Let’s put aside whether we can define defensive medicine, and what would or would not diminish it, or whether physicians practicing defensive medicine actually reduces their risk. Let’s even put aside the difficulties in estimating the costs of so called “defensive medicine”, and the fact that one physician’s defensive medicine is another’s necessary care. Or even the fact that without the profit motive, certain tests may not be as likely to be ordered in a single payer system. Put aside all that.
I think the problem with comparing other legal malpractice systems is that you also have to compare the healthcare system in conjunction. The need for pursuing a claim for future medical bills and lost wages and your overall decline in the quality of your life is not as urgent in countries with a deeper social safety net than that provided by the US. Even things like the relatively inexpensive availability of public transportation in places like that matter. If a person injured in the US is looking at a lifetime of specialized care, and mountains of past medical bills, that’s an expensive proposition, which becomes less expensive in single payer systems.
I say less expensive, but let’s be clear, the cost is the same overall, the paying party is just changed. In Canada, it’s the taxpayer that picks up the tab for malpractice. In the US, it’s the responsible party if the victim does not have the means to pay them themselves. So do we want the responsible party paying for the harm they caused, or do we want all us taxpayers sharing that cost? It’s a philisophical question. Just because Americans FILE claims more often than Canadians doesn’t mean health care is any cheaper there. It may mean simply that the injured party isn’t responsible for the direct cost of resulting damage so the incentive for filing isn’t there. And remember, filed claims don’t equal paid claims.
So simply to say, well, any cost savings is solely attributable to one thing is dangerous. If physicians go that route, they will eventually find people looking at the salaries of Canadian and US physicians and wondering why the difference and perhaps some money could be saved there as well.
You say you think “malpractice reform” would change things, but there are myriad proposed reforms out there now, so without being more specific it’s hard to say. It’s like saying that healthcare reform would save money. Without knowing the specific proposed reform, how can you make that determination?
And while you may be a fan of “health courts”, even if they were not a backdoor version of arbitrary caps, they still have a cost. You’re creating a whole group of experts, judges, staff, etc. at least one in every state if not more, to be paid by the taxpayer rather than the parties to the litigation. And the injured victim and the other party are still going to have lawyers, still going to have insurance, etc. So if you haven’t analyzed those costs, you aren’t being honest about the cost comparison.