The Current State of Health Care Reform

Congress has passed expansive legislation to “fix” health care. US health care, however, is not “broken”; rather, it functions according to purpose. The legal standard sets health care’s purpose as high-quality care, not care at a pervasive quantity or low cost. Juries focus on quality irrespective of cost, and the court’s concern is not cost but whether the defendant physician has met the standard of care. As the US health system does deliver high-quality (albeit high-cost) care, it is not broken; instead, the system that defines it is broken. The legal system defines the standard of care as the care that an average physician would deliver under similar circumstances. As 91% of physicians admit to practicing defensively excessive care, the legal care standard is therefore excessive care. However, the new health care legislation passed by Congress does not address tort reform. Instead, it reduces physician remuneration and increases penalty-driven cost care control regulations. Caught between a care standard that demands high quality regardless of cost and penalty-driven federal mandates demanding low-cost care regardless of the legal care standard, physicians bear the new law’s ultimate burden. US health care should not continue to focus on quality over cost and quantity; more important, the law should not continue to dictate that it do so. Rather, the system must import cost-effective care, and the law must so direct. To reduce health care costs, the legal system must first recognize a standard of care that respects cost—or tort reform that protects those physicians who do.