A Comparison Between the American Markets for Medical and Legal Services
Volume 67, Issue 5, 1331-66
America’s access to justice woes are paradoxical. We have more lawyers than every country except India and more lawyers per capita than every country except for Israel. We spend more on law as an absolute amount or as a percentage of GDP than any other country. At the high end, we provide best legal services in the world.
And yet we barely provide any legal services to the very poor, and our lawyers cost too much for the working poor or even the middle class. We graduate so many juris doctors that as many as a third fail to find work as a lawyer, despite clear signs of demand within the middle class. Why the mismatch between supply and demand? Why do we spend so much on law and provide so little? It turns out there is another American market for professional services that shares some of the same puzzling features: medicine. We spend more than any other country on law and medicine, and yet we have relatively poor outcomes in both.
This Article discusses the central puzzle in law and medicine: why do we pay so much and get so little? Law and medicine serve three different, very distinct American populations: the wealthy, the very poor, and the working poor. The wealthy and corporations get the very best in the world services. The very poor get at least some access to services. The working poor, however, are often worst off in America. Too “wealthy” to qualify for government subsidized services and too poor to pay out of pocket for a doctor or lawyer, this population is often squeezed out. The Article then asks what role professional regulation and education plays in this dynamic, and considers whether legislative help is very likely in law, using the passage of the Affordable Care Act as a model.