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May 19, 1993

Health Insurance Reform and the Physician-Patient Relationship

JAMA. 1993;269(19):2503. doi:10.1001/jama.1993.03500190045018

To the Editor.  —In the recent Law and Medicine column, Parmet1 concludes that a "centralized" health care system (presumably a "national" health care system) would deflate current tort standards and henceforth reduce overtreatment and excessive care provided by physicians who practice in the current US system. Such deflation would occur necessarily due to lower health care costs, which would in turn lessen the financial blow to a "malpractice victim" (plaintiff) incurred by an alleged injury from substandard medical care. Hence, patients would be considerably less likely to sue their physicians because the economic burden of future medical expenses for the injuries incurred would be minimal under a centralized system.The author also assumes that "many physicians" have an economic incentive to overtreat and that if such incentives were removed, "physicians would be held by the courts to a less rigorous standard of care."While I certainly agree with some