2011 - %3, June

Chart of the Day - Capping Malpractice Damages in Texas

| Thu Jun. 2, 2011 10:08 AM EDT

Does tort reform reduce healthcare costs by cutting down on frivolous medical malpractice lawsuits? Maybe. But how about the specific type of tort reform supported most strongly by the conservative movement, namely caps on non-economic damage awards? The evidence on that score is pretty strong: it has no effect at all. Today, Aaron Carroll presents the latest evidence about damage caps from a study of Medicare costs in Texas before and after they passed a damage cap law:

So what happened to costs of care after that law was put in place? Citizen Watch analyzed just that using data from the Dartmouth Atlas of Health Care....Texas is blue, the nation is red, and the law went into place at the dotted line. If anything, Texas’s Medicare spending seems to have gone up faster than the nation’s since 2003. Hardly a persuasive argument for tort reform = cost control.

Of course, you barely even need a study to understand the extreme unlikelihood of this working. The goal is to reduce the rate of unnecessary testing that doctors perform merely due to fear of frivolous lawsuits, but frivolous lawsuits, almost by definition, are small and aren't affected by damage caps. The only cases affected by caps are big, serious cases of malpractice, and those are both rare and complicated. They usually turn on some kind of gross negligence, and they're demonstrably non-frivolous. Capping damages in these cases simply has no effect at all on behavior meant to deter nuisance suits and therefore no effect on the practice of defensive medicine.

Of course, this is so obvious that even the Texas legislature surely understands it. However, they also understand something else: trial lawyers make their money on the big, serious cases, and if you cap damages in the big cases then you also limit the income of trial lawyers. And trial lawyers are big contributors to the Democratic Party. So capping damages in serious cases of malpractice does nothing to harm the storefront purveyors of frivolous lawsuits, but it does harm two other groups: victims of serious malpractice and the Democratic Party. That's a shame about the victims, but hey — you can't make an omelette without breaking a few eggs. It's all for the greater good, my friends.

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Feds Block Indiana Funding Cut to Planned Parenthood

| Thu Jun. 2, 2011 10:01 AM EDT

Last month, after the GOP's push to defund Planned Parenthood fizzled in Congress, Indiana became the first state to go after the organization on its own. The Republican-run legislature in the Hoosier State passed a bill barring Planned Parenthood from receiving Medicaid funds, and social conservatives cheered when GOP Gov. Mitch Daniels, who once spoke of the need for a social issues "truce," signed the bill into law.

On Wednesday, the Obama administration fired back, and said no dice. Donald Berwick, the controversial head of the Centers for Medicare and Medicaid Services, sent a letter to Indiana officials informing them that their new law illegally discriminates among health care providers. That's bad news for Indiana. States that don't follow the federal government's rules for distributing Medicaid money—including those that apply to family planning dollars—can in theory be stripped of all federal Medicaid funding. If that happened, slashing a few million dollars of family planning money for Planned Parenthood would end up costing Indiana billions.

Planned Parenthood is already challenging the defunding law in court, but the Obama administration move ups the ante by getting the executive branch directly involved. The letter also serves as a warning to any states that are considering following Indiana's lead: killing off Planned Parenthood won't be quite as easy as Daniels and state GOP leaders may have hoped. Berwick, who was given his job via a recess appointment, won't become any more popular with conservatives, who have dubbed him "Dr. Death" thanks to fears that he will impose health care rationing and death panels. But at least Democrats and pro-choice activists should be happy to see the Obama administration making a strong move to protect abortion services.

Meanwhile, since Indiana passed the new Medicaid law, private donors have filled Planned Parenthood's coffers with more than $100,000 in a strong show of support for the group. The donations aren't nearly enough to make up for the $2 million in Medicaid funds that Planned Parenthood's Indiana operation will lose if the defunding law survives, but they will keep services in the state up and running at least for another two weeks.

Unhappy With Candidates, GOPers Turn to...Unpopular Governor?

| Thu Jun. 2, 2011 9:48 AM EDT

It's a matter of public record that, at least at this point in the campaign, Republican primary voters really don't like their 2012 options. Hence the constant pining for Indiana Gov. Mitch Daniels (not running), former Florida Gov. Jeb Bush (not running)—even former Supreme Allied Commander and two-term President Dwight D. Eisenhower (deceased). Now, the new hope for discontented GOPers is New Jersey Gov. Chris Christie, a brash former US Attorney who's become a minor deity on the right on account of his contentious exchanges with (usually) public school teachers. Christie has said he's not running, but continues to hold the kind of meetings you'd hold if you were actually thinking of running. On Tuesday, he met with a delegation of influential Iowa Republicans in Princeton. Per the Des Moines Register:

It's too early to say the Iowa GOP mission to draft in-your-face New Jersey Gov. Chris Christie to run for president was unsuccessful, two team members said Wednesday.

