No-fault: The answer to the med mal crisis? Nobody wants a stinky Mercedes
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The system you described to reduce medical malpractice litigation ["Malpractice: Can no-fault work?" June 4] is not really no-fault. It's more like workers comp. Nevertheless, I think there's considerable potential for a true no-fault systemwhere the person at risk of injury, the patient, purchases the insurance. Automobile no-fault compensation has been with us for years; here's how it could work in the healthcare setting.
In the early 1970s, no-fault insurance was devised to get the medical bills of auto accident victims paid as quickly as possible. To expedite payment, insureds gave up their unrestricted right to sue for damages. In return, their auto insurer paid their medical bills, eliminating the need for costly, time-consuming litigation to determine who caused the accidenthence, no-fault. Today, all 12 auto no-fault states place a threshold on the right to bring a suit, based either on the dollar amount of a victim's medical bills or the severity of his injury.
In order to reduce the number of lawsuits even further, in the late 1980s New Jersey insurance carriers offered car owners an additional trade-off: a lower premium if they agreed to give up their right to sue for all but the most serious injuries. Now, more than 90 percent of New Jersey drivers choose this less-expensive option.
Might not the same dynamic apply in cases of medical malpractice? Say patients could buy a personal-injury-protection policy in addition to their basic health insurance. In return for their agreement to file malpractice suits only for more-serious injuries, the carrier would automatically cover bad outcomes without assigning fault to the doctor. With the assurance that his bills for treatment would be paid, would the patient then be willing to even further forfeit his right to sue his doctorfor a lower premium, say, or for additional health benefits or for a prescription drug coverage? The experience with automobile no-fault suggests that people would find such an option attractive.
The benefits to the healthcare system would be obvious. There would be far fewer malpractice suitsand subsequent awardsso malpractice premiums for doctors would plunge. As the necessity of practicing defensive medicine was eliminated, the cost of providing medical care would drop.
Steven Lomazow, MD
Look at the states that have no-fault auto insurance and see what happened to the premiums: New Jersey and New York, for example, have some of the highest rates in the nation. The same will happen with no-fault malpractice insurance. The only answer is tort reform that includes (1) "loser pays," (2) a cap on lawyers' fees, and (3) the separation of malpractice from the tort system, as is done in patent law.
John Hoch, MD
You can make the argument that a no-fault system would work better than our current tort system, but getting it approved by state or federal legislatures is remote, thanks to the political influence of the trial bar. There are proactive steps healthcare could embrace today, based on research, that can eliminate or mitigate many malpractice claims, while improving patient safety. Unfortunately, it seems many of us are stuck waiting and hoping for a legislative "silver bullet."
James H. Cunningham, Jr.
Oak Park, IL
Your excellent article on the resale value of used cars ["Which cars hold their value?" June 18] didn't mention one important deal killer. Even the faintest smell of tobacco smoke causes the value of a used car to plummet. So don't let anyone smoke in your car, unless you want to give it away.
Franklin D. Munkres, MD
Port Charlotte, FL
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Aug. 6, 2004;81:8.