Reports and Retorts
Wednesday, March 9, 2005 Posted: 3:17 PM EST (2017 GMT)
MILWAUKEE, Wisconsin (AP) -- A judge threw out a high school student's lawsuit against mandatory summer homework, saying he and his father should have done a little more studying themselves before bringing the case.
Students in the Whitnall High School math course -- honors pre-calculus -- were supposed to do three assignments by certain dates over the summer.
Peer Larson, 17, and his father, Bruce, had filed suit in Circuit Court, arguing that homework should not be required after the 180-day academic year is over.
The Larsons argued it was difficult for the boy to do the assignments because he had a summer job as a camp counselor. They also said students should be able to enjoy their summers free of homework.
But it's up to school boards to decide such things, Judge Richard J. Sankovitz ruled Tuesday.
"Had the Larsons done a bit more homework," he wrote, they would had learned that "the people of our state granted to the Legislature ... the power to establish school boards."
Bruce Larson said he had not immediately decided whether to appeal. He said the judge ignored a key issue -- whether it was reasonable for a school to spring "three lengthy assignments" on students just before summer vacation began.
Bush Administration 2005
Lawsuit Reform a Bush Priority
President Seeks to Limit Class-Action, Malpractice Cases
By Jonathan Weisman
Washington Post Staff Writer
Thursday, December 16, 2004; Page A06
President Bush yesterday demanded congressional action on legislation to rein in class-action, asbestos and medical malpractice lawsuits, telling a White House economic conference he would make changing the civil tort system a "priority issue."
Bush used the first day of the two-day economic gathering to focus on "the class-action meat grinder" and malpractice suits that "are driving really fine, competent people out of the practice of medicine." A series of bills limiting suits in civil cases have been held up in the Senate, mainly by Democrats but also by a handful of Republicans.
"I am here to . . . make it clear as I possibly can that I intend to take a legislative package to Congress which says we expect the House and the Senate to pass meaningful liability reform on asbestos, on class action and medical liability," Bush said.
The economic conference was called to highlight Bush’s domestic agenda, which includes revising the Social Security and tax systems. One panel addressed the growing complexity of the tax code, laying out the administration’s case for simplifying the code; cutting taxes on dividends, capital gains and business investment; and making Bush’s first-term tax cuts permanent.
The president appeared at only one of yesterday’s four panels, on "lawsuit abuse," underscoring his interest in changing a system the administration says is costing the economy more than $250 billion a year. Bush said that "defensive medicine" -- the use of unnecessary tests to avoid malpractice claims -- alone costs the federal government $27 billion annually.
Even with Republican gains in the House and Senate, the president will face a fight. The White House is likely to secure the 60 votes necessary to beat a filibuster on a bill shifting class-action lawsuits from state courts to federal courts. That would be "a step, but a small step" toward scaling back mass suits filed on behalf of thousands of plaintiffs, said George L. Priest, a Yale University professor of law and economics who is serving on the panel.
But Senate Republican leaders were unable to muster even a 50-vote majority on three bills to limit medical malpractice suits, and they appear far from a deal to end the proliferation of suits on behalf of those exposed to asbestos.
The Association of Trial Lawyers of America has been holding meetings with its members to raise millions of dollars for a nationwide campaign against the president’s initiatives. Participants at a meeting this week in the Washington area were told that ATLA wants to raise $8 million immediately and more over time, in part for a national television, radio and print advertising campaign.
Consumer and environmental groups charged yesterday that Bush was using tort legislation to reward his financial backers and compensate for an absence of effective policies to combat rising health care costs and sluggish job gains. ATLA said that the number of civil trials dropped 47 percent between 1992 and 2001, and that the median payout for tort cases dropped 56 percent over that period.
"Give us a break, Mr. President," chided Todd A. Smith, the association’s president. "Giving your friends in the insurance, drug, tobacco, chemical and other industries another windfall at the expense of American families is not an economic recovery plan."
On the economy, panelists painted a generally rosy picture of growth, the job market and the investment climate, and they focused on policies to sustain growth over the long term.
"Thank God the election is over; I have never seen so much economic misinformation," said Mary C. Farrell, managing director of UBS Wealth Management in New York. "We have a wonderful economy."
The discussion of tax-code changes was striking for what was absent. Gone were the expansive ideas that dominated Republican tax debates in the 1990s -- scrapping the entire tax code, for example, and replacing it with a single flat income tax rate or a national sales tax.
Instead, participants advocated incremental tax changes to spur savings and investment and make permanent earlier tax cuts, including the abolition of the estate tax.
The Treasury Department yesterday appeared to put tax legislation on a faster track than the administration initially indicated. Treasury spokesman Robert Nichols said a yet-to-be-named tax reform panel will be expected to quickly report recommendations to Treasury Secretary John W. Snow, who will forward his reform proposals to Bush in early 2005. Administration officials had earlier said the secretary’s recommendations probably would reach the White House late next year for a legislative push in 2006.
In a brief interview, Snow said that the timetable has not been changed, and that the tax panel will take time to hold hearings and gather facts.
"We’re going to look at everything," he said. "We’re going to look for the very best ideas out there."
But for the secretary to turn those ideas into recommendations early next year, the panel will have to work fast.
Treasury Department officials have a wealth of tax reform proposals from Bush’s first term to draw on, including one that fits many of the ideas endorsed by yesterday’s panelists. Those ideas include repealing the alternative minimum tax, establishing generous new savings accounts that would effectively end investment taxation for almost all Americans, simplifying tax rates and allowing most business investment to be fully deductible. Those changes would be paid for by ending the deductibility of state and local taxes and taxing health insurance and Social Security benefits as income.
At a separate session in the Oval Office yesterday, Bush reaffirmed his support for a strong dollar and pledged to work to roll back deficits in order to create a stronger economic climate for the U.S. currency. He noted that the interest rate increase the Federal Reserve approved on Tuesday indicated Fed Chairman Alan Greenspan’s concern as well.
"The policy of my government is a strong-dollar policy," Bush said, with visiting Italian Prime Minister Silvio Berlusconi at his side. "We believe that the markets should make the decision about the relationship between the dollar and the euro." He added: "We’ll do everything we can in the upcoming legislative session to send a signal to the markets that we’ll deal with our deficit, which, hopefully, will cause people to want to buy dollars."
Staff writers Jeffrey Birnbaum and Peter Baker contributed to this report.
