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This sounds like a really good idea, but self-regulated industries are notoriously bad at holding their own members accountable for bad actions. Seriously, in principal I like it, but in practice many people responsible for malpractice would get away with it. There's very little incentive for doctors to find malpractice--at the most basic level, it would increase their insurance rates. We see this problem in the legal community, which effectively regulates itself (most of the time).

Medina, if every government action regulating a market leads necessarily to communism, then every executive order leads to facism. Neither is true. But responding to criticism of our current medical system--which you just pointed out is a giant cluster--by accusing someone of advocating for communism and mass death is a bit much.

FYI, Pol Pot comes in a respectable 7th for worst mass murderes in the last 150 years. Mao, Hitler, the often forgotten King Leopold II (Belgium), Stalin, Tojo, and also forgotten Enver (of Turkey) were all responsible for more non-combat-related deaths. Hitler, Leopold II, Tojo, and Enver were not communists or socialists. Hitler was a facsist, and an enemy of socialism (and communism). Indeed, the USSR/Stalin saw England and Germany as the two biggest enemies of communism. Enver joined the side of the Whites--who fought against the Bolsheviks in the Russian civil war.

If the faulty doctor loses his license to practice (as they should) the insurance companies should be happy. Weed out the undesireables, so to speak.

Some will say Nazi is short for "National Socialist" ...

Again, theoretically it could be great. In practice, professionals have historically made poor regulators for their own industries. Frankly, the AMA itself is an example. If doctors thought weeding out the bad practitioners would be beneficial to them, they could have done it already. They haven't.

And yes, the Nazis had "socialist" in their name, but that didn't make them socialist any more than the Democratic People's Republic of Korea is democratic.

Problem #1a, as I see it, is that the US effectively subsidizes R&D for the entire world.  With most medicines the unit cost to produce a given pill is negligible.  The main cost is the R&D and that has to get amortized over the life of the pill.  The problem here is that most of the rest of the developed world either has price controls (Europe) or just steals the technology (China) and the less-developed parts of the world can't afford it so the US Drug Companies have to get their R&D investment back from their US customers only.  This is a trade issue that Trump should take on.  Somehow force Pharmaceutical companies to spread those costs over the rest of the world too. 

Problem #2 is the inherent problem of medicine that none of us have an incentive to save money.  We don't know what is going on and it is our health and someone else (insurance/government) is paying for it so we just do whatever "they" say.  The problem is that sometimes "they" are just generating bills or practicing defensive medicine and a lot of what we end up agreeing to is completely unnecessary. 

1a)  That's a huge problem for most versions of universal health care, when people use the term for whatever they are imagining.  All those countries that subsidize and "universalize" their health care?  Aren't making new things and finding new discoveries.  Unsurprisingly, the pushes forward is mostly confined to the spaces where there's a financial incentive to produce new things.  Profit-driven motives have their problems, and I wouldn't even argue with some of what people who oppose that paradigm cite as problems.  However, it's the only paradigm that keeps banging out crazy-awesome new stuff.  Which has helped untold millions.  

2)  I'm going to push back.  I think you're incorrect that no one has an incentive to save money.  Obviously consumers do, but do insurance companies and the government as well.  In fact it's the most common root cause of the common complaint "Insurance denied such and such."  Yeah, they did that because they don't want to pay for frivolous stuff.  In the long run, the consumer doesn't want their insurance companies paying for frivolous stuff either, and the free market, clunky and slow and messy as it is, has guided many instances of that.  Second, you're really shortchanging providers when you say they just generate bills or practice defensive medicine.  There are wasteful providers, to be sure, but they are the exception and not the rule.  Having seen the providers at the clinic I worked for up close and for a long period of time, one of whom I'm married to, and having dealt with and gotten to know a few of the specialists in our area, but more than that, getting to know their work by keeping track of our patients' medical records, I think it's a very unfair assessment to make that there's a lot of frivolous tests/procedures going on, or that they have no incentives to scale it back.  Here's what I can tell you.  Medicine is insanely complicated.  People think it's easy because they go into see their doctor and get 7 minutes with them, max, barely get to say anything, never feel like they got enough time with them, and then wonder how did the doctor get everything they need out of so little face to face time.  Must be easy.  What people don't know is the ten million things that provider is computing in their head based on what they're getting.  There is hardly a question of note you can ask a knowledgeable provider that isn't subject to complex background info.  They're thinking about things that can't possibly be explained to patients without medical background, in order to rule things out or prevent things that patient will hopefully never know about.  It's true that providers vary in their opinions on what is a serious enough concern to warrant some expensive test, but that is a relatively small variance.  Most stuff is fairly standard, procedurally speaking.  I would also say that on the margins, there are more cases of doctors not being preventative enough, rather than frivolously being too test/lab-happy.  And I'm not trying to say there aren't some major overhauls our entire system of medical practice is due for, including the way MD's are trained in med school to go about dealing with diseases.  But I take exception to the idea that providers are "generating bills" and have no incentive to save money.  That simply is too cynical a view, unsupported by data, and you may be unaware of the multiple, multiple safeguards in place throughout the industry built for the purpose of curtailing frivolity.  

