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Post-reform doctor supply in Texas II

Professor Silver,

Perhaps your intent was solely to show that a lobbyist group made a relatively unpublicized statement that was imprecise. (You don't question my characterization that the thrust of their argument is correct.) But your conclusion seems to stake out a much more aggressive position: "In sum, the 2003 Texas reforms transferred a lot of wealth from malpractice victims, their families, employers, and health insurers to physicians and their liability insurers. This was the main object of the 2003 reforms, and the reforms achieved it. But the reforms have not increased physician supply, which grew at a sub-par rate in the post-reform years. The facts show yet again how wealthy and concentrated interest groups use the political process to advantage, at the expense of groups whose members are anonymous and dispersed."

These statements are false, and you choose not to defend them.

You'll get no argument from me about the problems caused by socialist-style central planning. Medicine in this country would certainly benefit from more market-oriented mechanisms (though a couple of your co-bloggers here regularly argue for making things more socialist-style). But liability reform is hardly mutually exclusive from these other reforms. EMTALA, for example, created new legal causes of action that has hurt medical care in this country.

There are real issues of access to care that are not being captured by your single time-series. For example, if doctors are spending less time with lawyers and more time practicing medicine, that increases patient access without changing the raw numbers you identify. If doctors are substituting legally safer practices for matters like obstetrics and emergency medicine, the number of doctors does not change, but the access to care certainly does.

The number of doctors has been growing over the last fifteen years because medicine can do more today than it could fifteen years ago. So, indeed, if doctor growth is slower than it would be, that does affect access to care. The Texas Department of State Health Services says that "Texas has been experiencing shortages of many types of health care providers for years. This is supported by the fact that, for most professions, the supply ratios for Texas (the number of providers per 100,000 population) have been consistently lower than the U.S. average ratios for decades.... For example, as of March 2006, 118 of Texas� 254 counties (46%) were designated as [Health Professional Shortage Areas] for primary care."

In short: the doctors' organizations you are criticizing are correct, and your nitpicking demonstrates that they're failing to make the most precise argument in support of their position. But you haven't demonstrated that they are wrong, and nothing you state supports your florid conclusion.

You complain about the "conversation [some?] tort reform advocates are having with the public" because of this minor eliding of detail, but have you seen the conversation some reform opponents are having? For example, one opponent characterized the Texas reform as "patients' rights were slashed" and the reform movement as sinister interest group politics conspiring against a helpless anonymous majority (a strange way to characterize a referendum). The same advocate co-wrote an op-ed in the New York Times attacking caps and claiming that his research showed that President Bush's proposed malpractice caps wouldn't fix "skyrocketing insurance prices," but the final version of the published paper a few months later acknowledged "On economic grounds, one would expect liability caps to reduce both the number of large paid claims and the average payout per claim. In the long run, this should lead to lower insurance premiums." That reform opponent, to my knowledge, has not criticized other reform opponents who continue to release talking-points based on the overstated Times op-ed without correcting them to reflect the actual statements of the final paper. Do you find the oversimplification in your op-ed somehow less objectionable than the oversimplification from the doctors' group's talking points? Do you believe that these statements further the conversation debating reform, especially when these statements are made from the lofty position of a tenured law professor?





Rafael Mangual
Project Manager,
Legal Policy

Manhattan Institute


Published by the Manhattan Institute

The Manhattan Insitute's Center for Legal Policy.