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From the Editor |
The Malpractice Morass: Symbol Of Societal Conflict
According to the U.S. Department of Health and Human Services, the direct cost of medical liability insurance and the indirect cost that derives from defensive medicine raise federal health spending by an estimated $28 billion a year. In addition, many physicians are complaining bitterly that the rise in their liability insurance premiums is forcing them to take drastic measures. For these reasons and others, the Bush administration and congressional Republicans have made reform of medical malpractice law a large part of their policy agenda. For their part, Democrats assert that Republican efforts to impose strict caps on jury awards in malpractice cases would jeopardize the rights of patients to obtain full redress for untoward medical events. Three times within the past year, Senate Democrats have blocked a White House–backed effort to impose such caps on jury awards in medical malpractice cases. The malpractice issue has divided the two parties for more than a decade, and not even the strong support of a president has brought them much closer to a compromise. As William Sage, the author of our lead paper, writes, "Malpractice reform is now a rallying cry in a larger political context between the general business community and general trial lawyer and consumer interests over the effect of personal injury litigation on the U.S. economy and social fabric" (page 13). The Sage paper and three others are part of the Project on Medical Liability in Pennsylvania, which is funded by the Pew Charitable Trusts.
Beyond malpractice, the July/August issue is filled with a wealth of material on other subjects that are cause for controversy and concern in a troubled U.S. health care system. Jamie Robinson continues his examination of private health insurance enterprises and the central role they play, while Susan Foote and colleagues discuss the issues surrounding Medicare’s coverage process; Larry Gostin and colleagues report on the future of the public’s health; and David Mechanic and Scott Bilder explore the treatment of people with mental illness and how things have changed in the past decade. Jeff Goldsmith continues his provocative series of interviews with health leaders—this time engaging George Halvorson of the Kaiser Permanente Medical Care Program.
One of our recent Web Exclusives (5 May 2004) featured an interview with Health and Human Services (HHS) Secretary Tommy Thompson. A former governor who controlled Wisconsin’s political agenda for fourteen years, Thompson has never been shy about speaking his mind, even in a Cabinet post that serves at the pleasure of the president. Among a variety of provocative points, he described his frustrations in having to deal with the "supergod in our society"—the president’s Office of Management and Budget. He also asserted that America’s foreign policy and health policy would be more effective if they were integrated more closely. Characterizing his approach as "medical diplomacy," Thompson said: "Instead of worrying about any types of wars, if we could somehow substitute the integration of health policy with our state policy, I think we could accomplish a lot more." To read this interview, go to our Web site, www.healthaffairs.org.
Our weekly Web-Exclusive offerings continue to attract large audiences. Those papers, besides the Thompson interview, that have generated the most recent interest include "Medical Management after Managed Care," by Jamie Robinson and Jill Yegian (19 May 2004); "Cost-Effectiveness and Evidence Evaluation as Criteria for Coverage Policy," by Alan Garber (19 May 2004); "Medicare Spending, the Physician Workforce, and Beneficiaries’ Quality of Care," by Katherine Baicker and Amitabh Chandra (7 April 2004); and "Health Spending Projections through 2013," by Stephen Heffler and colleagues at the Centers for Medicare and Medicaid Services (11 February 2004). All are available free of charge to all site visitors. Our Web Exclusives are supported in part by a grant from the Commonwealth Fund.
This year Health Affairs will consider some 700 papers for publication; we end up publishing about 15 percent of those we receive. Even with this level of screening, we realize that readers are bombarded with more policy information than they could ever hope to read. To help readers customize their own screening process, we have added several new features to our Web site, www.healthaffairs.org. Readers can now save papers, abstracts, and search results to a "personal archive." Web-site users can also sign up for personalized e-mail alerts when Health Affairs or some 200 other participating journals publish papers on topics or by authors of their choice. Both features are free to all users of Health Affairs online. The full text of every paper that Health Affairs has ever published is available to subscribers who activate their online subscription at www.healthaffairs.org/activate.php.
Founding Editor
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