Happy Birthday
InstaPundit is celebrating his today, and, anticipating light blogging, points readers to Virginia Postrel.
Her brief post on "immigrants emigrating" surprised me; a Dallas resident ought to know better. She says,
Once they get established in the United States, immigrants who come into the traditional gateways, including California, leave for Sunbelt states like Texas[...]
This phenomenon means that immigrants in California will be disproportionately poor and unassimilated, adding to the other reasons why immigration is a hotter issue in California than in Texas.
First of all, Texas
is one of the traditional gateways. I have not only geography, common sense and personal experience to back this, but the
article Postrel links:
The report also shows that a smaller share of new arrivals are settling in states that have been immigrant magnets. About 60% of the foreign-born who came to the USA between 1995 and 2000 went to California, New York, Florida, Texas, Illinois and New Jersey, down from 73% a decade earlier.
Texas may be receiving immigrants who initially landed in other states, but it starts with plenty of its own.
Far more important to the difference in immigration debate between Texas and California is the level of care the state feels obliged to provide.
Texas doesn't give much to anyone -- citizen, documented worker or illegal alien -- and so immigrants are seen as more of a source of cheap labor than as a burden on public services. When you're delivering crap public school education, what's one more kid in the classroom?
California, on the other hand, is trying to maintain a higher level, which makes an influx of new residents more taxing (both literally and figuratively).
Speaking of birthdays and Texas, the state votes on Proposition 12 on my birthday. Thanks, y'all.
The Curmudgeonly Clerk has an excellent round-up of links regarding this proposed amendment to the Texas Constitution, which would cap damages (of the pain-and-suffering, punitive variety) in civil lawsuits. Successful plaintiffs still could obtain full compensation for medical costs and lost productivity, but not for the recurring aches in their backs or inability to play golf or have sex.
My dad, among other people who favor the change, considers it necessary to stop the increase in the size of malpractice awards. He thinks juries are too easily affected by the sobbing testimony of the injured party (or, in the unfortunate event of that person's decease, of her friends and family) and therefore give out excessively high awards.
I doubt that he would care about the size of the awards except for the fact that the malpractice insurance companies (the ones who pay out) justify jacking up their rates of coverage by pointing to these expensive lawsuits.
Frankly, I think my dad can afford it, but physicians who practice in lower-paying specialties, and general practitioners, really are getting hurt by this. The cost of malpractice insurance for ob-gyns, for example, can be prohibitive, because poking at women and delivering babies is high-risk -- thus requiring a lot of coverage -- but not high-return.
This being Texas, it does not occur to anyone to attempt some alternative strategies to address the problem of doctors' having to pay extremely high malpractice insurance rates.
No one in state government seems to have considered having the Texas medical board, which certifies doctors for practice, crack down on bad doctors who, like bad drivers, increase costs for everyone else.
According to Public Citizen, less than 5% of doctors account for over half of all malpractice awards, and less than 2% account for over a quarter of all awards. Consider this specimen:
Physician Number 37949, licensed in Texas, settled or lost 13 medical malpractice suits involving improper treatment or improper performance of surgery between 1990 and 1997. Two of the suits involved the same allegation: a foreign body left in the patient during surgery. Damages to this doctor’s patients exceeded $2 million. This doctor has never been disciplined by authorities in Texas.
Note that settling a suit is not equivalent to admitting fault. Insurance companies pressure doctors to settle malpractice suits instead of bringing them to trial because the companies assume that this will be cheaper for them, regardless of the cost to the doctor's reputation.
If there is a genuine concern that the cost of malpractice insurance is decreasing the availability of medical care, why not have the state of Texas run the insurance pool?
Private companies take the insurance money and speculate in the markets -- hence their sudden poor-mouthing in the wake of recession. They also take on high-risk business that can crumble and leave them insolvent.
I'm all in favor of investment and capitalism and apple pie (especially apple pie), but if we don't want doctors' med-mal rates to be determined by how well the insurance companies' portfolios are doing, then either we require companies to 1) stop putting money into fluctuating areas; 2) separate their med-mal business from everything else; or 3) have the state do the insuring.
It shouldn't be difficult; the doctors would pay in, the state would pay out for settlements and lost suits. The state also would become incentivized to take licenses away from doctors who were repeatedly negligent in order to save itself some money.
The Curmudgeonly Clerk concludes,
I am inclined to think that Proposition 12 is overly broad in the remedy that it prescribes.
Assuming without deciding that Yes On 12 et al. are correct in their assessment regarding existence of a medical malpractice crisis, its causes, its effects, and even its solution, why propose such a radical cure? That is, why amend the Texas Constitution so as to grant the legislature power to limit non-economic damages in all areas of the law rather than in healthcare litigation alone?
This particular aspect of the recommended treatment strikes me as being analogous to unnecessary surgery.
