Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax
In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.
Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.
Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.
“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”
Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.
But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.
Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”
As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”
He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.
Tort Reform Backfires in Texas
That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.
In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.
Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.
It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.
The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.
Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.
In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.
Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.
Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.
All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.
By: Wendell Potter, Center for Media and Democracy, September 1, 2011
Austerity Versus Salvation: What Price Life?
So the big, bad storm huffed and puffed and didn’t blow all the houses in.
Reversing Katrina, on the sixth anniversary of that shameful episode in American history, the response to Irene was more powerful than Irene.
And that made some solipsistic Gothamites who missed their subways and restaurants grouchy. There is no greater abuse to New Yorkers than inconvenience.
Once the storm became “Apocalypse Not,” as The New York Post called it, there were those who accused Mayor Michael Bloomberg and Gov. Chris Christie of New Jersey of overreacting to make up for their infamous underreactions to last year’s Christmas blizzard, when Hizzoner was baking in Bermuda and the Guv was playing at Disney World in Florida with his family.
In a Wall Street Journal column, Bret Stephens suggested “a new edition of the Three Little Pigs, this one for the CYA age.”
Ordered to evacuate from his Manhattan home near the Hudson River, Stephens took his family to his parents’ wood-framed house in Connecticut, where a 50-foot elm crashed in the yard. So he went hard on the Chicken Little mayor. “What’s the wisdom of the ages,” Stephens asked, “when a mayor wants to erase the stain of mishandling last winter’s snowstorms by forcibly relocating people from his zone of responsibility to places that are somebody else’s zone of responsibility?”
Should those whose job it is to prepare for the worst be punished because the worst didn’t happen?
What determines your judgment of politicians’ reaction is what happens to you. Those washed out from North Carolina to New Jersey to Vermont don’t think government overreacted. As Mel Brooks once said, “Tragedy is when I cut my finger. Comedy is when you walk into an open sewer and die.”
Asked at a Saturday hurricane briefing about the response in relation to the debate about the role of government, Christie made it clear that saving lives was the most important thing. The Republican said he didn’t think that Democrats and Republicans were debating this: “Protecting the safety of our citizens is one of the bedrock roles of government.”
Not so bedrock for some of the Flintstones types in Washington who are now hotly debating austerity versus salvation. The impressively hands-on performances of Christie, Bloomberg and Gov. Andrew Cuomo of New York were not enough to make Tea Partiers, Republican presidential candidate Ron Paul and Republican House Majority Leader Eric Cantor root for big government against rampaging nature.
Paul, a libertarian whose scorn of government is so great that he doesn’t even want it to coordinate in natural disasters, insisted that FEMA, which he calls “a giant contributor to deficit financing,” should be shut down.
Though his state of Virginia was the epicenter of an earthquake before being hit by Irene, Cantor has insisted that additional money for cash-strapped FEMA must be offset by spending cuts, echoing his remarks in May that money sent to traumatized tornado victims in Joplin, Mo., would mean cuts somewhere else.
The callous comments about disaster relief in recent days by Cantor, Paul and, believe it or not, the disgraced former FEMA Chief Michael “Heck of a job, Brownie” Brown infuriated Bernie Sanders, the independent Vermont senator touring his inundated state. He told Carl Hulse of The Times that coming together to help on disasters “is what being a nation is about.”
In a briefing at the White House Monday, FEMA Director Craig Fugate said that the lesson of Katrina is for the federal government to “get things going earlier” and not wait until an overwhelmed state “says we’re going to need help.”
Too bad that didn’t occur to W. in 2005. He met with Gov. Kathleen Blanco of Louisiana and New Orleans Mayor Ray Nagin on Air Force One and correctly assessed that they were not up to the job but then retreated behind clinical states’ rights arguments as a great American city drowned.
In his new memoir, Dick Cheney faults Blanco for dithering and not requesting that the president federalize the response to Katrina. It’s a variation on Rummy shrugging that “You go to war with the army you have.”
Always the hard-liner, Cheney notes: “President Bush has written that he should have sent in U.S. troops earlier, which may be true, but which to my mind lets state authorities off the hook too easily.” Why save lives if you can slap bumbling Democrats around? Proving once more that he is truly delusional, Vice praised President Bush in the wake of Katrina for “reaching out to people who needed to know that their government cared about them.”
The awful hypocrisy is this: As we saw when they spent trillions trying to impose democracy on Iraq and Afghanistan, W. and Cheney believe in big government, in a strong, centralized executive power. But with Katrina, they chose not to use it.
By: Maureen Dowd, Op-Ed Columnist, The New York Times, August 30, 2011
Morally Inept: The New GOP Resentment Of The Poor
In a decade of frenzied tax-cutting for the rich, the Republican Party just happened to lower tax rates for the poor, as well. Now several of the party’s most prominent presidential candidates and lawmakers want to correct that oversight and raise taxes on the poor and the working class, while protecting the rich, of course.
