Monday, September 19, 2011

Kiss the docs goodbye

Obamacare is a terrible piece of legislation. It is a bill to take care of a minor problem with insurance and in the process screws up medical care. As Mark Perry has pointed out, US medical care passes the market test with over 500,000 tourists coming here to get care. Why did not those people get care at home? Why did many of them come from managed care countries where it is "free" to pay for it here? The answer is obvious. What needs to be asked is whether those tourists will come here once Obamacare gets fully implemented? I doubt it. What I will do is invest in hospital groups that will set up offshore. If the governments in the Caribbean are smart, they will establish medical sanctuaries much as they have done with banking. One likelihood has been given little attention and is most troublesome. It is that Obamacare limits the tests that doctors can recommend for patients without capping malpractice awards. Although a fairly sizable portion of medical costs is attributed to testing, those tests are not being conducted to enrich the doctors but rather to protect them against malpractice suits. Yet Obamacare does not limit malpractice awards. This means that one of the protections for the doctors is taken away. Without those protections we can expect the doctors to start leaving the profession. Looking at malpractice under managed care in Canada and the UK shows that the doctors are shielded. In the UK where the docs work for the government, the government rather than the doctors defend against the suits. In Canada where the doctors remain in independent practices and are re-imbursed by the government, medical malpractice awards are limited to $300,000. An article in the St. Pete Times ( notes that neurosurgeons in Miami pay annual malpractice insurance premiums of $237,000 while in Canada a neurosurgeon in Toronto pays $29,000 and one in Vancouver BC pays only $10,650. Not surprising there were less than 1,000 suits in Canada last year and fewer than 100 went to trial. Without a limit on malpractice awards, removing the allowable tests and trying to control costs by squeezing reimbursements will drive doctors out of practice. So not only will we end up with worse medical care, we will also have worse medical care practiced by worse doctors.

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