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
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
This Texan Ain’t Shooting Straight: Rick Perry’s Double Talk On Social Security And The Constitution
This we know: Texas Gov. Rick Perry, the apparent GOP 2012 front-runner, doesn’t like Social Security.
He has, for example, described it in his recent book as not only a “Ponzi scheme,” but “by far the best example” of a program “violently tossing aside any respect for our founding principles,” and as having been put in place “at the expense of respect for the Constitution and limited government.” Elsewhere he has said that the Constitution’s “general welfare” clause does not cover Social Security and Medicare. In other words not only is Social Security bad policy, Perry believes, but actually in defiance of our founding principles in general and the Constitution in particular.
While he and his campaign had appeared to dance away from these characterizations, Perry was at it again in Iowa over the weekend, calling the program a “monstrous lie,” and saying that he stood by everything in his book (including, presumably, Social Security’s unconstitutionality).
So here’s what I want to know: What would President Rick Perry do about Social Security?
It’s one thing to note that Perry makes crazy comments. As Washington Monthly’s Steve Benen notes, “Perry is positioning himself well outside the American mainstream. It’s going to impress the Republican Party’s far-right base, but it won’t impress anyone else.”
But there is a necessary connection between views and policies. What would Perry’s policy toward Social Security be in the White House?
As it happens, he answered that question, in part, during his Iowa campaign swing. This from the Houston Chronicle:
He told the Ottumwa crowd that for people who are drawing Social Security or near eligibility “like me,” he wasn’t proposing a change in the program. But he said there should be a national conversation about potential changes for others, including raising the age of eligibility and establishing a threshold based on a person’s means.
“Does Warren Buffett need to get Social Security? Maybe not,” he said.
Huh? Let me see if I understand this. Social Security “violently tossed aside any respect for our founding principles,” and was instituted at the “expense of respect for the Constitution.” And his solution to these problems is … means testing? And a national conversation about entitlement reform?
Those responses seem awfully conventional for a pol who is so self-consciously talking such a big, radical game about one of the nation’s beloved government programs. Either he’s tossing cow chips when he decries the program, or has something else under his hat when he spouts mealy-mouthed solutions to what he sees as its problems. But either way, this Texan ain’t shooting straight.
Reporters should press Perry on Social Security—does he really believe the program is unconstitutional? If so, doesn’t he have an obligation to defend the Constitution by ending the illegal program (including for people drawing it or nearing eligibility)? And if not, what exactly does he mean when he says that the program violently tosses aside respect for the Constitution? And if it is constitutional, what is its constitutional basis, if not the general welfare clause?
If that all seems a bit much, maybe the moderator of the next GOP debate can boil it down simply: “Raise your hand if you think Social Security is unconstitutional.”
By: Robert Schlesinger, U. S. News and World Report, August 29, 2011
“We The People” And America’s Future: Is Rick Perry As American As He Thinks He Is?
A few weeks ago, I wrote a piece asking whether Governor Rick Perry could call himself a Christian given his opposition to government actions to help the hungry, aged, and ill. Not surprisingly, many challenged my view of Christianity. In letter after letter they pointed out that Christ spoke to individuals, not government. My observation that He was speaking to a conquered people, not free individuals who could use their power to make a more just state, was not convincing. My reference to the prophets Micah, Amos, Jeremiah, and Isaiah, each of whom called on governmental leaders to help the poor, was dismissed as being from the “Old Testament.”
I will surely return to the issue of Christianity again, but I devote this piece to Rick Perry’s character and the character he would nurture in American citizens. Teddy Roosevelt said, “Character, in the long run, is the decisive factor in the life of an individual and of nations alike.” So what is the character that Perry embodies? What is his view of the American citizen and the citizen’s responsibility to our country and to one’s fellows?
First, Perry himself.
His persona evokes the rugged individualist. His warning to Ben Bernanke, chairman of the Federal Reserve, not to come to Texas so that he can avoid being subjected to “real ugly” frontier justice evidences a character antithetical to one of the crowning achievements of the United States — a nation under law, not men. In a phrase, he dismisses the Bill of Rights — due process, trial by jury, the right to confront one’s accuser.
The real question is not what character he would make of the United States but whether he believes in America at all. He has threatened to secede. Central to his campaign is his pledge to shrink the federal government — making it impossible for our noble nation to lead the world, to serve as the “city on the Hill.”
