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Will consumers voluntarily accept changes in the ways cases of medical malpractice are handled? Yes, under certain circumstances, they maybecause the conditions are right. Consumers in this context include not merely individuals but also employers and unions who make volume purchasing decisions and are responsible for individuals' health insurance bills. Until very recently, nearly all these large-scale purchasers of health benefits accepted massive medical cost increases with hardly a wince. Indeed, they continued to expand coverage. Despite rhetoric to the contrary, their behavior suggested that they felt virtually no pain from soaring malpractice costs-or other cost increases. "Defensive medicine" was something doctors did to children, with needles, not a malpractice-law-induced cost problem.' In the last few years, however, the scene has changed dramatically. Today, hardly a CEO of a Fortune 500 company or a trustee of a union health and welfare plan is unconcerned about health benefit costs. Some companies seek solace in group commiseration at business coalition meetings.2 Others have shifted the burden to employees through larger deductibles and co-payments. Union leaders, harkening to a rising chorus of demands from the rank-and-file for MOB (maintenance of benefits), have resisted the increased deductibles and co-payments whenever possible. But they have accepted certain other limitations on health care services covered by their negotiated plans. Predetermination of coverage for inpatient stays, mandatory second surgical

Malpractice Reform through Consumer Choice and Consumer Education: Are New Concepts Marketable?