For a long time, I have believed that one of the major factors driving up the cost of health care throughout our country and in midcoast Maine is the cost of what’s commonly called malpractice insurance (medical liability insurance). Over the last three years, the cost of medical liability insurance has doubled each year for Northeast Health (NEH), a not-for-profit community health care system providing acute, long-term, skilled rehabilitation and home care to the people of midcoast Maine. In 2000 our liability insurance premium was approximately $360,000 a year. A year later it doubled to $700,000 a year. And last year, in 2002, we paid approximately $1.4 million for medical liability insurance.

That million-dollar increase over three years was not due to increased claims and did not provide us with any additional coverage. It is simply another million dollars of cost for which employers, patients and third- party insurers will pay.

Last month, President Bush an-nounced a renewed push to have limits set on jury awards and malpractice settlements. I applaud that effort and ask the Maine Congressional Delegation to support this national legislation.

It will be a daunting fight. The Trial Lawyers’ Association will fight tooth and nail against it. People will claim that reasonable caps on pain and suffering settlements deprive patients and citizens of their right to fair compensation. People may even claim that huge lawsuits force hospitals and physicians and other health care providers to improve quality of care.

However, in more than 28 years of working in health care, I have not found this to be true. The threat of a lawsuit generally does not improve clinical care or our systems, it merely drives up the cost of health care directly through the cost of liability insurance and indirectly through “defensive medicine,” practiced widely across the country. It has often been estimated that “defensive medicine” accounts for approximately 10 percent to 20 percent of the total cost of health care in the United States. It’s unnecessary, wasteful and something that our country simply can’t afford any longer. At a time when businesses and people in Maine are struggling to afford the cost of adequate healthcare insurance, we need to do everything we can to hold the line on health care costs.

Penobscot Bay Medical Center, a member of the NEH family, is blessed to have a superb medical staff of 88 physicians, most of whom are board certified in their area of expertise. I am greatly concerned that if Maine has the same type of medical liability cost crisis that is currently occurring in Florida, Nevada, New Jersey and West Virginia, we could lose some of our best physicians. In Miami, some obstetricians now pay more than $200,000 a year for their medical liability insurance. Does anyone think that makes sense? If a physician is paid $1,000 per delivery, that would mean he or she would have to do 200 deliveries just to pay for the cost of malprac-tice insurance. And we wonder why medical costs are going up.

The plan proposed by President Bush is largely modeled after a 1975 law in California that has helped keep medical malpractice premium increases below the national average. The plan would set a maximum damage award for “pain and suffering” at $250,000 and reduce lawyers’ fees. Such a system has worked in states where there is political will to enact such reform. I believe it should now be enacted across the country.

We are a litigious society. Perhaps it is one of the unanticipated problems of being a “country of law.” Does anyone really believe that a $5 million or $10 million settlement improves health care? I am fully in favor of reasonable payments where damage has been done due to the fault of a health care provider. If people have lost jobs or suffered unnecessarily because of a mistake, they should receive reasonable compensation for lost wages and to provide for basic needs, the so-called “economic damages.” It should not be perceived as another way of “hitting the lottery.”

If we are serious about trying to bring down the cost of health care, one thing we could do right now is to enact a reasonable cap on pain and suffering. If we can’t do it at the national level, then let’s do it in Maine. It would be a major step forward in restraining health care costs for businesses and individuals.

Roy A. Hitchings Jr. is president and chief executive officer of Northeast Health.