Insurance Law Commons^™

Comparative Effectiveness Research As Choice Architecture: The Behavioral Law And Economics Solution To The Health Care Cost Crisis, Russell Korobkin

Michigan Law Review

With the Patient Protection and Affordable Care Act (“ACA”) set to dramatically increase access to medical care, the problem of rising costs will move center stage in health law and policy discussions. “Consumer directed health care” proposals, which provide patients with financial incentives to equate marginal costs and benefits of care at the point of treatment, demand more decisionmaking ability from consumers than is plausible due to bounded rationality. Proposals that seek to change the incentives of health care providers threaten to create conflicts of interest between doctors and patients. New approaches are desperately needed. This Article proposes a government-facilitated …

Patients As Consumers: Courts, Cotnracts, And The New Medical Marketplace, Mark A. Hall, Carl E. Schneider

Michigan Law Review

The persistent riddle of health-care policy is how to control the costs while improving the quality of care. The riddle's oncepromising answer-managed care-has been politically ravaged, and consumerist solutions are now winning favor This Article examines the legal condition of the patient-as-consumer in today's health-care market. It finds that insurers bargain with some success for rates for the people they insure. The uninsured, however, must contract to pay whatever a provider charges and then are regularly charged prices that are several times insurers'pricesa nd providers' actual costs. Perhaps because they do not understand the healthcare market, courts generally enforce these …

Offsetting Risks, Ariel Porat

Michigan Law Review

Under prevailing tort law, an injurer who must choose between Course of Action A, which creates a risk of 500 (there is a probability of .1 that a harm of 5000 will result), and Course of Action B, which creates a risk of 400 (there is a probability of.] that a harm of 4000 will result), and who negligently opts for the former will be held liable for the entire harm of 5000 that materializes. This full liability forces the injurer to pay damages that are five times higher than would be necessary to internalize the risk of 100 that …

Chicago Hope Meets The Chicago School, Gail B. Agrawal

Michigan Law Review

Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …

Regulation Through The Looking Glass: Hospitals, Blue Cross, And Certificate-Of-Need, Sallyanne Payton, Rhoda M. Powsner

Michigan Law Review

A clear focus on the commitment of the public health and hospital establishments to the large teaching hospital and their belief in rationalizing the health care system through community-based planning allows us to understand the ideas and institutions that have produced our present system of hospital regulation. It can also help us to understand the structure and behavior of the hospital industry and can illuminate current controversies over health care policy.

What follows is a narrative account of the development of regional planning and certificate-of-need legislation. As part of that story, we trace the evolution of the Blue Cross, explain …

The Extension Of Insurance Subrogation, Spencer L. Kimball, Don A. Davis

Michigan Law Review

When an insured loss occurs under circumstances that make a third person liable to reimburse the insured, there are various possible ways to adjust the loss among the three persons involved. One solution would permit the policyholder to recover both on the insurance and from the third person, i.e., would permit double recovery for the loss. A second solution would give the third person the benefit of the insurance by denying recovery from him. A third solution would subrogate the insurer to the policyholder's rights against the third person. Combinations of these three solutions are possible by applying sometimes …

Insurance-Death Of Insured Resulting From Criminal Abortion- Right Of Beneficiary, R. V. Wellman

Michigan Law Review

Insured died as the result of a criminal abortion to which she had voluntarily submitted. The policies issued on her life contained a provision to the effect that no benefits should be payable or recoverable should the insured die as a result of a violation of law. The insurer resisted the action brought by the named beneficiary on the policy on two grounds: (a) The insured's death was caused by her violation of law; (b) Although the stated terms of the policy be held not to exclude the risk of death thus caused, it would be contrary to public policy …

Contracts--Consideration-Performance Of One Alternatlve When There Is Dispute As To Which Is Owed, L. B. Lea

Michigan Law Review

Defendant issued a membership certificate to one Flowers providing for payment of $5000 in case of accidental death or $500 in case of death due to heart disease. Later Flowers was injured in an automobile accident and died an hour afterward. The beneficiary submitted proofs of loss, including a statement of a physician that death was caused by "coronary thrombosis. Shock from auto accident about one hour before death." Defendant sent to the beneficiary a draft for $500 clearly stating on its face that the endorsement of the check would be a settlement in full. After cashing the check, the …

Evidence -Witnesses - Privileged Communications Between Physician And Patient--Statutory Effect Of Asserting Privilege In Actions On Insurance Contracts, William H. Buchanan S.Ed.

