January 7, 2000
Liability Expansion Not the
As Congress returns
shortly and a House-Senate conference committee works on health
legislation, they should consider that expanding the liability of
health plans and employers won't solve the chief problems in health
care: improving the quality of and access to care.
•The liability expansion
in the Dingell-Norwood bill only turns loose the plaintiffs'
bar. It does nothing toward quality improvement, and threatens
to increase the number of uninsured. The House-passed bill
goes way too far in opening the Pandora's box of litigation.
•As the Urban Institute's Randall Bovbjerg wrote recently in the
Los Angeles Times: "What going too far means is allowing trial
lawyers to launch any and all lawsuits they can think of against
health plans, whether related to patient rights or appeals processes
or not. It means giving the nod to any amount of damages,
including punitive awards unrelated to harm caused."
Were the Dingell-Norwood liability provision to become law, it
would only add to the culture of blame that already hinders quality
•Dennis O'Leary of the Joint Commission on Accreditation of
Healthcare Organizations notes the need for knowledge and analysis
of medical errors. He says, "But that won't happen unless the
caregivers involved feel safe – from blame and punishment – in
•The threat of lawsuits against employers and health plans under
Dingell-Norwood also would cause many employers to limit their
liability exposure by ceasing to offer employees health
Congress should look at how other industries have dealt with
liability concerns in their error reporting systems.
•The aviation and nuclear power industries, for example,
could provide models for how to promote error reporting while
limiting liability exposure.
•A key component of developing a system to collect reliable,
useful information to improve quality is limiting liability, not
The goal should be improving patient care and
creating informed consumers. Enriching trial lawyers doesn't
move us toward achieving that goal.