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Comment and Controversy

Liability: Pass cost to the public

November 2003 · Vol. 15, No. 11
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To the editor:

I understand and appreciate Dr. Barbieri’s points in “What’s really at stake in the jackpot liability game?” (August 2003).

One factor that’s often neglected in analyses of this problem is that medical liability insurance is simply a cost of doing business, like any other item of overhead. In any other industry in America, increased overhead translates into increased costs for the goods or services in question. The only reason why doctors suddenly “cannot afford” liability insurance is that government and insurance industry price-fixing does not allow them to pass along their increased costs.

If Americans want to play “the jackpot liability game,” they should be allowed to do so. But its costs should be borne by the public, not physicians.


DR. Barbieri responds:

I agree with Dr. Gorski that the damage of the current liability crisis would be tempered if physicians could pass the costs of liability premiums directly to patients and insurers. However, I disagree that the escalation in medical liability insurance premiums is “like any other item of overhead.”

Fundamentally, physicians have entered into a “social contract” with the larger society, as we wrote in an editorial, “Physician walkouts and the fraying of the social contract” (OBG Management, March 2003). In return for a decade of sacrifice and intense training, followed by a lifelong commitment to the health of their patients, physicians expect society to treat them fairly, respect their autonomy, and trust their professionalism. The liability insurance crisis threatens to disrupt the standing social contract, and place all physicians in a defensive position.

This is a topsy-turvy world in which physicians base practice decisions on the beliefs of plaintiff attorneys rather than their convictions of what constitutes the best medical care. Few other “items of overhead” bring such a dysfunctional response to the practice of medicine.

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