These Republican leaders, who think nothing of widening tax loopholes for corporations and multimillion-dollar estates, are offended by the idea that people making less than $40,000 might benefit from the progressive tax code. They are infuriated by the earned income tax credit (the pride of Ronald Reagan), which has become the biggest and most effective antipoverty program by giving working families thousands of dollars a year in tax refunds. They scoff at continuing President Obama’s payroll tax cut, which is tilted toward low- and middle-income workers and expires in December.
Until fairly recently, Republicans, at least, have been fairly consistent in their position that tax cuts should benefit everyone. Though the Bush tax cuts were primarily for the rich, they did lower rates for almost all taxpayers, providing a veneer of egalitarianism. Then the recession pushed down incomes severely, many below the minimum income tax level, and the stimulus act lowered that level further with new tax cuts. The number of families not paying income tax has risen from about 30 percent before the recession to about half, and, suddenly, Republicans have a new tool to stoke class resentment.
Representative Michele Bachmann noted recently that 47 percent of Americans do not pay federal income tax; all of them, she said, should pay something because they benefit from parks, roads and national security. (Interesting that she acknowledged government has a purpose.) Gov. Rick Perry, in the announcement of his candidacy, said he was dismayed at the “injustice” that nearly half of Americans do not pay income tax. Jon Huntsman Jr., up to now the most reasonable in the Republican presidential field, said not enough Americans pay tax.
Representative Eric Cantor, the House majority leader, and several senators have made similar arguments, variations of the idea expressed earlier by Senator Dan Coats of Indiana that “everyone needs to have some skin in the game.”
This is factually wrong, economically wrong and morally wrong. First, the facts: a vast majority of Americans have skin in the tax game. Even if they earn too little to qualify for the income tax, they pay payroll taxes (which Republicans want to raise), gasoline excise taxes and state and local taxes. Only 14 percent of households pay neither income nor payroll taxes, according to the Tax Policy Center at the Brookings Institution. The poorest fifth paid an average of 16.3 percent of income in taxes in 2010.
Economically, reducing the earned income tax credit and the child tax credit — which would be required if everyone paid income taxes — makes no sense at a time of high unemployment. The credits, which only go to working people, have always been a strong incentive to work, as even some conservative economists say, and have increased the labor force while reducing the welfare rolls.
The moral argument would have been obvious before this polarized year. Nearly 90 percent of the families that paid no income tax make less than $40,000, most much less. The real problem is that so many Americans are struggling on such a small income, not whether they pay taxes. The two tax credits lifted 7.2 million people out of poverty in 2009, including four million children. At a time when high-income households are paying their lowest share of federal taxes in decades, when corporations frequently avoid paying any tax, it is clear who should bear a larger burden and who should not.
By: Editorial, The New York Times, August 30, 2011
The GOP Assault On Voting Rights: A Poll Tax By Another Name
AS we celebrate the Martin Luther King Jr. Memorial, we reflect on the life and legacy of this great man. But recent legislation on voting reminds us that there is still work to do. Since January, a majority of state legislatures have passed or considered election-law changes that, taken together, constitute the most concerted effort to restrict the right to vote since before the Voting Rights Act of 1965.
Growing up as the son of an Alabama sharecropper, I experienced Jim Crow firsthand. It was enforced by the slander of “separate but equal,” willful blindness to acts of racially motivated violence and the threat of economic retaliation. The pernicious effect of those strategies was to institutionalize second-class citizenship and restrict political participation to the majority alone.
We have come a long way since the 1960s. When the Voting Rights Act was passed, there were only 300 elected African-American officials in the United States; today there are more than 9,000, including 43 members of Congress. The 1993 National Voter Registration Act — also known as the Motor Voter Act — made it easier to register to vote, while the 2002 Help America Vote Act responded to the irregularities of the 2000 presidential race with improved election standards.
Despite decades of progress, this year’s Republican-backed wave of voting restrictions has demonstrated that the fundamental right to vote is still subject to partisan manipulation. The most common new requirement, that citizens obtain and display unexpired government-issued photo identification before entering the voting booth, was advanced in 35 states and passed by Republican legislatures in Alabama, Minnesota, Missouri and nine other states — despite the fact that as many as 25 percent of African-Americans lack acceptable identification.
Having fought for voting rights as a student, I am especially troubled that these laws disproportionately affect young voters. Students at state universities in Wisconsin cannot vote using their current IDs (because the new law requires the cards to have signatures, which those do not). South Carolina prohibits the use of student IDs altogether. Texas also rejects student IDs, but allows voting by those who have a license to carry a concealed handgun. These schemes are clearly crafted to affect not just how we vote, but who votes.
