The Health Care Debate

[Tosspot]

A big part of it is because we sue for the slightest reason, settlement amounts are beyond belief and medical providers have to cover themselves. We pay for it.

As I said, pettifoggery.

[phxcat]

A big part of it is because we sue for the slightest reason, settlement amounts are beyond belief and medical providers have to cover themselves. We pay for it.

How true is this?  Granted, frivolous lawsuits do occur, but people have been demonizing judges and juries (which are made up of regular people like you or I) to make it sound like they are always making insane judgements.  Usually, if you hear about a crazy case (like the McDonalds coffee case), you will be appalled until you do some research and find that there is more to it, or less, than meets the eye.
(see http://www.lectlaw.com/files/cur78.htm for some facts on the case)  Doctors do sometimes make mistakes (although the vast majority do a great job, IMO), and if they are at fault due to negligence, they should be held accountable.  I don't know what the legal system does to separate the frivolous suits from the good ones, but we shouldn;t be too quick to jump on the lawyers.

One part of the system that should be reformed is the role of the insurance companies.  As long as insurance companies are run as businesses whose primary interest is to make money, health care will cost far more than it should.  Insurance companies should be run as non-profits or should be highly regulated so that the goal will be the delivery of health care, not profit.

[Roanoker]

As long as insurance companies are run as businesses whose primary interest is to make money, health care will cost far more than it should.

Of course their primary interest is to make money. That's my primary reason for going to work every day. With all its flaws, the free enterprise system works pretty well.

I place a bet with my insurance carrier every payday that I will get terribly sick or have a horrible accident, and I hope they win. 

[Gretz]

Click here for an interesting article in last weeks economist about state moves for healthcare reform, specifically Arnold's new plan for universal coverage in California and the current legislation for Massachusets.  I'm not sure that it will work for non-subscribers but I think it should.  http://www.economist.com/world/na/displ ... id=8522104

[KCMax]

Universal health care to me would seem to destroy a large part of the US economy, and I am not talking about insurance companies. Who exactly would foot the bill for new and innovative medical procedures? What happens to the millions of people who work in the healthcare industry when the govenment starts regulating their wages? Who will pay to open new hospitals, clinics, etc if the profit margin is tightly regulated? The result will be much worse care, especially for those of us who already have insurance.

Universal health care does not mean the govt regulates wages. I think your arguments about margins and wages being restricted are strawmen. Not every universal health care plan has anything to do with that, in fact, I haven't heard of one that does. The existing health care system is already destroying the US economy. How can Ford compete overseas when so much of its expense is dedicated to health care that other foreign companies like Toyota aren't obligated to pay?

As for lawyers and health care, in states where there have been litigation restriction, caps on awards, etc., there hasn't been an appreciable decline in insurance premiums making me believe that lawyers are just the bogeyman, and not really much of a significant factor in escalating health care costs.

[Highlander]

How true is this?  Granted, frivolous lawsuits do occur, but people have been demonizing judges and juries (which are made up of regular people like you or I) to make it sound like they are always making insane judgements.  Usually, if you hear about a crazy case (like the McDonalds coffee case), you will be appalled until you do some research and find that there is more to it, or less, than meets the eye.

I have to disagree with the authors of the article you linked.  I guess I just have a much stronger sense of personal responsibility than that.  In any event, the plaintiffs sought an award well beyond compensation for actual damages.  They sued for and were rewarded a significant amount of punitive damages as well.  I strongly feel that punitive damages should never be awarded to individuals in plaintiff suits.  If there is penalty to be incurred, that is the responsibility of the state and the funds should go to the state as a fine.  The awarding of outlandish punitive damages is where juries truly earn the demonization they have incurred.  

(see http://www.lectlaw.com/files/cur78.htm for some facts on the case)  Doctors do sometimes make mistakes (although the vast majority do a great job, IMO), and if they are at fault due to negligence, they should be held accountable.  I don't know what the legal system does to separate the frivolous suits from the good ones, but we shouldn;t be too quick to jump on the lawyers.

One part of the system that should be reformed is the role of the insurance companies.  As long as insurance companies are run as businesses whose primary interest is to make money, health care will cost far more than it should.  Insurance companies should be run as non-profits or should be highly regulated so that the goal will be the delivery of health care, not profit.

