With contributions by numerous experts

Kenneth Abraham explores the development and interdependency of the tort liability regime and the insurance system in the United States during the twentieth century and beyond, including the events of September 11, 2001. From its beginning late in the nineteenth century, the availability of liability insurance led to the creation of new forms of liability, heavily influenced expansion of the liabilities that already existed, and continually promoted increases in the amount of money that was awarded in tort suits. A “liability-and-insurance spiral” emerged, in which the availability of liability insurance encouraged the imposition of more liability, and, in turn, the imposition of liability encouraged the further spread of insurance. Liability insurance was not merely a source of funding for ever-greater amounts of tort liability. Liability insurers came to dominate tort litigation. They defended lawsuits against their policyholders, and they decided which cases to settle, fight, or appeal. The very idea behind insurance––that spreading losses among large numbers of policyholders is desirable––came to influence the ideology of tort law. To serve the aim of loss spreading, liability had to expand. Today the tort liability and insurance systems constantly interact, and to reform one the role of the other must be fully understood.

The debate over the structure of tort law and victim compensation.

The United States has recently witnessed an explosion of personal injury lawsuits involving medical malpractice, unsafe products, and widespread environmental hazards. Jury awards and out-of-court settlements have escalated in many cases to hundreds of thousands of dollars. At the same time, premiums for liability insurance have skyrocketed. As a result, physicians have cut back services and some municipalities and businesses have been denied liability coverage altogether. Some experts claim that only fundamental reform of the nation's civil justice system will end this "insurance crisis." But critics of such wholesale judicial reform contend that the insurance industry has launced a "tort reform" campaign to cover its own past underwriting mistakes. Liability brings together economists and experts in liability law and the insurance industry to assess the merits of the conflicting positions and to formulate sound public policy. Led by Robert Litan and Clifford Winston, the contributors describe the major changes that have contributed to the insurance crunch and set forth a methodological framework for evaluating the debate over the current liability system. They conclude that increases in premiums and cutbacks in coverage have been real but selective; that the forces in the judicial system responsible for rising liability costs are not readily subject to change; and that we know too little about the cost and benefits of the current tort system to replace it with an alternative compensation program.

"Drawing on an unusually rich trove of data, the authors have refuted more politically convenient myths in one book than most academics do in a lifetime." —Nicholas Bagley, professor of law, University of Michigan Law School "Synthesizing decades of their own and others’ research on medical liability, the authors unravel what we know and don’t know about our medical malpractice system, why neither patients nor doctors are being rightly served, and what economics can teach us about the path forward." —Anupam B. Jena, Harvard Medical School Over the past 50 years, the United States experienced three major medical malpractice crises, each marked by dramatic increases in the cost of malpractice liability insurance. These crises fostered a vigorous politicized debate about the causes of the premium spikes, and the impact on access to care and defensive medicine. State legislatures responded to the premium spikes by enacting damages caps on non-economic, punitive, or total damages and Congress has periodically debated the merits of a federal cap on damages. However, the intense political debate has been marked by a shortage of evidence, as well as misstatements and overclaiming. The public is confused about answers to some basic questions. What caused the premium spikes? What effect did tort reform actually have? Did tort reform reduce frivolous litigation? Did tort reform actually improve access to health care or reduce defensive medicine? Both sides in the debate have strong opinions about these matters, but their positions are mostly talking points or are based on anecdotes. Medical Malpractice Litigation provides factual answers to these and other questions about the performance of the med mal system. The authors, all experts in the field and from across the political spectrum, provide an accessible, fact-based response to the questions ordinary Americans and policymakers have about the performance of the med mal litigation system.