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Dr. Feld:

Many thanks for your ongoing column. Senator Durbin's sanctimonious diatribe was exactly what you said it was - a closing argument to a jury. Neither the Senator nor the President recognize the intrinsic dysfunction of medical tort. As succintly described in a 2004 NEJM article (NEJM 350;3 283-292), the current medical malpractice system serves neither of its potential societal duties: promoting safe medicine and reimbursing the truly aggrieved. The system of advocacy (and untethered sympathy) that drives medical tort is based on the same entitlement mentality that causes medical cost to sky-rocket.

The irony is that if the President were to concede this point to the medical community (we are told it would only cost one fifth of one percent of all medical costs to "buy off" the plaintiff's bar), he would win the the emotional hearts of nearly all the practicing physicians in this country who would probably forgive all of his plan's other major short-comings.

If you have not already read it, I would recommend Phil Howard's "Life Without Lawyers" to your already busy reading list.

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