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LegalCare:
It is Time to Lower Legal Costs and Ensure Affordable, Accessible
Legal Coverage for All by
Matthew S. Rice, M. D.,
Journal of American Physicians and Surgeons, AAPS
According
to the American Bar Association, thousands of innocent working
Americans are wrongfully convicted of crimes every year, in part
due to negligent or poorly trained lawyers, careless judges, and
prosecutorial misconduct. Samuel R. Gross, Professor of Law at
University of Michigan, estimates that between 3.3 percent and 7
percent of convictions are erroneous, meaning that between 60,000
and 140,000 innocent Americans are incarcerated.
With
attorney-legislators scrutinizing and planning the reform of
medicine and the health insurance industry, it is only fitting
that physicians apply the most current progressive healthcare
reform principles to the legal profession. Attorney-legislators
and other politicians and appointees are strongly encouraged to
use the present healthcare reform momentum to simultaneously
reform the legal profession. Doing so would greatly add to their
credibility among constituents and other stakeholders, since they
know essentially nothing about medicine and everything about law.
Legal reform: it is time.
IllustrativeAnecdotes
·
Cameron Willingham was convicted of murdering his children
by arson in 1992. Due in part to poverty, inadequate
representation by legal counsel, and an inefficient, haphazard,
paper-dependent Legalcare system based on medieval principles and
practices, he was executed in 2004. The Texas Forensic Science
Commission has been examining the flawed investigation that
contributed to the execution of this man, thought by many arson
experts to be innocent . . .
·
Eddie Lloyd was wrongfully convicted of rape and murder in
1985. Contributing factors to this tragic injustice included
representation by a court-appointed attorney, poor hand-off
between defense attorneys prior to trial, and the fact that
another state-appointed attorney failed to meet with Lloyd or file
a claim of ineffective assistance of counsel. Lloyd was exonerated
after spending 17 years in prison, and died two years later.
Scope
and Severity of the Problem
Legalcare
costs in the U.S. are skyrocketing, with tort costs alone draining
Americans of $865 billion dollars annually, a sum greater than the
entire combined gross domestic products of New Zealand, Hong Kong,
Ireland, Vietnam, Qatar, Ecuador, and Luxembourg. Billions more
are wasted by fearful business owners complying with dubious
regulations drafted by lawyers. Are we getting our money's worth?
Is the United States anymore safe, just, or lawful than Japan or
Great Britain, where the legal-cost burden is half of what we pay?
According to The Times
of London, our legal system is worse than that of either Russia or
China.
The
prohibitive costs of lawsuits and liability insurance are
smothering small business owners and working Americans, who bear
almost 70 percent of business tort liability costs.
Class-action
lawsuits result in multi-million dollar payouts to lawyers while
consumers end up with nothing of value. David de Alba, a
California Superior Court Judge, awarded attorneys who filed a
class-action lawsuit against Ford Motor Company $25 million. What
did the plaintiffs receive? Coupons they could apply toward the purchase of a new vehicle.
Expenses
related to defensive medicine practices add $124 billion annually
to healthcare costs, more than enough to give a $10,000 health
insurance premium to each chronically uninsured American.
The
burden of lawsuits in America is an unseen "tax" of
$9,827 on each working family of four. Unless you're Warren
Buffett or Bill Gates, your family or small business is just one
serious legal bill away from bankruptcy, and all bankruptcies in
America involve at least one expensive legal bill. . .
While
half of all Americans will require Legalcare services in any given
year, almost 280 million Americans lack legal insurance. For those
few Americans who do have legal insurance coverage, most plans
only cover a limited number of attorney visits and fail to provide
coverage for preexisting situations such as divorce proceedings,
custody cases, bankruptcy, or cases involving alcohol or drugs,
thus exposing hardworking families to unlimited financial
liabilities. Even those Americans with coverage are struggling to
cope with soaring legal expenses. As a nation we can no longer
afford to accept the status quo. The cost of inaction is simply
too much to bear. . .
