Category Archives: health care

The Myth of Defensive Medicine Costs


The standard refrain of opponents to comprehensive health care reform efforts, like Obamacare, is that one of the major drivers of escalating medical cost is defensive medicine practices caused by fear of lawsuits. Fix that and you’ll move a long way toward keeping health costs from escalating, or so the theory goes. The science to back up this claim has never been borne out.  Yet Red State legislatures — including Texas and Georgia — dutifully bought the wisdom of conservative think tanks in recent years and enacted tort reforms making it more difficult to file, as well as limiting the amount of damages plaintiffs can win in medical malpractice lawsuits. Now we have some additional studies that these news laws haven’t really made much of a difference in terms of controlling costs. Today’s New York Times Upshot reports about it.

When you talk about rising health care costs you have to deal with, among other things: an aging population in need and demanding care for chronic illnesses;  new, more sophisticated medical technologies that replace cheaper, less expensive diagnostic tools;  the high-cost of recovering research expenses by overcharging for new drugs to the market; a reimbursement system that pays physicians more for ordering tests and procedures than it does for keeping patients well; and the 20-25 cents on the premium dollar that goes to profit, marketing and administration of commercial health insurance plans. The fear of malpractice, no doubt, is another factor. But it is chump change. And when you hear it come up in serious policy discussions, it is more than likely just a way to distract you from the serious issues this country still faces in making health care affordable.

Mike King is a retired health policy reporter, editor and columnist for The Atlanta Journal-Constitution. He is the author of “Diversion,” a book about how large public hospitals have become the safety valve for the nation’s highly profitable $3 trillion a year health care economy. The book — as viewed through the experience of Atlanta’s Grady Memorial Hospital — is expected to be published next year.

Back in the game with some interesting reading

Been gone a while. But now that the dust is settling on the Obamacare rollout — we’re still a long way from being able to talk about cost control and whether access to affordable plans has been greatly expanded (or just good enough to be happy about year one) — I thought you might be interested in a couple of good reads I saw recently on

This first one deals with why Republicans always choke on a viable alternative to Obamacare. (Hint: It was because it was THEIR plan to begin with.

Speaking of a plan that many thoughtful people long ago concluded is the only way to truly get universal access and have a real shot at controlling costs, Sara Kliff of Vox offers this lengthy explanation of what’s going on in Vermont.

And lastly, my favorite website since the first of the year is this one. It shows how we Georgia taxpayers, since the first of the year, have been sending our hard-earned federal taxes to New Jersey, Kentucky, California and other states to help subsidize their expansion of Medicaid enrollment for the working poor while we sit here listening to our elected state leaders say they are proud to give up those dollars and let our working poor fend for themselves. Consider, for a moment, whether they would be willing to give up federal highway funds? Or public safety funds? Wouldn’t it be great if we had one of those billboards — like the one on Peachtree that used to roll out the ever increasing Atlanta population — that showed how much money (about $100 per second, by my count) Georgia’s hog-tied and Tea Party bound GOP leadership is purposefully throwing away for our state. Within the next few days, this number will reach $1 billion (billion, with a “b”) since the first of the year.

A helpful look at Georgia’s priorities

My friend, and former AJC reporter/editor Tom Baxter has a great column discussing the difference in how Georgia’s political leaders think about spending money on a project like deepening the Port of Savannah versus expanding the Medicaid program to cover an additional 650,000 uninsured Georgians. It’s on the Saporta Report website. The standard brush off line that the governor’s office gives to reporters asking about why Georgia won’t take advantage of Obamacare’s offer to pay the full cost of the expansion for the first three years and at least 90 percent of the costs after that is “the state can’t afford it.” Georgia has a $20 billion annual budget. The “cost” to the state to expand Medicaid would run about $200 million a year. Do the math. It ain’t much. But can we afford a lot more than that to expand the port? Sure we can. An expanded port provides jobs, right? (Well, hopefully, although the promised benefit is pretty much a best, most optimistic guess.) Whereas the Medicaid expansion results in more Georgians being covered, a revitalized health care sector and, more than likely saved lives that might actually help the state improve its dismal health rankings. We could probably afford to do both. But you won’t hear that from the state’s leaders. It’s a matter of priority. What Nathan Deal and Ralph Hudgens mean to say about the Medicaid expansion is not that “the state can’t afford it,” it’s that we don’t think its worth spending any more money on poor people. They ought to at least be honest about that.

Here’s the link to Tom’s column.

Welcome to Comment on Health

This site is devoted to helping understand all the changes happening in our nation’s health care and insurance system. It is open to thoughtful, serious, sometimes comical and, hopefully, always engaging commentary. Opinions are welcome. Made up stuff isn’t. Nor is re-posting unverified and/or demonstrably false “facts” about health care reform.  Don’t be bringing that crap here. Do your homework. If you want to spew unchallenged, non-factually based opinions, take them back to your respective campfires and discuss it among yourselves. They won’t be posted here. (Yeah, yeah, I’m elitist and old school about this.) Having said that, all informed opinions that challenge conventional wisdom and common narratives about the subject of health care are otherwise welcomed. Still, part of what we want to do here is some helpful myth-busting. That means, from time to time, I will dissect some of the misinformation that makes its way into the mainstream, on Facebook, Twitter and other venues. I apologize in advance for even referencing some of these whoppers — putting anything on them World Wide Internets nowadays, even the blatantly false stuff — can sometimes result in extending the very life of the lie itself, despite the best effort to lay it to rest. (Think “death panels,” and “government takeover of health care.”) So I promise to do this with only  the most despicable of these claims, and only then with the aim of explaining who created it and why they want to mislead you.


Here’s what you need to know about me. I spent nearly 40 years in the daily newspaper business, much of it covering science, health and health care policy. I still write a lot about it, mostly as a freelance journalist. I don’t consider myself an expert on policy, but I know something about how the system works for real people and how to help people understand the issues connected to it. I am unabashed proponent of expanding both government and private programs so that all Americans are covered by an affordable, quality health insurance plan. It is not only good for the nation’s economy, it is — bottom line — the right thing to do. I consider it a sad commentary on our nation’s standing in the world that we have yet to come to grips with this basic societal need. One day we will. Until then, let’s talk about how best to get there. See you around the blog. — mike king