"Lawsuit Crisis" in General
The Myth of America’s ’Lawsuit Crisis’ By Stephanie Mencimer, Washington Monthly Last December, Newsweek featured a cover package by Stuart Taylor and Evan Thomas that blared: "Lawsuit Hell: Doctors. Teachers. Coaches. Ministers. They all share a common fear: being sued on the job." Paired with a weeklong tie-in on NBC News and online chats on MSNBC.com, the article claimed that because "Americans will sue each other at the slightest provocation," the country is suffering from an "onslaught of litigation" that costs Americans $200 billion a year. The story was full of tales claiming to illustrate Americans’ overarching sense of legal entitlement and desire to "win a jackpot from a system that allows sympathetic juries to award plaintiffs not just real damages…but millions more for the impossible-to-measure ’pain and suffering’ and highly arbitrary ’punitive damages.’" Among others, the story featured a softball tournament organizer, a minister, and a doctor who all claimed to have modified their behavior because they were terrified of lawsuits. Ryan Warner, an insurance salesman in Page, Ariz., told Newsweek that he had recently cancelled an annual charity softball tournament because an injured player had sued the city of Page for $100,000. Warner said that he worried he might be added as a defendant. The story as published, though, lacks a few critical details. Newsweek didn’t mention, for instance, that the 1997 federal Volunteer Protection Act ensures that people like Warner are immunized from these types of lawsuits. The article also excluded the injured man, Richard Sawyer, a locomotive engineer who suffered a dislocated ankle and a spiral fracture to the fibula – and missed months of work as a result – after he slid into a base that was supposed to break away on impact but didn’t because the city hadn’t followed the manufacturer’s instructions for maintaining these fixtures properly, according to Kevin Garrison, Sawyer’s lawyer. The event organizers had insurance – required by the city – to protect against exactly this kind of situation, but Warner cancelled the tournament anyway because he says the lawsuit was "a hassle." Canceling the tournament proved a smart PR move, as it brought out an immense amount of pressure on Sawyer to drop his suit, says Garrison. The case was settled this January for an undisclosed amount and Warner was never named. In fact, the tournament has been revived and scheduled for early September. Not only were the particulars of the Newsweek story misleading. The essence of the story was wrong, too. Newsweek’s "onslaught" of lawsuits simply hasn’t happened. According to the National Center for State Courts, a research group funded by state courts, personal injury and other tort filings, when controlled for population growth, have declined nationally by 8 percent since the 1975, and have been falling steadily in real numbers since 1996. The numbers are even more dramatic in places with rapid population growth, like Texas, where the rate of tort filings fell 37 percent between 1990 and 2000. Even in liberal California, the rate of filings has plummeted 45 percent over the past decade. And those overly sympathetic juries Newsweek derides as so eager to dole out big bucks to injured victims? In 2001, they voted against plaintiffs in 75 percent of all medical malpractice trials, according to the federal government’s Bureau of Justice Statistics (BJS). In an interview, Taylor dismisses these numbers as insignificant compared with the tort system’s $200 billion drag on the economy. "The costs of the tort system to society have gone up astronomically," he says. That figure, though, comes from the insurance-industry consulting firm Tillinghast-Towers Perrin (TTP), which includes in its definition of the "tort system" insurance company administrative costs and overhead and the salaries of highly paid insurance company CEOs (Maurice "Hank" Greenberg, chairman of AIG, one of the world’s largest insurance companies, makes $29 million a year). One thing TTP doesn’t include: court budgets, which makes its study seem a lot more like an assessment of the insurance industry than of the legal system. It’s not as though Newsweek wasn’t aware of these facts. On Friday, Dec. 5, a day before the story went to press, Taylor contacted the Association of Trial Lawyers of America (ATLA) for a quote. ATLA relayed the request to the nonprofit Center for Justice and Democracy (CJD), whose director, Joanne Doroshow, emailed Taylor information that contradicted some of the assertions in the story, including the state court data and a critique of the TTP study. (Doroshow provided the entire email exchange to The Washington Monthly.) Taylor dismissed it all, telling Doroshow, "Based on your many emails to me over the past 24 hours, you have very little thoughtful analysis to contribute to that debate." Taylor did, however, take lots of his information from Philip K. Howard, the founder of Common Good, a group funded by corporations and physicians seeking to limit their legal liability for wrongdoing. Common Good’s agenda includes advocating for legislation that would end the civil jury’s role in many lawsuits. To advance the cause, Common Good helps reporters generate anti-lawsuit articles by distributing colorful litigation horror stories from around the country – the story from the Arizona Sun about Warner’s softball tournament, for instance, was linked on Common Good’s Web site a few months before the Newsweek story appeared. Incidentally, Howard also works for the law firm of Covington & Burling, which represents Newsweek’s parent company. Post-Newsweek Inc. has been sued a number of times for employment discrimination and was hit with an $8.3 million verdict in 1999, a fact that Newsweek didn’t mention in the story. Unfortunately, Newsweek’s one-sided coverage of the civil justice system is the rule, not the exception. Every few months, one or another newspaper, magazine, or television show does a story just like it. They all hew to a standard line, starting with a juicy but misleading – or even fictitious – lawsuit horror story typically describing an irresponsible plaintiff, followed by "studies" on the economic damage of the tort system published by corporate front groups, finally ending with calls for "reforms" to rein in mushy-headed juries and greedy trial lawyers. Such skewed coverage represents a victory in a sustained, 50-year public relations assault on the civil justice system by the insurance industry, tobacco companies, and other corporate giants. It’s helped fuel political support for curtailing Americans’ right to hold corporations and individuals accountable for negligence, fraud, and other malfeasance in court. Perhaps more serious, journalists’ willingness to perpetuate anti-lawsuit propaganda has gravely jeopardized Americans’ unique democratic right to participate on civil juries. Runaway Hedge-clippers The current PR campaign by the insurance industry and other big corporations is just the latest iteration of a long fight tracing back to the 1950s. That was when plaintiffs’ lawyers started breaking down some of the legal barriers that had long protected industry from responsibility for injuries to workers and consumers and opened up jury pools to make them more representative of the general public. The blood bath on the nation’s highways during the post-war auto boom also created a whole new arena of litigation over who should pay for the injuries and deaths caused in car accidents. Auto insurance companies were frequently in the middle of these disputes (as they are today; insurance companies are the defendants in 90 percent of all auto-accident lawsuits). With their profits threatened by unfavorable jury verdicts, the insurance industry started running anti-lawsuit ads targeted at jurors. For instance, in 1953, the industry ran ads in Life magazine and The Saturday Evening Post that declared, "ruled by emotion