defending managed care

Doug Henwood dhenwood at panix.com
Mon Jan 15 10:22:59 PST 2001


[the latest from the always-lovely Epstein]

"The Assault on Managed Care: Vicarious Liability, Class Actions

and the Patient's Bill of Rights"

BY: RICHARD A. EPSTEIN

University of Chicago Law School

ALAN O. SYKES

University of Chicago Law School

Document: Available from the SSRN Electronic Paper Collection:

http://papers.ssrn.com/paper.taf?abstract_id=253328

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http://www.law.uchicago.edu/Publications/Working/

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Paper ID: U Chicago Law & Economics, Olin Working Paper No. 112

Date: December 2000

Contact: RICHARD A. EPSTEIN

Email: Mailto:repstein at midway.uchicago.edu

Postal: University of Chicago Law School

1111 E. 60th St.

Chicago, IL 60637 USA

Phone: 773-702-9563

Fax: 773-702-0730

Co-Auth: ALAN O. SYKES

Email: Mailto:alan_sykes at law.uchicago.edu

Postal: University of Chicago Law School

Frank and Bernice J. Greenberg Professor of Law

1111 E. 60th St.

Chicago, IL 60637 USA

Paper Requests:

Contact Marjorie Holme, Program Administrator and Discussion

Paper Coordinator, Olin Law and Economics Program, University of

Chicago Law School, 1111 E. 60th Street, Chicago, IL 60637.

Phone:(773)702-0220. Fax:(773)702-0730.

Mailto:mholme at uchicago.edu

ABSTRACT:

The current level of public dissatisfaction has engendered a

long list of proposed reforms that seek to increase the overall

level of public regulation of Managed Care Organizations (MCOs),

by limiting the scope of preemption under ERISA, by expanding

doctrines of vicarious liability and implied agency, by adopting

a patient's bill of rights, and by exposing them to class

actions by disappointed plan participants. In response, this

paper argues that most of these reforms are ill-conceived, in

the sense that they do not hold any realistic possibility of

improving the performance of the health care system relative to

the current set of tort and contract doctrines that are now in

place. Direct actions against MCOs for example are likely to

hamper their mission to contain costs. The usual conditions that

make vicarious liability sensible, for example, are not likely

to pertain here when physician groups have assets to meet

anticipated claims against them. And the use of class actions

runs the serious risk of introducing dubious claims for

liability based on some broadside allegations of fraud when

their proper function is restricted to allowing the amalgamation

of individual claims that would otherwise be too costly to

pursue on an individual basis. The real problem with MCOs is

that in conditions of scarcity, the public is unable to

reconcile its inconsistent demands for low premiums ex ante with

comprehensive and deep coverage ex post.



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