A Citizen's Guide to Indiana

I mentioned earlier my belief that limiting medical malpractice liability won’t do much to drive down the cost of health care. So, what will? My favorite health care futurist — ok, the *only* health care futurist I know — Joe Flower, has a list. Click through the link for the narrative, but the list is as follows:

1. Single payer.
2. “Robust” public option.
3. Limiting medical loss ratios.
4. Negotiating drug prices.
5. Bundling.
6. Publishing outcomes.
7. Publishing prices.
8. Banning discounts.
9. Giving a premium to integrated “accountable care organizations.”
10. Increasing subsidies for digitization, tied to productivity improvements.
11. Subsidizing automation.
12. Standardization and checklists.
13. Warranties.

The issue of “medical loss” is one that really captures my attention. It has to do with what percentage of health insurance premium dollars actually go toward providing health care. A high percentage suggests an efficient health care system and a low percentage suggests an inefficient system. Flower has this to say about medical loss in the U.S. versus Europe:

Many European countries dictate that health plans must return 85% or 90% or 92.5% of the premium paid in as medical services paid out. U.S. health plans, in contrast, compete on (and brag to Wall Street analysts about) how low their medical loss ratio is. Some are as low as 60%.

Maureen Groppe, writing for Gannett, has an article about increased attention to “tort reform” in the context of the health care debate.

Medical malpractice costs are getting increasing attention in the health care debate, despite studies that show capping jury awards in malpractice cases would do little to lower health care spending.

I mentioned last week Jeff Hagedorn’s opinion piece in the Perry County News citing studies that suggest the rise and fall of medical malpractice premiums correlate much more strongly with shifts in the stock market than they do with malpractice costs.

But, never mind the reality. That medical malpractice claims have something significant to do with health care costs has become an article of faith among voters and, consequently, among politicians seeking their votes.

The Groppe article points out that Indiana has a pretty doctor-friendly malpractice system and yet there is little evidence that this has done much to keep health care costs down in our state.

Indiana’s health spending per capita is slightly higher than the national average. Hoosiers spend less per person on doctors, but more for hospitals and health insurance premiums, according to the Kaiser Family Foundation, a health policy research group.

WellPoint Inc., the Indianapolis-based insurance giant, said in a May report that malpractice suits are one of the popular explanations for rising health care costs, but falsely so.

I don’t really have a dog in the medical malpractice fight. I don’t practice that kind of law and, if I did, chances are I’d be defending and would find further restrictions advantageous for a client. But, in terms of the health care debate, it’s little more than a distraction.

Eric Weddle has an article in the Lafayette Journal & Courier about federal funds being given to general aviation airports. I don’t have a great deal of knowledge about these facilities. I served a brief stint as counsel for the Frankfort airport authority until a couple of thorny issues were resolved and the local political situation changed there and it no longer made sense for them to pay a Lafayette attorney to come to their meetings.

General aviation airports are those, generally speaking, that do not primarily serve the military or scheduled, commercial flights. They are the smaller airports that serve chartered and private airplanes, among other things. I have a theoretical sense that it’s good that these airports are available for decentralized air travel. But, in a lot of cases, they serve a very limited segment of the population. They are sometimes cited as an economic development tool because the lives of executives with local factories are easier if they can land a chartered plane close to a factory. Don’t get me wrong, some of my best friends — or at least one of my best friends — is a pilot who uses general aviation airports. But, unless I’m underestimating their value to the community, I suspect that these airports are probably on the edges of what we need government to fund when we’re dealing with limited tax dollars.

I see that at least one of the airports defended themselves on the grounds that they are nearly self-sufficient with hangar and fuel charges. But, in Indiana, these airport authorities do have taxing authority and condemnation powers, even if their use of such powers may be limited. In the overall scheme of things, this is probably just a drop in the bucket.

Obviously, I’m all over the map on this one. Sometimes it’s just good to ramble.

