Malpractice & Liability

Citation: American Journal of Law & Medicine, Spring 1996 22 n1 p7-50

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Abstract: Enterprise liability would be an effective way of imposing

liability for health care malpractice in view of the case

management power third party payors and health maintenance

organizations have acquired. Enterprise liability is the

conceptual basis for the American idea that the free market

will be the source for filling all human needs. ERISA's

preemption of health care plan liability is outdated, impedes

competition and robs consumers of remedies they deserve. ERISA

should be amended to include enterprise liability for medical

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Full Text COPYRIGHT American Society of Law & Medicine Inc. 1996

As Canada approaches the end of its first decade of government-run

health care with universal coverage and controlled costs, the majority

in the United States Congress has proposed repealing the federal

guarantee of health coverage to poor and disabled persons embodied in

Medicaid.(1) This somber turn in the history of American health care

comes only a few years after an optimistic President Clinton re

. . .
rinciples of the insurance industry, that the insured event: (1) be susceptible to unambiguous description; (2) be something the insured person has no control over; and (3) be a relatively uncommon occurrence for individuals but have a predictable incidence for a group.(68) In health care, once it was understood that the existence of insurance actually increases the utilization of services, the setting of premiums became inherently problematic. The Depression appeared to push aside these doubts. The New Deal left out health care, leaving hospitals with empty beds and patients too poor to pay for services.(69) Following an example in Baylor, Texas, where a hospital provided school teachers with up to twenty-one days of care for a premium of fifty cents per month, hospitals began the non-profit Blue Cross plans. With pressure from physicians, Blue Cross coverage became multi-hospital, and private insurance companies soon entered the market with cash indemnity plans.(70) Physicians organized in California to provide coverage for their own services under Blue Shield.(71) Expansion of employee coverage received a major boost during World War II, when the War Labor Board ruled that health coverage to workers did not
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Some common words found in the essay are:
Hospital Association, Blue Cross, Fleming James, President Clinton, Shedd Smith, ERISA14 ERISA, DRGs132 Equipped, Friedrich Kessler, Motor Co, Medicare Medicaid, health care, enterprise liability, utilization review, blue cross, managed care, medical care, insurance companies, medical treatment, contract law, private sector, health care delivery, health care providers, duty care patient, risk-sharing pool cover, methodological tools developed,
Approximate Word count = 8675
Approximate Pages = 35 (250 words per page)

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