rather than facts, [jurors] arrive at unfounded or excessive awards – verdicts occasionally even higher than requested!" The ads implored potential jurors to remember that "you pay for liability and damage suit verdicts whether you are insured or not." The industry also successfully planted articles in national magazines and TV shows that were designed to look like investigative reporting. In 1962, CBS broadcast "Smash-Up," a fictionalized docudrama that portrayed sleazy lawyers faking auto accident cases. The Insurance Information Institute, the industry’s public relations arm, helped write the script. In 1977, the venerable insurance company Crum & Forester sponsored one of the first print ads that included what would become a staple of anti-lawsuit rhetoric: the fictional lawsuit horror story. The ad told the story of a guy who collected a $500,000 jury verdict after he was injured using a lawnmower as a hedge clipper. The agency later conceded that it had no factual basis for the story, but that didn’t keep it from circulating widely in the media and in conservative political speeches. The industry knew what it was doing. In 1979, Elizabeth Loftus, the famous memory researcher and University of California psychologist, tested the effects of this kind of advertising on potential jurors and their decision making in the jury box. At the time, the industry was spending $10 million on a series of ads in a host of national magazines. In an article in The American Bar Association Journal, Loftus reported that potential jurors who were exposed to even one insurance ad awarded much less for pain and suffering than those who weren’t. In the mid-1980s, with insurance companies hitting a slump, the insurance industry’s "tort reform" movement, as it became known, broadened its emphasis. Instead of limiting itself to targeting individual jurors through mass media advertising, the industry began to heavily lobby legislators to restrict citizens’ ability to sue. The movement pursued strict caps on damage awards, tougher standards for proving liability, and caps on plaintiffs’ attorney fees. The industry’s crusade was taken up by small government conservatives, who believed that tort reform paralleled their own efforts to fill the federal bench with pro-business jurists and roll back government regulations. They were also upset by changes in the 1960s and 1970s that broadened legal protections for women and minorities, such as the 1964 Civil Rights Act, and the expansion of product liability doctrines that made it easier for injured consumers to force companies to compensate them for faulty products. Politically, it was a lot easier to attack juries and trial lawyers than the popular consumer, civil rights, and environmental protection laws they enforced – or the injured victims they represented. Advertising was a key component of those efforts. In 1986, Newsweek ran a series of ads sponsored by the insurance industry under the heading, "We all pay the price." The ads warned that lawsuits were driving ob/gyns out of business, shuttering local school sports programs, and scaring the clergy out of counseling their flocks – though few of these assertions turned out to be true. That same year, 1,600 tort reform measures were introduced in 44 state legislatures, 21 of which passed significant restrictions on lawsuits and jury awards before adjourning. Tort reformers still weren’t satisfied but were hamstrung by the fact that most Americans didn’t see lawsuits as a huge problem. After all, most people never have any contact with the legal system unless they’re getting divorced. So, a group of corporate leaders, including AIG’s Greenberg, set about to change that by pumping money into right-wing think tanks to prepare a body of "evidence" proving that not only was there a crisis in the courthouse but also that "we all pay the price" as a result. One of the most influential of those groups is the Manhattan Institute, founded by the late CIA director William Casey. In 1986, the institute created its Project on Civil Justice Reform with funding from all the same insurance companies who’d been responsible for circulating bogus lawsuit horror stories. The project was targeted specifically at journalists. In a 1992 memo, institute president William Hammett explained the strategy for molding reporters into a "pro-tort reform" position: "Journalists need copy, and it’s an established fact that over time they’ll ’bend’ in the direction in which it flows. For that reason, it is imperative that a steady stream of understandable research, analysis, and commentary supporting the need for liability reform be produced. If sometime during the present decade, a consensus emerges in favor of serious judicial reform, it will be because millions of minds have been changed, and only one institution is powerful enough to bring that about: the combined force of the nation’s print and broadcast media, the most potent instrument for public education – or miseducation – in existence." Over the next decade, the institute produced a blizzard of reports, conferences, op-eds, books, and mailings all decrying the "litigation explosion" and greedy trial lawyers. They cultivated sympathetic and influential journalists such as "20/20"’s John Stossel, then-New Republic editor Michael Kinsley, and TNR columnist Fred Barnes, and more recently, Stuart Taylor, who frequently cites their work in his columns for Newsweek, The National Journal, and The Atlantic Monthly. The "research" conducted by the institute usually purported to show how lawsuits impact the average consumer’s daily life by raising the cost of groceries or auto insurance or driving their favorite physicians out of business. But some of the institute’s "scholars" played a little fast and loose with the facts. Take the idea of a "tort tax," the financial hit allegedly taken by every citizen because of the legal system, which Taylor raised in his December Newsweek article. It dates back to 1988, when Manhattan Institute fellow Peter Huber coined the term in his book, Liability, and claimed that the tort system cost Americans $300 billion a year. Three years later, the figure made its way into a speech given by Vice President Dan Quayle, who blamed lawyers for wrecking the economy. After the speech, several researchers examined the methods Huber had used to arrive at that figure. Huber, they found, had simply made it up. As The Economist observed in 1992, "the $300 billion figure has no discernible connection to reality." While the Manhattan Institute targeted the media elite, large corporations also set about creating the appearance of a "grassroots" movement to persuade lawmakers that tort reform had broad populist appeal. As Neal Cohen, one of the PR geniuses behind this project explained to a meeting of the Public Affairs Council in 1994, "In a tort reform battle, if State Farm...is the leader of the coalition, you’re not going to pass the bill. It is not credible. OK? Because it’s so self-serving." Cohen was speaking from experience. Since 1988, he had been running Philip Morris’s "family tort project" through the D.C. consulting firm APCO, where he helped the tobacco industry wage a multi-million stealth campaign to insulate itself from smokers’ lawsuits. By 1995, the tobacco industry was providing almost half the budget – $5.5 million in a single year – for the American Tort Reform Association (ATRA). ATRA, in turn, helped funnel money to state level organizations called Citizens Against Lawsuit Abuse (CALA). These chapters were responsible for holding "lawsuit abuse awareness week," buying ads on buses and billboards, providing experts for reporters, generating "polls" that claimed 99 percent of Americans believe there are too many frivolous lawsuits. The groups were hardly grass-roots organizations of inflamed citizens; the original chapter, in Weslaco, Texas, is just a shell corporation housed in the local chamber of commerce. Even after the