Public Plan For Malpractice

A Vastly Expanded Federal Tort Claims Act Would Protect Both Doctors And Patients

Almost any doctor will readily offer up horror stories of trying to find and pay for medical malpractice insurance. Such policies are cost-prohibitive and increasingly scarce, and require many to practice "defensive medicine" - ordering extra precautionary tests and procedures that contribute mightily to the rise in health costs.

A growing number of policymakers are calling for a cap on medical malpractice awards as a partial solution to the national health care debate. Rooting out frivolous lawsuits is a laudable goal, but limiting damage awards for patients who have been wronged is akin to fixing a broken leg with a band-aid. High-dollar, juror-granted purses are not the only drivers of professional liability costs for doctors; much can be blamed on the greedy practices of medical malpractice insurance companies. The time has come to cut the middleman out of the equation.

Some health care providers have already done this, but at great personal and professional peril. Doctors who self-insure against potential malpractice claims are "naked" in their practices because of their exposure to high risk. We must replace the risk with rewards to incentivize more providers to forgo private medical malpractice insurance and to instead rely on a government-securitized option.

The basic model already exists - we just need to build upon it. Primary-care providers who practice at federally qualified health centers do not need to purchase medical malpractice insurance. Why? The government promises to cover any claims against them under the Federal Tort Claims Act. If a patient has a successful malpractice case against the health center provider, the government becomes the insurer and agrees to pay the claim.

The national health reform debate should include a proposal to expand Federal Tort Claims Act coverage to all primary care providers, regardless of where they practice, and to certain specialists (such as obstetricians) where access to care is threatened. Doing so would have multiple benefits: Doctors, nurse practitioners and other primary care providers would be freed from the burdens of finding and paying for costly malpractice insurance; future medical students would have an incentive to choose primary care, addressing a critical shortage; and we would finally begin to bend the "cost curve" in health care.