Federal Tort Reform Ideas Lost in Obamacare Decision

Andrew Cochran
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Posted by Andrew CochranJune 29, 2012 3:33 PM

In the Obamacare decision on Thursday, the five conservative Supreme Court Justices rejected the unlimited scope of the Commerce Clause and the Necessary & Proper Clause envisioned by proponents of federal tort reform bills (especially caps on damages in medical malpractice lawsuits). Justice Roberts was especially deferential to federalism, employing the terms "state sovereignty" and "enumerated powers" often in his decision. Proponents of federal tort reform are among the big losers in the Obamacare decision.

Moreover, the majority adopted the framework for decisions on both clauses as proposed in amici briefs or articles by numerous anti-Obamacare legal experts, such as Profs. Randy Barnett and Ilya Somin; Virginia AG Ken Cuccinelli; Rob Natelson of the Independence Institute and Tenth Amendment Center; Prof. John Baker of LSU and Catholic University Law Schools; Carrie Severino of the Judicial Crisis Network; and Senator Mike Lee.

Each of the conservative and libertarian legal experts cited above are anti-Obamacare ANDanti-federal tort reform. They know that Obamacare and federal tort reform, especiallyH.R. 5, the bill to cap medmal damages, are the "Wickard Twins," equally based on the 1942 Wickard v Filburn decision by the Supreme Court. The decision, cited numerous times in the Obamacare decision by all of the Justices, led to the explosion in the scope of the Commerce Clause that finally ended with the Obamacare ruling.

And other legal experts, particularly Rob Natelson, have written frequently that the Necessary & Proper Clause doesn't create additional powers for Congress; it enables Congress to exercise those powers which are merely "incidental" to Congress's enumerated powers. The conservative majority adopted that view in toto, thus further limiting the constitutional basis for federal laws designed to take over state tort law and courtrooms.

So any Congressman or Senator looking for support from Randy Barnett, or any of the other experts cited above, for federal tort reform is in for a rude awakening. They've already warned Republican leaders that federal tort reform, especially medmal caps, are just as unconstitutional as Obamacare, for the same reasons. Those leaders just don't want to listen.

Here are illustrative quotes in Justice Roberts' rulings on the Commerce Clause and the Necessary & Proper Clause, equally applicable to any federal scheme to take over state tort law:

"State sovereignty is not just an end in itself: Rather, federalism secures to citizens the liberties that derive from the diffusion of sovereign power." New York v. United States, 505 U. S. 144, 181 (1992). Because the police power is controlled by 50 different States instead of one national sovereign, the facets of governing that touch on citizens' daily lives are normally administered by smaller governments closer to the governed. The Framers thus ensured that powers which "in the ordinary course of affairs, concern the lives, liberties, and properties of the people" were held by governments more local and more accountable than a distant federal bureaucracy. The Federalist No. 45, at 293(J. Madison).."

"The Constitution has never been understood to confer upon Congress the ability to require the States to govern according to Congress' instructions. Otherwise the two-government system established by the Framers would give way to a system that vests power in one central government, and individual liberty would suffer."

"The Commerce Clause is not a general license to regulate an individual from cradle to grave, simply because he will predictably engage in particular transactions. Any police power to regulate individuals as such, as opposed to their activities, remains vested in the States."

"Applying these principles, the individual mandate cannot be sustained under the Necessary and Proper Clause as an essential component of the insurance reforms. Each of our prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power...The individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power... Rather, such a conception of the Necessary and Proper Clause would work a substantial expansion of federal authority. No longer would Congress be limited to regulating under the Commerce Clause those who by some preexisting activity bring themselves within the sphere of federal regulation. Instead, Congress could reach beyond the natural limit of its authority and draw within its regulatory scope those who otherwise would be outside of it."