Racial
minorities, the poor, non-citizens, and men receive longer prison
sentences than whites, the wealthy, citizens, and women,
respectively. Recent studies by the American Bar Association
estimate that half of all poor Americans suffer from at least one
serious legal problem each year, but 75 percent of them have no
access to Legalcare services. While the average profit per partner
of the most successful law firms soared to $755,000 annually over
the past 10 years, these same attorneys only provided eight
minutes per day of pro-bono Legalcare services to the needy and
helpless who suffer from serious legal conditions. Clearly,
perverse profit motives have hindered the ability of many
attorneys to reach their potential in providing low-cost or free
Legalcare services to the poor.
Imagine an America in which disenfranchised socioeconomic
groups and disparity ethnic groups had access to the same quality
Legalcare afforded to the wealthiest Americans!
Too
many Americans go without high-value preventive Legalcare services
such as professional income tax preparation and reviews; estate,
will, and trust planning; legal risk reviews; precrime legal
mitigation assessments; and other critical legal services
available only to the wealthiest Americans. Routine use of
preventive legal services could help Americans avoid future
liabilities, but owing to prohibitive costs, many working American
families forgo such counsel only to suffer the far greater
consequences of future legal or regulatory noncompliance. Our
legal system has become a criminal and civil system, and the time
for reform is well overdue.
Lower
Costs to Make Our Legalcare System Work for People and
Businesses— Not Just for Lawyers.
Inefficient
and poor-quality Legalcare costs the nation hundreds of billions
of dollars every year. Billions more are wasted on administration
and overhead, and this problem will only worsen as legal spending
increases over the next decade. We must redesign our Legalcare
system to reduce inefficiency and waste, and improve Legalcare
quality, driving down costs for families and businesses. We can do
this by: (1) adopting state-of-the-art legal information
technology systems; (2) ensuring that clients receive, and
attorneys deliver, the best possible counsel, including preventive
legal services and chronic-offender management services; and (3)
liberating attorneys from perverse profit incentives by
implementing a national single-payer Legalcare system.
Legal
costs and quality can vary tremendously among firms and attorneys;
however clients have limited access to this information.
We must require firms and attorneys to collect and publicly
report measures of legal costs and quality, including data on
hourly fees, legal errors, miscarriages of justice,
attorney-to-client staffing ratios, overruled motions, reversed
verdicts, and conviction rates.
We
must align incentives with excellence. Sadly, many attorneys
collect fees based on the volume of services provided rather than
on the quality of those services. For example, a working parent
might take her obese child to an attorney to sue a school for
damages arising from chronic illnesses caused by the federally
funded school lunch program. The attorney might think to himself,
"I could make a lot more money by taking this case and
billing these people $400 per hour, rather than telling them that
the case is futile."
Enter
Legalcare, a national single payer legal system that would set
reimbursement rates for attorneys and link quality legal counsel
with incentives. Legalcare would cover all Americans and drive
down legal costs across the board. Legalcare would be administered
by a Department of Legal Services (DLS). Reimbursement rates would
be modeled on the highly successful Medicare program, and would
range from $12.56 to $170.65 per attorney-client session, based on
coded documentation of the complexity and quality of Legalcare
services provided.
Tackling
the Disparities in Legalcare
Although
all Americans are affected by this crisis in our Legalcare
delivery system, an overwhelming body of evidence indicates that
certain populations are significantly more likely to receive lower
quality Legalcare than others.
Do
not all Americans deserve access to the best available Legalcare?
Could a poor working member accused of drug possession simply walk
into the office of a politically connected trial lawyer, and
receive the Legalcare he needed and deserved at an affordable
price? Of course not! Lawyers demand cash retainers, ranging in
the thousands to tens of thousands of dollars for criminal
defense. He would likely end up with a poorly trained,
non-connected public defender, and spend years languishing in
prison. According to a damning 2002 report, many public defenders
are "unqualified, irresponsible, or overburdened and do
little if any meaningful work for [their] clients." It is our
nation's moral duty to ensure that attorneys and law firms provide
affordable counsel to all Americans, especially our most
vulnerable and disenfranchised; and to end the practice of
"cherry-picking" easy clients or lucrative cases. . .
