Propositions 45 and 46: This Won’t Hurt. Much

by on October 15, 2014 · 6 comments

in California, Election, Health, Politics, San Diego

dr cash2

Editor: The following analyses of Propositions 45 and 46 represent the opinions of the writer, Doug Porter, a member of the San Diego Free Press Editorial Board. The rest of the editorial board may or may not agree with him. The SDFP is the online media partner of the OB Rag. For all the articles on the upcoming election, check out the San Diego Free Press’  2014 Progressive Voter’s Guide.

By Doug Porter

There are no special interests more special than insurance companies, doctors and lawyers. Here we have two propositions involving all three groups. And there is more subterfuge going on than anybody can keep track of.

Monies from the committees supporting and opposing the different measures overlap. There is a joint campaign committee in support of both 45 and 46. “No on 45” funds have been transferred into the State GOP coffers and mysteriously reappeared three days later with interest.

Generally speaking Prop 45 is supported by consumer groups, Democrats and lawyers along with medical and professional unions. Prop 45 is opposed by the insurance industry, chambers of commerce, the GOP and blue collar trade unions.

Proposition 46 is generally supported by lawyers, consumer groups, and the California Nurses Association PAC. It is opposed by virtually the entire medical profession (it’s a phone book full of groups), organized labor, (trigger alert) the GOP, chambers of commerce and the ACLU.

(Endorsements are coming,soon. We just don’t meet that often)

The People Who Opposed Obamacare Have a Proposition for You

Proposition 45 Healthcare Insurance. Rate Changes. Initiative Statute.

Supporters: Consumer Watchdog,

Opponents: Californians Against Higher Health Care Costs,

Ballotpedia Guide: The details, in plain English

You Might Not Know: California is the only state where auto insurance rates actually went down over the last 25 years. That’s because of Proposition 103, passed in 1989. Proposition 45 is the same kind of legislation, only for the Health Insurance industry.

dr cash3My Analysis: Talk about your basic David vs. Goliath scenario. The health insurance industry has over $37 million banked to defeat Prop. 45 vs the less than $5 million raised by its proponents.

Just about every Chamber of Commerce in the state, the Republican Party, the California Medical Association and a host of trade unions all think Prop 45 is a bad idea.

The real money for the opposition, however, is coming from the Health Insurance industry. These are the same people who, while mouthing support for the Affordable Care Act, secretly pumped over $86 million into the US Chamber of Commerce campaign to defeat the bill

The gist of industry opposition to Prop 45 is that “special interests” (what the hell are the medical and insurance lobbies- non-special interests?) are out to give ONE POLITICIAN (their capitalization) new power over health care. They’re also pumping the airwaves full of vague predictions about the quality of health care services declining. (Does anybody remember the Obamacare Death Panels?)

That politician is the State Commissioner of Insurance, whose office has saved Californians an average annual savings of $345 per household, or $8,625 per family over the past 25 years on auto insurance.

Prop 45 requires companies to be transparent and truthful when applying for rate increases for health insurance. While the Affordable Healthcare Act made insurance available to millions of people, it does nothing about what they get charged for that coverage. Given that rates have gone up 185% over the past decade, maybe it’s time that California joined the 35 other states requiring insurers to justify rates for health coverage.

Please ignore the ads against Prop 45. Don’t be a sucker. Your wallet will thank you. Vote for 45.

Bringing the Drug War to Your Doctor’s Office

Proposition 46 Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.

Supporters: Yes on 46, Consumer Watchdog

Opponents: No on 46

Ballotpedia Guide: The details, in plain English

You Might Not Know: Supporters of Yes on 46 include Candace Lightner, Founder of Mothers Against Drunk Driving (MADD), Consumer Advocate Erin Brokovich, Actor Dennis Quaid, and California State Insurance Commissioner Dave Jones (the ONE POLITICIAN cast as a bad guy by the No on 45 crowd)

dr cash4My Analysis: We’ve got a real problem with medical competence in this country. By some estimates, as many as 440,000 people die each year from preventable medical negligence.

A premise underlying Prop 46 is that raising the $250,000 cap on pain and suffering damages, which has never been adjusted for inflation, will address this issue.