[Gretz]

          quote from Highlander  "Well, not really.  The article is tainted by our cultural acceptance of the lack of personal responsibility.  Something that is very unique to the US.  Drinking coffee in a vehicle is inherently risky whether you are driving or not; I have never done it as I recognize that risk.  The temperature of the coffee was irrelevant.  In any event, the award went well beyond actual damages with punitive damages.  I am absolutely against the concept of individuals suing for punitive damages.  In my opinion, the issuance of penalty should be solely a state function and any such funds collected should go to the state."

The hot coffee example is an obvious case of a ludicrous lawsuit, and is not at all representative of the vast majority of lawsuits in our country.  In order to convince 12 reasonable people that an individual or company did something to warrant a settlement, one must usually have good grounds.  This example is extreme but rare.


As for malpractice settlements, however, the French system uses set tables for compensation from "medical accidents."  http://www.info-france-usa.org/atoz/health.asp

On March 4, 2002, the government passed another law, establishing compensation for all medical-related accidents whether fault is found or not. These new rights were added to other long established rights, such as compensation payments in the case of pregnancy or disease prevention, medical care for workers and students, family planning, and systematic screening of certain diseases.

I would agree with a system limiting punitive settlements in doctor-patient suits, in cases of accidents or incompetent treatment.  However, our system needs punitive damages to protect consumers in other situations.  For example, courts need to be able to award settlements in cases where a company, say a drug manufacturer or medical device maker, is concerned if it can be proved that a company knowingly put something dangerous on the market or falsified information to doctors or consumers about the risks.  If settlements in these cases were capped, like the Bush administration has proposed, companies would only find it worthwhile to disclose problems and risks if they thought the number of persons affectedXcapped settlement cost would be enough to make economic sense for them to do so.  This is the basis of the punitive damage system: It allows juries to penalize entities at a level that forces them to respect the safety of consumers.  For example, if a certain drug was thought to kill only 0.01% of people who took it and those people could only get 1 million each a company might calculate that it makes sense to put it on the market because the total money taken in on the drug would exceed the settlements that they would have to pay to each family who had someone die.  Punitive damages need to be available so that a jury can penalize the company at a level that destroys their profit incentive to exhibit this behaviour, and the only way to do that is through un-capped punitive damages.  The same applies to many other industries of course, and the system works, as a means to protect the public's interest as numerous examples have shown.

More broadly, what about the example of the French socialised medical system?  The lengthy waits inherent in the British and German systems do not exist there because of a hybrid system in which 80% of citizens have supplemental care.  France spends far less per person on health care than us, yet has the world's best health care system according to the World Health Organization.  See the link above for some information about their system.

[Highlander]

          quote from Highlander  "Well, not really.  The article is tainted by our cultural acceptance of the lack of personal responsibility.  Something that is very unique to the US.  Drinking coffee in a vehicle is inherently risky whether you are driving or not; I have never done it as I recognize that risk.  The temperature of the coffee was irrelevant.  In any event, the award went well beyond actual damages with punitive damages.  I am absolutely against the concept of individuals suing for punitive damages.  In my opinion, the issuance of penalty should be solely a state function and any such funds collected should go to the state."

The French system uses set tables for compensation from "medical accidents."  http://www.info-france-usa.org/atoz/health.asp

On March 4, 2002, the government passed another law, establishing compensation for all medical-related accidents whether fault is found or not. These new rights were added to other long established rights, such as compensation payments in the case of pregnancy or disease prevention, medical care for workers and students, family planning, and systematic screening of certain diseases.

I would agree with a system limiting punitive settlements in doctor-patient, in cases of accidents or incompetent treatment.  However, our system needs punitive damages to protect consumers in other situations.  For example, courts need to be able to award settlements in cases where a company, say a drug manufacturer or medical device maker, is concerned if it can be proved that a company knowingly put something dangerous on the market or falsified information to doctors or consumers about the risks.  If settlements in these cases were capped, like the Bush administration has proposed, companies would only find it worthwhile to disclose problems and risks if they thought the number of persons affectedXcapped settlement cost would be enough to make economic sense for them to do so.  This is the basis of the punitive damage system: It allows juries to penalize entities at a level that forces them to respect the safety of consumers.  For example, if a certain drug was thought to kill only 0.01% of people who took it and those people could only get 1 million each a company might calculate that it makes sense to put it on the market because the total money taken in on the drug would exceed the settlements that they would have to pay to each family who had someone die.  Punitive damages need to be available so that a jury can penalize the company at a level that destroys their profit incentive to exhibit this behaviour, and the only way to do that is through un-capped punitive damages.  The same applies to many other industries of course, and the system works, as a means to protect the public's interest as numerous examples have shown.

