I had a feeling of deja vu as I read about attempts to find a legislative solution to the liability insurance crisis in Connecticut ("Conn. Ob.Gyns. Seek Malpractice Solutions," April 1, 2005, p. 1).

From 2001 to 2003--my last years in practice in Florida--physicians had optimism that

the state legislature would pass meaningful tort reform. After all, our governor backed tort reform and both houses of the legislature were Republican controlled and solidly behind it. Well, if our experience in Florida is any indicator, I would advise my colleagues in Connecticut not to hold their breath.

As for health insurance companies that reimburse physicians at a rate that is one-fourth to one-third of their UCR fees in the late 1980s, if physicians could charge patients fees that were realistic and constrained by managed care, legislators would be more willing to tackle tort reform ("Class-Action Suits Against Insurers Moving Ahead," April 1, 2005, p. 1).

If patients complained en masse to their elected representatives, there would be much more urgency. As long as physicians keep providing anything other than emergency care, there is no impetus for government to solve our crisis. In addition, any class action suit that doesn't force insurance companies to stop using Medicare fee schedules as a basis for reimbursement and start paying physicians realistically is a suit that has been lost.

We have to depend on ourselves for a solution; that may mean that physicians call in sick a great deal. That is not a pleasant solution, because we have an obligation to our patients. But we also have an obligation to those physicians who will come after us and stand on our shoulders. We must ensure that their foundation is strong.

Jesse A. Kane, M.D.

Jacksonville, Ark.

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