Throughout this series, we’ve explored the potential implications of California’s SB 623 for healthcare providers, patients, attorneys, and the broader personal injury ecosystem.

We’ve discussed medical liens. Medical funding. Provider risk. Patient access. FAIR Health. Referral declarations. Healthcare economics.

If the series ended there, however, it would be incomplete.

Because every significant piece of legislation is usually introduced to solve a problem.

Whether that solution is ultimately the right one is a separate question.

But before anyone can fairly evaluate SB 623, they should first understand why many policymakers, insurers, consumer advocates, and others believed reform was necessary.

If we want better public policy, we have to be willing to understand both sides of the conversation.

Every Industry Has Bad Actors

Let’s begin with an uncomfortable truth.

Every profession has bad actors.

Medicine does. Law does. Insurance does. Finance does. Government does.

Personal injury is no exception.

Most healthcare providers practice ethically. Most attorneys advocate honestly. Most claims professionals perform their jobs professionally.

But no one would seriously argue that abuse never occurs.

Some providers overtreat. Some perform unnecessary procedures. Some bill aggressively without adequate documentation.

Some attorneys develop inappropriate referral relationships. Some attorneys charge excessive fees and phantom costs when on contingency. Some refuse to be transparent on settlement results and intended disbursements yet will seek to cram lien reductions down medical provider and physician throats.

Some insurers deny legitimate claims. Some insurers delay resolutions. Some devalue the work of medical providers and physicians. Some defend going on the offensive with a scorched-earth policy to increase the cost of litigation to get law firms and their clients to give up.

Some funding arrangements become unnecessarily complex or expensive. Some funders take advantage of medical providers, law firms and the personal injury system.

Those realities should not be ignored.

Acknowledging them strengthens, not weakens, the discussion.

Transparency Is a Reasonable Goal

One of the central themes of SB 623 is transparency.

On its face, transparency is difficult to oppose.

Patients should understand how treatment will be paid and what the care they receive may cost them. Financial relationships should be disclosed where appropriate. Conflicts of interest should be identified. Courts should have accurate information.

All who participate in the personal injury ecosystem ethically should have little reason to fear transparency itself. Instead, they should desire it and demand it.

Transparency often benefits ethical professionals by distinguishing them from those who cut corners or seek to hide things.

The challenge is ensuring that transparency requirements are practical, balanced, and fairly allocated among all participants.

Patients Deserve Protection

Supporters of SB 623 also argue that patients deserve protection from situations in which medical bills consume an excessive portion of their settlement.

That concern deserves thoughtful consideration.

An injured patient who receives a settlement but walks away with very little after attorney fees, costs, and medical obligations understandably may question whether the system worked as intended.

Healthcare providers and patient law firms should not dismiss that concern.

Patient-centered care requires us to recognize that financial outcomes matter alongside medical outcomes.

The question is not whether patients deserve protection. They do.

The question is how to provide that protection while preserving access to medically necessary care.

The Cost of Litigation Matters

Supporters also point to rising litigation costs.

Large medical bills can influence settlement negotiations, litigation strategy, and jury verdicts.

The ever-rising percentage that attorneys take out of personal injury settlements, from 33% to 60% of a case settlement, increases the burden and need for higher recoveries. That way there is more available for their clients and the medical providers and physicians who treated them and provided the evidentiary support for the case recovery.

And this is why SB 623, Uber’s initial ballot initiative to cap attorney fees at 25%, made a lot of sense.

We all know the legal industry will never clean up its own house. Thus, the Legal Lobby came to the table with Uber and got what it wanted: the removal of the 25% fee cap that California voters would likely have passed. In exchange, Uber got what it wanted, but much of the compliance burden was shifted onto the medical professionals who weren’t at the table.

Businesses, insurers, and transportation companies argue that greater predictability benefits everyone by reducing unnecessary litigation and encouraging earlier resolution.

Reasonable people can agree that predictability has value. Courts also benefit from clearer evidentiary standards.

Again, the discussion is not whether these objectives are legitimate. The discussion is whether the chosen mechanism achieves them without creating unintended consequences elsewhere.

And closely reviewing the motivations and self-interest of those involved in making SB 623 law is important.

Conflicts of Interest Should Be Addressed

No ethical provider would defend improper referral relationships.

Likewise, no ethical attorney supports kickbacks, fee splitting, or undisclosed financial arrangements.