I was thinking about this.

Rather than litigate a malpractice case, how about guilt or malpractice be settled by a tribunal of blind peers? In other words, they don't know who the doctor is - they are simply presented with the facts of the patient and the doctor's OR report.

Let them decide if mistakes were made. Then, when settled, arbiters step in and negotiate a reasonable settlement.

No courtroom, no juries, no expert witnesses.

What you are close to here is a Workmen's Compensation type system.  

To back way up and explain ( @SFBadger96 , @ELA , and any other attorneys who want to comment/clarify/correct please feel free):
Prior to Workmen's Compensation an at-work injury was litigated like any other case.  If you got hurt at work you could sue your employer.  You had to prove negligence.  In order to get punitive damages you had to prove more than mere negligence, more on the order of gross negligence.  

There were problems with this on both sides.  For employees it was almost a complete crapshoot.  If you got hurt at work you *MIGHT* get nothing or you might get some compensation or you might get a windfall.  Also, back then contributory negligence usually kiboshed a case and the injured employee was almost always at least somewhat negligent so a lot of workers just got left out in the cold on that alone.  For employers frequently it meant you didn't have to pay anything at all but once in a while you got hammered with a massive judgement.  In theory the employers who got hammered with the massive judgements were the ones that were grossly negligent but in practice luck had a lot to do with it.  Some plaintiffs are extremely sympathetic while others are off-putting.  Some potential jurors are friendly while others are hostile.  If you rolled those dice and came up with an off-putting plaintiff and a friendly jury you walked for free.  If the dice came up with a sympathetic plaintiff and a hostile jury you were probably going bankrupt.  

Workmens' Compensation was designed as a compromise.  It is a "no fault" system.  If you are hurt at work, you are covered by Workmens' Compensation.  Period, full stop.  There is no litigation of negligence (fault) because the system doesn't take that into account.  You get paid regardless of whether your employer or you were at fault.  That is the benefit for workers.  What workers gave up was the chance at the windfall of punitive damages.  You get compensation but you ONLY get compensation, no chance for more.  

Some sort of system like that might work but I honestly don't know.  

One of the biggest problems in Medical Malpractice is that the result doesn't prove anything.  Allow me to (try to) explain:
If I'm hurt at work the injury proves that I was hurt.  The only thing to litigate is whether or not it happened "at work"*.  If @847badgerfan goes in for heart surgery and dies, the death *MIGHT* be a result of a medical error or it might have been unavoidable.  

My Doctor friend (mentioned above) went to LawSchool with me.  He was furious when we had a case where a doc got dinged for not having an IV hooked up to a woman who died of an amniotic aneurism during childbirth.  He was furious because, according to him the IV would have been completely irrelevant.  In class he literally said "what would I put in it, chocolate?".  The problem with a case like that is that the plaintiff is INCREDIBLY sympathetic.  A young woman died in childbirth.  Was there a medical mistake?  I don't know.  I lean no since my Doctor friend said no but I'm obviously getting that second hand.  I'm sure the plaintiff had an expert who said that an IV full of chocolate would have saved the woman's life or something.  

How do you handle that?  If an error was made the Doc needs to be held accountable but it is entirely possible that the death was a result of things beyond the control of the Doc.  In that case it should be filed under "S" for "Shit happens".  It is incredibly sad but it it what it is.  



*"At work":
Since it is a no-fault system, a lot of the WC litigation is over the issue of whether or not an injury happened "at work".  The black and white cases obviously don't get litigated.  If you are in your office working, you are indisputably at work.  If you are at home having dinner with your family you are indisputably NOT at work.  Lawyers who deal with this argue about detours vs frolics (Detours are covered, frolics are not).  If I am driving from my office to the post office with mail for my employer, I am "at work" on that trip.  If I stop at home for lunch on the way it gets into a gray area.  Basically and VERY generally, if the side trip home for lunch is a minor deviation then it is a detour and I am still covered.  If it is a major deviation then it is a frolic and I'm not but exactly when I enter and exit being "at work" is REALLY important in these cases.  

