567

Round the World

United States

LEGISLATIVE INSURRECTION

IT is very difficult to imagine at the moment what isgoing to happen in the next few months here. ThePresident is opposed to the setting up of any nationalhealth schemes, allegedly because it would increase thefederal deficit, which he was not going to increase becauseit would be inflationary. Many of the proposals putforward seemed designed to increase the burdens on thepoor and leave the rich far less adversely affected. It ishere that the crunch seems likely to come with the Congress,which is apparently scenting the wind of legislation of itsown devising for the first time in decades of presidentialrule. It has also been flexing its new-found muscles bythe remarkable action of voting out of office several com-mittee chairmen of long service, very senior standing, andgreat power, which in the past was not always wisely ortactfully employed, having often been used to thwart thedesires of a large majority of the party. This misuse of

power was allowed to happen because for 70 years ithad been an unwritten rule of Congress that seniority wasall-important. As a result the more conservative membershave tended to stay longer in Congress, and to be returnedin election after election, especially if they were southernDemocrats; and with rising power in committee theyhave been able to steer more and more federal installationsto their constituencies and thereby improve their electionprospects till death, or senility, if recognised, overcamethem. The State of Massagravy, that mythical southernState that sank into the Atlantic under the sheer weight offederal installations, may be a fantasy of Russell Baker’simagination, but it’s only just beyond the bounds of

reality.

The first break came in the Goldwater debacle when

many crusted reactionaries went down to defeat, but theimpact, important as it was, was slight because the chair-manships then went to the next senior man down theline, who might be, and probably was, of similar age andoutlook. Of course, it had always been technically possibleto overrule a chairman and thus force legislation through acommittee, but it was virtually impossible if all conserva-tive elements of both parties combine in opposition, for asimple majority does not suffice. In this way committeechairmen could bottle up legislation that had been desiredby the majority for years, and could be extremely autocraticand even hostile to fellow legislators, including partymembers.

However, the Democratic party, now in the majority,have decided that they would not accept automatic nomina-tion of chairmen by seniority, but would insist on an openvote. The results have rather stunned observers here.

, Four powerful senior chairmen have been voted out, tothe dismay and indignation of some, and others have hadvery near squeaks, on which they will no doubt ponder.There is a new chairman of the Ways and Means Com-mittee, which has been increased in size, with a considerableaccession of liberal members, and of the Banking, theAgriculture, and the Armed Services Committees. The

days when the Pentagon had only to ask are, it seems, gone.All this promises to go far beyond a palace revolution onCapitol Hill. The new chairmen and members seem likelyto streamline committee operations, and to be active in

bringing out legislative measures, and the conservativeelements in Congress may not be strong enough to holdthem back or to uphold presidential vetoes. The Presidentso far has broken all records in the use of his power of veto;complete impasses could develop. In the serious circum-stances of today everyone talks about the need for coopera-tion between legislative and executive branches, but we arein a new, and very uncertain, situation, and it would beunwise to rule out anything, even a national health schemeopposed by the President.

MALPRAXIS PROBLEMS

THE focus of medical malpraxis troubles lately has beenNew York State, where the Argonaut Insurance Companyof California, not satisfied with its almost 100% increasedpremium, has asked for a further rise of nearly 200%.Adverse underwriting experience was the excuse, butthere were dark hints, strongly denied, that its parentconglomerate had taken a huge loss on stocks and saw away of recouping via the doctors. The insurers have beenheld to their present premiums until July, when they arewithdrawing, and what will happen then is quite uncertain.New York doctors have lobbied their legislature and asympathetic new governor, who described the premiumincrease as " obscene ", an adjective much in fashion overhere just now. However, the problem is not just a local one;a much more experienced insurance company, one that hasoperated for years in 47 States, has declared that, in thepresent state of the law and with existing levels of awards, itcannot carry on. Since the federal Government’s com-mission failed to come up with any solution to the malpraxisproblem, general opinion seems to be that no shuffling ofresponsibility back and forth will suffice, and that the lawswill have to be changed. The insurers’ main proposalwould seem to be that the physician’s premium shouldprotect him only for claims made during the period forwhich he was covered by his premium; this would meanthat to secure coverage for subsequent claims arising fromalleged malpraxis in this period, he would have to take outfurther, very costly, insurance-which leads us back tosquare one.

The main proposals from the medical side seem to bethe cutting of the lawyers’ contingency fees, a very sorepoint, the extension to medical malpraxis litigation of thesame protection that other defendants enjoy under thelaw (a protection much breached in recent years by judicialdecisions), mediation panels whose evidence and decisionswould be read to the court, compulsory arbitration,awards systems with limits on the amounts of awards,similar to the workmen’s pensions, and, if all else fails,no-fault insurance. There are other approaches to theproblem; some people believe that there has in fact beenno significant rise in the number of malpraxis cases, whileothers claim that by going along with group insurance viacounty or State medical associations the profession haslocked itself into a monopolistic situation. Thus if the low-risk, low-claims physician tried he might get very favourableterms in comparison with his high-risk, high-claimscolleague, who would have to pay much more or mend hisways. This sounds all right, and indeed group insurancemay not be as sensible as it seems, but still presumablyone would have to have " catastrophe " insurance to coverthe low-risk, low-claims, unblemished individual to whom,once in a lifetime, something awful befalls. However youlook at it, by July, in New York State at least, we must havean answer of some kind, or there will be an " obscene

. rise in medical costs.