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doi:
10.1377/hlthaff.2014.0077
Malpractice Reform: The Authors Reply Marc Franklin is a renowned legal scholar, and his questions about our article (Jan 2014) are reasonable ones. We address them in turn. Why act now? If we can reduce the disorganization and waste in our health care system, patients will be able to afford care, the care will be better, and injuries will happen less often. But we are unlikely to fix these problems without the willing cooperation of physicians—and the deal we propose seems like a very good way to obtain that cooperation. Why act at the federal level? We certainly would not object if a state, as part of the experimentation that Franklin favors, considered its options and decided to make a similar deal. But the Affordable Care Act is a federal law, and physicians’ cooperation will make a difference in its implementation. Why propose reform along the lines of California’s Medical Injury Com-
pensation Reform Act of 1975 (MICRA)? For a stand-alone reform, we have always preferred more systematic approaches to medical error than MICRA provides. Prior research, including our own, has shown that caps on noneconomic damages are blunt instruments and may have undesirable effects. Despite these concerns, thirty-one states already have such caps. It also is clear that physicians value MICRA-style damages caps well out of proportion to their actual impact. That creates an opportunity for the public to get a lot more value than it gives up. The deal we propose is not a perfect fix. Policy making is not about perfect. It is about improving on the status quo. Given the state of play in health policy, we believe the deal is one worth making. William M. Sage University of Texas School of Law AUSTIN , TEXAS David A. Hyman University of Illinois CHAMPAIGN , ILLINOIS
March 2014
33 : 3
H e a lt h A f fai r s
519
doi:
10.1377/hlthaff.2014.0077
Malpractice Reform: The Authors Reply Marc Franklin is a renowned legal scholar, and his questions about our article (Jan 2014) are reasonable ones. We address them in turn. Why act now? If we can reduce the disorganization and waste in our health care system, patients will be able to afford care, the care will be better, and injuries will happen less often. But we are unlikely to fix these problems without the willing cooperation of physicians—and the deal we propose seems like a very good way to obtain that cooperation. Why act at the federal level? We certainly would not object if a state, as part of the experimentation that Franklin favors, considered its options and decided to make a similar deal. But the Affordable Care Act is a federal law, and physicians’ cooperation will make a difference in its implementation. Why propose reform along the lines of California’s Medical Injury Com-
pensation Reform Act of 1975 (MICRA)? For a stand-alone reform, we have always preferred more systematic approaches to medical error than MICRA provides. Prior research, including our own, has shown that caps on noneconomic damages are blunt instruments and may have undesirable effects. Despite these concerns, thirty-one states already have such caps. It also is clear that physicians value MICRA-style damages caps well out of proportion to their actual impact. That creates an opportunity for the public to get a lot more value than it gives up. The deal we propose is not a perfect fix. Policy making is not about perfect. It is about improving on the status quo. Given the state of play in health policy, we believe the deal is one worth making. William M. Sage University of Texas School of Law AUSTIN , TEXAS David A. Hyman University of Illinois CHAMPAIGN , ILLINOIS
March 2014
33 : 3
H e a lt h A f fai r s
519