The "why" is pretty obvious to those who have followed the tort deform debate in Texas:
complaints about doctors' being driven out of practice by the cost of malpractice insurance is the perfect cover for pushing through a measure that, presented in naked honesty as an attempt to remove the burden of expensive lawsuits from corporations, would have raised even more of a ruckus than the current proposal.
People don't want doctors to be unable to practice, so if the issue is presented as "Vote Yes or go without medical care," they'll pull the lever for Prop. 12.
If you haven't guessed, I'm more opposed to Prop. 12 than is the Clerk. Even if it is restricted to healthcare litigation, it will be an excessive response to the problem. I would prefer to attempt other remedies before choosing to amend the state constitution and limit the decision-making power of juries in civil suits.
The ugliest fight of the session, which naturally had nothing to do with the $10 billion deficit, was over tort deform, yet again. As you recall, the state has already been through two major rounds of tort deform, and each time we are promised that if we will just give up even more of the right to sue doctors and corporations that have done us terrible damage, insurance rates will fall, "frivolous" lawsuits will disappear, our teeth will be whiter, our breath fresher, and there will be sunshine and joy in Mudville. Every time, they promise us the world, and every time it doesn't work -- because we never regulate the insurance companies. So they come back and do it again.
This is, I think, a fundamental difference in perspective for liberals and conservatives. Conservatives appear to prefer giving incentives and assuming/ hoping that certain results will follow, without tying the incentive to producing that result.
Take reducing taxes for businesses as a way to encourage hiring. I'm perfectly happy with using lower taxes as an incentive to increase employment, but we have to making hiring a condition of getting the tax breaks. Otherwise, how can we ensure that the incentive actually will produce the desired consequence? (Or, in
The Onion's example, assuming that deregulated energy companies will use their profits to update the power grid.)
Similarly, the proponents of Prop. 12
assume that insurance companies will use the increased revenue produced by not having to pay high awards to reduce their medical malpractice rates. But there is nothing in the amendment that requires them to do so.
Patrick Rose, the young UT Law student representing Dripping Springs in the Texas Legislature, had the right idea. He amended the House tort-reform bill to require a medical-malpractice insurance rate rollback -- a smart move that helped to get him named "Rookie of the Year" in Texas Monthly's annual rundown of the Best and Worst legislators.
Before we can fix the problem of excessively high rates, however, we need to stop a bad "solution." Don't forget to vote no on September 13.
Fellow absentee voters: Friday, September 5 is the last day to accept an application for a ballot to be voted by mail; Saturday the 13th is the deadline to receive that ballot if sent within the U.S., Monday the 15th if sent from outside the U.S.
UPDATE: Burnt Orange recommends Dr. Rangel's argument for Prop. 12, but color me unimpressed (though not maroon).
First, Rangel spends his entire time bitching against trial lawyers, even though trial lawyers are not the ones who make the multi-million dollar awards. Juries are.
Joe Schmoe, who is outraged by a doctor's malpractice and decides that by gum, Jenny from the block deserves $10 million, is the person who decides.
Yet I never do seem to hear tort deformers telling us how evil the average men and women who sit on juries and who, let's face it, aren't always the brightest Crayons in the box, are. Nope, it's all the trial lawyers' fault.
Someone unacquainted with the American civil law system could be forgiven for thinking that there is no jury and that plaintiff's attornies decide guilt and penalty, going on the rhetoric of those who want to limit juries' powers without actually saying a word about juries and their flaws.
Rangel ventures toward Constitutional analysis with somewhat unfortunate results, alternatively misidentifying the Eighth Amendment's prohibitions of excessive bail and fines, and of cruel and unusual punishments, as the Fourth and Ninth Amendments.
More seriously problematic, he conflates the civil and criminal justice systems in a way that would goosebump a libertarian. The entire Bill of Rights is intended to preserve the rights of individuals (and perhaps of states) against the government.
The Seventh Amendment specifically guarantees the right to trial by jury for all civil suits, and is separate from the Sixth Amendment that mandates the right to a jury for criminal prosecutions. This ensures that a tool of the government -- i.e. a judge -- cannot make these decisions.
It is the basis of the recent Supreme Court rulings in Ring v. Arizona and Apprendi v. New Jersey, which said that juries, and not judges, must do the crucial fact-finding to give the death penalty or any sentence higher than the ordinary statutory maximum.
The Sixth and Seventh Amendments are all about empowering juries, not judges and certainly not legislators.
Of course, my real problem with Rangel's defense of Prop. 12 is that it doesn't answer any of my objections.
He doesn't talk about the fact that the majority of successful suits are brought against a small minority of doctors;
that insurance companies are just now crying because of the collapse in the financial markets in which they invested;
that there is no assurance that giving away juries' power to set non-economic damages would keep med-mal rates reasonable.