More broadly, what about the example of the French socialised medical system?  The lengthy waits inherent in the British and German systems do not exist there because of a hybrid system in which 80% of citizens have supplemental care.  France spends far less per person on health care than us, yet has the world's best health care system according to the World Health Organization, which is no small entity?  See the link above for some information about their system.

I stongly disagree with your assessment of punitive damages.  If there is wrongdoing, that is a matter for the state to decide, not an advesarial legal system juried by a number of individuals with absolutely no training in the subject matter they are being presented.  It is almost a gaurantee that the wrong decisions will be made and I strongly believe that is exactly what happens over and over again.  I don't have a problem with penalizing companies large sums of money that have behaved in absolutely irresponsible manners (let governemental agencies investigate and levy fines), but giving such vast sums of money to an individual and their legal representatives on the basis of a decision of  uninformed and often uneducated members of the public is not justice.  Punitive damages are the least efficient method of regulation available to us to ensure corporate responsibility and the large awards tend to encourage suits that have no basis.  I might add that for a drug to go on the market, it is not the sole decision of a drug company, the FDA has to approve it.  And here is a pertinent question; what if a drug goes on the market and saves the lives of 50% of those that take it but it does kill that .01%....the risks are known but is it proper to levy punitive damages against the company as it is saving far more lives than it is taking?

I am assuming that you are lawyer.  I am a scientist and I recognize that no drug, no endeavor, nothing is ever going to be risk free.  That should be self evident to everyone who is involved in every process from supply to consumer.  There is always going to be a risk.  So, with every drug that does unfotunately kill someone, the drug company knows there is a risk; it's inherent to the business.  It's not a matter of premediated calculation, it's a unfortunate fact of the interaction between medication and physiology.  We have become a society, however, that somehow began to assume a risk-free environment and that is the problem with punitive damages, the premise of risk is simply not understood by the jury and conveniently forgotten by the legal community.     

Back on the subject of health care

As for a combined health care system that involves comprehensive care with the possibility for supplemental insurance, I don't have a problem with that, I think a tiered system is necassary to ensure the level of care that many already have but include those currently left out of the system. 

[chrizow]

there is some confusion here between medical malpractice and products liability.

(a) in products liability cases, punitive damages are by FAR the exception and not the rule.  punitive damages are for the (thankfully rare) case where a company has placed a dangerous product into the marketplace, the company knows it's dangerous, does not fix it, and usually some exec will be on record saying "eh, fuck it, let 1 out of a million children receive third-degree burns!"  conversely, as a matter of law and policy we let manufacturers place somewhat risky products in the marketplace all the time, but they will be held accountible only for negligence in the design or manufacture of the product.  the damages are typically limited to what you would expect - medical bills, lost wages, pain and suffering, etc.  it varies widely by state, but some states permit STRICT liability for certain kinds of harm caused by products - if the product injures someone foreseeably, the company pays out - period.  like insurance, this is a combination of law, policy, risk, etc.

(b) in medical malpractice cases, punitive damages are, once again, the exception and not the norm.  only egregious behavior or awful negligence will result in punitives.  there is no correlation between insurance costs and jury awards - that is a pervasive insurance-industry myth.  for the most part, i think medical malpractice cases work themselves out pretty well - based on what i've read anyway.  it sucks when a doctor, who is merely doing her best, does something (or, more commonly, omits to do something) that results in injury.  i've talked with doctors firsthand who are either hurt or angry when their conduct is questioned, but it needs to be done.  however, when you have an injured person and someone is arguably responsible, the injured party/family should be compensated. 

(c) highlander, you're correct that all products (and human conduct) carries a certain amount of risk.  the law does not punish all actors for all consequences of all risks.  actionable negligence is a much higher threshold than most people realize.  huge jury awards have given the law a bad name when literally 99.9999% of cases do not even GO TO TRIAL, let alone result in huge verdicts.  most cases settle, and if they settle that means the parties got together and somehow arrived on a figure that both could live with.  again, like insurance, it's risk management - if an insurer (say, for a hospital, pharm company, or doctor) feels that there is too much risk of exposure from a jury verdict, they settle - as they should.  if a product injures 1 out of 100000 people, then the company should have to pay that one person.  it's just the cost of doing business for them, and the family that is shattered by a relative's catastrophic reaction to a drug can at least take care of expenses.  it works out.