I read articles like this one from Maureen Groppe and Peter Urban about Republicans whining about the use of “czars” in the Obama administration, and it makes me question whether I’ll care when newspapers finally go under. Its full of “some say one thing but others say another thing” reporting, and it’s not until deep in the article that you find out that the Republicans had nothing to say when the same thing was going on in the Obama Bush administration. That information should have been in about paragraph two and it should have been a statement of fact not a quote from someone else.

For all the legitimate policy differences one might have with the Obama administration, this is a bullshit, made up issue and for real journalists to spend any time on it is ridiculous.

The Associated Press has an article on the loss of cursive. Basically, kids aren’t learning cursive because they don’t really need it. Most communication is typed any more, and printing gets the job done for the tasks that need to be written.

As might be expected with any change, there are those who see the loss of cursive as a significant loss. But, for me, this goes in the buggy whip column. It served a purpose and, with that purpose fading, the need to learn it also fades.

I’m biased though. My cursive was never any good. I went back to printing as soon as my teachers stopped caring. I regard it as the Victorian gingerbread house of writing.

The Lafayette Journal & Courier has a reasonable editorial on the Voter ID law recently struck down as unconstitutional because it treated absentee voters more leniently than in-person voters. The J&C suggests that legislators simply go back and treat absentee voters the same as in-person voters.

Rather than appeal Thursday’s ruling, it might be a better route for lawmakers to close the loopholes and adopt a new law that applies uniformly to all voters.

Given that many of the state’s problems with voter fraud have occurred with absentee ballots, it seems reasonable that the photo ID rule apply to them, or that some other method of verifying identification be adopted.

Reasonable as it is, it starts with the flawed premise that this was ever fundamentally about combatting voter fraud. Consider that the law’s proponents rejected proposed amendments to make this law apply to absentee voters and could not point to any real life instances of fraud that this would have stopped, certainly not any that had any particular impact on an actual election.

These items don’t fit into the narrative where Voter ID proponents are crusading to protect the integrity of the electoral system from the scourge of fraud. In my misspent youth, I experimented with a little Ayn Rand. I’ve discarded most of that rubbish but one quote that stuck with me, overblown as it is, was this: “Contradictions do not exist. Whenever you think you are facing a contradiction, check your premises. You will find that one of them is wrong.” O.k., so that’s just an overbearing way of saying that when things don’t fit together, you ought to check your premises.

The facts fit together a lot better if you discard the premise that voter fraud was the purpose of the Voter ID law and replace it with the premise that one political party, temporarily ascendant, saw fit to pass a law that would shave a percentage point or two off the other side’s voters. The Republicans made a calculation that the voters who would: a) vote in person; and b) not have identification would skew toward the Democrats. That calculus changes if you apply the ID requirement to those who vote absentee. Therefore, the absentee voters were not subjected to the same level of scrutiny.

If the Journal & Courier’s premise is correct, I would expect simple legislation to correct the disparate treatment. If my premise is correct, I would expect a trip to the Supreme Court and a lot of public gnashing of teeth that never seems to address why absentee voters should be subjected to less scrutiny than in-person voters.

I thought it was may a one or two time thing, but the more I read Paul Ogden, the more it seems he’s becoming a watchdog for political privatization in Indiana. Today’s installment is on possible privatization of parking garage and shuttle service at the Indianapolis Airport.

He’s probably a more credible critic of government privatization operations since he is (or at least was) temperamentally predisposed to be in favor of it but has seen good theory turn into corrupt practice. My first real, direct experience was seeing things work well in reverse — watching the legislature take bill printing in-house at a substantial savings over the private printer it had been using. That probably gives me a predisposition against privatization.

Says Ogden:

Bottom line is that the Airport Board overbuilt and is now scrambling to find the resources to cover CIB-type operating deficits that loom in the future. To close the inevitable gap, the Airport Board is looking at using the long term (50 years) privatization contracts to generate substantial upfront revenue.

