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To the Editor:
Nuwer et al,1 in an invited article, provide a concise overview of problems with organization of health care delivery in the United States. As is often the case with physician discussions of health care costs, they highlight the role of malpractice costs and litigation in fueling rising health care costs. This emphasis may be misplaced.
Some experts argue that the relationship between litigation and the vicissitudes of malpractice markets is tenuous. Malpractice premium “crises” are driven by the peculiar dynamics of insurance markets.2 These same experts argue that direct malpractice costs and torts play only a modest role in rising health care costs.2 A common yet difficult argument is that medical malpractice litigation has a large adverse penumbra because of “defensive” practice, resulting in considerable duplication of tests and services.
In my experience, however, defensive …
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