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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Kristen Silverberg
Deputy Assistant to the President for Domestic Policy
In Focus: Medical Liability

January 5, 2005

Thank you for participating in today's online chat about medical liability reform. Kristen is ready to answer your questions, so let's begin.

Huan, from Austin, TX writes:
Ms. Silverberg, Why do we need liability reform? Would you point me to an online resource that would provide data on:

1. Problems we're trying to address with liability reform. 2. Cost to society without doing any reform. 3. Proposals for reform along with proscons.

Thank you.

Kristen Silverberg
Thanks for your interest Huan. Let me first recommend that you read a transcript of the President’s remarks on the issue from today. You can find them on this website. You should also review a report entitled “Addressing the New Health Care Crisis: Reforming the Medical Litigation System to Improve the Quality of Health Care” prepared by the Department of Health and Human Services. You can find it at

Austin, from Illinois writes:
As Deputy Assistant to the President for Domestic Policy What Do You Do?

Kristen Silverberg
Well, my job is to help advise the President on issues such as health care, education, transportation and the environment. I work with some of the top experts on these issues. It’s a great privilege. My colleagues and I brief the President on policy issues, work with Members of Congress and congressional staff, and seek the advice of outside experts. Today, the President announced a new Assistant to the President for Domestic Policy, Claude Allen. You’ll probably see Claude on Ask the White House soon!

Sara, from Chicago Illinois writes:
Kristen,I have a friend who is currently in medical school. She would like to be a surgeon...but she is concerned about increasing medical insurance costs and has settled on being a family practitioner.

What is the administration going to do so that our future doctors don't have to make decisions like this again?

Thank you

Kristen Silverberg
That is a good question, Sara.

Many medical schools are reporting decreased enrollment and fewer students are pursuing specialties such as surgery and obstetrics. The high cost of liability insurance and the unpredictable and unfair nature of our medical liability system are cited as reasons and many current doctors are warning students about their own experiences. Strong medical liability reform is clearly needed to help ensure that an adequate supply of dedicated and talented health professionals are available to care for the impending aging of the baby boom population.

Patrick, from Knoxville, TN writes:
I realize that the medical malpractice issue is one of importance, but as a small business owner, I am concerned about a much broader Tort reform. If only malpractice issues are addressed, the attorneys will simply begin chaising the next easy target. Why is the White House singularly focused on Medical malpractice and not a complete and broad Tort Reform policy that will help prevent frivolous lawsuits and exorbitant awards?

Kristen Silverberg
Patrick – President Bush agrees that broader litigation reform is necessary to help protect small business owners and consumers from excessive litigation. According to one recent study, frivolous litigation has helped drive the total cost of our tort system to more than 230 billion dollars a year – $3,200 for every family of four! Today, President Bush again called on Congress to take action by changing the rules regarding large, interstate class actions. There is bipartisan support for class action reform in Congress, and the President looks forward to working with Members to pass a bill as soon as possible. He also called on Congress to pass asbestos liability reform. Asbestos-related litigation has led to at least 74 bankruptcies and the loss of tens of thousands of jobs. Lawyers have benefited, but people with actual, serious injuries have no meaningful compensation. President Bush believes that Congress needs to act to address the asbestos crisis this year.

Howard, from Birmingham, AL writes:
As an individual who is concerned about rising health care cost, I too am in favor of some tort reform. My concern is that an imbalanced approach will shield the insurance companies from more liabilityresponsibility and provide even less viable health care alternatives to individuals like myself. How can this administration work to achieve tort reform, while restoring the balance of power between the individuals along with thier MD's and the insurance companies (which seem to be holding all the cards at present)?

Kristen Silverberg
Thank you for your question, Howard. President Bush agrees that we need to empower doctors and patients to make health care decisions. That’s one of the reasons President Bush proposed to make it easier for owners and employees of small businesses to open Health Savings Accounts. With a Health Savings Account, you can have a low-cost, high-deductible health plan for serious health expenses and you can set aside money tax-free for routine health care costs. Under the President’s plan, your monthly premium would also be tax deductible. And, the President would provide a tax rebate to a small business for the first $200 it contributes to an employees' health savings account.

In addition to the tax savings, Health Savings Accounts offer an important additional benefit – you own and control them yourself. A worker who wants to change jobs does not need to worry about losing health coverage – the worker takes his Health Savings Account with him. And, with Health Savings Accounts, you don’t negotiate with an HMO over treatment – you and your doctor decide whether a treatment makes sense.

The President also supports Association Health Plans, which allow small businesses to band together and negotiate lower costs on behalf of the employees – just like large businesses do.

Latoya, from Auckland, New Zealand writes:
In my country all medical services are free to New Zealand citizens, I am aware that our country is much smaller than yours, but your country makes alot more money than mine.Why are the medical services in USA not free? You can afford it.

Kristen Silverberg
Thank for writing Latoya. You must be up late in New Zealand.

President Bush is committed to providing Americans with a health care system that is affordable, accessible, and offers the best quality in the world. You may be surprised to know how extensive public health care programs in America are already. Medicaid, the public program for low-income individuals; Medicare, the public program for seniors and the disabled; and all other public health programs compose 44% of all health care spending in the country.

