “At best one might point out that Texas rates increased by a lesser degree than the national averages.” But, you missed or willfully ignored Buff’s point of the demographic changes.
You are again arguing against something never said: “There was no reduction in costs of any premiums.” Who said there was? Your inability to actually make a legitimate point without all the personal attack and misdirection is getting tiresome. Why should anyone bother responding to your pointless and angry comments?
The link Jack provided is correct and the table of contents is pretty clear. If this topic is of such importance to you, I would assume you’d want to read each of the articles that pertain to the subject. It’s very easy to see which ones are pertinent from the titles of the articles.
Given that the link opens to the table of content for the issue and given that the second listing after a word from the Editor in Chief is;
“Entry_Point
Select this article Averting Medical Malpractice Lawsuits: Effective Medicine—Or Inadequate Cure? Stephen Langel Health Aff September 2010 29:91565–1568; doi:10.1377/hlthaff.2010.0764
And given that the title and content of Micheal’s post are strongly suggestive that malpractice issues are the crux of the discussion. It doesn’t seem too far fetched to assume that the article, a relatively brief one, is readily identifiable.
My point CoRev is that if you go to the forest looking for cows you’re more likely to prove that there are more deer and bear than there are cows. Try going to the farm when you want to count cows.
“unfortunately, between 2003 and 2007 testing expenditures per Medicare enrollee grew at 50% greater than the national average”
That measure of growth without reference to other age groups or to the growth in available testing procedures or to any general changes in medical practice procedures is not reliable as a measure of unnecessary medical defensiveness when treating Medicare eligible patients. And is “defensive” medicine really unnecessary practice? The question of how much testing is too much is an ethical, professional, moral and practical one.
Wow Dan. It hasn’t slowed the rate of increase. Has increased the rate of adminstrative costs, and MA still the highest HC cost state. Was any of this anticipated?
jonsax, it may just be a style thing, but I prefer a “pull quote” and the link from which it was pulled. Just saves time and discussion of how best to intuit the source, and the specific points contained within.
No sir. There is no reduction at all in either case. Maybe there is a slower rate of growth, but that is not a reduction by comparison. It is only a slo9wer rate of growth for which there may be any number of unspecified factors. I find it to be good exercise pointing out the deceptive nature of so many of your comments. Angry? That’s what Freud would have called projection. No my friend, just diligent and vigilant in support of the truth.
Co Rev — here is the data from the Texas Board of
Physician Licencing.
It shows that after tort reform the growth in the number of doctors in Texas actually slowed from a 3.7% five year average growth rate before reform to a 2.4% growth rate after reform.
This data directly contradicts you claim that the reform lead to a 40% increase in the number of doctors in Texas. What is the souce of the data behind your claim.
the second column is the number of Drs. in Texas.
the third column is the annual percent change.
The third column is the five year average growth in the number of Drs.
% ch % ch 5 yr avg 1990 22711 1991 23119 1.80 1992 ………23609 ………..2.12 1993 ………23656 …………0.20 1994 ………24993 …………5.65 1994 ………25912 …………3.68 …………2.69 1995 ………27348 …………5.54 ………….3.44 1996 ………26248 ………..-4.02 ………….2.21 1997 ………28007 …………6.70 ………….3.51 1998 ……..28778 …………2.75 ………….2.93 1999 ………30348 …………5.46 …………3.29 2000 ……….31769 ………….4.68 ………….3.11 2001 ……….32281 ………….1.61 ………….4.24 2002 ……….33094 ………….2.52 ………….3.40 2003 ……….34432 ………….4.04 ………….3.66 2004 ……….34904 ………….1.37 ………….2.85 2005 ……….35811 ………….2.60 ………….2.43 2006 ……….36450 ………….1.78 ………….2.46 2007 ……….37177 ………….1.99 ………….2.36 2008 ……….38387 ………….3.25 ………….2.20 2009 ……….39374 ………….2.57 ………….2.44
you can find the data here
http://www.dshs.state.tx.us/chs/hprc/PHYS-lnk.shtm
Spencer, my source was Michael’s own writing which he later corrected after I questioned it. “The additional physician presence has only increased because of an increasing population as well, and when it was analyzed, there was only an increase of 0.4 (correction…0.4%) physicians per capita after the law was passed.”
Hello Michael:
Nice to have you write in this arena.
I would suggest there is a far bigger issue with patient safety resulting from malpractice than there is in malpractice litigation by patients. I forget the exact ratio but, I believe the numbers that sue doctors are 1:15. Insurance premium increases are more apt to be related to fund investment having a lesser return than they are with malpractice payouts. Malpractice payouts have been decreasing over the years.
Google Public Citizen and the National Data Bank for more info.
Actually, plans are also rated the best in the nation. And was the most expensive for a long time. BC/BS drove the combination of combining non-group individual/small business plans and rates, so the rate structure is heavbily skewed.
Cost containment was left to the future, which everyone knew, especially Romney, who appears to have had no intention of actually running the state. The great recession threw in a monkey wrench to the works. Costs are driven by the hospital association power bloc…regular care procedures tend to subsidize the fancy stuff as many charges are quite high compared to smaller hospitals, but smaller hospitals do not drive policy.
But while Texas maintained #33, MA also went with trend. The national press has not really followed the data here, they just go with slogans and the one word: NationalhealthcarewasmodeledontheMAssexperiment, which it was not except in some broad way, and the details are quite different.
Torts represent an alternative to regulation. Typically, countries with strong regulatory protections of consumer rights have limited recourse through the courts. The US tends to offer less regulatory protection than other countries, but greater access to legal remedy.
Which makes the question about “regulating” torts an odd one. It is tantamount to suggesting that we use a corrupt a consumer protection tool, turning a consumer protection tool into a tool to limit consumer protection.
That is to say, the US offers less regulatory protection than other highly developed countries.
Please define “unnecessary” testing. My wife’s life was saved by an “unnecessary” MRI. The people who call for an end to “unnecessary” testing should make that decision when they or a loved one is sick.
Rodger,
This will be the primary focus of the next post, which will be a little more complicated.