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Medical malpractice reform is both necessary and desirable, yet certain types of reform are clearly preferable to others. We argue that "traditional" tort reform remedies such as stringent damage caps not only fail to address the root causes of negligence and the adverse effects that fear of suit can have on physicians, but also fail to address the needs of patients. Physicians ought to view themselves as professionals who are dedicated to putting patients' interests ahead of their own. Professionally responsible malpractice reform should therefore be at least as patient-centered as it is physician-centered. Examples of more professionally responsible malpractice reform exist where institutions take a pro-active approach to identification, investigation, and remediation of possible malpractice. Such programs should be implemented more generally, and state laws enacted to facilitate them.

a physician walked into my (N.P.'s) mother's hospital room and introduced himself as a palliative care specialist. I was terrified. A little more than two years before, my mother, at the age of fifty, had been diagnosed with advanced ovarian cancer. After countless rounds of aggressive chemotherapy treatments, she had enjoyed a few short months of remission before an MRI revealed the cancer had returned and metastasized to her brain. Although we were told this meant the cancer was no longer "curable," none of the physicians said anything about my mother eventually dying or even used the word "death" in any context. And I never wanted them to. As ridiculous as it sounds, I had made it my ultimate goal to protect my mom from the fact that she was dying. In an attempt to prevent the physicians from giving us any kind of prognosis, I made sure to attend all doctor visits with my mom; I knew if I were in the exam room, she would not ask how long she had to live because, ironically, she was protecting me from the same reality. Neither of us wanted to hear the gravity of our situation, and consequently, we never did. When it came to prognoses, the doctors were always silent.Despite the fact that my mother and I avoided the topic, I did not believe we were in denial about her death. I truly believed that if her death was imminent, I would have heard something about it from her doctors. So, one could imagine my surprise-and terrorupon meeting the palliative care physician that day. I cordially shook his hand, although I wanted to push him out the door and into the hallway so I could explain to him that he was not allowed to tell my mom the truth. Instead, I stood there quietly as he explained The "Advance Care Planning Consultation" would have fostered discussions about end-of-life issues with Medicare patients, but it would also have imposed a structure on them, and in the context of the costcontainment goals of the overall health care reform effort, that structure helped doom it.

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Annals of Health Law beneficiaries already do work. The Obama administration temporarily arrested this trend through policy changes at the Center for Medicare and Medicaid Services ("CMS") and the enactment of the ACA, which expanded Medicaid to all adults earning less than 133% of the federal poverty level in participating states without imposing any special requirements on beneficiaries and in the process treating Medicaid more as a social support for average, lower-income Americans such as the Earned Income Tax Credit ("EITC") rather than as a welfare program such as TANF. 8 Under the Trump administration, however, proponents of a welfare model of Medicaid are now in power, with ardent, active allies at the federal, state, and local levels. 9 The House of Representative's version of the American Health Care Act, passed on May 4, 2017, contained a provision allowing states to impose work requirements on "able-bodied" adult Medicaid beneficiaries, and gave participating states a five percent increase in their Federal Medical Assistance Percentages (FMAP) to effectuate the provision. 0 The Senate's version contained identical provisions. 1 Head administrators at the Department of Health and Human Services (HHS) and a number of states such as Indiana, Maine, and Wisconsin share this vision, proposing work requirements and/or time limits across this so-called "ablebodied" adult Medicaid population.

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