Even in New Zealand, your medical services are not free--citizens pay for health care through their taxes and the Government controls many of the decisions regarding an individual’s health options. The President favors a system in which individuals keep more of their own resources and have the ability to make choices as to what providers and services are best for them. His health care agenda consists of proposals to increase the availability of affordable coverage and to put control of health care decisions in the hands of patients and doctors; not government or insurance bureaucrats, or trial lawyers.

Janice, from Glenview, IL writes:
Isn't it true that the fact that investment returns are so low greatly impacts the price of insurance in general? Higher returns allowed insurance companies to invest premiums and pay claims from proceeds. So in addition to looking at tort reform and benefit changes, shouldn't the government also look at the economy for investors?

Kristen Silverberg
Thanks for the question Janice.

Experience in states across the country has proven that lawsuit abuse is the reason for increases in medical liability insurance premiums. If investment returns were responsible, we would expect every state to experience premium increases equally. In fact, states that have enacted liability reforms are faring much better than states with unlimited liability. For example, the liability reforms passed in California in 1975 have proven to be the standard for success in maintaining affordable medical liability insurance and keeping doctors in communities. Other states that have reformed their liability systems also have lower liability insurance premiums.

For more information, take a look at which features a report entitled Update on the Medical Liability Crisis: Not a Result of the Insurance Cycle or you can also look at the June 2003 report by the non-partisan General Accounting Office, which concluded that while several factors can increase the cost of medical liability insurance, rapidly increasing claims are the primary reason for the current medical liability crisis.

Jay, from chicago writes:
The CBO estimates that malpractice awards amount to only 2 of the money spent on health care. How much does that 2 constitute?

Kristen Silverberg
Thank you for writing. Malpractice costs include lawyer’s fees, damage awards, and settlements in cases in which doctors know they are innocent but are unable to afford long and costly legal proceedings. These costs are eventually passed on to all patients. The Congressional Budget Office estimated that malpractice costs account for about 2 percent of health care spending, equaling about $28 billion per year. In 2002 malpractice costs equaled $225 per household in America – almost half of what the average household spends on prescription drugs.

In addition, there are other costs not addressed in the CBO study such as the cost of defensive medicine. Doctors are often afraid of being sued and therefore order expensive tests and procedures that they would otherwise consider unnecessary in order to serve as a defense if they happen to be targeted by trial lawyers. This practice is known as defensive medicine and one study puts these expenses at an additional $60 - $108 billion a year.

Paul, from Camillus, NY writes:
I believe that medical liability and product liability tort reform is needed. I further believe there should be no cap on compensatory damages, but should be a cap on punitive damages. Consideration must be given to the total lifetime income that would be earned by a plantiff so that ordinary and necessary living expenses could be met. I further believe attorney fees should be limited to 25 percent of the total award given to plantiffs. Do you agree or disagree?

Kristen Silverberg
Thanks for the question, Paul. You have clearly been studying this issue.

Any health professional can tell you, however, that good doctors are too often the target of frivolous and junk lawsuits. The President believes that his proposals will reform the medical liability system so that trial lawyers are discouraged from filing frivolous and junk lawsuits in hopes of winning the litigation lottery. That way the legal system can be freed up to focus on ensuring appropriate damage awards for those who are truly victims of malpractice.

Our current broken medical liability system serves the interests of trial lawyers at the expense of family doctors and patients. Today in Illinois, the President is meeting with several doctors who have been forced to limit or move their practices because of rising liability premiums, even though they have never been the target of a lawsuit. Nationwide, frivolous lawsuits have caused 20 percent of hospitals to cut back on some critical services. This reduces the availability of health care services in many communities which may be needed in an emergency. Over the past two years, the President has met with many women whose OB/GYNs have left their communities to escape rising liability premiums. This has left many to struggle to find doctors who can provide the prenatal care that is so important to a healthy baby.

The President has called for common-sense medical liability reforms to stop the rapidly rising costs associated with frivolous lawsuits. As more and more doctors are unable to afford liability insurance, many have raised prices or limited their services. Some have stopped practicing medicine altogether.

The President believes that plaintiffs should receive quick, unlimited compensation for their current and future economic damages such as wages, medical expenses, and the loss of ability to provide unpaid services like care for children or parents. In determining a plaintiff’s economic damages, juries can look at a plaintiff’s future income. The President believes that non-economic damages and punitive damages should be held to a reasonable amount and that punitive damages should be available only in cases of egregious conduct.

The President has also proposed measures to ensure that old cases cannot be brought years after an event, and that defendants pay judgments in proportion to their fault.

Shehzad, from Saint Louis, Missouri writes:
Medical reform is needed for survival of medical professionals, Will President Bush deliver his promise regarding Medical reform?

Kristen Silverberg
Shehzad, passing medical liability reform is one of the President’s highest priorities. It is a centerpiece of his plan to lower health costs, expand access, and improve the quality of care for Americans. He mentioned it in nearly every speech he gave during last year’s campaign.

The House of Representatives has previously passed medical liability reform measures on several occasions, but trial lawyers and their allies have prevented the issue from being approved in the Senate. The President is meeting with doctors and patients today to highlight the crisis and to call on Congress to pass medical liability reform legislation immediately.

Thank you for participating in today's "Ask the White House." Kristen enjoyed taking your questions and encourages you to read the President's speech on medical liability reform he gave while in Illinois today.

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