corporate backing of these groups came to light (thanks in part to Cohen’s speech, a tape of which was obtained by some muckraking reporters), tort reformers have continuted to use variations of the technique. Most recently, doctors seeking to restrict medical malpractice lawsuits have worked with corporate front groups like Texans for Patient Access and Californians Allied for Patient Protection. After 50 years and hundreds of millions of dollars spent convincing the public of a litigation crisis, the tort reformers have largely succeeded. There’s very little that journalists won’t repeat and readers won’t swallow about the evils of the civil liability system. The Lying Florists In November 2002, viewers of "60 Minutes" learned that Fayette, Miss., was the nation’s capital of "jackpot justice," a place where "plaintiffs’ lawyers have found that juries in rural, impoverished places can be mighty sympathetic when one of their own goes up against a big, rich, multinational corporation." In the story, Morley Safer interviewed a local florist who had received a multi-million dollar settlement in a diet-drug lawsuit. The unnamed florist alleged that trial lawyers were bribing jurors to give big awards. "The jury awarded these people this money because they felt as if they were going to get a cut off of it," he told Safer. During the broadcast, Safer interviewed Wyatt Emmerich, the publisher of a newspaper in Jackson, who explained a few big verdicts there by saying, "Look at the jurors. These are disenfranchised people. These are people who’ve been left out of the system, who feel like, ’Hey, stick it to the Yankee companies. Stick it to the insurance companies. Stick it to the pharmaceutical companies.’ The African Americans feel like it’s payback for disenfranchisement. And the rednecks, shall we say, it’s like, ’Hey, you know, get back at’ revenge for the Civil War. So there’s a lot of resentment, a lot of class anger, a lot of racial anger. And it’s very easy to weave this racial conflict and this class conflict into a big pot of money for the attorneys." The day after the program aired, the legislature passed new restrictions on lawsuits. Tiny Jefferson County’s national reputation as a "judicial hellhole" came in part from intense publicity from the American Tort Reform Association, which every year publishes a "study" purporting to identify various jurisdictions around the country it deems too plaintiff-friendly and in need of reform. At the time of the "60 Minutes" episode, the U.S. Chamber of Commerce’s Institute for Legal Reform was spending millions nationally on advertising and lobbying for restrictions on citizens’ rights to sue. At least $100,000 of that had recently gone into an advertising campaign in Mississippi to push for a cap on damages in lawsuits against corporations. Those facts weren’t included in the story. Meanwhile, the florist, Beau Strittman, retracted his comments about the payoffs, telling the AP, "I just said it as a joking statement." CBS spokesman Kevin Tedesco said the network could not comment on the segment because several jurors have sued CBS for libel over the broadcast. It wasn’t the first time "60 Minutes" got duped in an anti-lawsuit segment. Back in 1986, the show profiled the owner of a ladder manufacturing company who claimed his company had been hit with a $300,000 jury verdict in a suit by a man who fell off a ladder because he set it in a pile of manure. The business owner claimed the lawsuit alleged the company should have warned buyers of the dangers of setting ladders in dung. The real lawsuit had nothing to do with manure; the ladder had broken with less than 450 pounds on it, even though it had a safety rating that said it could support up to 1,000. Tedesco says the show never ran a correction. The print media, mostly opinion columnists, have proven even more gullible in publishing stories about lawsuits that are simply fictional. For instance, in June 2003, in a column entitled, "Welcome to Sue City, U.S.A.," U.S. News & World Report owner Mort Zuckerman claimed that "litigation has become our national pastime." As proof, he offered several examples of lawsuits that illustrated the nation’s "enormous inflation of rights over responsibilities." Zuckerman wrote, "A woman throws a soft drink at her boyfriend at a restaurant, then slips on the floor she wet and breaks her tailbone. She sues. Bingo – a jury says the restaurant owes her $100,000! A woman tries to sneak through a restroom window at a nightclub to avoid paying the $3.50 cover charge. She falls, knocks out two front teeth, and sues. A jury awards her $12,000 for dental expenses." The anecdotes were catchy. Unfortunately, they weren’t true. The stories had been circulating in an email for two years and had made it into several mainstream news outlets, including another Zuckerman property, The New York Daily News, which had published an email containing one of the fake lawsuits in the sports section a year earlier (with no correction). When The Washington Post’s Howard Kurtz called him on the U.S. News error, Zuckerman was unapologetic. The magazine only published a brief clarification about the fictional suits, which ended by saying, "Mr. Zuckerman continues to believe, and most Americans agree, that we live in a country where far too many frivolous lawsuits are filed each year." When contacted by The Washington Monthly, a spokesperson for Zuckerman refused to disclose the source of the lawsuit anecdotes or to offer an explanation as to why Zuckerman would publish anything from a spam email without checking it out first. Small-town papers seem even more vulnerable to such fabrications than the national media, yet their impact is substantial, as battles over most tort reform laws are fought in state legislatures, and juries are drawn from local pools. For instance, in February last year, the Weirton Daily Times in Weirton, W. Va., published an editorial supporting tort reform and blaming juries for outrageous decisions in frivolous lawsuits. Among the examples was the story of an Oklahoma man who put his Winnebago on cruise control at 70 mph and "calmly left the driver’s seat to go into the back and make himself a cup of coffee." Naturally, after the crash, the man sued Winnebago for not advising him of the dangers of cruise control. A jury awarded the man $1.75 million and a new motor home, the paper said. But it turned out that every one of the lawsuits mentioned in the Daily Times editorial stemmed from an anonymous email and was fiction. A local attorney, Michael Nogay, called Daily Times managing editor Richard Crofton and alerted him to the error. But rather than print a humble retraction, Crofton argued in print that the essence of the editorial was true and published several examples of "real" frivolous lawsuits. "What really killed me was that they didn’t even say ’we’re sorry,’" says Nogay, who notes that the column came a week or so after the state chamber of commerce had run a full-page ad in the paper calling for tort reform while the legislature was in session. When I asked what made him write about the suits without checking their veracity, Crofton says, "We’re a small paper, and I don’t have the resources to track down things all over the country." The media mogul Steve Brill first wrote about litigation myths back in 1986, when, as a journalist he traced several examples of the allegedly "frivolous lawsuits" for The American Lawyer magazine and found that many of them were simply urban legends. He says, "I had gone back through the archives of Time magazine, and every ten years, Time declared a ’litigation crisis.’ But there was no crisis." Reporters’ perpetuation of the litigation myths has become one of Brill’s pet peeves, even though, as a business owner himself, he supports legal changes that would protect businesses. "Reporters are basically lazy," says Brill. "You can always find a ridiculous lawsuit to make the system look crazy." The $30,000 Jackpot The plain fact is, most lawsuits are neither ridiculous nor lucrative. Despite the eye-popping headlines about billion-dollar fen-phen verdicts or David v. Goliath movies about little guys taking on corporate wrongdoers in court, the civil justice system looks a lot more like this: On Aug. 2, 1997, Bonnie Daniels rear-ended Diane Pitnikoff in Cumberland County, Maine, and was arrested for drunk driving. Pitnikoff suffered a number of lingering injuries and ran up $42,000 in medical bills. Pitnikoff sued Daniels for $100,000. On March 20, 2003, a jury voted in favor of Pitnikoff, awarding her a grand total of $21,000. It’s not a very sexy story – hardly the kind of thing that captures the imagination and lands on the cover of Newsweek. Yet most tort lawsuits in this country – nearly 60 percent – involve simple fender-benders, and the awards are generally quite small and getting smaller. New data released in April by the Justice Department’s BJS show that in state courts, the median "jackpot" jury verdict in all tort suits was a mere $37,000 in 2001 – down from $65,000 in 1992. And what of the undeserved billions in punitive damages that Newsweek says Americans win from sympathetic juries? Punitive damage awards are intended to punish wrongdoers for reprehensible conduct, and as a result, must be high enough to get the defendant’s attention. That’s why an Alaska jury hit Exxon with a $4.5 billion penalty in the wake of the Valdez spill. But such awards are so rare that, according to BJS, the median punitive damage award in 2001 was only $50,000. Only 7 percent of all plaintiffs were awarded $1 million or more. Because the Justice Department data conflict so sharply with conventional wisdom, you’d think it would have been big news. The media coverage that resulted from the new government study? Forty words in the USA Today. As of mid-August, no major media outlet had covered the study, including Newsweek. National editor Tom Watson says that his magazine has a strict policy of not commenting on its own news coverage. "No one is willing to report that tort awards are down, and that they’re 30,000 bucks, not 5 million," says Theodore Eisenberg, a Cornell University law school professor who does empirical research on the legal system. Indeed, the tort reformers’ message has proven remarkably resistant to correction. Part of the reason is that those who have another side of the story to present have vastly fewer resources with which to make their case. BJS has a publicity budget of zero dollars, making it tough for the bureau to publicize its remarkable findings. Trial lawyers, who do have some money, have been reluctant to fight back in the media because they recognize that they are universally mistrusted. They’ve picked their fight in the courthouse, where they challenge tort reform proposals as unconstitutional. Tort reformers, too, have deftly manipulated reporters’ weaknesses, like the over-reliance on the anecdotal lead. Editors are always imploring writers to find a perfect anecdote that can sum up a complicated problem in 40 words or less. This can be a useful tool for conveying information to a reader, but when it comes to something as complex as civil justice system, the technique often backfires because the juiciest anecdotes tend to be the exception rather than the rule. And reporters simply don’t expect to be lied to when an advocacy group hands them tales of a crazy lawsuit or a study about economic trends – a naiveté that the tort reform movement has skillfully exploited. Gary Alan Fine, a sociology professor at Northwestern University and an expert on contemporary legends, says most people, including reporters, "rely on the trust we have of others." Lobbying groups and industry financed think tanks have also taken advantage of an information vacuum. For years, most state courts never collected information on case outcomes and jury awards, so real numbers were hard to come by. Tort reformers have expertly filled this void with their own figures. "When there’s no data, you can just make stuff up," says Eisenberg. Even when there are relatively good data, they are easy to misread. The RAND Corporation’s Institute for Civil Justice has reliable jury verdict data for two counties in Illinois and California going back 40 years. At one point, California’s average jury verdicts showed a big jump. A tort reform lobbyist might point to the same data as proof that emotional jurors are giving away a lot more money. In fact, what happened was that California raised the dollar limits for cases that could be pressed in small claims court, taking the small cases out of the main court, thus pushing up its statistical average even when the actual awards stayed constant. "It’s really, really hard to make any inferences about what’s going on out there from jury verdicts," says RAND’s Seth Seabury. Indeed, the "onslaught of litigation" over the past 30 years decried in Newsweek is a relative term. In 1962, for instance, only about 300 civil rights lawsuits were filed in federal courts. In 2000, there were more than 40,000 – an onslaught, to be sure, but that’s because prior to 1964, racial discrimination was legal. Michael McCann, director of the Comparative Law and Society Studies Center at the University of Washington, suspects that legal myths remain so pervasive because Americans want to believe them. He says that tort reformers have turned the frivolous lawsuit "into a morality tale about the loss of personal responsibility." He also suspects that the flexible American legal system lends itself to such caricatures because in America, fat people really can sue McDonalds (whether they would win is an entirely different matter), so many of the fake lawsuit stories don’t seem like that much of a stretch. The news coverage may be creating some unexpected consequences: Some academic researchers suspect that all the hype about the litigation crisis might actually be making Americans more litigious by giving them the erroneous impression that compensation is available through the courts for most injuries. As McCann says, "Tort reformers may have produced more frivolous claims while making legitimate claims harder to bring." Indeed, if Americans really are overcome with fear of lawsuits, it might be because they’ve been reading too many Newsweek articles. At least that’s the rationale cited by the organizers of annual Polar Bear Plunge back in Page, Ariz. In January, organizer Paul Ostapuk told the local newspaper that he was canceling the annual event at Lake Powell because "Given the rampant rise in frivolous lawsuits across the nation and the recent Newsweek article…I’ve had to play it safe and rethink the 2004 Polar Bear Plunge event." Ostapuk said he was planning to reschedule for next year – after buying some insurance. © 2004 Independent Media Institute. All rights reserved. |
Medical Malpractice
Point
Point
The power brokers obsessed with tort reform really have the jargon down. They travel the country with overheated stories about runaway juries and jackpot justice. The way they tell it, sinister lawyers and opportunistic plaintiffs are on the hunt, preying on virtuous corporations, hospitals and doctors in search of that big payout from the lawsuit lottery.
President Bush has been complaining about "junk and frivolous" lawsuits for years. So it’s interesting to hear the following from the Center for Justice and Democracy, a consumer advocacy group: "It may be hard to understand why `tort reform’ is even on the national agenda at a time when insurance industry profits are booming, tort filings are declining, only 2 percent of injured people sue for compensation, punitive damages are rarely awarded, liability insurance costs for businesses are minuscule, medical malpractice insurance and claims are both less than 1 percent of all health care costs in America, and premium-gouging underwriting practices of the insurance industry have been widely exposed."
