Did Proposition 12 Bring Doctors to Texas?
As I was getting ready to move away from Texas, I was active in the fight to "Stop Prop 12," which was a proposition to amend the Texas constitution to allow for noneconomic damage caps. The "reform" movement told us that Proposition 12 would create jobs, lower the cost of products and services, bring doctors to the state, punish evil trial lawyers, cure cancer, and bring terrorists to justice.
I exaggerate, but not by much.
The measure passed, and I've recently read a handful of articles that claim Proposition 12 worked, and that doctors have been flooding into the state. I've had a few thoughts about this phenomenon:
- Do I really want to go to a doctor who moved to my state just because it's harder to sue him for malpractice here than in his home state?
- Texas isn't having a hard time attracting people in general, so why should we be surprised that doctors are moving there, too?
- Did existing doctors lower their fees in order to pass this enormous savings onto their patients?
As it turns out the "flood of doctors" into the state hasn't benefited everyone equally. According to "Baby, I lied" by Suzanne Batchelor, the "flood" of doctors has been into wealthy, populous counties in Texas. For example:
"Collin County, the Dallas suburb that is the wealthiest in Texas in terms of per capita income, gained the most obstetricians. Its 34 new ones increased its obstetrician ranks by an impressive 45 percent since Proposition 12 passed."
Great! Proposition 12 accomplished the Herculean task of attracting doctors to the wealthiest county in a heavily-populated state! Perhaps with more reform measurers, we can figure out how to get real estate developers and restaurateurs to move there, too.
One of the primary reasons voters were told to pass Proposition 12 was to increase the number of obstetricians in the state, as Texas had a shortage of doctors in rural areas. Prior to the passage of Prop 12, there were 152 counties in Texas that didn't have a single obstetrician. The graphic below shows the drastic changes in obstetrician availability four years after Prop 12.
Why, if you look very closely, you'll see a couple of counties that now have obstetricians that didn't used to! But... if you look closer, you'll see that there are now some counties who no longer have the obstetricians they used to. As of September of 2007, 152 counties in Texas have no obstetricians - the exact same number as before the passage of Proposition 12. Prior to Prop 12, there were 20 counties with no physician at all - now there are 21. Yes indeed, Texans are better off today than they were prior to Prop 12.
The article explains the obvious: Doctors are moving to wealthy counties that have high populations of individuals with private medical insurance; doctors aren't moving to counties where there aren't many people or where the majority of the populace has Medicare; the "reform" movement doesn't want to talk about the numbers above; etc. My favorite quote is that doctors are "following the Willie Sutton model." (Willie Sutton is the bank robber who explained that he robbed banks because "That's where the money is."
So did Proposition 12 work? It did for wealthy, insured individuals in heavily-populated counties; those people now have less of a wait to see a doctor than they did before. It didn't work for the poor, uninsured individuals in Texas' many rural counties.
But as I've said before, that's what tort reform is all about: Protecting the wealthy by punishing the poor.