Doctors and the AMA

So I really do health care policy and tax policy in my spare time. Likely this makes me a weirdo, and it makes me highly unpopular and boring.

Nicholas Kristof wrote about the American Medical Association (AMA) today in his column. In it, he rightly points out that the AMA is losing members, and indeed many doctors in the AMA are using the trust that we give them. See e.g. Kaiser Family Foundation, NPR, and Harvard School of Public Health Poll and associated NPR stories. However, as Kristof points out many are tired of the AMA's rhetoric too.

I remain concerned though that we tend to put a lot of trust in our doctors. And that is not just because I do law as well. I think that we fail to understand how fallible they really are, and how there is just too much information to digest. Perhaps if we had something like the British NICE that uses research and cost analysis to determine reimbursement policy, doctors would have less of a problem because a certain level of decisions are made already. If we had EMR, we could have greater collaboration, and we should create other policies to aid in that regard, because there is just too much to know, and we must leverage everyone's knowledge.

Additionally, beyond incentives, we must look at situational factors. In some sense my favorite health care article in the last year because it says what I have wanted to say only so much better, points to the idea of culture. There is a lot of situational factors in play with the notion of culture pointed to by Gawande.

Finally, one notion on malpractice. A lot of the problems lie not in the notions of judgments and punitive damages, but the transaction costs. First, we could likely fix some of the problems if these Medical Review Boards were less back-scratching. Second, perhaps we could create some sort of strict liability system to prevent the large costs of finding negligence, but reduce the rewards paid out, and perhaps have every patient fund the system like an insurance and like worker's compensation. I do not know the solution, but one should carefully look at Texas's tort reform, which essentially has closed the courts for people who have actually suffered loss (the old system pre-tort reform was ridiculously pro-plaintiff though).