PAIN AND PROFIT: The Politics of Malpractice by Sylvia & Steven Polan Law

PAIN AND PROFIT: The Politics of Malpractice

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What caused the medical malpractice crisis of the mid-1970s? Why did insurance rates soar, carriers withdraw from business, doctors threaten strikes, and physicians and hospitals face loss of coverage? Sylvia Law and Steven Polan, attorneys who specialize in health law, find the crisis manufactured. The industry scared itself into a national panic, they say, on the basis of one company's atypical experience (a shortage of assets after wholesale transfers to its corporate parent). Then, the crisis was exacerbated by economic threats to the insurance business not limited to malpractice. Law and Polan go far beyond the emergency. A proper reimbursement system, they suggest, should compensate the injured--but must also operate to minimize medical maltreatment causing harm to patients. Other conclusions: too much of the malpractice premium dollar goes to lawyers (contingent fees are defended, however, as enabling victims without substantial assets to sue); malpractice insurance can profit carriers greatly became of the long intervals between claims and payments during which reserves grow; the system implicitly favors the affluent, since lost future earnings make up a substantial portion of malpractice awards; self-policing by physicians has largely been ineffective in controlling doctors' performance and thus reducing malpractice; no-fault approaches are adequate (the book's analysis on this point appears uncharacteristically weak); physician- or hospital-owned ""captive"" insurance companies may keep premium costs down, but do little to assure quality medical services. Among suggested changes are greater aggressiveness by government regulators and modification of the fee-for-service nature of American medicine, inimical to the elimination of malpractice. An important, intelligent book which, published earlier, might well have averted the crisis.

Pub Date: June 28th, 1978
Publisher: Harper & Row