Although Christie didn't promise to enter the race during the dinner with the seven Iowa Republicans on Tuesday night, he never flatly declared he wouldn't, said Gary Kirke, a business entrepreneur and an organizer of the recruitment trip.

Consider this: Christie had 13 of his people at the table, all trusted advisers, said Michael Richards, a West Des Moines Republican who also went on the 9½-hour trip.

Of course, as my colleague Andy Kroll has noted, Iowa Republicans are pretty much the only folks who actually seem to like Chris Christie, whose approval ratings in New Jersey have plummeted in the last 12 months. Hey, there's always Rick Perry.

GE, Exxon, 10 Other Major Corporations Paid Negative Tax Rate

| Thu Jun. 2, 2011 9:07 AM EDT

As billionaire investor Warren Buffett likes to point out, he pays a lower annual tax rate on the tens of millions of dollars he earns than does his secretary, who makes $60,000 a year. It's an illustration, he says, of how the backward and loophole-ridden the US tax system is.

Here's another: Between 2008 and 2010, a dozen major US corporations—including General Electric, ExxonMobil, and Verizon—paid a negative tax rate, despite collectively recording $171 billion in pretax US profits, according to an analysis by Citizens for Tax Justice. Taken together, these companies' tax burden was -$2.5 billion, and ten of the companies recorded at least one no-tax year between 2008 and 2010.

Here's more from CTJ:

Not a single one of the companies paid anything close to the 35 percent statutory tax rate. In fact, the "highest tax" company on our list, Exxon Mobil, paid an effective three-year tax rate of only 14.2 percent. That’s 60 percent below the 35 percent rate that companies are supposed to pay. And over the past two years, Exxon Mobil’s net tax on its $9.9 billion in U.S. pretax profits was a minuscule $39 million, an effective tax rate of only 0.4 percent.

Had these 12 companies paid the full 35 percent corporate tax, their federal income taxes over the three years would have totaled $59.9 billion. Instead, they enjoyed so many tax subsidies that they paid $62.4 billion less than that.

If just these 12 companies had paid at a 35 percent tax rate over the past three years, total federal revenues from corporate taxes would have been 12 percent higher than they actually were.

Here's the data from the CTJ analysis:

CTJ's report comes as President Obama and Congress eye changes to the nation's corporate tax code. The president says he wants to eliminate the many loopholes American companies use to reduce their tax liabilities, but offset those changes by lowering the overall corporate tax rate—what are called "revenue neutral" reforms. For their part, Republicans simply want to lower taxes across the board, for individuals and corporations alike; they say American companies already pay too much when compared with competitors in the rest of the world.

Not so, according to CTJ. "These 12 companies are just the tip of an iceberg of widespread corporate tax avoidance," Bob McIntyre, CTJ's director, said in a statement. "Our elected officials have a duty to the American public to make reducing or eliminating the vast array of corporate tax subsidies the centerpiece of any deficit-reduction strategy."

What Good are Polls on RyanCare?

| Thu Jun. 2, 2011 8:00 AM EDT

Another day, another poll on Rep. Paul Ryan's plan to voucherize Medicare. The latest one comes from two liberal groups, Herndon Alliance and Know Your Care, which found that voters rejected RyanCare by a 16-point margin, with 54 percent of voters opposing the plan and 38 percent supporting it.

Via Greg Sargent, here's the way the plan was described to voters: "Instead of the government paying doctors and hospitals directly for treating seniors as Medicare does now, the government would provide vouchers to help seniors buy their own private health insurance policy." Among two key voting blocs, opposition was even more adamant, with nearly 58 percent of seniors and 60 percent of independents rejecting the plan.

But as Jonathan Chait points out, it's important to take all these one-off polls with a grain of salt, particularly those commissioned by groups with an agenda. "Advocacy groups for every cause under the sun like to commission polls that show that the public agrees with them, and it can almost always be done if the wording is just right. If that somehow fails, the pollster-for-hire can present the respondents with arguments that are designed to push them toward the desired result," Chait writes.

What's more, the problem with this type of poll is that they often pose the question outside of a broader political discussion or debate—the context in which voters are far more likely to encounter them, as opposed to a succinct, one-message description. To that end, Nate Silver highlights a poll recently conducted by the non-partisan Kaiser Family Foundation that presented voters with the broader arguments that the supporters and opponents of RyanCare have been making:

To the 50 percent who were opposed to the plan originally, Kaiser recited a series of arguments that resemble those that Mr. Ryan himself is making: That the plan would reduce the deficit, that the plan would increase choice and that it would save Medicare from fiscal insolvency. Some respondents, 17 percent of those who were originally opposed to the plan, changed their mind after hearing these arguments.