If only they’d come up with some evidence that states with higher awards for pain and suffering have better medical care, I’d be all for this. I would most likely support this part in any case; $250,000 doesn’t go very far these days.

So when the trial lawyers (that’s who’s funding Prop 46) got around to marketing the idea of an initiative for bigger payouts, they found polling (and very passionate patient advocates) indicating that incompetent doctors were a concern for many voters. Who better to sell this measure than aggrieved loves ones?

This measure would also require doctors to crosscheck a database with prescribing controlled substances as a means of combating the process of “doctor-shopping” common to abusers of prescription drugs. This process has worked in other states. Somehow, opponents claim, it will never work in California: Hogwash.

Supporters of this initiative have painted the medical world as riddled with substance abuse problems, citing California Medical Board estimates pointing to almost one-in-five doctors (18%) who’ve suffered from drug and/or alcohol abuse at some point during their careers.

Given that 10% of all Americans consider themselves to be in recovery from drug or alcohol abuse problems and another 6.8% were dependent on alcohol or had problems related to their use of alcohol in 2012 AND 9.2 % of the population—had used an illicit drug or abused a psychotherapeutic medication in the past month, I’d say this 18% “scare stat” doesn’t really tell us much more than doctors are human.

What I take issue with about Proposition 46 –which I believe is well-meaning– is the drug testing requirement. That smacks of the “war on drugs” mentality to me. I don’t care if my caregiver smoked a joint before the Paul McCartney concert.

Furthermore, drug testing doesn’t work. Fact: educated users have been beating drug tests for years.

I think people should be able to sue for more money for pain and suffering. Doctors should have to cross check prescriptions for controlled substances. The medical profession needs a lot of policing, including a stringent (non-peer) review process. (not covered in this measure)

I just don’t think peeing in a cup solves this problem. Or any problem for that matter. I won’t vote for this.

And, yes, I realize I’m voting the way the GOP wants me to.



{ 6 comments… read them below or add one }

CliffHanger October 15, 2014 at 7:04 pm

I work in healthcare. Prop 46 really is a BS attempt to pad the lawyers’ pockets with more cash. And it’s an insult to the majority of docs who are good and who, if 46 is passed, will see this as the last straw as they give a flying finger to trying to practice medicine these days.

Bring on single payer healthcare and reasonable malpractice policies that recognize that diseases are not all perfectly curable, patients themselves bear a portion of responsibility for their conditions and yes, all people trying their best to care for you will make mistakes even when they are perfectly well-intentioned.

Come back and talk to me when the lawyers are peeing in a cup!!!


J P October 16, 2014 at 7:24 pm

I work in the legal industry. Vote for prop 45 and your malpractice rates will be reasonable.
Vote for 46 and you can let poor and rich people be treated the same for the same injuries.
Also if I mess up at my job someone may lose some $$$. When health care workers mess up people die. This is the same for pilots, truck drivers, and other people who have jobs that when the screw up kill people. Do you think doctors are really detered by only having to pay 250k for killing a baby? Thats how the law currently works.


want2surf October 17, 2014 at 4:11 pm

“Killing a baby…”
nice, classic lawyer histrionics. Start with the conclusion you want and “build your ca$e” to get there. You suffer ZERO consequence for your mistakes.
Doctors all will make a mistake some time. Medicine is imperfect, so ate doctors.
Get a grip.


J P October 18, 2014 at 1:09 pm

440, 000 health care practioner mistakes a year KILL people, including babies. Its the third leading cause of death in th united states. Do you find those mistakes acceptable?

Lawyers can get get disbarred for mistakes and can get sued for malpractice except there is no cap on damages, unlike doctors, nurses, and dentists. I’m sure you may feel differently about a doctors mistake if it resulted in you not walking again, or killing a loved one.

How about a nurse nit reading a doctors orders and overdosing a person on blood thinners to the point it cause spinal tissue death and paralysis from the neck down…is that acceptable?