Conservative proponents have argued for photo ID mandates by claiming that widespread voter impersonation exists in America, despite overwhelming evidence to the contrary. While defending its photo ID law before the Supreme Court, Indiana was unable to cite a single instance of actual voter impersonation at any point in its history. Likewise, in Kansas, there were far more reports of U.F.O. sightings than allegations of voter fraud in the past decade. These theories of systematic fraud are really unfounded fears being exploited to threaten the franchise.
In Georgia, Florida, Ohio and other states, legislatures have significantly reduced opportunities to cast ballots before Election Day — an option that was disproportionately used by African-American voters in 2008. In this case the justification is often fiscal: Republicans in North Carolina attempted to eliminate early voting, claiming it would save money. Fortunately, the effort failed after the State Election Board demonstrated that cuts to early voting would actually be more expensive because new election precincts and additional voting machines would be required to handle the surge of voters on Election Day.
Voters in other states weren’t so lucky. Florida has cut its early voting period by half, from 96 mandated hours over 14 days to a minimum of 48 hours over just eight days, and has severely restricted voter registration drives, prompting the venerable League of Women Voters to cease registering voters in the state altogether. Again, this affects very specific types of voters: according to the nonpartisan Brennan Center for Justice, African-Americans and Latinos were more than twice as likely as white voters to register through a voter registration drive.
These restrictions purportedly apply to all citizens equally. In reality, we know that they will disproportionately burden African Americans and other racial minorities, yet again. They are poll taxes by another name.
The King Memorial reminds us that out of a mountain of despair we may hew a stone of hope. Forty-eight years after the March on Washington, we must continue our work with hope that all citizens will have an unfettered right to vote. Second-class citizenship is not citizenship at all.
We’ve come some distance and have made great progress, but Dr. King’s dream has not been realized in full. New restraints on the right to vote do not merely slow us down. They turn us backward, setting us in the wrong direction on a course where we have already traveled too far and sacrificed too much.
By: Rep John Lewis, Op-Ed Contributor, The New York Times, August 27, 2011
Just Plain Sinful: GOP Hostage Taking Now Extends To Disaster Relief
Hurricane Irene made landfall this morning, hitting North Carolina with sustained winds of 90 miles per hour. Irene was downgraded overnight to a Category 1 hurricane, but it remains a powerful storm capable of doing serious harm.
Obviously, we can all hope the severity of the damage is limited. Regrettably, though, the line on federal disaster aid from congressional Republicans has not changed.
This week, House Majority Leader Eric Cantor (R-Va.) said the GOP approach would break from how U.S. policymakers have operated. Whereas Congress used to provide emergency funds after a disaster, without regard for budget caps or offsets, Republicans have said they will no longer accept such an approach — if Democrats want emergency assistance in the wake of a natural disaster, Republicans will insist on attaching some strings to the relief funds.
In this case, the strings are cuts elsewhere in the budget. Or as Cantor’s spokesperson put it, GOP leaders expect “additional funds for federal disaster relief” to be “offset with spending cuts.”
The Republican position is already drawing fire.
“It is sinful to require us to cut somewhere … in order to provide emergency disaster assistance for American citizens,” Rep. Cedric Richmond (D-La.) told The Huffington Post on Friday.
The Louisiana Democrat pointed out that this weekend is the sixth anniversary of Hurricane Katrina, which devastated his district and cost the federal government more than $100 billion. That recovery effort would have been delayed “by years” if Congress had required the same kind of spending cuts to offset aid, he said.
“I have been one who has been preparing for the hurricane, trying to give people some comfort. One thing they need to know is the federal government can come to their aid,” Richmond said. “I don’t think we’re in a position, given the rules set up by the majority, that we’re going to be able to come to their aid quickly.”
Perhaps realizing the potential for a political nightmare — Republicans are already unpopular; just wait until they hold hostage relief funds for communities hit by a hurricane — GOP leaders weren’t eager to talk about their position yesterday.
But they didn’t disavow it, either. Cantor’s office rejected questions about “hypothetical federal aid caused by hypothetical damage,” despite the fact that the Majority Leader and his spokesperson were more than willing to discuss the position 24 hours earlier.
House Speaker John Boehner’s (R-Ohio) office was also cagey, saying policymakers will “discuss costs when and if they occur.”
Neither Republican leader offered the correct response, which is, “Of course we’ll do whatever it takes to help the affected communities.”
With any luck, this will be a moot point. If the damage isn’t severe, Congress won’t have to approve emergency relief. At this point, we just don’t know.
But in the event of extensive damage, there’s a real possibility that the first question from congressional Republicans won’t be, “How can we help?” but rather, “What will Democrats give us in exchange for disaster aid?”
By: Steve Benen, Contributing Writer, Washington Monthly Political Animal, August 27, 2011
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