Reforming the relationship between medicine and the law of tort

The Australian Government's medical indemnity package is predicated on the belief that the current crisis is primarily one of insurance. However, an examination of the fault-based tort system illustrates that, irrespective of their insurance status, doctors are profoundly affected by the adversarial process and their response to it is leading to sub-optimal patient care. This article argues that the adversarial system of medical negligence fails to satisfy the main aims of tort law, those being equitable compensation of plaintiffs, correction of mistakes and deterrence of negligence. Instead, doctors experience litigation as a punishment and, in order to avoid exposure to the system, have resorted not to corrective or educational measures but to defensive medicine, a practice which the evidence indicates both decreases patient autonomy and increases iatrogenic injury. This is unacceptable and suggests that the package has missed the point. This article proposes an alternative medico-legal tort scheme which attempts to overcome some of these problems.     

How some rules just don't matter: The regulation of lobbyists

Brinig, Holcombe, and Schwartzstein (1993) have argued recently that lobby regulation restricts entry into the population of lobbying organizations, and that the number of lobbying organizations then influences legislative activity. However, they analyze only the relationship between the restrictiveness of lobby regulation and legislative activity, thereby assuming that regulation actually reduces numbers of registered interest organizations. We test this assumption with data on state interest organization populations and find little support for it. We consider several other explanations and comment more generally on the status of institutions and their rules in the study of political phenomena.     

Parents' Achievement Goals and Perfectionism in Their Academically Talented Children

Parents of academically talented students have been accused of pushing their children to attain high levels of achievement, as well as fostering performance anxiety and perfectionism in their children. Parents' achievement goals for their children, in terms of the focus on high performance or learning for understanding, were examined in relation to children's perfectionism. Parents (127 sets) and their sixth-grade academically talented children (56% boys) completed the Multidimensional Perfectionism Scale and parents reported their achievement goals for their children. Most parents reported learning goals, suggesting that emphasis on meeting external standards is not predominant among parents of talented students. Children of performance goal parents were significantly more likely to exhibit dysfunctional perfectionism than children of learning goal parents, reporting a combination of high concern about mistakes, doubts about actions, parental expectations, and parental criticism. Parents' achievement goals can help predict which students might be at risk for adjustment problems and future underachievement.     

Promise and peril

The size of the federal budget tells only one part of the tale of government's presence in the market economy. The enormous amounts of non-tax dollars government requires to be spent on regulation – estimated at $647 billion per year – powerfully argue for some sort of regulatory scorekeeping. Regulatory costs are equivalent to over one-third of the level of government spending. A regulatory budget can be an effective tool both for spurring reform and monitoring regulatory activity.At bottom, today's rulemaking process is plagued by the fact that agency bureaucrats are not accountable to voters. And Congress – though responsible for the underlying statutes that usually propel those unanswerable agencies – nevertheless can conveniently blame agencies for regulatory excesses. Indeed, Americans live under a regime of Regulation Without Representation.A regulatory budget could promote greater accountability by limiting the regulatory costs agencies could impose on the private sector. Congress could either specify a limit on compliance costs for each newly enacted law or reauthorization of existing law, or Congress could enact a more ambitious full-scale budget paralleling the fiscal budget, a riskier approach. A comprehensive budget would require Congress to divide to a total budget among agencies. Agencies' responsibility would be to rank hazards serially, from most to least severe, and address them within their budget constraint. In either version of a regulatory budget, any agency desiring to exceed its budget would need to seek congressional approval.Regulatory costs imposed on the private sector by federal agencies can never be precisely measured, and a budget cannot achieve absolute precision. Nonetheless, a regulatory budget is a valuable tool. The real innovation of regulatory budgeting is its potential to impose the consequences of regulatory decisionmaking on agencies rather than on the regulated parties alone. Agencies that today rarely admit a rule provides negligible benefit would be forced to compete for the right to regulate. While agencies would be free to regulate as unwisely as they do now, the consequences could be transfer of the squandered budgetary allocation to a rival agency that saves more lives.Budgeting could fundamentally change incentives. Under a budget, adopting a costly, but marginally beneficial, regulation will suddenly be irrational. Congress would weigh an agency's claimed benefits against alternative means of protecting public health and safety, giving agencies incentives to compete and expose one another's bogus benefits. Budgeting could encourage greater recognition of the fact that some risks are far more remote than those we undertake daily. In the long run, a regulatory budget would force agencies to compete with one another on the most important bottom line of all: that their least-effective rules save more lives per dollar spent (or correct some alleged market imperfection better) than those of other agencies.There are clear benefits to regulatory budgeting, but there are also pitfalls. For instance, under a budget, agencies have incentives to underestimate compliance costs while regulated parties have the opposite incentive. Self-correcting techniques that may force opposing cost calculations to converge are only at the thought- experiment stage. However, limitations on the delegation of regulatory power and enhancing congressional accountability can help.Certain principles and antecedents can help ensure that a regulatory budgeting effort succeeds. Explicitly recognizing that an agency's basic impulse is to overstate the benefits of its activities, a budget would relieve agencies of benefit calculation responsibilities altogether. Agencies would concentrate on properly assessing only the costs of their initiatives. Since an agency must try to maximize benefits within its budget constraint or risk losing its budget allocation, it would be rational for agencies to monitor benefits, but Congress need not require it.Other ways to promote the success of a budget are to: establish an incremental rather than total budget; collect and summarize annual report card data on the numbers of regulations in each agency; establish a regulatory cost freeze; implement a Regulatory Reduction Commission; employ separate budgets for economic and environmental/social regulation; and control indirect costs by limiting the regulatory methods that most often generate them.A regulatory budget is not a magic device alone capable of reducing the current $647 billion regulatory burden. Yet a cautious one deserve consideration. Having good information is an aid in grappling with the regulatory state just as compiling the federal fiscal budget is indispensable to any effort to plan and control government spending.     

Public accountability: Effectiveness, equity, ethics

This article tests a wide range of government activities against requirements for public accountability. The article explores the incentives for ethical behaviour by public officials; the need for more outcome focused performance indicators, tensions between parliamentary and managerial accountability; the standards of accountability applied to public providers of services can be applied to private providers; the utility of spelling out service requirements in advance; the impacts on accountability of the convergence of the public and private sectors; the need, where responsibility for programs is collaborative, for a clear governance framework, tensions between representative and participative democracy, and trends towards more participative and collaborative leadership.