Rick Strand October 28, 2014 at 2:33 pm

My daughter, 24 a healthy mother of just 4 months, died ~ Gross medical negligence! Prop 46 will make the Dr. slow down and spend more time on the patient. Prop 46 will hold the Dr.. accountable when they’re careless. Prop 46 will require be drug/alcohol tested, ensuring our safety. The days of the 5 minute appointment, tossing out a plethora of prescriptions without proper diagnosis is coming to an end!! The days of marginalizing our loved ones is .coming to an END. Finally, this white coat, God like complex and arrogance is coming to an END! I look forward to this becoming a law! * The doctor who carelessly gave her 2 medication that put her to sleep killing her and the opposition wants me to be accepting? Not so much! This health and safety initiative reaches into each of our homes, providing that very necessary added layer of security for our families. For those thinking this is about the attorney’s…..Keep in mind that this is the only door open to you when you seek justice and want to hold a Dr. accountable. The only door!! ~ unless it falls under MICRA. Just as soon as Dr’s learn of our loved one’s death, they call legal, circling the wagons while we’re still in shock, bawling uncontrollably. We can expect more and we are going to get it……….Yes on 46!


Paul J. Molinaro, M.D., J.D. October 28, 2014 at 4:54 pm

With regard to the “cap,” please take note that… even if one believes that the cap is an effective means to keep scumbag lawyers on a leash while still fully compensating victims of hack doctors, the amount which our legislature thought to be the perfect amount was $250,000… in 1975… it is now 2014… inflation has reached us in every area… there should be no reasonable argument against the notion that a dollar is 1975 bought more than it does in 2014. An adjustment for inflation to 2014 values should be acceptable… even for those promoting the cap.

Another point to make is that MICRA is absolutely discriminatory in its effect… the limit on pain and suffering of $250,000 is very often the limit of the entire case when it comes to the elderly and more often than it should be when it comes to women and minorities… Punitive damages? There are no punitive damages in medical malpractice cases… Lost wages? People over 65 are retired and women and minorities earn less than white males. Medical Costs? People over 65 have MediCare so there is none, and people on MediCal have none either. People, think before you vote. This law hurts the elderly and women and minorities and the poor… the very people who seem to NOT get the best medical care in the first place.

As a medical malpractice attorney AND physician, I found it difficult to read most of the Internet posts on this topic due to the misinformation, the hatred toward lawyers, the dramatic boo hoo me posts from physicians, and such. It’s really a very simple issue when boiled down. There are of course many great opinions posted, too bad they are often obscured by many over the top replies.

When I look into talking on a medical malpractice case, I know that physicians are not held to a standard of perfection or even to the standard of being the best or even almost the best in their field… They are held to the standard of care for their community and peers. The California legislature has made the legal procedures and rules for medical malpractice cases different from other areas, and done so with a purpose – that purpose being protection of doctors… and while there are many who see protecting doctors as a bad thing, it is not in and of itself really so… some doctors should be protected while others should not get the extra-legal shield afforded by the law. Physicians provide an extremely valuable services to the public and one that requires an enormous amount of skill and brain power to provide correctly – all in a field which is not black and white science but science and art combined – lives are at stake, opinions vary, advancements in science abound, no two patients are alike, etc. In addition, medical malpractice cases are extremely expensive and difficult to bring (properly, that is… anyone can slam together an unintelligible complaint and pay the filing fee). To make a suit “worth it,” there needs to be significant damages – and damages that would not have occurred otherwise. As a generalized example, a one month delay in treatment, that is just as effective one month later as it would have been earlier is not going to provide significant damages.

The current law makes bringing frivolous or even low dollar suits economically destructive for an attorney… as it stands now, those of us who know what we are doing will only take the high dollar cases… the hard costs of suit are enormous (as medical experts now regularly charge upwards of $800 an hour for testimony).

As for people who figure this is someone else’s problem… I hate to remind people that the victims of medical malpractice never thought they would be victims before they were… they were plain old people who trusted doctors and such prior to their “incident” (as defense counsel like to callously call it). Their lives are ruined and they deserve fair compensation… since medical injury cannot be undone, all the courts can offer is money.

– Paul
Paul J. Molinaro, M.D., J.D.
Attorney at Law, Physician


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