(d) it should also be noted that there have been studies where lay-jurors and "experts" are presented with the same case and both juries arrive at the same verdict approximately the same % of the time as they do with other lay-juries, other expert-juries, and vice-versa.  juries really aren't stupid, and skilled lawyers (who undoubtedly are called in when there is a lot of $ at stake) can present the case to them adequately. 

[Highlander]

there is some confusion here between medical malpractice and products liability.

(a) in products liability cases, punitive damages are by FAR the exception and not the rule.  punitive damages are for the (thankfully rare) case where a company has placed a dangerous product into the marketplace, the company knows it's dangerous, does not fix it, and usually some exec will be on record saying "eh, fuck it, let 1 out of a million children receive third-degree burns!"  conversely, as a matter of law and policy we let manufacturers place somewhat risky products in the marketplace all the time, but they will be held accountible only for negligence in the design or manufacture of the product.  the damages are typically limited to what you would expect - medical bills, lost wages, pain and suffering, etc.  it varies widely by state, but some states permit STRICT liability for certain kinds of harm caused by products - if the product injures someone foreseeably, the company pays out - period.  like insurance, this is a combination of law, policy, risk, etc.

(b) in medical malpractice cases, punitive damages are, once again, the exception and not the norm.  only egregious behavior or awful negligence will result in punitives.  there is no correlation between insurance costs and jury awards - that is a pervasive insurance-industry myth.  for the most part, i think medical malpractice cases work themselves out pretty well - based on what i've read anyway.  it sucks when a doctor, who is merely doing her best, does something (or, more commonly, omits to do something) that results in injury.  i've talked with doctors firsthand who are either hurt or angry when their conduct is questioned, but it needs to be done.  however, when you have an injured person and someone is arguably responsible, the injured party/family should be compensated. 

(c) highlander, you're correct that all products (and human conduct) carries a certain amount of risk.  the law does not punish all actors for all consequences of all risks.  actionable negligence is a much higher threshold than most people realize.  huge jury awards have given the law a bad name when literally 99.9999% of cases do not even GO TO TRIAL, let alone result in huge verdicts.  most cases settle, and if they settle that means the parties got together and somehow arrived on a figure that both could live with.  again, like insurance, it's risk management - if an insurer (say, for a hospital, pharm company, or doctor) feels that there is too much risk of exposure from a jury verdict, they settle - as they should.  if a product injures 1 out of 100000 people, then the company should have to pay that one person.  it's just the cost of doing business for them, and the family that is shattered by a relative's catastrophic reaction to a drug can at least take care of expenses.  it works out.

(d) it should also be noted that there have been studies where lay-jurors and "experts" are presented with the same case and both juries arrive at the same verdict approximately the same % of the time as they do with other lay-juries, other expert-juries, and vice-versa.  juries really aren't stupid, and skilled lawyers (who undoubtedly are called in when there is a lot of $ at stake) can present the case to them adequately. 

I do not necassarily agree with all you said but all other arguments aside, when there is a billion dollar punitive damage award, would it not make more sense for this award to go to the state rather than to the individual?  In other cases where there has been corporate irresponsibility such as unsafe workplace fines and environmental pollution, awards are levied by the state and the money collected enters the treasury of the state.  After the family is compensated for actual damages, why not use the punitive damages for the betterment of society rather than to concentrate that wealth in the hands of a very few.  I realize that these awards are not the norm but the current system does not make sense to me and it does encourage litigation. 

[chrizow]

i dont see anything wrong with encouraging litigation per se - although misguided litigation does not really help anyone. 

indeed, there are instances where courts and juries impose penalties upon the defendant beyond or aside from paying the plaintiff.  depending on the nature of the case, the jury/court could force the defendants to contribute to and/or establish programs to help persons in the plaintiff's position, create new policies/legislation/regulations that could prevent similar injuries, pay into funds that help the community, community service, environmental remediation, etc. 

the remedy for any given civil dispute is very broad.  due to media attention and a lack of familiarity with how things work, people think that "litigation" means "pissed off person suing another pissed-off person for a huge settlement."  such is sometimes the case, sometimes not. 

