What’s Up Doc Revisited…Again: A Second and Final Reply To Ted Frank (American Enterprise Institute)
When I signed on as a contributor to this blog, I agreed to spend an hour or so a month responding to comments. Answering Ted Frank’s comments has taken me well beyond both that cutoff and the point of diminishing returns. Frank seems to derive unlimited utility from online debating. I do not.
I also dislike Frank’s style of engagement, which is replete with rhetorical tricks and other practices academics disdain. Consider the following two sentences from his last comment:
"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.)"
By over-larding the first sentence with propositions of mixed truth values, Frank makes a succinct response impossible.
• Yes, my sole intent was to show that tort reformers made false claims (plural, not “a claim,” as Frank wrote).
• No, my intent was not to discuss a “relatively unpublicized statement.” The statements I criticized were disseminated widely and are still being publicized today. They can easily be found on tort reform websites.
• No, my intent was not to say that “a,” i.e., 1, lobbyist group made false statements. I identified TMA and TAPA. I could have added Texans for Lawsuit Reform (and possibly other organizations, had I made a thorough search) that republished these statements.
• No, it was not my intent to say the statements were “imprecise.” That’s Frank’s spin. The statements contained numbers or described the growth in Texas’ physician population as “staggering.” They were sufficiently precise. They were just wrong.
Now consider the second sentence quoted above, Frank’s parenthetical. Any fair-minded reader would see that I rejected his characterization of the “thrust” of the tort reformers’ assertions. Why did Frank infer otherwise? Because I did not reject his mischaracterization explicitly. Apparently, when exchanging views with Frank one must include a closing sentence denying all assertions not expressly endorsed.
Frank also points out that “[t]here are real issues of access to care that are not being captured by [my] single time-series.” Did I ever say otherwise? No. I said the time series, which describes the size of Texas’ doctor population, shows that tort reformers’ claims about the growth of that population are false. Not satisfied with mischaracterizing the tort reformers’ claims, Frank puts words in my mouth as well. Then he accuses me speaking falsely. Amazing.
Nor did I deny, as Frank implies, that a lower marginal growth rate in the number of doctors can affect patients’ access to care. Nothing in my column addressed this. The connection between the difference in marginal growth rates and access is, however, a complicated matter. Access depends not just on the number of new doctors, but on where they locate, the specialties they choose, the availability of insurance, the amount of charity care they provide, and probably other variables. Access must also be distinguished from quality and patient wellbeing. Researchers have identified volume/quality relationships in many areas of medicine. This creates the possibility that patients may be better served if fewer doctors or hospitals offer a service than if more do. A smaller number of providers with higher volumes per provider may mean less mortality rates, fewer infections, and healthier patients.
Frank also employs the weird tactic of condemnation by association. I’m referring here to the comments in which he impugns me or other contributors to this blog by pointing out that our opinions differ. Insofar as I am aware, other contributors have no duty to agree with me, and I have no duty to agree with them. Toeing the party line may be the order of the day at PointofLaw.com, but other blogs allow disagreement.
Now consider Frank’s slap-back tactic. Frank contends that I cannot criticize the tort reformers for misinforming the public because I published an op-ed in the New York Times that contradicted my published research. Assume for the sake of argument that I am guilty as charged. Does this have any bearing on the size of Texas’ physician population or the accuracy of the tort reformers’ claims? No. Frank is just throwing mud.
Moreover, the contradiction Frank claims to have found exists solely in his imagination. Insurance crises occur when premiums shoot up dramatically in the short-term, meaning a few years. In Texas, the rate spike for med mal coverage lasted roughly from 2000 to 2003. Both my op-ed and my published research showed that no short-term change in the cost of processing med mal claims preceded this premium spike. As stated in the op-ed:
"Malpractice premiums have risen sharply in Texas and many other states. But, at least in Texas, the sharp spikes in insurance prices reflect forces operating outside the tort system. The medical malpractice system has many problems, but a crisis in claims, payouts and jury verdicts is not among them."
Clearly, the op-ed focused on “sharp spikes” and “cris[e]s, i.e., significant short-term changes. Yet, the sentence in the article upon which Frank seized expressly focused on “the long run.” There is no contradiction in believing (1) that forces outside the tort system can generate significant short-term premium fluctuations, and (2) that over the long run, premiums charged in competitive markets should reflect underlying costs, including payments on claims.
John Maynard Keynes famously observed that “[i]n the long run, we’re all dead.” Frank asserts that what is true in the long-run must be true in the short-run as well. I therefore infer that we’re all dead already. The good news is that the inference forces this pointless exchange to end.
Charles Silver: Author Bio | Other Posts
Posted at 9:51 AM, Nov 13, 2006 in Civil Justice | Debunking Tort "Reform" | Health Care | Health Insurance | Medical Malpractice
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