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Enacted caps on malpractice awards and proposed early offer reform address the sometimes excessive verdicts of conventional liability and its very high overhead costs. However, such reforms greatly benefit medical defendants while doing too little for claimants or patients in general. Caps and early offer only affect current claims; far broader reforms are therefore needed to improve the woeful performance of liability as a general promoter of patient safety and injury compensation. Broad reforms, however desirable, seldom surmount high political and practical hurdles. A good, more evenhanded start would seek to make claims resolution faster, more accurate, more predictable, and less expensive, while separately promoting medical quality and safety as well as greater transparency for law, medicine, and insurance.

This Article discusses these issues in considering the "competitive" approach to reforming medical care financing and delivery.Although the approach is an extremely promising one, strongly held individual and social values underlie the current system, and powerful private interests have a stake in the status quo. Reforms,therefore, may never be fully implemented or realize their theoretical potential in practice. In any case they will take some time to work; no approach can be an immediate panacea. If government is to embark upon a "procompetitive" course, it needs to proceed carefully. Especially during the transition to a more competitive system, we need to be particularly careful to create constructive incentives, whether through regulatory or competitive means, and not to get the worst of both worlds by inappropriately mixing them. This Article considers the sources of current cost problems,discusses regulatory and procompetitive responses, notes the lessons of today's unproductive competition for future procompetitive efforts, and makes some policy suggestions.

Cancer insurance is one of the most rapidly growing forms of insurance in the US. However, such insurance does not meet a genuine insurance need, since it largely duplicates basic health insurance coverage. It is not favorably priced, returning typically less than 50% of premiums as benefits, as compared to 80% or more for group policies. Finally, it is based on advertising that appeals to uninformed fears. The appeal of such insurance is based on provision of a cash windfall to cancer victims; an appropriate regulatory policy would be to require that fixed & explicitly stated cash payments be offered for stated prices, making explicit comparison of returns possible. W. H. Stoddard.

Contents: Science versus analysis: a false dichotomy, by Lawrence M. Mead; Research lessons from the Great Society, by Richard P. Nathan; What policy analysts do: three research styles, by Philip J. Cook and James W. Vaupel; Policy analysts, clients, and social scientists, by Robert D. Behn.