In looking at medical malpractice cases, I’ve been amazed by the cold-blooded attitude so many people have taken toward patients who have been seriously, and sometimes grotesquely, harmed. Referring to a Wisconsin woman who had both of her breasts removed after a laboratory mix-up mistakenly indicated she had cancer, a doctor from South Carolina told a Congressional subcommittee: "She did not lose her life, and with the plastic surgery she’ll have breast reconstruction better than she had before."
Last week I interviewed a woman in Minerva, Ohio, whose abdominal aorta was somehow ruptured while a doctor was performing a tubal ligation. In a discussion of her malpractice suit, the woman, Deborah Rayburn, said the foul-up was not immediately detected. When it became clear that she was in serious trouble, another doctor was called in. "He ended up cutting me open," she said, "and he clamped the aorta."
Ms. Rayburn, who has two children, was unable to work for 18 months. The surgery left her with a scar from chest to groin, and she said she still experiences frequent abdominal pain.
When Ms. Rayburn filed suit, she said, she was made to feel as though she had done something wrong, as if seeking compensation was in some sense an affront to the system.
As a trial date approached, she said, she felt pressured by all the parties involved to agree to a settlement, which she did. She would have preferred to go to trial, she said, not because she was looking for a big payday, but because all the details of her case would then have come out publicly.
And that is one of the essential points that is overlooked by the tort reform zealots: the problem when it comes to malpractice is not the amount of money the insurance companies are making (they’re doing fine) or the rates the doctors have to pay, but rather the terrible physical and emotional damage that is done to so many unsuspecting patients who fall into the hands of careless or incompetent medical personnel.
What is needed is a nationwide crackdown on malpractice, not a campaign to roll back the rights of patients who are injured. This is another utterly typical example of the Bush administration going to bat for those who are economically and politically powerful against those who are economically and politically weak.
Despite claims by the insurance industry, there is no evidence that soaring malpractice premiums are the result of sharp increases in the amounts of money paid out for malpractice claims. And, tellingly, industry executives are generally careful not to say that the tort reforms sought by the Bush administration will result in premium reductions.
This is all about greed. What tort reform will lead to, not surprisingly, is an unwarranted burst of additional profits for the insurance industry, which is why the industry is sinking so much money into its unrelenting campaign for "reform."
It would be helpful if the nation’s many good doctors would blow the whistle on the insurance industry and its exploitive practices, and on the members of their own august profession who violate that essential maxim, "First, do no harm."
http://www.nytimes.com/2004/06/21/opinion/21HERB.html?ex=1089380679&ei=1&en=ad49899ddb3eab28
Counter-Points
To the Editor:
Re "Malpractice Myths," by Bob Herbert (column, June 21): We all agree that patients should have the right to sue negligent doctors for malpractice. But complications of surgery are a risk taken by every patient and every doctor.
I believe that the increase in pain and suffering awards is raising malpractice premiums to the point where doctors in many parts of the country can no longer afford to practice.
In Chicago, we have witnessed the departure of doctors, especially neurosurgeons and obstetricians, for other states or other fields, because they could no longer keep up with the insurance premiums. Some have even decided to fly without a net, forgoing malpractice insurance but risking their personal assets if they are sued.
This is not "all about greed," as Mr. Herbert maintains.
This is about a national health and insurance crisis that is forcing good doctors out of business and increasing morbidity and mortality in some parts of the country.
JUDITH WEINSTEIN
Chicago, June 22, 2004
The writer is a health care researcher and educator.
To the Editor:
Frivolous lawsuits and astronomical jury awards are driving up costs and crippling our health care system.
On any given day, 125,000 liability lawsuits choke the system. Yet the vast majority of claims, nearly 70 percent, do not result in any payments to patients. Of those that do go to a jury verdict, more than 80 percent are decided in the doctor’s favor.
The millions used to defend frivolous lawsuits would be better spent on improving patient safety.
The goals of improving patient safety and protecting doctors from meritless lawsuits are not mutually exclusive. Our patients deserve both.
JOHN C. NELSON, M.D.
President
American Medical Association
Chicago, June 21, 2004
To the Editor:
I have been a medical malpractice lawyer for 18 years. For half my career, I represented doctors and hospitals.
Impartial and unimpassioned appellate judges routinely review and reduce excessive jury awards to fair and reasonable amounts. Many indefensible malpractice actions are bitterly fought to the end by doctors and their insurance company-paid lawyers, thereby unnecessarily driving up the costs of litigation.
Dismissive attitudes toward patients and the secretiveness of doctors remain the primary instigating causes of medical malpractice lawsuits. The medical profession may feel in extremis, but true healing always begins from within.
PETER D. ASSAIL
New York, June 21, 2004
http://www.nytimes.com/2004/06/24/opinion/L24DOCS.html?ex=1089380653&ei=1&en=3a7db3376e191381
"Bob Herbert’s ’Malpractice Myths’ " (cyber-response to Herbert’s columns) Ted Frank PointofLaw.com June 23, 2004
"This is all about greed," Bob Herbert explains, talking about medical malpractice. ("Malpractice Myths", NY Times, Jun. 21). Very few would disagree with this sentence standing by itself. But Herbert, without any obvious irony, is ascribing this sin to insurance companies, rather than to the trial lawyers who have caused losses paid per doctor to increase 1300% since 1975--more than twice the rate of medical-care inflation. This is not a question of a handful of incompetent doctors; more than half of all doctors have been sued for malpractice.
Herbert’s piece is unencumbered by such trivial things as data. He baldly asserts that "there is no evidence that soaring malpractice premiums are the result of sharp increases in the amounts of money paid out for malpractice claims." This is utterly false, as our Overlawyered.com site documented Jul. 29 and Mar. 24.
The GAO found (as did HHS and the House Joint Economic Committee) that increases in malpractice rates were due largely to the high payoffs in legal claims. A study in Contingencies, the journal of the American Academy of Actuaries, who doesn’t have a dog in this fight, also found that malpractice premiums are directly related to malpractice losses.
No, insurance companies have not promised to lower rates in response to reform, but that’s because the reforms being proposed are minor; again, both the government and the actuarial studies showed that states that endorsed such reforms experienced a slowing in their premium increases. According to HHS, "Malpractice reforms in the 1980s led to a 34% decline in malpractice premiums in those states that enacted reforms compared with states that did not enact reforms."
