Understanding the First Malpractice Crisis of the 21st Century

Professional liability insurance crises in medicine have been intermittent, reaching magnitudes sufficient to generate widespread concern only in the mid-1970s, the mid-1980s, and 2002-2003. It is easy for health policymakers and the public to view each crisis as an upswing of the same pendulum. Malpractice premiums rise, doctors accuse lawyers, lawyers point back at doctors, and legislatures debate tort reform in arcane and repetitive terms ("collateral source offsets," "noneconomic damage caps," etc.).

This experience of déjà vu, however, is misleading. The current crisis is not simply a reprise of events in the 1970s or 1980s.

The principal difference this time around is that malpractice liability is clearly connected to overall health policy.