This is something I have preached about before. To work, privatization has to be about instilling market competition into the delivery of services. Handing a company a long term contract to provide a service not only does not instill competition, it creates a government-sanctioned monopoly. Insulated from market competition by the long-term privatization contract, the service provided by these monopolies inevitably declines.

The Court of Appeals’ decision striking down the Voter ID law as unconstitutional under Indiana’s Equal Privileges and Immunities clause drew a petulant response from Gov. Daniels.

At a news conference, Gov. Mitch Daniels, a second-term Republican, called the ruling “preposterous” and said that “there’s nothing in the Indiana Constitution that goes beyond what the federal Constitution provides here.”

He is alluding here to the case of Crawford v. Marion County which was in a different procedural posture and didn’t address the same issues. And, in any case, Indiana courts are the controlling authority on the Indiana constitution (to the extent it isn’t in conflict with the United States Constitution.) Note what he doesn’t address: the fundamental issue of why absentee voters should be treated more leniently in terms of identification than in-person voters. That was the crux of the Court of Appeals decision. Critics of the appellate court’s decision simply lack credibility if they do not address that central question.

Gov. Daniels just bellyaches about prior litigation which has no preclusive effect on the present case. I thought he had a law degree. He obviously knows better. He just doesn’t care and chooses to ignore the central question and start huffing about judicial arrogance. He didn’t get his way and decided to have himself a little tantrum.

For future reference – not that I suppose the Governor is going to take advice from the likes of me – I would suggest something along the lines of, “I respectfully disagree with the Court of Appeals’ decision and believe it will be overturned by the Indiana Supreme Court. Less stringent identification is appropriate for absentee voters than for in-person voters because ______.” And then use that big old brain to fill in the blank more convincingly than the attorney general was able to do in front of the Court of Appeals.

Incidentally, the legislature can probably fix this simply by applying the voter identification requirements equally to all voters.

Update Doghouse has a nice entry on the Governor’s return to Car Bomb form, complete with video. And his is much more fun to read. My favorite line, “He’s like a guy who starts a small business, not to get rich, not for love of his product, but just so he can fire minimum-wage earners at will.”

I have been interested in space for a long time. I recall that, when I was 5 or 6, I had a conversation with my uncle where I told him I either wanted to be a lawyer or an astronomer. From the choices I have made, my decision making skills are obviously suspect. But, I’ve been even more attuned to information about the Big Bang for the past year or so. At some point, Cole was a little agitated about something that had happened at school. He was under the impression that one of his teachers thought he wasn’t telling the truth when he talked about the Big Bang. As best I could piece together, one of his teachers was maybe trying to tell him that the Big Bang might not be accurate, presumably based on religious concerns. (Cole also came back at one point talking about how God had made every snowflake different.)

So, that’s the background noise in my head when I read about the Planck Observatory sending back information about radiation that first swept out across space just 380,000 years after the Big Bang. Planck was launched by the European Space Agency last may and is about a million miles from Earth (about 4x more distant than the moon.)

The Planck observatory, launched in May, is surveying radiation that first swept out across space just 380,000 years after the Big Bang.

The light holds details about the age, contents and evolution of the cosmos.
. . .
It is trying to make the finest-ever measurements of what has become known as the Cosmic Microwave Background (CMB).

This is light that was finally allowed to move out across space once a post-Big-Bang Universe had cooled sufficiently to permit the formation of hydrogen atoms.

Before that time, scientists say, the Universe would have been so hot that matter and radiation would have been “coupled” – the cosmos would have been opaque.

Researchers can detect temperature variations in this ancient heat energy that give them insights into the early structure of the Universe.

With Planck, they also hope to find firm evidence of “inflation”, the faster-than-light expansion that cosmologists believe the Universe experienced in its first, fleeting moments.

Theory predicts this event ought to be “imprinted” in the CMB and the detail should be retrievable with sufficiently sensitive instruments. Planck is designed to have that capability.

