According to Steve Forbes, the medical malpractice crisis is the fault of greedy plaintiffs and rapacious lawyers and the solution may be: caps on noneconomic damages although since California adopted a $250,000 cap in 1975, 23 states have followed suit. The average cost for malpractice coverage per physician increased from $34,616.67 in 2000 to $78,818.18 in 2003 and the question is why are some doctors paying $50,000 or $100,000 a year to their malpractice insurers? The companies have learned to over-classify their risk pools, thereby reducing their number to specific specialties like obstetrics or orthopedic surgery in order to charge much more. Good specialists pay as much as incompetent ones with a large number of payouts. I think that the greatest positive impact of the policy would be to restructure the insurance market over time. The issue is of the liability system, including judicial resolution of claims and financing through liability insurance. In many states the problem is liability insurance which costs too much and option point out to either reducing costs or to change jury attitudes such as putting on caps - or some other source of financing has to be found. Most people are asking for both options. Possibly a program of medical error communication and mediation-based dispute resolution can improve patient care as well as reduce malpractice litigation, which can be adopted both by hospitals and physicians. Medical courts system can be simplified and more effective ways may be implemented with respect to both liability and damages. The problem is that recent rises in malpractice premiums has driven concerns about patient access to care which are fueled by reports about physicians retiring early, relocating practices in to reduce their malpractice risk. Another problem is between is between political stakeholders and the academic community and policymakers view the malpractice reform debate as a contest over the desirability of limiting lawsuits. Medical malpractice system seems to be flawed and the real problem involves liability which is threatened both the affordability and the quality of health care. The crisis arises between first-party health insurance and third-party malpractice insurance and Medicare and Medicaid seem to play a major role in the medical liability system of the future. Erosion of access to care is real and evidence of the erosion is not visible in the state’s aggregate number of physicians. Practice decisions in response to rising liability costs, as well as perceptions of the impact of the malpractice environment on patient access to care seem to be another problem.