In particular, the election represents a “turning point” in health care—for individuals, their physicians, and hospitals. “The American people have two choices,” he said. “Either we move toward the government taking over more control, or we go in the direction of less government control. Essentially, the choice is socialized medicine or developing the private sector.”


Published 5/1/2008
Carolyn Rogers

Giuliani urges accountability, tort reform

“America’s mayor” calls mandated health care “a disaster”

“This is an enormously important election,” declared Rudolph W. Giuliani, 2008 Annual Meeting Presidential Guest Speaker and former mayor of New York City, during his address. “We’re facing significant choices about the direction this country will take that will affect everyone for the next two or three decades.”

Rudolph W. Giuliani

Empower patients, not government
Market forces can be used to keep healthcare prices down and make care accessible to all Americans, Mr. Giuliani said.

To make insurance more affordable, he recommends a $15,000 income tax exemption for citizens to pay for their own health insurance or care. He would also expand access to Health Savings Accounts.

Characterizing his views on health care as “very strong,” Mr. Giuliani said his experience running the New York City Health and Hospitals Corporation (NYC HHC)—the third-largest public hospital system in the country—helped shape many of his views on health care and the direction it needs to move.

“At the time that I took over the [NYC HHC] system in 1993 or 1994,” he recalled, “5 of the 11 hospitals had lost either partial or full accreditation. They were in a sorry state.”

After failing at his attempt to privatize the system, he reorganized it instead.

“We ended up with 12,000 fewer employees and made each hospital accountable for its own performance,” he said. “We treated them as if they were private hospitals.”

By the time he left office in 2001, every hospital in the system was accredited and able to support itself.

In addition, “they did it with much higher quality of care measured by all the various indices,” he reported. “So with 12,000 fewer employees, but with accountability imposed on them, it was a much better hospital system.”

That experience reinforced his belief that “creating accountability wherever possible is a much more effective way to solve our problems than by increasing government’s role in health care.”

Medical liability reform
His experience with NYC HHC also helped inform his views on tort reform.

“The system was self-insured, so each year I would shell out $500 million to $550 million in damages,” he recalled. “In many cases the claims weren’t valid, of course, but we still had to pay up because it cost a lot more to fight them than it did to settle.”

The experience made him a “big proponent” of tort reform and for holding people accountable for the lawsuits they file, he said.

“No one should underestimate the damage done by out-of-control lawsuits to the medical profession,” he said.

Follow Texas
To address tort reform, Mr. Giuliani suggested that the federal government follow the path set by the Lone Star State.

“Texas enacted a law several years ago that capped noneconomic damages at $250,000,” he said.

Since the law went into effect, the number of doctors applying to get medical licenses in Texas has increased every year. “Pretty soon Texas will be the only place you’ll be able to find an OBGYN!” he joked.

The law had another positive side effect, he added. “I’ve heard several reports of Texas personal injury lawyers who are now writing wills,” he said, to a loud burst of applause.

To reinforce his point on the need for tort reform, Mr. Giuliani cited the case of a Washington, D.C., man who recently sued his dry cleaner for $54 million because they lost his pants.

“And the case actually went to trial for $54 million,” he said. “That’s one heck of a pair of pants!” The plaintiff lost his case, but is appealing the decision.

“In the meantime, the family who owns the dry cleaning store has spent $100,000 on this case,” he said. “Shouldn’t this guy have to pay them $100,000?”

If the case had occurred in England, the loser would be required to pay up, he said. “England has a ‘loser pays’ rule,” he explained. “We should have that in the United States.”

The standing-room-only audience heartily (and loudly) agreed with that assertion.

Again, “it comes back to an issue of accountability,” he said. “When you have to put your money behind the decisions that you make, you make better decisions.”

Mandated health care: A “disaster”
“Let’s talk about universal heath care and mandated heath care for a minute,” he said. “When you talk about universal health care with a mandate, you are now talking about government-controlled medicine.”

This would be a “disaster” for the United States, he said. “It moves the country in a direction “we shouldn’t have to go…and we don’t have to go.”

Instead, he would create a system in which more consumers are making their own healthcare decisions.

“Think about it: How many of your patients have asked you for your help to get an operation in Canada? Or in England, France, Italy, or Cuba?” he asked. “Well, I guess Michael Moore.”

Mr. Giuliani doesn’t understand the “rational thinking” behind the healthcare plans that Senators Hillary Clinton and Barack Obama are proposing.

“They are going to hurt the people they are trying to help by deteriorating health care,” he said.

America is at war
According to the man known around the world for his steady hand during the recovery of his city after September 11, the single most important issue of this presidential election is national security.

“America is at war,” he said.

“We could decide to end this war tomorrow, but the extremists will still be at war with us.”

Therefore, the country needs a commander-in-chief who will “stay on the offensive,” he said. “We can get this war over faster by remaining strong and assertive than by becoming weak.”

Carolyn Rogers is a staff writer for AAOS Now. She can be reached at