What you are close to here is a Workmen's Compensation type system. 

To back way up and explain ( @SFBadger96 , @ELA , and any other attorneys who want to comment/clarify/correct please feel free):
Prior to Workmen's Compensation an at-work injury was litigated like any other case.  If you got hurt at work you could sue your employer.  You had to prove negligence.  In order to get punitive damages you had to prove more than mere negligence, more on the order of gross negligence. 

There were problems with this on both sides.  For employees it was almost a complete crapshoot.  If you got hurt at work you *MIGHT* get nothing or you might get some compensation or you might get a windfall.  Also, back then contributory negligence usually kiboshed a case and the injured employee was almost always at least somewhat negligent so a lot of workers just got left out in the cold on that alone.  For employers frequently it meant you didn't have to pay anything at all but once in a while you got hammered with a massive judgement.  In theory the employers who got hammered with the massive judgements were the ones that were grossly negligent but in practice luck had a lot to do with it.  Some plaintiffs are extremely sympathetic while others are off-putting.  Some potential jurors are friendly while others are hostile.  If you rolled those dice and came up with an off-putting plaintiff and a friendly jury you walked for free.  If the dice came up with a sympathetic plaintiff and a hostile jury you were probably going bankrupt. 

Workmens' Compensation was designed as a compromise.  It is a "no fault" system.  If you are hurt at work, you are covered by Workmens' Compensation.  Period, full stop.  There is no litigation of negligence (fault) because the system doesn't take that into account.  You get paid regardless of whether your employer or you were at fault.  That is the benefit for workers.  What workers gave up was the chance at the windfall of punitive damages.  You get compensation but you ONLY get compensation, no chance for more. 

Some sort of system like that might work but I honestly don't know. 

One of the biggest problems in Medical Malpractice is that the result doesn't prove anything.  Allow me to (try to) explain:
If I'm hurt at work the injury proves that I was hurt.  The only thing to litigate is whether or not it happened "at work"*.  If @847badgerfan goes in for heart surgery and dies, the death *MIGHT* be a result of a medical error or it might have been unavoidable. 

My Doctor friend (mentioned above) went to LawSchool with me.  He was furious when we had a case where a doc got dinged for not having an IV hooked up to a woman who died of an amniotic aneurism during childbirth.  He was furious because, according to him the IV would have been completely irrelevant.  In class he literally said "what would I put in it, chocolate?".  The problem with a case like that is that the plaintiff is INCREDIBLY sympathetic.  A young woman died in childbirth.  Was there a medical mistake?  I don't know.  I lean no since my Doctor friend said no but I'm obviously getting that second hand.  I'm sure the plaintiff had an expert who said that an IV full of chocolate would have saved the woman's life or something. 

How do you handle that?  If an error was made the Doc needs to be held accountable but it is entirely possible that the death was a result of things beyond the control of the Doc.  In that case it should be filed under "S" for "Shit happens".  It is incredibly sad but it it what it is. 



*"At work":
Since it is a no-fault system, a lot of the WC litigation is over the issue of whether or not an injury happened "at work".  The black and white cases obviously don't get litigated.  If you are in your office working, you are indisputably at work.  If you are at home having dinner with your family you are indisputably NOT at work.  Lawyers who deal with this argue about detours vs frolics (Detours are covered, frolics are not).  If I am driving from my office to the post office with mail for my employer, I am "at work" on that trip.  If I stop at home for lunch on the way it gets into a gray area.  Basically and VERY generally, if the side trip home for lunch is a minor deviation then it is a detour and I am still covered.  If it is a major deviation then it is a frolic and I'm not but exactly when I enter and exit being "at work" is REALLY important in these cases. 

At least in California there's also a fall back for wrongful denials of WC claims (Section 132 claim is what they are here, I think). That gets you out of the system and back into jury land.
I'm not sure that Badge was proposing that, but it's also an interesting idea. There are other places a system like that makes sense: the left overs of asbestos litigation, for instance. The truly bad actors were all put out of business a long time ago. Now its just deep pockets that get forced to pay for something that probably has very little to do with them. And it is extremely dependent on the attorneys involved, the sympathy for a particular plaintiff, and who settles with who on what terms and when. I know people won't like hearing me say it, but similar to WC, a pooled recovery fund from the insurers of the still functioning defendants and an agency that administers claims based on a reasonably quantifiable set of criteria would be much more efficient, and probably more fair, than the jury system. And like WC, maybe there's an escape valve for egregious circumstances, but it has a high threshold to open it. I don't think that works for all torts, but I think there's a decent amount of room for more of that kind of system than we currently have.