Meanwhile, to the voters who originally supported the plan, Kaiser read another set of arguments, those which resemble the ones that Democrats are making. They said that the plan would increase health care costs and reduce benefits, would do too much to empower private insurance companies, and would "eliminate traditional Medicare." Upon hearing these arguments, 42 percent of voters who originally supported the plans changed their minds and said they were no longer in favor of it.

Democrats, in other words, seem to have the more persuasive side of the argument — their case was more than twice as likely to change a voter’s mind.

So while both the Herndon Alliance/Know Your Care and Kaiser polls are likely to cheer Democrats who are betting that RyanCare is widely unpopular, the results of the latter may be a better indicator of how voters will really react to Democratic entreaties to reject the GOP plan.

Is Herman Cain Really Like Most Tea Partiers?

| Thu Jun. 2, 2011 5:07 AM EDT

This week, Mark Meckler, one of the national coordinators of the Tea Party Patriots, told the Washington Post that recently declared presidential candidate Herman Cain “is a lot more like us than anyone who has run for president in our lifetimes.”

His comment got me thinking: Is Herman Cain really more like the average tea partier than anyone who’s run for president in the past 60 years? More than Ron Paul? More than Ronald Reagan?? On the surface, Cain and the tea partiers have some pretty striking differences. The most obvious one is that Cain is black and 94 percent of tea partiers are white. Cain grew up in the segregated South drinking from the “colored” water fountains. Many tea partiers would have been on the white side. But putting those big glaring differences aside, are there other things that Cain and the tea partiers genuinely have in common? I came up with a few.

Goofy hats: Tea partiers are famous for wearing tricorne hats. Cain doesn’t wear one of those, but he does have a thing for black cowboy hats.

Fanatic (but often wrong) about the Constitution: Both Cain and the tea partiers share this particular trait. They revere the Constitution but don’t seem to know exactly what’s in it. (Remember when Rep. Michele Bachmann (R-Minn.) said she wouldn’t fill out her US Census forms fully because the Constitution said she didn’t have to?) When Cain announced last month that he would be officially running for president, he included in his speech a big lecture about how Americans need to reread the Constitution. He said:

We don’t need to rewrite the Constitution of the United States of America, we need to reread the Constitution and enforce the Constitution. … And I know that there are some people that are not going to do that, so for the benefit of those who are not going to read it because they don’t want us to go by the Constitution, there’s a little section in there that talks about “life, liberty and the pursuit of happiness.”

You know, those ideals that we live by, we believe in, your parents believed in, they instilled in you. When you get to the part about “life, liberty and the pursuit of happiness,” don’t stop there, keep reading. Cause that’s when it says “when any form of government becomes destructive of those ideals, it is the right of the people to alter or abolish it.” We’ve got some altering and some abolishing to do!

The Constitution does not actually say this. That was the Declaration of Independence.

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We're Still at War: Photo of the Day for June 2, 2011

Thu Jun. 2, 2011 5:00 AM EDT

U.S. Army Sgt. Richard Toon, with Delta Company, 2nd Battalion, 506th Infantry Regiment, 4th Brigade Combat Team, 101st Airborne Division, provides security atop a mountain during Operation Oqab Behar VI in Paktika province, Afghanistan, May 20, 2011. The mission provided security along the Afghanistan-Pakistan border. (U.S. Army photo by Spc. George N. Hunt/Released)

Return to Kurdistan - Part 2

| Thu Jun. 2, 2011 5:00 AM EDT

This is the second part of a three-part series of dispatches from Jonathan Dworkin, an infectious diseases fellow at Brown who spent several months in Iraqi Kurdistan in 2006 and returned for a followup visit in May. Part 1 is here. The final installment will appear tomorrow.


In 2006, during my first week in Sulaimania, a physician colleague made an off-hand comment. He told me that speech here is free, but “not as free.” It struck me as a revealing phrase, but I did not realize how soon the issue would become paramount. In the Kurdish provinces there has been a steady growth of independent media since 2003. During my 2006 visit this consisted mostly of newspapers, including one called Hawlati, or “the people.” This was a cautious beginning, and most criticism of the ruling parties was measured. In the last five years, however, there has been a rapid growth in the independent media, which now consists of satellite television channels, magazines, and websites, as well as newspapers. As is typical with television, and particularly with web media, the change has led to more vitriolic criticism of the government. The government’s response has been one of the defining disasters of the Kurdistan region.

In May of 2010 a Kurdish student named Sardasht Osman was abducted outside his college in Erbil, the capital of the Kurdistan region. Two days later his body was found in Mosul. It was a gruesome murder, and it was highly unusual. Erbil, like the rest of the Kurdish region, has experienced almost no terrorism-related violence in the Iraq War. The unofficial boundary between Kurdish and Arab Iraq is patrolled by the peshmerga, Kurdish soldiers who man checkpoints along all the major roads. Furthermore, Osman was a well-known critic of Massoud Barzani, the Kurdish region’s president, and he had written several inflammatory articles for Kurdish websites. In an article written five months before his death, he wrote metaphorically that he wished he could marry one of Barzani’s daughters, so that he could benefit from the family’s famous nepotism.