Attorneys
must be required to keep electronic legal records (ELR) for their
clients, the benefits of which are substantial: improved
administrative efficiencies, improved quality of Legalcare,
elimination of legal errors, reduction of redundancies and
paperwork, and lower Legalcare costs, among others. The ELR should
be modeled after the functional and efficient Department of
Defense electronic medical record, AHLTA, which is arguably the
"Porsche" of electronic medical records. The National
Coordinator of Legal Information Technology would ensure that
attorneys who fail to be meaningful users of the approved ELR
(Attorney Hypermetric Longitudinal Technology Application)
by 2015 face reduced payments and other financial penalties from
the DLS. In a general sense, meaningful users of the ELR are
defined as attorneys who demonstrate to the government that they
are using electronic documentation, that their technology is
connected in a manner that provides for electronic exchange of
legal data to improve quality of legal services, and those
attorneys who submit information to the government on legal
outcome measures.
The
National Institute of Comparative Legal Effectiveness would
monitor attorney-client decisions via the ELR to make sure that
lawyers do what the DLS deems appropriate, fair, and
cost-effective. The
goal is to reduce costs and guide attorneys' decisions, with the
aim of standardizing and improving legal outcomes for all
Americans. . .
Affordable,
Accessible Coverage for All
We
must guarantee affordable and accessible legal counsel for all
Americans. Currently, with nearly 280 million Americans lacking
legal insurance, rising costs are a burden on working families and
small businesses. It is simply too expensive for individuals and
families to buy the Legalcare they need and deserve on the open
market, and is impossible for many with ongoing or preexisting
legal problems.
We
must require law firms and attorneys to accept clients with
pre-existing legal problems (to include recalcitrant criminal
behavior, drug and alcohol addictions, and civil problems such as
complicated divorce and custody battles), at fair reimbursement
rates set by the DLS. We can no longer allow attorneys and firms
to accept easy or lucrative cases while dismissing those who
cannot pay, or who suffer from challenging legal conditions.
Legalcare
would be budget-neutral if it were funded with a small addition to
the existing Federal Insurance Contributions Act tax (FICA), and a
federal tax of 75 percent on all tort awards and on all court
filing fees. Legalcare will enable all deserving Americans to get
the comprehensive and quality legal benefits they need and deserve
at a fair and stable price. It will eliminate the two-tiered
Legalcare system currently in place, keeping courthouse doors open
for all, regardless of economic status or race.
Read
the entire Legalcare proposal at www.jpands.org/vol14no4/rice.pdf.
Matthew
S. Rice, M.D. is a family physician in Tacoma, Wash. Contact:
matthew_s_rice@yahoo.com.
Also see www.SinglePayerLegal.org.
©
The Association of the American Physicians and Surgeons, Jane M
Orient, MD, Executive Director, Managing Editor; Winter issue of
JAPS, Lawrence R Huntoon, MD, PhD, Editor-in-Chief, editor@Jpands.org
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NOVEL
CRYSTAL BALL: One day Y-shaped molecules called autoantibodies in
a patient's blood may tell doctors whether a patient is
"brewing" certain diseases and may even indicate roughly
how soon the individual will begin to feel symptoms.
By Abner Louis Notkins Scientific
American
Overview/Predictive
Antibodies
■
In autoimmune
diseases, such as type 1 diabetes, the immune system mistakenly
manufactures antibodies that target the body's tissues.
■
Certain of these
"autoantibodies" appear many years before overt symptoms
of disease, suggesting that screening for these molecules could be
used to predict who is at risk of falling ill.
■
Autoantibodies
might also serve as guides to disease severity and progression and
might even warn of risk for some nonimmune disorders.
■
Screening for
predictive autoantibodies could one day become routine, although a
dearth of preventive treatments currently stands in the way.
