There are numerous questions about health care that just aren't getting asked -- by the left or the right. Yet these questions seem essential to any real solutions to the problems we face. Today I will begin the first in this series.
#1: Whatever happened to the small, family-practice GP?
If you're keeping score, you've probably noticed that the small, family-practice doctor with his own office is essentially a thing of the past. Nowadays, doctors as a rule band together into small consortia, primarily to defray the costs of malpractice insurance, which are considerable.
What are the consequences of this? Well, for one thing, the fact that you probably aren't going to a small-town doctor (heck, you probably don't even live in a small town) means your relationship to that doctor probably isn't one of considerable trust. You aren't a part of the same community, and in that situation people are going to be more suspicious and, perhaps, more likely to sue.
Of course, these consortia, their insurance rates, and the buildings that house them all contribute to medical costs. A doctor is going to charge more if, in addition to the overhead inherent in providing medical care, he has to pay astronomical rates for insurance as well as the mortgage or rent on the shiny medical center just off the interstate.
The solutions, of course, are tricky. Putting arbitrary caps on even punitive damages in malpractice suits seems unfair: who are legislators to declare what it was worth to you when they sawed off the wrong leg?
An alternative might be voluntary contracts between you and your doctor not to sue for malpractice in exchange for lower rates, a prescient suggestion Walter Block makes in a lecture on health care. These might include clauses that the doctor will provide you additional care for free if anything goes wrong, or that you waive the right to sue as long as the doctor follows some set of "best practices"--even if something nevertheless goes wrong.
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