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I have heard the exact comment you made here from a good friend (well, my closest friend...met in kindergarten while our parents attended Republican party meetings in the Eisenhower era...) who is currently in a managerial role for a large hospital operating group.

His comment was that with the high cost of even one mistake, the actual costs would stay high since SOMEONE is going to make a mistake and probably one a day across the national system, leading to massive risk exposure on a daily basis.

Not that the general quality of docs was bad, just that with the sheer number of opportunities to have something go south, something would. And the resulting cost would be astronomical.

But I think the solution is two fold, and it’s based on my own rather unpleasant experience: have seen actual mistakes made by a foreign doc - he got wire brushed by the State Medical board after I referred him, and after a few other similar complaints, I think he’s relaxing in a condo near a beach somewhere, without the opportunity to drop the ball on another case - and in another instance (my father’s last days on planet Earth), a foreign doc who was not incompetent, but not particularly brilliant either, and got pushed by a Chief Resident to take the path of least resistance because it was expedient.

And thus the two points...

1 - Tort reform as you point out; much medical time/expense is now devoted to layers of CYA review/testing etc to produce a paper trail that can’t be assailed (but will be anyway in court)

2 - A larger group of MDs and concomitant residency slots who should be able to produce overall better results at a lower cost since Item 1 will free up available cash for them, not tests, lawyers, and awards.

An emotional and patriotic benefit would be that more homegrown docs would be involved due to Item 2; it’s ridiculous that the current game appears to be artificially limiting the number of docs in this country with the assumption that any shortfall can be cheaply made up by importing eager foreigners of questionable quality.

My viewpoint may be simplistic and certainly one from the consumer side, but I’ve seen examples of both situations and experienced their side effects.