15 Comments

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jc
Posted by jc
July 04, 2012 1:51 PM

It is too bad that medical malpractice tort reform is not a central part of Obamacare. My neighbor, an OB/GYN just retired from practice after 30 years. Malpractice rates played a role in his decision. A local general surgeon retired 2 yrs ago and a urologist is heading for the exits along with 2 of my partners. I expect that the physician count will decrease by 20% before 2014 just when 50 million people get added to the insurance roles by Obamacare. All these people who pay taxes and insurance are going to want to see the doctor and there will be waits. You can expect these mad frustrated patients to sue somebody when things don't work out and the doctor is the first guy on the hit list. No socialized medical country has a litigation system like we have - -it is incompatable with Obamacare.

Andrew CochranInjury Board Contributor
Posted by Andrew Cochran
July 04, 2012 4:33 PM

There's no evidence that state medmal limits have increased access to health care or lowered health care costs. It's a phony solution, and federal medmal limits violate states' rights.

jc
Posted by jc
July 04, 2012 8:46 PM

I have practical experience which totally disagrees with you conclusions. Ohio, where I practice has very liberal malpractice laws. In the late 90s, medical mal insurance was outrageous. In my small community, we had 5 neurosurgeons. Three moved out of state, one retired and one practiced, paying 200K a year in med mal. He could not be on call every night, so if you got in an accident on Thursday, you got helicoptered out to Columbus or Cleveland. We instituted a cap on "pain and suffering" and my malpractice rates have since gone down 40%! In Texas, they went even further in med mal reform and a colleague of mine pays a third of what I pay in malpractice. So plaintiff attorneys who say state med mal limits make no difference are just trying to pay for their new Porche! There is no reason Congress cannot pass a law stating that they will only pay 80% of the typical federal contribution to Medicaid and Medicare unless states reform their malpractice laws and become more like Texas! Why should Texans pay higher taxes to fund plaintiff attorney porches in Ohio?

Andrew CochranInjury Board Contributor
Posted by Andrew Cochran
July 04, 2012 9:06 PM

Nice stories. Show me ONE state with medmal limits in which health care costs for the CONSUMER have decreased. Oh yeah, the docs have made out great- but not the patients.

jc
Posted by jc
July 05, 2012 6:08 AM

It is hard to say what happens to the patient cost of health care, but according to Kaizer, in 2009 Texas, and California, two states with malpractice reform had health care costs among the lowest in the nation at #5,031 - $6,411/per capita vs $7,635 per capita in more liberal litigation states. Makes sense too - -if you reduce the cost of malpractice insurance to doctors, you reduce their overhead causing them to have to charge lower professional fees. If you increase their med mal insurance it increases their costs causing them to increase their fees. Basic economics.

M B
Posted by M B
July 05, 2012 8:45 PM

The real high cost of malpractice is the malpractice insurance companies and the re-insurance companies taking advantage of physicians. As a physician I concede that the rest of the costs is bad doctors. The high cost of litigation of these cases has taken care of any frivilous lawsuits that occurred in the past. The real reason for the increase of medical care is technology. But don't worry - that will not continue as ObamaCare has taxes on new technology that will prohibit it from advancing.

Dr. RS
Posted by Dr. RS
July 05, 2012 10:54 PM

Mr. Cochran asks to show him ONE state where healthcare costs to consumers has decreased, knowing full well, there are so many other issues that continue to increase costs, beside OUT OF CONTROL law suits. That shows the dishonesty of some who want to insert themselves into tort reform. Lots and lots of money is a stake, but the anti tort reformers want it in their pockets.

Andrew CochranInjury Board Contributor
Posted by Andrew Cochran
July 06, 2012 7:48 AM

Your side claims that tort reform will lower health care costs. Prove it! It hasn't happened in states enacting tort reform.

jc
Posted by jc
July 06, 2012 7:54 AM

MB - -don't think that frivolous malpractice litigation has disappeared. 80% of medical malpractice cases which go to court are won by the defendant doctor. Today's plaintiff attorneys have a better chance of winning a coin flipping contest than a med mal case. The underlying problem is that med mal cases are complex, yet there is no lawyer training for them. In other words any lawyer who passes a state bar can sue a doc the next day. Imagine if hospitals let an intern who finished his internship do neurosurgery the next day and you understand the reason frivolous litigation is still filed, even today.

