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Even though, as I have stated, I am not opposed to malpractice insurance reform, I still want to make a couple of points here (one being that this should be confined to medical malpractice for now, not all torts).

As to why it is not front and center in the reform effort, trial lawyers' lobbying efforts surely play a role. Their efforts, of course are as legitimate as those of any other lobbying group.

The more significant reason is that it is only natural to go after the big issues first and the "small potatoes" of malpractice reform just naturally take a back seat in the general discussion. I think it is similar to the reformers' desire for computerization of health information- important, but not the main show.

Personally, I think malpractice reform would be better addressed in separate legislation because more would be required than simply a cap on awards or similar quick fixes. Reform should include another change conservatives claim to want- sale of health insurance across state lines as insurance plays a key role in the malpractice arena. (BTW, I get a chuckle when I see them earnestly saying they favor sales across state lines to increase competition when confining insurance to state regulation is the result of long standing conservative policy to keep it away from Federal regulation!)

If we are to move toward something closer to those systems for dealing with malpractice that exist in other countries, we must also adopt their approaches to regulation. If health insurance is sold on a national basis, it must be regulated on a national basis. Next, there should be effective sanctions against providers who repeatedly are found to be practicing substandard medicine. This would also mean that a doctor could not be found at fault multiple times in one state only to move his practice to another.

I think the results would be similar to those in workman's compensation schemes. Many more people would be compensated for errors, but each amount would be substantially smaller.

Very, very few cases result in the large awards that get all the attention and, in those cases the amount is determined by a jury selected from people many of whom, I suspect, would have favored caps on recovery until they heard the details of the case. There is also no doubt that these same folks are more generous because they know there is insurance involved. Notice, also, that there are very few headlines when the award is drastically reduced by trial judge or on appeal.

So, bring on malpractice reform, but do it in a comprehensive way that still provides a remedy for those harmed.
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