Herbert claims that medical malpractice insurance and claims is only 1% of health-care costs; but that figure ignores the billions spent on inefficient defensive medicine, on hospital in-house lawyers, on time doctors spend with lawyers instead of with patients, and on self-insurance. It also ignores the effects of runaway claims on specialists such as obstetricians that face six-digit premiums--even the trial-lawyer front group Center for Justice and Democracy, who Herbert relies upon, admits that the average OB/GYN pays about a quarter of her net income in premiums, and that figure is much higher in "crisis" states. If it really is the case that only 2% of malpractice injuries result in suits (and, again, the Center for Justice and Democracy has claimed elsewhere the number is much higher when it suits their purposes), it goes to show how broken and inefficient the malpractice litigation system is; whatever it is trial lawyers are protecting, it’s not the rights of injured patients.
Herbert’s column becomes especially incoherent when talking about the case of Deborah Rayburn, who sued over a tubal ligation gone wrong. The lawyers agreed to a settlement, but Rayburn "would have preferred to go to trial, she said, not because she was looking for a big payday, but because all the details of her case would then have come out publicly." The tragically-injured plaintiff who claims not to care about a payday is rapidly becoming a cliched op-ed archetype, and I’ve never understood why. Why is a lengthy trial--taking up the time of lawyers, doctors, experts, and jurors--to pointlessly resolve a settled dispute a desireable result? Why does Herbert think medical malpractice reform has anything to do with Deborah Rayburn’s preference for a trial to a payday (a preference that apparently wasn’t strong enough to insist her lawyers refuse to settle)? If Herbert wants to see greed, he should see the reaction of trial lawyers if he proposes that they replace their settlement paydays with pro bono public inquests to make people like Deborah Rayburn feel better about their misfortune.
[Please go to http://www.pointoflaw.com/archives/000229.php to follow links imbedded in the original]
"The New York Times on Medical Malpractice" (cyber-response to Herbert’s columns) James R. Copland PointofLaw.com June 22, 2004
In yesterday’s New York Times, columnist Bob Herbert attacked tort reform as "all about greed." According to Herbert, "[w]hat tort reform will lead to, not surprisingly, is an unwarranted burst of additional profits for the insurance industry, which is why the industry is sinking so much money into its unrelenting campaign for ’reform.’" Herbert repeated the familiar trial lawyer canard that "there is no evidence that soaring malpractice premiums are the result of sharp increases in the amounts of money paid out for malpractice claims."
And the source of information for Herbert’s contention? None other than the "Center for Justice and Democracy." Innocently called a "consumer advocacy group" by Herbert, the CJD is a Naderite group (its president, Joanne Doroshow, began working with Nader in 1986), heavily funded by the trial bar, and started with seed money by Michael Moore (yes, that Michael Moore), who remains on the group’s board.
Problem is, the CJD’s own data refute its claims that the "premium-gouging underwriting practices of the insurance industry have been widely exposed." The very "study" the CJD issued through its subsidiary group, "Americans for Insurance Reform," showed that since 1975, actual liability losses paid by doctors have escalated 1300%, versus a general 500% medical cost inflation, and only a 300% rise in actual premiums written per doctor. The result, of course, is that the paid-loss ratio -- the percentage of insurance premiums going to cover tort losses -- escalated from about 25% in 1975 to about 80% today. (CJD either doesn’t understand its own data, or it deliberately misrepresents them. For more thoughts on the weakness of the CJD’s claim that medical malpractice insurance rate increases are not linked to rising tort costs, see Ted Frank’s earlier commentaries here and here.)
The medical malpractice insurance industry, therefore, has been a decidedly unprofitable business. In 2001, the country’s biggest malpractice insurer, the St. Paul Companies, exited the business entirely after incurring nearly $1 billion in losses. In Pennsylvania, one of 20 states with out-of-control rates, only two malpractice insurers remain, down from ten only five years ago. In Mississippi, at least 15 insurers have exited the market since 1997.
In this environment, the majority of doctors today are insured through mutual insurance companies -- i.e., those owned by the doctors themselves. In other words, if the doctors’ malpractice insurance rate hikes were "all about greed," it would be a peculiar greed indeed, since the doctors themselves control most the companies through which they are insured.
Herbert’s column would be amusing were its implications not so deadly serious. Faced with potential bogus "botched delivery" suits, many obstetricians are limiting their practices to gynecology, forcing women in some areas to travel hours for prenatal care and delivery. High-risk specialists such as neurosurgeons are exiting some parts of the country entirely, meaning that stroke patients and head- and spinal-trauma victims have to be helicoptered to neighboring states.
Americans potentially have access to the best health care in the history of the world, but that health care is being threatened by a system that is reducing their access to care through a random and haphazard system of law. Of course, in medicine, mistakes happen, and some of those are due to doctor negligence. A system of deterring those mistakes, and compensating the victims of negligent mistakes, is extremely important. But that’s not what our system is doing; our system is broken and it needs to be fixed. Instead of pointing a finger at the insurance industry, we should be thinking about solutions to the problem.
[underlining indicates imbedded links in original at http://www.pointoflaw.com/archives/000225.php]
To the Editor:
"Malpractice Myths" (column, June 21), by Bob Herbert, akes one side in the trench warfare between trial lawyers and doctors. But the warfare does little to advance the goal of affordable, quality health care. Nor does medical justice today come close to achieving fairness. Most medical errors go uncompensated, and according to a Harvard medical practice study, 80 percent of claims are made against doctors who made no medical errors at all.
What’s needed is a new system of medical justice that can make deliberate, predictable choices on standards of care. Specialized health courts - like those that exist for tax issues and workers’ compensation - could begin to restore the reliability needed to heal American health care.
PHILIP K. HOWARD
TROYEN ANTHONY BRENNAN, M.D.
New York,
June 23, 2004
The writers are, respectively, the chairman of Common Good and a professor of medicine at Harvard.
http://www.nytimes.com/2004/06/27/opinion/L27MALP.html?ex=1089380522&ei=1&en=dfe9ebdf3b6c9a8a
Point
"Cooking Up a Crisis" (Op-ed Column) Bob Herbert, The New York Times June 25, 2004
If you hear something enough times from people in authority, you tend to believe it.
The tort reform zealots - including doctors, insurance company executives and legions of politicians across the country - have been hammering away at the idea that crackpot jury awards and lawsuits from undeserving patients are driving up the costs of health care and driving good doctors out of their profession.
