President Obama took an important step away from special interest politics when he committed to changing justice to solve the problem of defensive medicine in his address to Congress. "I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today."
The wires were abuzz this morning over what he really had in mind. The trial lawyers will try to limit the damage with some sort of program that doesn't limit their ability to make emotional arguments to the jury. But restoring trust in justice--the only way to eliminate defensive medicine--requires consistency and reliability. That means standards of care need to be decided as a matter of law, in written rulings that all can see, by a court that knows what it's talking about.
Because modern medicine is so complex, reliability almost certainly requires some kind of special court. This country has a long history of such courts, such as bankruptcy courts, and it's hard to imagine an area of society in greater need of special judicial expertise than health-care. That's why a broad coalition has come out for pilot projects--including AARP, the AMA, the American College of Obstetricians and Gynecologists, the Joint Commission on the Accreditation of Health-care Organizations, and many others.