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I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare.

No, doctors try to make you as fully aware as possible of the options available to you, so that you or your heirs don't turn around and sue them later for 'withholding information that could have saved your life' or something along those lines. Arguably, these suits are motivated in part by the need to defray the extremely high costs of care and pushing back at the physician or caregiver about the quality of clinical care is a powerful negotiating strategy because it plays well to a jury.

"Lawsuits" are an easy scapegoat, but it's probably not a significant driving factor. For example, Texas has very strict tort reform laws which basically make it impossible to sue a doctor for malpractice. But defensive medicine hasn't faded at all in the four years since those laws took effect.

Structurally, our system is designed to over-treat. With co-pays, insurance, subsidized care, and contractual discounts, patients seldom are aware of the exact cost of treatment. How often do Doctors explain to patients up front both the tests to be performed and the line-item cost (both to you and to the payor) of each?

Most doctors don't, and realistically can't, know the cost for each patient under each plan. Usually, it's a binary decision for the doctor (covered or not covered).

Try it sometime. When your physician suggests a procedure, ask what the real cost is, and whether he/she thinks that the value of the results will be worth the expenditure compared to alternatives. It's simply not something that's "baked in" to the thought process of the medical profession either in medical school, residency, or thereafter.

I agree lawsuits are not the primary or even a major driver of costs, but every doctor I've met worries about them, and I was responding to speculation about what motivates doctors as individuals.

As for Texas, you're quite right - indeed, medical costs seem to have risen since the 'reforms' were put in place: http://www.dayontorts.com/tort-reform-medical-malpractice-to... - according to a tort lawyer, but consistent with everything else I've read on the subject.

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