Its detectors, or bolometers, are the most sensitive ever flown in space, and operate at a staggering minus 273.05C – just a tenth of a degree above what scientists term “absolute zero”.

The Indiana Court of Appeals has decided, in the case of League of Women Voters v. Todd Rokita (pdf) that the Voter ID law (P.L. 109-2005) violates Article 1, Section 23 of the Indiana Constitution which states: “Section 23. The General Assembly shall not grant to any citizen, or class of citizens, privileges or immunities, which, upon the same terms, shall not equally belong to all citizens.”

The Court of Appeals, therefore, reversed the order of the trial court and remanded the case with instructions that the trial court enter an order declaring the Voter ID law void.

Update The primary reason for the Court Appeals finding the Voter ID law to be unconstitutional seems to be the disparate treatment between absentee voters and in-person voters. (Incidentally, when the bill was originally considered, a proposed amendment that would have treated in-person and absentee voter requirements more equally was voted down.)

In 2005, the Indiana General Assembly passed a law requiring “citizens voting in person on election day or casting a ballot in person at the office of the circuit court clerk prior to election day to present photo identification issued by the government.” Crawford v. Marion County Election Bd., 128 S. Ct. 1610, 1613 (2008). The Voter I.D. Law applies to voting in both primary and general elections. Ind. Code §§ 3-10-1-7.2 and 3-11-8-25.1. It does not apply, however, to voters casting absentee ballots by mail or those who happen to reside at a state licensed care facility where a precinct polling place is located. I.C. §§ 3-10-1-7.2(e), 3-11-8-25.1(e), and 3-11-10-1.2.

The Court of Appeals found that the Voter ID law did not violate Article 2, section 2 by impermissibly imposing an additional qualification for voting. Rather, the Court of Appeals held that the Voter ID law was a regulation of the time, place, and manner in which eligible citizens could cast their vote.

Turning to the Equal Privileges and Immunities Clause (Art 1, sec. 23):

The League contends that three aspects of the Voter I.D. Law violates Section 23: (1) the disparate treatment between mail-in absentee voters and in-person voters; (2) the disparate treatment between voters who reside at state licensed care facilities that by happenstance are polling places and elderly and disabled voters who do not reside at state licensed care facilities that also happen to be polling places; and (3) the requirements that an identification contain an expiration date and photograph is not reasonably related to the purpose of the statute.

Citing to a case where the Supreme Court decided that a provision placing more stringent requirements on absentee ballots to be included in a recount than in-person ballots was constitutional, the court of appeals noted the Supreme Court’s rationale:

Our supreme court declared to the contrary that the statute was constitutional, because inherent differences make mailed-in ballots more susceptible to improper influences or fraud, and, therefore, “it is reasonable that the legislature believed it in the interest of Indiana voters to more stringently govern absentee balloting.”

It would be irrational for the legislature to believe that mailed-in ballots are inherently more susceptible to fraud on one hand and less susceptible to fraud on the other hand. (There is a legal fiction that the legislature acts rationally.) Consequently, imposing more stringent requirements on in-person voters than on absentee voters is unreasonable and violates the equal privileges and immunities clause of the Indiana Constitution.

Apparently there is a provision which exempts from the ID requirement individuals residing in care facilities which also serve as polling places. The Court determined that the inherent natural characteristics of such a class of people did not justify treating them differently in this fashion. “The nature of state licensed care facilities and the inherent natural characteristics of the residents who reside in them may make them subject to certain directed legislation, but the Voter I.D.?s grant of immunity from the identification requirement for in-person voters is not appropriately related to those characteristics.”

There was also some discussion of the photo and requirement that the ID have an expiration date which had not yet passed. The Court did not have any problems with those requirements. Specifically noting the incident where Purdue student IDs were accepted as identification without expiration dates, the Court said that this was irrelevant to a facial challenge to the statute. It would be a challenge to the way a statute was being applied, which is a different sort of lawsuit.