For months before his death Osman had received anonymous threatening calls. These increased in intensity after the article dealing with Barzani’s daughter. His friends and family say that he was terrified, particularly around government security vehicles. He went to the police in Erbil, but he received no help. After the murder, Barzani’s government promised an investigation. The conclusion of an anonymous committee was that Osman was connected to a terrorist group, and his death was due to his refusal to participate in terrorism. This report — notably clumsy considering Osman was a well-known secularist — was immediately rejected by everyone who knew the victim. Even the terrorist group, Ansar al Islam, took the unusual step of denying the killing. Human Rights Watch, in a report on journalistic freedom in Iraq, concluded that the investigation was bogus.

If the incident were isolated, the Kurdish government might have some leeway. Unfortunately the murder is part of a broader context of ugly attacks on journalists and opposition members. A Times story on the murder referenced the Kurdistan Journalists Syndicate, which reported 357 cases of intimidation, assault, or arrest in 2009. Libel suits and threats to shut down “unlicensed” media outlets are the most common forms of harassment. As Michael Rubin has pointed out, Kurdish authorities have not investigated the murder of an opposition journalist for Lvin magazine in 2008, nor did they investigate the murder of an opposition politician in Dohuk in 2005. Human Rights Watch, in its report on the Osman murder, documented several threats made against Osman’s friends and family after they refused to accept the findings of Barzani’s anonymous commission. Most importantly, the media crackdown has not ended with the cessation of the recent protests. Intimidation is ongoing, as evidenced by the arrest of the editor of Lvin during my current visit.

Speech in Iraqi Kurdistan is not free, but it is valued. Sardasht Osman’s murder led to large protests, which foreshadowed the even larger protests this spring. Despite the violence, opposition media continue to proliferate. Nalia, the television station recently burned down in German Village, is again up and running. The secular opposition Goran (“Change”) Party has an immensely popular channel, which each night features stories of government abuse and corruption. Hawlati and the other independent papers are now the most respected, and the internet is proving as difficult to control here as it has in other countries. Given the personal risks people take to speak their mind in Kurdistan, it is immensely reassuring to see such a growth in activity. The press here is bruised, but it is kicking harder than ever.

The damage done to the Kurdish government’s credibility, though, may be irreversible. Rather than establishing normal party politics, accepting criticism, and ultimately allowing for a healthy ebb and flow of power, they are digging in. They are, as many here have pointed out, imitating the Arab despotisms that they have long claimed to despise. This explains the growing pessimism in Sulaimania. Though people have not given up on the project of building a democratic society, most no longer have faith in their ability to shape their government. Violence is the new reality, and opposition is the only path left open to them.

Zero Tolerance Losing Its Appeal?

| Wed Jun. 1, 2011 10:20 PM EDT

The Washington Post reports that we're having a sudden outbreak of common sense:

Nearly two decades after a zero-tolerance culture took hold in American schools, a growing number of educators and elected leaders are scaling back discipline policies that led to lengthy suspensions and ousters for such mistakes as carrying toy guns or Advil.

....The shift is a quiet counterpoint to a long string of high-profile cases about severe punishments for childhood misjudgments. In recent months, a high school lacrosse player was suspended in Easton, Md., and led away in handcuffs for having a pocketknife in his gear bag that he said was for fixing lacrosse sticks. Earlier, a teenager in the Virginia community of Spotsylvania was expelled for blowing plastic pellets through a tube at classmates.

....In Delaware, for example, zero-tolerance cases were a repeated issue in the Christina School District, where a 6-year-old with a camping utensil that included a knife was suspended in 2009. Discipline procedures were revamped last year, giving administrators the discretion to consider a student’s intent and grade, as well as the risk of harm. Out-of-school suspensions in the state’s largest school system fell by one-third in a year.

How on earth did we ever stampede ourselves into adopting en masse a policy aimed at children that didn't consider age, intent, and risk of harm? It was like we were suffering from a bout of collective insanity. I understand the problems that teachers and principals have these days, both with legal liability and with parents who scream about discrimination whenever their little darlings are alleged to have misbehaved. But there's just no way that zero tolerance was ever the best answer to these problems. Hopefully we're all finally figuring that out.

Corn on "Hardball": the Palin Problem

Wed Jun. 1, 2011 8:51 PM EDT

David Corn and former chairman of the RNC Michael Steele joined Chris Matthews on MSNBC's Hardball to discuss Sarah Palin's controversial bus tour and how she has stolen the limelight from the other GOP presidential hopefuls.

David Corn is Mother Jones' Washington bureau chief. For more of his stories, click here. He's also on Twitter and Facebook. Get David Corn's RSS feed.