Perry may want to pretend that he is taking America back to a better past, but his actions are part of the movement away from nation-states, where countries are largely irrelevant. The notion that we are at the end of the need for nation-states is gaining more adherents globally. The fortunate few, commonly referred to as the Davos groupies, hang out with the other well off and well-heeled all over the world. Summering in Europe, wintering in Colorado, the global elite have more in common with and feel more loyal to their carefully connected crowd than with their fellow citizens. When one’s loyalty lies with one’s own class, where does that leave one’s country?
In declaring his wish to shrink the size of government, Perry believes that government should have as little role in people’s lives as possible. No investment in education, science research, building the railroads, highways, or sewage systems of the future. Why care about America’s future, why set inspirational goals that bring people together, if you don’t believe in “We the people”?
Nationalism, patriotism, commitment to one another are for Perry an anachronism, a thing of the past. He has not said that those with the greatest wealth, talent, and circumstances have any special responsibility to our country or their fellow citizens. He has not said we are all Americans together. Rather, he seems to be able to watch human suffering with equanimity — as though America should be a place of survival of the fittest. No Social Security, no Medicare, no unemployment insurance, no laws to protect clean air, clean water. When hurricanes, tornadoes, earthquakes, and flood destroy home and communities — no FEMA, no help. “We” are on our own.
In his book Fed Up!: Our Fight to Save America From Washington, Perry writes that the 16th Amendment, which gave birth to the federal income tax, was “the great milestone on the road to serfdom,” because it represented “the birth of wealth redistribution in the United States.”
Individualism, self-reliance, self-respect — these are great virtues, useful in many fields of endeavor. But they are not enough to sustain a nation. Virtues don’t spring into being in a moment. They need to be exercised and practiced. Nations at war need courage, quick thinking, and selflessness. Nations at peace require that sense of duty to others. No man goes into a burning building for mere money. Nor does a fierce individualism nurture the patience that a teacher requires, the love given by a hospice nurse caring for a dying man.
Citizens’ moral compasses do not stem only from their faith. Government also defines the moral standard of a nation. If we are told that blacks are worth but three-fifths of whites, many will see this as the acceptable treatment of their fellow man. Likewise, when the government declares it illegal to discriminate on the basis of race, we see that discrimination is also wrong.
When a candidate like Governor Perry boasts that he will shrink government by cutting those programs that grasp the nation’s imagination of what we can do together, he is saying that America does not need the one institution in which we make our most solemn decisions together. We need not nurture a nation of laws, nor educate the young, nor protect the elderly. Teddy Roosevelt took on the trusts, protected the environment, made America more just. The character of the nation improved with his leadership. Can it improve with Perry’s?
By: Kathleen Kennedy Townsend, The Atlantic, August 29, 2011
You’re Not Under Oath: Is Gov Rick Perry Dumb?
Politico asks the question out loud.
The answer from Perry’s friends and supporters is not reassuring.
“If he should know about John Locke, he’ll know about John Locke,” said [Tex lobbyist and Perry supporter] Bill Miller. “If it’s not on his schedule, it’s irrelevant to him.”
In other words: his aides run him.
His policy focus as governor hasn’t been complex – it’s almost entirely jobs and business-focused – but that’s not where Perry’s mind is, say those who know him.
He’s a power politician and very canny one. And what seems to animate him is competition.
Whether it is winning elections, beating out other states in attracting jobs or besting them for college football recruits, Perry is ferociously single-minded.
In other words: he is keenly political, but has little policy focus – which will be some handicap for a president who will face after 2013 the toughest economic policy challenges since the 1930s.
“There were some guys we always thought were the brainiacs, the ones who got into the minutiae of legislation,” recalled Cliff Johnson, an Austin lobbyist and close Perry friend and former roommate from their days serving together as Democratic legislators. “We sought information from trusted folks.”
In other words: lobbyists will run him.
Trained as an Air Force pilot right out of A&M, Perry was “taught to trust your information,” said Johnson.
And associates say the same lessons that Perry learned when he was flying C-130s apply now.
“Pilots execute flight plans,” said Miller. “They have a plan, they fly a certain pattern and that’s the way he’s always operated — he has a flight plan for what he’s trying to do and he executes.”
That’s quite an insult to combat pilots, who must react, respond and improvise. “Executing the flight plan” seems a terrible way to approach the presidency. It’s the president’s job to write the flight plan.
Mike Baselice, Perry’s longtime pollster, said his client is of the Ronald Reagan school of management: “Trust people and manage well.”
“His job is to go meet voters,” said Baselice. “We’ll figure out the details of the messaging.”
Voters would do well to ask: Who’s this “we” that will really be running the country during a Perry presidency?
By: David Frum, The FrumForum, August 29, 2011
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