WASHINGTON — According to Democratic presidential candidate and malpractice attorney John Edwards, the way to solve the malpractice insurance crisis is to put the onus on … the malpractice attorneys.

“The bulk of the problem is created when cases are filed in the legal system that should never be there, said the former senator from North Carolina.

In Sen. Edwards' ideal world, before a medical malpractice case could be filed, the plaintiff's lawyer would have to conduct a complete investigation, including independent review by at least two experts in the field “who determine that the case is, first, meritorious, and second, serious,” he said. “Then you require the lawyer to certify that that has been done as part of the filing. … If they fail to certify, the lawyer should bear the cost. If they do it three times, it's three strikes and you're out—you lose your right as a lawyer to file these cases.”

The bigger topic at the forum, though, was covering the uninsured. In February, Sen. Edwards unveiled a universal coverage plan, which calls for expanding both the State Children's Health Insurance Program and Medicaid, and for keeping Medicare in place. Employers would be required either to provide coverage to employees or to contribute to a system of regional Health Care Markets—nonprofit purchasing pools offering a choice of insurance plans. At least one of the plans would be a public plan based on the Medicare program.

Once the markets were set up and other provisions put in place—including tax credits and limits on premiums for low- and moderate-income families—a mandate would go into effect requiring all citizens to obtain health insurance, Sen. Edwards said at a press briefing after the forum. “Anybody who comes into contact with the health care system or any public agency will be signed up. If you go into the emergency room and are not part of the system, in order to get care you will be signed up.”

Sen. Edwards said Medicare beneficiaries should have a “medical home” with a single provider responsible for coordinating chronic care, “so we don't have overlapping care or unnecessary care.”

He also said that he favors three steps to lower prescription drug costs in the Medicare program: using the bargaining power of government to negotiate prices, allowing prescription drugs to be “safely imported” into the United States, and doing “what we can constitutionally to control drug company ads on television.”

This universal coverage plan “was not intended to take us from where we are today directly to [a single-payer system],” Sen. Edwards said at the forum. “It was intended to allow Americans to decide whether they want government-run health care, or whether they want to continue the private system they have today.”

He noted that there are “real benefits to single-payer [systems]. The administrative cost associated with [government-run systems like] Medicare is 3%–4%, compared with 30%–40% profit and overhead in private insurance companies.”

But some people say that with single-payer systems like those in Canada and the United Kingdom, people have to wait too long for some procedures, he added. “We're going to let Americans make that decision” by choosing which type of plan they prefer, he said. “Over time, we will see in which direction this system gravitates. It will be an extraordinary American model for what works and what doesn't work.”

Sen. Edwards said the cost of his plan was estimated at $90-$120 billion, and it would be paid for by rolling back tax cuts for Americans making over $200,000 per year.

A reporter asked Sen. Edwards about the differences between his plan and that of Sen. Hillary Rodham Clinton (D-N.Y.), another Democratic presidential candidate. Sen. Clinton's plan, released in September, contains many provisions similar to Sen. Edwards' plan, such as an array of private plans for people to choose from as well as a public plan similar to Medicare.

“Sen. Clinton appears to believe that you can take money from health insurance and drug company lobbyists and sit at the table with them and negotiate a compromise. I absolutely reject that. The way you get it done is to convince the American people about the rightness of what you want to do,” Sen. Edwards said.

Editor's Note

This look at the health care proposals of former Sen. John Edwards (D-N.C.) is the first in an occasional series highlighting the health policy views of those seeking to be our next president. Each article is based on a 1-hour health policy forum with an individual candidate held at the Kaiser Family Foundation in Washington, D.C., and sponsored by Families USA and the Federation of American Hospitals.

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Sen. John Edwards' universal coverage plan includes Medicaid and Medicare.

Edwards Outlines Tort And Health Care Reform