Submitted by Jamie Grifo MD PhD, Feb 7, 2008 20:32

Clinton's ideas about health care insurance ignore the big problem with medicine in the US. It is true that we have the most expensive healthcare system in the world. It is no coincidence that we have the highest malpractice rates in the world. Our litigation system costs are buried in every medical transaction, medical device, drug and procedure. It is curious that no politician is willing to question whether the current litigation system truly improves the quality of medical care and is worth the cost. Perhaps there is a more cost effective and fair alternative to manage human error and bad outcomes in medicine. Indeed, 40% of the revenue used to maintain this inefficient system goes to the trial lawyers and insurance companies instead of the victims it serves. This seems a high price to pay. In fact when that system makes a mistake nothing happens (remember the breast implant litigation which after the fact now studies showed no cause and effect relationship and yet the trial lawyers did not give back any money).

Also under the radar is the high cost of the regulatory environment that this system encourages. We, in medicine are barraged with regulation some of which is useful and some of which simply serves as a scribe role for litigation, doesn't improve care at all and costs a bundle. In fact, it causes care givers to lose focus on the true mission of delivering high quality care by rewarding costly defensive medicine.

Some estimates of the true cost of our litigation system (not the 1% the trial lawyers claim) have been as high as 20-30%% of the medical GNP. If those dollars were spent on health care instead of a bad victim remuneration system just imagine how many more people could be cared for. Any politician looking to really improve the value of dollars spent on health care needs to streamline the system with information technology, standardize insurance claim forms and methodology and completely overhaul the tort approach to malpractice. There needs to be a separate arbitration board where there are no overpaid expert witnesses, uneducated juries, lawyers receiving 30% contingency fees and a mechanism that remunerates victims fairly and not less then trial lawyers and insurance companies. This is a tall order for a politician who fills the coffers with trial lawyer money and believes the government can deliver better health care than the private sector.

Jamie Grifo MD PhD

43-45 East 19^th st ste7

NY NY 10003

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