bad-doctorI live in Charleston, South Carolina, which is a regional health care center with a local medical school and a lot of doctors, some of them my neighbors. So I hear a lot of doctors bitching about their professional lives.  And that bitching generally comes down to a single argument: “I’m bringing home less money than I used to: if this medical system is so out of control, why isn’t my income out of control, too?”

One of my doctor neighbors who does a lot of surgery spends $70,000 per year on medical malpractice insurance premiums.  I asked him if an extra $70,000 per year in income would stop his complaining.  He said it would.

So let’s save him the money.  The legal and financial costs of medical malpractice in the U.S. amounted to about $17 billion in 2005.  That isn’t much compared to the almost $2 trillion total cost of healthcare, but divided among the nation’s 700,000 physicians it’s over $20,000 per head.

Ultimately we patients pay the cost of malpractice anyway through medical fees and insurance premiums, which amount to around $50 per patient per year.  Why not handle it, then, the same way we do uninsured motorists on our car insurance policies?  Throw on an extra $30-per-year fee (we’re cutting out the lawyers, remember? so the amount can be less than $50) to handle medical malpractice.

If your surgeon comes to work drunk and takes your wrong kidney, you don’t sue him, you file a claim with YOUR insurance company.  Claims get a medical vetting but awards follow standard actuarial algorithms, which ought to both mean that true costs are covered AND the insurance company makes a small profit on your pain, keeping the system stable.

Lawyers in this system would limited to going after doctors for professional sanctions and non-monetary penalties like having their medical licenses revoked.  As my old dean told me, “When there is no money people fight over turf.” So in a disconnected malpractice system the professional penalties are likely to get more stern, not less.

This is not intended to let the bad docs get away with malpractice, because they’d be quickly blackballed by health insurance companies refusing to do business with physicians who cost them extra money

Politicians like to talk about tort reform, which comes down to limiting lawsuits and victims going uncompensated.  It doesn’t have to work that way.  Let’s just change the game to one where bad doctors — not all doctors — are punished.