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May 19, 1993

Health Insurance Reform and the Physician-Patient Relationship-Reply

Author Affiliations

Northeastern University School of Law Boston, Mass

JAMA. 1993;269(19):2504. doi:10.1001/jama.1993.03500190045020

In Reply.  —Both Dr Casey and Mr Kupor make the valuable point that reform of the health care financing system alone will not resolve the problems associated with malpractice litigation. Nor will it ensure quality care. Nevertheless, there is still reason to believe that guaranteeing universal access to care, especially through a centralized system, will help.While Kupor is correct in stating that some studies suggest that the abolition of the collateral source rule has led to only modest reductions in damages in those states in which it has been tried, such experiences may not predict accurately the effects of universal access. Under current conditions, abolition of the collateral source rule has no effect whatsoever in the case of uninsured patients. Nor can would-be litigants and jurors be assured that all future medical expenses associated with an injury will be covered by existing medical insurance. With universal coverage, these problems