Why Don’t Doctors & Lawyers (Strangers in the Night) Get Their Act Together?

Health care in America is an expensive, complicated, inefficient, tangled mess – everybody says so. Patients decry its complexity, health care executives bemoan its lack of coherence, physicians plead for universal coverage to simplify their lives so they can just get on with taking care of patients, and everyone complains about health care costs. The best health care in the world is theoretically available here, but we deliver and pay for it in some of the world’s worst ways. Occam’s razor (“Among competing hypotheses, favor the simplest one”) is of little help here. There are no simple hypotheses – everything seems to conspire to make a bad situation worse. Moreover, despite abundant speculation, no one has yet come up with the silver bullet for reform. So why don’t doctors and lawyers, who consume health care themselves, get their act together and do something about it? Into this morass comes Peter D. Jacobson to offer cold comfort and a fiduciary band-aid with Strangers in the Night: Law and Medicine in the Managed Care Era, which illuminates why doctors and lawyers often have a hard time working with each other. The book promises to “explain . . . how the legal system helps shape health care delivery and policy, explore . . . new ways of lookign at the relationship between law and medicine, and reflect . . . on why it all matters” (book jacket). Professor Jacobson does manage to do that in the course of this purportedly limited examination of law and managed care, which he defines as “the generic name for the new health care delivery system . . . characterized by large patient populations within integrated [i.e., combining financing and provisions of health services in one entity] delivery systems” (p. 7). By the end of the book, however, one is left with a depressed sense that things could get a whole lot worse for all of us, not just for doctors and lawyers, before we just might – with luck – restructure the whole shooting match into a more humane and efficient health care delivery system.