[Gretz]

I stongly disagree with your assessment of punitive damages.  If there is wrongdoing, that is a matter for the state to decide, not an advesarial legal system juried by a number of individuals with absolutely no training in the subject matter they are being presented.  It is almost a gaurantee that the wrong decisions will be made and I strongly believe that is exactly what happens over and over again.  I don't have a problem with penalizing companies large sums of money that have behaved in absolutely irresponsible manners (let governemental agencies investigate and levy fines), but giving such vast sums of money to an individual and their legal representatives on the basis of a decision of  uninformed and often uneducated members of the public is not justice.  Punitive damages are the least efficient method of regulation available to us to ensure corporate responsibility and the large awards tend to encourage suits that have no basis.  I might add that for a drug to go on the market, it is not the sole decision of a drug company, the FDA has to approve it.  And here is a pertinent question; what if a drug goes on the market and saves the lives of 50% of those that take it but it does kill that .01%....the risks are known but is it proper to levy punitive damages against the company as it is saving far more lives than it is taking?

As I stated below, "For example, courts need to be able to award punitive settlements in cases where a company, say a drug manufacturer or medical device maker, is concerned if it can be proved that a company knowingly put something dangerous on the market or falsified information to doctors or consumers about the risks."

Of course many treatments do involve some risk.  As long as these are disclosed and their is no willfull misconduct it is unlikely that punitive damages would be sought or applied, according to Chriz' eloquent explanation of the nuances of our civil legal system. 

I am assuming that you are lawyer.  I am a scientist and I recognize that no drug, no endeavor, nothing is ever going to be risk free.  That should be self evident to everyone who is involved in every process from supply to consumer.  There is always going to be a risk.  So, with every drug that does unfotunately kill someone, the drug company knows there is a risk; it's inherent to the business.  It's not a matter of premediated calculation, it's a unfortunate fact of the interaction between medication and physiology.  We have become a society, however, that somehow began to assume a risk-free environment and that is the problem with punitive damages, the premise of risk is simply not understood by the jury and conveniently forgotten by the legal community. 

In these cases companies do need to be held responsible for the consequences that they have unknowingly exposed people to as well, I think.  Just a matter of opinion.  More broadly I believe our legal system to be an acceptable and generally effective means of resolving civil disputes.  To take these powers away from the courts and give them to some newly created governmental body whose place it would be to regulate medical matters would shake the foundations of our constitution by giving unprecedented powers to legislative and executive authorities and open up huge areas of policy to political tampering, with regulations be changed and rewritten at the whims of legislators and executors and hence special interests.  While our courts may come up with questionable settlements now and again, I think they generally do a good job.  I guess legislators could legislate the courts out of such matters but who's to say a regulator would be a fair executor of the public's will?  Likely an executive would be able to have this new regulator focus it's efforts one way or the other based on its ideology, and legislators could do the same, whereas the courts are generally impartial and matters are decided by randomly selected individuals rather than political appointees. I wouldn't trust a Republican adminstation/congress to protect patients against insurers and I wouldn't trust a leftist administration/congress to protect large hydro-energy producers from the interests of migratory salmon.  It's the way things have always been done here, and tort reform on the level that would be required to take away the courts' ability to decide civil matters, medical or otherwise, would represent a major change in the way our country functions.  Oh, and no, I'm not a lawyer actually, though I'll likely end up in law school soon, however much I try to avoid it.       

Back on the subject of health care

As for a combined health care system that involves comprehensive care with the possibility for supplemental insurance, I don't have a problem with that, I think a tiered system is necassary to ensure the level of care that many already have but include those currently left out of the system.  We can agree on this much at least.  I'm not sure how such a system would look HERE or how we would go about creating it, but with some states beginning to experiment with their systems we will have some examples to look at in the next few years. http://www.economist.com/world/na/displ ... id=8522104

[Gretz]

Wow, that yellow is really obnoxious.  Sorry about that. 

[Roanoker]

Wow, that yellow is really obnoxious.  Sorry about that. 

No problem. Dragging one's cursor over the text it turns it to black easily enough.

I appreciate everyone's contributions from their areas of expertise. Thank you, all!

[phxcat]

Of course their primary interest is to make money. That's my primary reason for going to work every day. With all its flaws, the free enterprise system works pretty well.

I place a bet with my insurance carrier every payday that I will get terribly sick or have a horrible accident, and I hope they win. 

If my primary interst were to make money, I wouldn't be a teacher (though teachers do not get paid as badly as many people make it out to be).  Doing a better job of teaching does not get me more money.  I try to do the best I can because I am in an industry whose primary purpose os to help society.  That is the way insurance companies should veiw their industry, but they don't- and because of that, their service is often notwhat it could be.  Why would they, for instance, provide for preventative care when it will cost them money now, but not save them money in the future, when the problem in question would arrive and the customer is off with another company anyway?