Public confidence and professionalism depend upon trust.

When inappropriate financial relationships exist, they should be addressed.

SB 623 attempts to address some of those concerns through disclosure requirements and restrictions involving attorney-provider financial relationships.

Those objectives deserve respect.

Everyone benefits when unethical conduct is identified and eliminated.

Bad actors damage the reputation of everyone else.

Why FAIR Health Appeals to Policymakers

Supporters often describe FAIR Health as an objective benchmark.

From a policymaker’s perspective, that argument has appeal.

Rather than relying upon competing experts in every case, a standardized reference point may appear to create greater consistency and predictability.

Whether FAIR Health represents the best benchmark is open to debate.

But the desire for objective standards is understandable.

The important discussion is whether any single benchmark can adequately account for the diversity and complexity of healthcare delivery.

Where Many Providers Become Concerned

This is where perspectives begin to diverge.

Supporters focus on: Transparency. Predictability. Consumer protection. Cost control. Consistency.

Providers often focus on different questions: Will patients still receive timely care, and will access to needed care be restricted? Will specialists continue accepting lien-based cases? Will financing remain available? Will providers assume additional administrative burdens and liability exposures?

Will ethical practices be unintentionally affected by reforms aimed at addressing bad actors?

Those are not competing goals. They are competing concerns.

Good public policy should strive to address both.

Reform Should Target Conduct, Not Care

Perhaps the most important principle is this: Reform should target inappropriate conduct, not discourage appropriate care.

If a provider performs unnecessary procedures, that should be addressed.

If an attorney participates in improper referral arrangements, that should be addressed.

If billing is fraudulent, that should be addressed.

If patients are misled, that should be addressed.

Strong enforcement against unethical conduct strengthens the integrity of the personal injury ecosystem.

The challenge is ensuring that reforms directed at abuse do not unintentionally discourage ethical providers from continuing to care for injured patients.

That balance is difficult. But it is essential.

This Is Not an “Either-Or” Conversation

Too often, public policy debates become polarized.

You’re either for providers. Or you’re for insurers.

You’re either for attorneys. Or you’re for defendants.

Healthcare and personal injury rarely work that way. Patients need physicians. Physicians need fair reimbursement. Attorneys need credible medical evidence. Insurers need accurate documentation. Courts need reliable information.

Society benefits when each participant fulfills their role ethically.

The most durable reforms recognize that everyone has legitimate interests.

The Better Question

Rather than asking whether SB 623 is entirely good or entirely bad, perhaps we should ask a different question: Does the legislation strike the right balance?

To answer that question, you need to ask several others, such as: Does it improve transparency? Does it reduce abuse? Does it preserve patient access to needed healthcare? Does it support ethical providers? Does it maintain confidence in the legal, medical, and insurer systems?

Those questions cannot be answered immediately.

They will be answered over time through implementation, judicial interpretation, provider participation, and patient experience.

That is why thoughtful monitoring is so important.

Looking Forward

Healthcare providers should never fear honest evaluation of their profession.

Every industry benefits from continuous improvement. Transparency, accountability, and ethical practice strengthen medicine. But reform should always be measured against its ultimate purpose.

Not simply reducing costs. Not simply increasing recoveries. Not simply improving efficiency.

Its purpose should be improving outcomes for the people the system exists to serve. Patients.

Everything else is secondary.

A Closing Thought

The easiest articles to write are those that tell readers exactly what they want to hear.

The more difficult, and ultimately more valuable, articles are those that ask readers to consider viewpoints they may disagree with.

Understanding the strongest arguments supporting SB 623 does not require agreeing with every provision or with my opinion.

It requires recognizing that meaningful reform begins with honest dialogue.

If we are willing to acknowledge legitimate concerns on all sides, we stand a far better chance of building a personal injury healthcare ecosystem that is transparent, ethical, financially sustainable, centered on the needs of injured patients, and provides fair compensation.

That is a goal worth pursuing together.

Next in the Series

From Debate to Direction

A Practical Guide for Healthcare Providers Navigating the Future of Personal Injury Healthcare

In our final article, we’ll move beyond analysis and focus on action. Regardless of your opinion about SB 623, what should healthcare providers, practice owners, and healthcare organizations be doing today to prepare for tomorrow? We’ll outline practical steps to strengthen compliance, improve documentation, enhance collaboration, protect patient access, and position your practice for success in an evolving personal injury landscape.