A
middle-aged woman—call her Anne—was taken aback when one day
her right hand refused to hold a pen. A few weeks later her right
foot began to drag reluctantly behind her left. After her
symptoms worsened over months, she consulted a neurologist.
Anne, it turned out, was suffering from multiple sclerosis, a
potentially disabling type of autoimmune disease. The immune
system normally jumps into action in response to bacteria and
viruses, deploying antibodies, other molecules and various white
blood cells to recognize and destroy trespassers. But in
autoimmune disorders, components of the body's immune system
target one or more of the person's own tissues. In Anne's case,
her defensive system had begun to turn against her nerves,
eroding her ability to move.
Every
story of autoimmune disease is sad—but collectively the impact
of these illnesses is staggering. More than 40 autoimmune conditions
have been identified, including such common examples as type 1
(insulin-dependent) diabetes, rheumatoid arthritis and celiac
disease. Together they constitute the third leading cause of
sickness and death after heart disease and cancer. And they
afflict between 5 and 8 percent of the U.S. population, racking up
an annual medical bill in the tens of billions of dollars.
Recent
findings offer a way to brighten this gloomy picture. In the past
10 years a growing number of studies have revealed that the body
makes certain antibodies directed against itself—otherwise known
as autoantibodies—years, and sometimes a decade, before
autoimmunity causes clinical disease, damaging tissues so much
that people begin showing symptoms. This profound insight is
changing the way that doctors and researchers think about
autoimmune conditions and how long they take to arise. It suggests
that physicians might one day screen a healthy person's blood
for certain autoantibodies and foretell whether a specific
disease is likely to develop years down the line. Armed with such
predictions, patients could start fighting the ailment with
drugs or other available interventions, thereby preventing or
delaying symptoms. . . .
Early
Insight from Diabetes
People
familiar with advances in genetics might wonder why researchers
would want to develop tests for predictive autoantibodies when
doctors might soon be able to scan a person's genes for those that
put the individual at risk of various disorders. The answer is
that most chronic diseases arise from a complex interplay
between environmental influences and multiple genes (each of
which makes but a small contribution to a disease). So detection
of susceptibility genes would not necessarily reveal with any
certainty whether or when an individual will come down with a
particular autoimmune condition. In contrast, detection of
specific autoantibodies would signal that a disease-causing
process was already under way. Eventually, genetic screening for
those with an inherited predisposition to a disease may help
reveal those who need early autoantibody screening.
Studies
of patients with type 1 diabetes provided the first clues that
autoantibodies could be valuable for predicting later illness.
In this condition, which typically arises in children or
teenagers, the immune system ambushes the beta cells in the
pancreas. These cells are the manufacturers of insulin, a hormone
that enables cells to take up vital glucose from the blood for
energy. When the body lacks insulin, cells starve and blood
glucose levels soar, potentially leading to blindness, kidney
failure, and a host of other complications. . .
More
important, these studies also raised the prospect that doctors
might forecast whether a child is at risk for type 1 diabetes by
testing blood for the presence of these autoantibodies. Clinical
researchers found that an individual with one autoantibody has a
10 percent risk of showing symptoms within five years. With two
autoantibodies, the chance of disease jumps to 50 percent; with
three autoantibodies, the threat rockets to between 60 and 80
percent. . .
The
discovery that autoantibodies frequently herald the onset of type
1 diabetes prompted scientists to examine whether the same might
be true in other autoimmune diseases. One that has been the
focus of especially intense research is rheumatoid arthritis, a
debilitating condition that is highly prevalent, afflicting
about 1 percent of the world's population. In those affected, the
immune system attacks and destroys the lining of the joints,
causing swelling, chronic pain and eventual loss of movement.
Predicting
Other Diseases
Immunologists
have recently unearthed an autoantibody that is present in 30 to
70 percent of patients diagnosed with rheumatoid arthritis . . .
To
read the rest of this remarkable research. . .
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