Michael A. StrattonInjury Board Attorney Member
Posted by Michael A. Stratton
July 07, 2012 9:51 AM

The people who advocate caps on people injured by malpractice can never ever cite a single study supporting their claims. it is always anecdotal: "I knew a guy once who left the state because...". We heard that over and over in Connecticut, and then when we looked at actual numbers in scientifically valid statistics we found: Medical Malpractice insurance costs going down, number of doctors going up, payouts going down, access going up.

So lets look at real evidence As doctors, you all should at the very least understand "evidence based" as opposed to anecdotal. If we lived in an anecdotal world, you people would still be advising the use of leeches, and st. john's wort.

jc
Posted by jc
July 07, 2012 10:53 AM

Michael- your argument about "evidence based" statistics ignores the fact that 80% of trial verdicts are for the defendant doc. That means that most cases that go to court are frivolous. You would think that the American Bar Association would be alarmed at plaintiff attorneys and their 80% failure rate at trial. Yet I have not seen any evidence that the ABA recognizes or is trying to correct this problem. Your statistics don't mean too much to the individual doc who has to go thru 3-10 years of emotionally draining malpractice litigation.

Jon Lewis
Posted by Jon Lewis
July 07, 2012 11:30 AM

Losing a case does not make it frivolous. The laws in Alabama are so in favor of the medical profession. Discovery is highly limited, and you have to have experts testify, and it is VERY rare to be able to find an expert within the state to testify against another doctor within the state. In my county, I believe the loss rate is closer to 90%. These statistics do not reflect the cases which are never brought.

Mike BryantInjury Board Attorney Member
Posted by Mike Bryant
July 07, 2012 2:32 PM

I see Dr Cox is back making up stories again. So Dr Cox have you called the family that you lied to about the death of there loved one yet? Maybe offer the insurance premium you saved?

It took you a couple of rounds, but again we see the meaningless statistic you always fall back on. You know a majority of the no question malpractice cases are first hidden, then there is the group that the person find out about and decides they don't want to do anything ( research supports that truthful doctors do make a difference), then there is the group that talk to a lawyer and the advice is to not pursue the claim, then there is the group that settle, and finally there is the case that try.
There are many reason why cases are lost. Juries like doctors and the laws are written in their favor. Some cases are just lost. Others involve Doctors changing their stories.
You have heard all this and ignore it all the time. Do the right thing and contact the family.

mb
Posted by mb
July 08, 2012 1:17 PM

jc, I never said that there was no frivolous malpractice cases have disappeared. In Cook County, Illinois more than 90% go for the defendants. An attorney who invests over $100,000.00 into a case and loses would be a fool to do it over and over again. As far as the future- you're correct ObamaCare is going to lower the standard of care and choke technology with his 24 taxes in the law. In ten years we will be just like Europe and there will be a decrease in lawsuits as the standard of care is decreased.

jc
Posted by jc
July 09, 2012 11:30 PM

Mike Bryant - -I really do not know what you are talking about. In the real world that I inhabit, most malpractice suits are frivolous. Typically, a patient has had a bad result, usually because he did not follow up with the doctor or did not follow instructions or the disease process progressed. A nurse came to me this week when I was in ER and told me a woman was complaining that Dr. X missed an ear infection 2 weeks ago and now her toddler had a brain abscess. So I look in the record and Dr. X told Mom 2 weeks earlier that the toddler needed to be sedated to get a CT Head because the ear infection could lead to serious complications. Mom refused sedation against medical advice and left the ER. Now she comes back with the kid with a brain abscess. Notice that the Mom did not say, "I screwed up and did not follow the doc's advice and now my kid has a brain abscess and will have to have neurosurgery and lose hearing and neurons." Nope, according to Mom, it is that incompetent Doctor X that caused this problem! Happens all the time, which is why I do not consider statistics where patients claim medical malpractice occurred to be statistically valid.

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