Political Animal

MEDICAL MALPRACTICE AND TORT REFORM….My

MEDICAL MALPRACTICE AND TORT REFORM….My head hurts. Is there a doctor around?

I’m sure there must be another policy dispute in which both sides try as desperately as this one to avoid presenting the actual facts and figures, but I haven’t found it yet. All I want is a simple table that shows for each of the 50 states (a) whether tort reform has been enacted, (b) average malpractice payouts, and (c) malpractice premiums rates. The fact that I can’t find it leads me to believe that the actual figures would be damaging to both sides in this controversy.

Still, here are a few miscellaneous items that shed a little bit of light on the situation:

  • Here in California we enacted tort reform in 1975 and it was judged constitutional in 1986. Bush’s proposal is based heavily on California’s law, usually referred to as MICRA.

  • Justene Adamec over at Calblog has a summary of this HHS report that compares experiences in states with and without tort reform. She points in particular to a chart on page 19 of the study showing that premiums have risen much more slowly in California than in the rest of the country. (Her overall conclusion is that tort reform is needed, but payout caps are not a good way of getting it.)

  • However, the HHS report shows only “selected” states and makes heroic efforts not to present a comprehensive table. For a different view of California vs. the nation, check out this report from the Foundation for Taxpayer and Consumer Rights: it says that between 1991 and 1999 premiums went up 3.5% in California vs. 1.9% in the rest of the country. In other words, California did worse than other states. What’s more, it claims that average premiums are only slightly lower in California than in the rest of the country.

  • And there are some other problems as well. Who chose $250,000 as the right cap on pain and suffering payouts? Why is it not indexed to inflation (it hasn’t changed in California since 1975)? The Bush proposal recommends annual payouts instead of lump sums, so why not specify the payout cap in annual terms? And why is this a federal matter anyway? Why not leave it up to the states?

So who’s right? Beats me. The HHS report is obviously selective and biased, but a similar report from the Center for Justice and Democracy also pretty studiously avoids some sensitive topics as well.

There are clearly other problems at work besides jury awards: insurance companies have had to increase premiums recently to make up for investment losses and there has been plenty of documentation of rampant mismanagement during the 90s that has driven several companies out of business. Still, basic data on jury awards by state shouldn’t be so hard to come by. If anyone can help me find it, I’d be grateful.

UPDATE: Dwight Meredith points to this post at the Bloviator for more info. Also, there’s this lengthy 1993 report from the Office of Technology Assessment. Both conclude that caps have an effect on reducing malpractice premiums, but there’s still no state-by-state data. Dwight suggests that good data may be hard to come by because many settlements are confidential.

My head still hurts.

TIME MAGAZINE TAKES A LOOK

TIME MAGAZINE TAKES A LOOK AT ANTI-AMERICANISM….Avedon Carol has a message for Time magazine: “Bush is not America, and Europeans know this.” I’ve spent the past decade working with Europeans of various stripes, so Avedon’s complaint really hit home with me.

My experience has been pretty simple: most Europeans are not anti-American. I can’t vouch for what they say when I’m not around, of course, but in person political disagreements are pretty good natured. If anything, Europeans tend to be hypersensitive about cultural differences ? what with all those countries packed into a smallish continent and all ? and they mostly accept American culture as simply different from theirs. They may disagree with American policy frequently, but they don’t hate America.

But it’s a whole different story with George Bush. They just don’t get it. “Did people actually vote for him?” they ask, as if some horrible psychosis must have temporarily taken hold of the American population when they went to the polls in 2000. Most Europeans I’ve talked to find him simply incomprehensible: scary, intolerant, short fused, and ill educated. A hick, not a president of the United States.

And so we get to Time magazine, which last week ran a cover story about anti-Americanism in its European edition. And sure enough, here’s what it says:

Scratch a European complaint about the U.S. and it almost always reveals the person of George W. Bush ? the “toxic Texan,” as one American diplomat ruefully puts it. The President’s domestic record embodies things many Europeans find strange, if not repellent, about the U.S.: pro-gun, pro-death penalty, pro-Christian, antiabortion, strongly patriotic….Particularly offensive to Europeans are Bush’s swagger, tough talk and invocations of God and right and wrong, part of his born-again tradition that is attuned to the U.S. mood after Sept. 11. “We don’t see the common guy from Chicago,” says G?rald Duchaussoy, a 28-year-old office worker in Paris. “We see Bush. And politicians here don’t speak with his language.”

And this:

A former cabinet minister in the British Conservative Party, which is officially even more pro-American than Bush’s First Friend Tony Blair, recently leaned over at lunch and described Bush as “terrifying,” “ignorant,” “a prisoner of the religious right who believes God tells him what to do,” and “like a child running around with a grenade with the pin pulled out.”

Conclusions? None, really, except to take “anti-Americanism” with a grain of salt. It’s been around ? as has anti-Europeanism on this side of the Atlantic ? for a long time, and in any case its current incarnation is often more anti-Bushism than anti-Americanism anyway. It will likely subside in time, just as it has in the past.

PRE-EMPTIVE WAR….Chris Bertram sums up

PRE-EMPTIVE WAR….Chris Bertram sums up the intelligent anti-war viewpoint pretty well today. It’s worth reading, especially if you’re pro-war.

I am nominally on the opposite side from Chris, but I agree with him that most pro-war partisans are unwilling to face up to the essential weakness of their arguments. Pre-emptive war is a horrible doctrine, and once let loose it will not obediently crawl back into its hole simply because we are done with it for the moment. The bar should be set very high for an act of pre-emptive war, and in the case of Iraq ? if we are there at all ? we are only barely there. The argument balances on a knife edge.

Allowing WMDs to fall into the hands of a man who has started two unprovoked wars against his neighbors in the past two decades ? and who is also a brutal, sadistic dictator ? is clearly something the rest of the world has a right to be concerned about. But the way the world goes about disarming him matters.

If the United States does it alone, the message we send is that any single nation state has the right to attack another if it feels sufficiently threatened. This is a dangerous precedent to set since, after all, we are not the only nation state in the world.

Contrariwise, if we invade Iraq under UN auspices, we send a different message: pre-emptive war is justified in the extreme, but no single nation state is justified in doing it on its own. You have to persuade a group of neutral third parties first.

This is a principle worth keeping. Not because the United States should be held hostage to the United Nations, but because everyone should be. This is a case where it is in America’s best interest to keep Pandora’s Box firmly and solidly shut.

POSTSCRIPT: I should add that Chris also echoes my concerns about what we are going to do in Iraq after the fighting is over. As he says, our track record here is not exemplary, and it makes a big difference. If we are fighting to bring some level of democracy and tolerance to Iraq, well and good. However, if we simply install a friendlier dictator who will keep the oil flowing, then we will have lost whatever moral authority we ever had in the first place. George Bush’s relative silence on this question is not a good sign.