Justinian Lane

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."

Baby, I Lied by Suzanne Batchelor - The Texas Observer

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.


Map of Texas counties without obstetricians before and after Proposition 12 passed

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.

Justinian Lane: Author Bio | Other Posts
Posted at 12:39 PM, Nov 12, 2007 in Medical Malpractice
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Justinian: Your misleading left wing garbage has not changed.

I have a huge lawn to mow. I want you to do it. I do not want to pay you. I want to sue you if you make any mistake.

When can you be over to do the job?

Posted by: Supremacy Claus | November 12, 2007 10:08 PM

I think it is transparently clear that everyone is out to make a buck. The legal profession supports any and all legislation that will enable them to make more money. The doctors support any and all legislation that enables them to keep the hands of lawyers out of their pants pockets

The maps you show are interesting but four years is too soon a period of time for the real effects of the tort reform to show up. Doctors with existing practices are unlikely to uproot their lives, and it takes a while for newly-minted doctors to work their way through internships and residencies into private practice. Revisit this issue in about six more years and then let's see what the data tells us

Posted by: Paul W Dennis | November 13, 2007 3:06 AM

Supremacy: If you're not going to pay me, I'm not going to mow your lawn. If you convince the legislature to pass the "Yard Worker Protection Act" that prevents you from suing me, I'm still not going to mow your lawn. The way to attract doctors to rural areas isn't to limit their liability for the same reason.

Paul: And if you still don't get the results you like in ten years, wanna go for fifteen? Maybe twenty?

Posted by: Justinian Lane | November 13, 2007 11:06 AM

Justinian: Naturally, your attitude about doing hard work for less than its worth is lawful, reasonable, and entirely appropriate. OB is no different. The doctor is among the most regulated if not the most regulated of services or product providers. Any regulatory relief, such as tort reform, increases the attraction of a location. The OB has far more onerous regulation than the yard worker, including second guessing by weak case filing plaintiff lawyers.

If someone learns you know what you are doing, they say, mow the lawn. They pay you. In the case of the doctor, the second guessing is every minute, and by people who know nothing about OB. They sue and take 1000 hours of preparation time for the case. There is no compensation for such anxiety and hard work, preparing. That taking by the lawyer is unlawful, uncompensated, and unjust if dismissed or found not guilty, as happens in 80% of cases.

Posted by: Supremacy Claus | November 13, 2007 12:19 PM

No Kia, if after ten years something hasn't worked, I'd say it is a failure. I am not one of those who believes that anything that doesn't produce instant gratification is a failure. The trial bar has had since 1932 to screw up the legal system , I think it will take a good ten years to unscrew it

Posted by: Paul W Dennis | November 13, 2007 3:35 PM

Paul: I'm the one who responded, not Kia. :)

Second - Four years after the passage of the legislation, there's one Texas county that doesn't have doctors that used to, and no increase in the number of counties with obstetricians. Maybe it's because I'm a member of the "instant gratification generation," but I thought that maybe 1 or 2 counties would have gained at least ONE doctor.

Posted by: Justinian Lane | November 13, 2007 7:59 PM