[aknowledgeableperson]

Of course, if the USA did adopt an universal health care plan there is one negative that has not been explored.  That is, as costs (paid by taxes) go up pressure will applied to Congress and the President to limit costs and their increases.  One way to do that is the restrict care given due to age and/or ailment.  Some states tried to do this a few years ago with the Medicaid program but were unsuccessful.  It would be easy to do if one would rank DRG's and then apply the patient's age.

[Roanoker]

If my primary interst were to make money, I wouldn't be a teacher (though teachers do not get paid as badly as many people make it out to be).  Doing a better job of teaching does not get me more money.  I try to do the best I can because I am in an industry whose primary purpose os to help society.  That is the way insurance companies should veiw their industry, but they don't- and because of that, their service is often notwhat it could be.  Why would they, for instance, provide for preventative care when it will cost them money now, but not save them money in the future, when the problem in question would arrive and the customer is off with another company anyway?

Kudos to you and all the other fine folks who choose occupations for the sole purpose of helping other people. I didn't do that, and I forget there are those who do. (I wanted to be a housewife who would take care of her husband and children, but I was asked to contribute monetarily.)

We need good health care. We need good schools. We need food. We need clothes. We need auto parts and/or bicycle chains. I suppose we need good entertainment. I guess we need the Chiefs football team and the stadium they play in.

Who's to say who should get paid what? Who really cares what an individual's or corporation's motivation is? I want to do the best job I can wherever I work.

I don't have any real answers, so I'll be quiet now.

[Highlander]

OK, I am not even going to try to reproduce your yellow print but....

My problem with the idea that punitive damages are necessary to protect the consumer from corporate irresponsibility is that it gives those in the legal community who have assumed the role of "corporate watchdog" a huge financial incentive for finding fault.  The "enforcer" (effectively, the legal community) stands to gain considerable financial rewards by making an accusation.  No other part of our regulatory system works that way.  That kind of incentive-based judicial/regulatory system (it's basically a self-appointed regulatory system as you have described it)  is an open invitation for abuse.  Would it be acceptable if prosecuting attorneys in the criminal justice system were paid on the basis of convictions and received larger sums of money based on the seriousness of the crime?  I think most would balk at the idea because of the obvious potential for abuse.  Yet, we are perfectly happy to apply the same rationale in the civil arena.  I really cannot see how the current civil law system (with respect to puntive damages, not actual damages) is effectively any different than the rhetorical criminal system I have described.     

[LenexatoKCMO]

You are going to take a lot of flak for that comment but I think it is partly correct.  Lawyers certainly have their hands in the health care till and their involvement does impact the way medicine is practised which drives up the cost.  My opinion is that the more you can reduce the cottage industries that tax the health care system, the more efficient the system will be. 

The AMA and other MD lobbiests, medical academia, pharmaceutical companies the hospital industry, and the insurance industry have all spent many millions the last several years to convince folks like you that medical malpractice, and more specifically lawyers, are responsible for skyrocketing medical expenses.  In truth, med mal accounts for the tiniest drop in the proverbial bucket of health care expenses and has actually been very stable for decades (while health costs soar) - however, the groups above have found that it is far easier to demonize and blame lawyers than it is to have the public poking in their closets and taking a look at some of the systemic failures and/or profit taking in their own industry. 

[Highlander]

The AMA and other MD lobbiests, medical academia, pharmaceutical companies the hospital industry, and the insurance industry have all spent many millions the last several years to convince folks like you that medical malpractice, and more specifically lawyers, are responsible for skyrocketing medical expenses.  In truth, med mal accounts for the tiniest drop in the proverbial bucket of health care expenses and has actually been very stable for decades (while health costs soar) - however, the groups above have found that it is far easier to demonize and blame lawyers than it is to have the public poking in their closets and taking a look at some of the systemic failures and/or profit taking in their own industry.   

Well, we spend so incredibly much on health care that I would not doubt that the actual rewards for malpractice are indeed a very small portion of the entire health care bill.  But, there are other ways that health care is impacted by litigation and one is defensive medicine.  I have a lot of friends who are physicians and they universally and passionately point to medical malpractice as one of the biggest culprits in soaring medical costs, my many lawyer friends (and brother-in-law) tell me the exact opposite, I have read convincing articles pointing the finger in both directions and both entities have a huge vested interest in the outcome.