Michigan Law Review

Plaintiff, beneficiary of an insurance policy (but not the personal representative of the deceased insured), sued to recover the amount of the policy from the insurance company. As a defense the defendant claimed that the policy never became effective because the insured had made material misrepresentations in the application as to his state of health. To show that there had been such misrepresentations, the defendant proved that the insured had been treated by physicians during the five years preceding the issuance of the policy. Upon objectionμ by plaintiff the court excluded the testimony of the doctors as to the nature …

Simulation Of Nervous And Mental Disease, Moses Keschner

Michigan Law Review

Simulation may be defined as a wilful, deliberate and fraudulent imitation or exaggeration of illness intended to deceive the observer for the purpose of gaining a consciously desired end. Simulation of a physical or mental illness is usually resorted to: (1) by persons who have sustained an injury, the disability resulting therefrom being compensable by benefits payable under the workmen's compensation law or by damages in personal injury actions based on alleged negligence; (2) by persons who wish to obtain insurance benefits for disability in accordance with the provisions of health, accident and life insurance policies, and included in this …

Corporations - Physicians And Surgeons - Insurance - Sale Of Professional Services By A Corporation, Charles H. Haines Jr.

Michigan Law Review

The Group Health Association, a corporation for the mutual benefit of its members, employed licensed physicians to give medical care to its members. For a lump sum consideration of $40,000 the association agreed to extend similar medical and hospital services to such employees of the Home Owners' Loan Corporation office as paid the monthly fee. In fear of quo warranto proceedings by the district attorney for illegal practice of medicine and by the superintendent of insurance for selling insurance, the association sought a declaration of its right to provide medical services in this manner. Held, a non-profit corporation through …

Recent Important Decisions, Michigal Law Review

Michigan Law Review

Appeal and Error--Attorney's Interest in Case on Appeal--Contingent Fee; Bankruptcy--discharge--subsequent Action for Fraud; Bills and Notes--Usury No Defense Against a bona Fide Holder--Construction of Negotiable Instruments Statute; Boundaries--Street, Terminus A Quo; Carriers--Hepbern Act--State and Federal Courts--Phrase "Caused by It"; Chattel Mortgages--Payment without Notice of Assignment--Construction of a Mortgage Provision; Constitutional Law--Equal Protection of Laws--Statute Requiring Screens on Cars Operated by Corporations; Constitutional Law--Equal Protection of the Laws--Class Legislation; Contracts--No Recovery Under an Entire Illegal Contract; Contracts--Validity of Contract in Contemplation of Divorce; Courts--Federal Courts--authority of Decision of State Courts--"Telegraph"; Covenants--Breach of that Against Incumbrances; Elections--Ballots--Indication of Choice by Voter; Evidence--Facts …

Recent Important Decisions, Michigan Law Review

Michigan Law Review

Bills and Notes--Fictitious or Non-Existing Payee--Knowledge of Maker--English and American Views; Bills and Notes--Holder in Due Course; Carriers--Exemption from Liability for Negligence Under Special Contract; Colleges--Entrance Discriminations--Mandamus Not Remedy for Refusing Admission; Constitutional law--Aliens--Keeping for Immoral Purposes; Constitutional Law--Class Legislation--Licensing Itinerant Vendors; Constitutional Law--Legislative Power--Intoxicating Liquors--License System; Constitutional Law--Police Power--Intoxicating Liquors; Constitutional Law--Police Power--Ordinance Absolutely Prohibiting Billboards; Corporations--Ultra Vires--Organizing Another Corporation--Dissenting Stockholder; Deeds--Cancellation for Fraud--False Representations as to Intention; Deeds--Description--Parol Evidence to Explain Ambiguity; Deeds--Effect of Statute Abolishing the Use of Private Seals; Divorce--Adultery--Consent of Plaintiff; Elections--Qualification of Voters--Payment of Taxes--Payment by Unauthorized Person; Evidence--Privileged Communications--Professional Nurse and Patient; Health--Offering …