"Junk and frivolous lawsuits" is the term of choice for President Bush, who told an audience in Youngstown, Ohio, last month that "junk and frivolous lawsuits discourage good docs from even practicing medicine in the first place."
According to the American Medical Association, "There are now 20 states in a full-blown medical liability crisis - up from 12 in 2002."
As the A.M.A. tells it, "America’s patients are losing access to care because the nation’s out-of-control legal system is forcing physicians in some areas of the country to retire early, relocate or give up performing high-risk medical procedures."
Full-blown crisis! Out of control!
All right. Calm down. Take a deep breath.
Just last January the nonpartisan Congressional Budget Office said this about the link between high malpractice premiums and the availability of physicians in various specialties: The General Accounting Office "investigated the situations in five states with reported access problems and found mixed evidence. On the one hand, G.A.O. confirmed instances of reduced access to emergency surgery and newborn delivery, albeit `in scattered, often rural, areas where providers identified other long-standing factors that affect the availability of services.’ On the other hand, it found that many reported reductions in supply by health care providers could not be substantiated or `did not widely affect access to health care.’ "
That hardly sounds like a crisis. Moreover, in several states specifically characterized by the A.M.A. as in "crisis," the evidence is rolling in that malpractice claims and awards are not appreciably increasing, and in some instances are declining.
The A.M.A. has its crisis states marked in red on a map of the U.S. on its Web site. One of the red states is Missouri. But a press release in April from the Missouri Department of Insurance said, "Missouri medical malpractice claims, filed and paid, fell to all-time lows in 2003 while insurers enjoyed a cash-flow windfall."
Another red state on the A.M.A. map is New Jersey. Earlier this month, over the furious objections of physicians’ representatives, a judge ordered the release of data showing how much was being paid out to satisfy malpractice claims. The judge’s order was in response to a suit by The Bergen Record.
The newspaper reported that an analysis of the data showed that malpractice payments in New Jersey had declined by 21 percent from 2001 to 2003. But malpractice insurance premiums surged over the same period. A.M.A. officials told me yesterday that they thought the New Jersey data was "incomplete," but they did not dispute the 21 percent figure.
Last summer a legislative committee in Florida, another red state, put insurance executives, lawyers and medical lobbyists under oath in an effort to get to the truth about malpractice costs. When questions about frivolous lawsuits arose, Sandra Mortham, the chief executive of the Florida Medical Association, told the panel, "I don’t feel that I have the information to say whether or not there are frivolous lawsuits in the state of Florida."
There is no question that malpractice insurance premiums have increased sharply over the past few years. In some instances they have skyrocketed. But, as the Congressional Budget Office has noted, there are a variety of reasons for that, including the cost of malpractice awards, decreases in the investment income of insurance companies and cyclical factors in the insurance market.
"Insurance companies’ investment yields have been lower for the past few years," the budget office said in a report in January, "putting pressure on premiums to make up the difference."
The disinformation campaign of the tort reform zealots, and their sustained attacks on the rights of patients who have been harmed by doctors, have been disgraceful. The proper prescription for this apparently chronic disorder is a strong dose of the truth.
E-mail: bobherb@nytimes.com
http://www.nytimes.com/2004/06/25/opinion/25HERB.html?ex=1089380575&ei=1&en=6fed4dddbff7dce6
Point
In an article a few years ago in The Journal of the American Medical Association, Dr. Barbara Starfield of the Johns Hopkins School of Medicine took a look at the overall health of the American people, and compared conditions here to those in other industrialized countries.
What she found was disturbing.
"The fact is that the U.S. population does not have anywhere near the best health in the world," she wrote. "Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators."
She said the U.S. came in 13th, dead last, in terms of low birth weight percentages; 13th for neonatal mortality and infant mortality over all; 13th for years of potential life lost (excluding external causes); 11th for life expectancy at the age of 1 for females and 12th for males; and 10th for life expectancy at the age of 15 for females and 12th for males.
She noted in the article that more than 40 million Americans lacked health insurance (the figure is about 43 million now) and she described the state of Americans’ health as "relatively poor."
"U.S. children are particularly disadvantaged," she said, adding, "But even the relatively advantaged position of elderly persons in the United States is slipping. The U.S. relative position for life expectancy in the oldest age group was better in the 1980’s than in the 1990’s."
The article was published in the summer of 2000. At the time Japan ranked highest among developed countries in terms of health, and the United States ranked among the lowest.
Last week I talked with Dr. Starfield, an internationally respected physician, professor and researcher, and asked whether the situation had improved over the last four years.
"It’s getting worse," she said, noting, "We’ve done a lot more studies in terms of the international comparisons. We’ve done them a million different ways. The findings are so robust that I think they’re probably incontrovertible."
The U.S. has the most expensive health care system on the planet, but millions of Americans without access to care die from illnesses that could have been successfully treated if diagnosed in time. Poor people line up at emergency rooms for care that should be provided in a doctor’s office or clinic. Each year tens of thousands of men, women and children die from medical errors and many more are maimed.
But when you look for leadership on these issues, you find yourself staring into the void. If you want to get physicians’ representatives excited, ask them about tort reform, not patient care. Elected officials give lip service to health care issues, but at the end of the campaign day their allegiance goes to the highest bidders, and they are never the people who put patients first.
To get a sense of just how backward we’re becoming on these matters, consider that in places like Texas, Florida and Mississippi the politicians are dreaming up new ways to remove the protective cloak of health coverage from children, the elderly and the poor. Texas and Florida have been pulling the plug on coverage for low-income kids. And Mississippi recently approved the deepest cut in Medicaid eligibility for senior citizens and the disabled that has ever been approved anywhere in the U.S.
Even the affluent are finding it more difficult to obtain access to care. For patients with insurance the route to treatment is often a confusing maze of gatekeepers and maddening regulations. The costs of insurance are shifting from employers to employees, and important health decisions are increasingly being made by bureaucrats and pitchmen interested solely in profits.
In the maddening din that passes for a national conversation in this country, distinguished voices like Dr. Starfield’s are not easily heard.
Echoing so many other patient advocates, she continues to call for movement on two crucial needs: coverage for the many millions who currently do not have access to care, and the development of a first-rate primary care system, which would bring a sense of coherence to a health care environment that is both chaotic and wildly expensive.
"We don’t have any national health policy at all in this country," said Dr. Starfield.
And there is no sign of that changing anytime soon.
http://www.nytimes.com/2004/06/28/opinion/28HERB.html?ex=1089461272&ei=1&en=dd2218506a08ee99