To Make Health Care Affordable, Tackle Defensive Medicine

By: RICHARD L. JACKSON

Appeared in Investors Business Daily on March 26, 2015


On the fifth anniversary of the passage of the Affordable Care Act this week, one issue remains constant: There is a great need to find a solution to skyrocketing health care costs.

The answer lies in a simple reform: eliminating defensive medicine.

Defensive medicine is defined as unnecessary tests, procedures and medications of no clinical value that a physician orders as legal protection from a medical malpractice lawsuit. Doctors have the greatest influence on health care costs as they are the ones that order patient expenditures, and physicians nationwide validate that defensive medicine is a problem.

Gallup, in a nationwide survey of physicians, found in 2010 that one in four health care dollars spent on patients — or $650 billion annually — can be attributed to defensive medicine.

Most doctors will tell you their greatest fear in the practice of medicine is a medical malpractice lawsuit. It influences how they treat patients every day. According to a 2011 Pacific Survey, 92% of physicians in the U.S. reported practicing defensive medicine, while the response rate was zero for Canada, the United Kingdom and New Zealand.

A doctor will practice defensive medicine, for example, if a patient presents himself with chest pains and the cardiologist does blood work and finds the patient is not having a heart attack. To avoid a lawsuit, the doctor may still order additional costly tests such as an echocardiogram, a CT scan or an MRI.

In 2012, the independent health care economics firm BioScience Valuation estimated $140 billion in Medicare and $120 billion in Medicaid plans are spent on defensive medicine annually.

Unfortunately, when Congress debated the ACA it failed to address medical malpractice, and the impact of defensive medicine on the cost of health care. Health care has and will continue to remain unaffordable unless we tackle defensive medicine.

Consumer spending on health care jumped 16% from the first quarter of 2012 to the fourth quarter of 2014, according the Bureau of Economic Analysis. Health care spending is projected to continue growing faster than our economy between 2013 and 2025, according to the Centers for Medicare and Medicaid Services.

Costs will continue to skyrocket until we realize what is driving up health care costs is costly diversions such as defensive medicine.

While Democrats and Republicans continually debate the intricacies of the ACA, the current health care law will not reduce health care costs. Instead, a proposal now before legislators in four states to eliminate defensive medicine would do what the ACA failed to.