3.

> The NTSB...

We have what are called "morbidity and mortality conferences." If something goes to shit, the doc responsible gets to take the stage in front of his and all related departments next week, and explain the entire course of the medical episode and the decisions taken at each step, while being monday-morning quarterbacked by every doctor they're even vaguely familiar with. The episode is also forward to Quality Improvement, which is a hospital-led group looking to address systemic and process errors. And, lastly, malpractice suits are the final inspection.

When docs fuck up, there isn't a shortage of post-mortem. None of that does anything to shield physicians from malpractice liability.

(An exception: if you operate in a FQHC - federally qualified health center - for the underprivileged, and you maintain a QI program that meets government standards and audits, the government assumes your facility's liability risk. But physicians are still fire-able at the end of the day as part of the QI process, so the incentive for Cover Your Ass medicine remains.)

"Bad Doctors" are a rarity, in my experience. What is more an issue is "doctors good enough to practice good medicine under modern time constraints, and those that aren't." Not everyone can manage a complex patient in 3 minutes. In fact, most can't. But with everyone squeezing down hard on reimbursement, that's become a necessity. No one wants to pay for the time that good care requires. So, docs default to shotgun medicine - throw all the tests at the patient so you can't be accused of overlooking something, and hope that something comes back unambiguously positive. Next patient.

> In your specific case, I believe having a single payer system would improve the outcome related to the above considerations. Affected individuals would still be covered by 'the system', good doctors would not be burdened by specific negative outcomes that happened to occur under their care, and bad workers of any type would be removed.

I think I should clarify what a single payor is. It's often abused in popular literature to mean something like "government monopoly on healthcare." It's more literal than that, though: it's a single payor. So that can mean things like:

a) A government monopoly on healthcare, where all healthcare facilities and providers are owened by the government, paid by the government, etc. HC is distributed as a utility, and people assume it is covered by their taxes (UK) or they pay a nominal fee (Canada, if I'm not mistaken).

b) Government monopoly on health insurance, but healthcare facilities and providers remain private competitive entities. Healthcare provision remains fragmented as a competitive market, but at least these facilities can expect uniform negotiations and documentation across all their patients, since they're all coming in with the same insurer. Patients expect their care to be covered by their taxes, premiums, or some combination of the two. This is closest to "Medicare for All."

c) Regional monopolies on health insurance. As per "b", except that inter-state entities continue to see some heterogeneity in payors. This regional monopoly might be governmental (e.g., Medicaid For All) or private (such as areas where only one private insurer is available.)

None of these things change the liability landscape directly, although in "a" malpractice liability is usually assumed by the government as hc providers are employees. This doesn't eliminate CYA concerns, but does shift them from "do everything the patient wants, whether or not it's best for them" to "follow local policy and guidelines, whether or not it's best (for the patient)."

> Also of note is that for a 'single payer' system the costs SHOULD be divorced from the actual treatment; though might be a considered criteria when a given standard of treatment is selected.

Why is that? Regardless of who the single payor is, they have budgetary constraints. The appetite for healthcare is infinite compared to resource inputs. Someone is going to be squeezed to make those resource allocations. Currently it's the physicians, but if not physicians, someone else.