Medical Malpractice Litigation

Medical Malpractice Litigation

How It Works, Why Tort Reform Hasn't Helped

Bernard S. Black, David A. Hyman, Myungho Paik, William M. Sage, Charles Silver


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"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.


Bernard S. Black:
Bernard S. Black is the Nicholas D. Chabraja Professor at Northwestern University, with positions in the Pritzker School of Law, the Institute for Policy Research, and the Kellogg School of Management Department of Finance.|||David A. Hyman is an adjunct scholar at the Cato Institute and a professor at Georgetown University Law Center. He is the coauthor of Overcharged: Why Americans Pay Too Much for Health Care (2018) and the author of Medicare Meets Mephistopheles, which was selected by the U.S. Chamber of Commerce/National Chamber Foundation as one of the top 10 books of 2007.|||Myungho Paik is an associate professor in the Department of Policy Studies at Hanyang University. Before joining Hanyang University in 2015, he worked as a postdoctoral fellow at the University of Texas School of Law and as a research associate at Northwestern University School of Law.|||William M. Sage is the James R. Dougherty Chair for Faculty Excellence in the School of Law at the University of Texas at Austin and professor of surgery and perioperative care in the Dell Medical School.|||Charles Silver is an adjunct scholar at the Cato Institute and holds the Roy W. and Eugenia C. McDonald Endowed Chair in Civil Procedure at the University of Texas School of Law, where he teaches about civil litigation, health care policy, legal ethics, and insurance. He is the coauthor of Overcharged: Why Americans Pay Too Much for Health Care (2018).