Lawrence J. McQuillan’s & Hovannes Abramyan’s 2010 edition of the U.S. Tort Liability Index, which has a number of measurements included in the U.S. Index of Health Ownership, ranks states according to 42 variables.

Eight of the measurements in the U.S. Tort Liability Index are relevant to the U.S Index of Health Ownership: One output and seven inputs. The previous edition of the U.S Index of Health Ownership included six measurements of medical tort, but McQuillan & Abramyan have discovered more variables for their 2010 edition of the Tort Liability Index, allowing more detailed measurement.

As a partial update of the U.S. Index of Health Ownership, this brief analysis calculates a medical-tort index from a simple average of the eight relevant variables.  Mississippi, Nevada, Michigan, Colorado, and Louisiana lead the pack; while Vermont, Rhode Island, Kentucky, Pennsylvania, and Iowa bring up the rear. Even the leaders, however, lag in some measurements.

Mississippi, for example, leads on procedural rules: Pre-trial screening or arbitration and conditions on the use of expert witnesses. However, it does not limit lawyers’ ability to abuse their privilege by limiting their share of awards. Colorado and Louisiana also fail to impose limits. Unfortunately, the laggards do not show a similar pattern: The bottom five states perform poorly in all eight measurements.

Reducing the burden of medical tort is critical to increasing Americans’ health ownership and reducing medical costs that curtail our access to care. Some progress is evident, but states aiming to improve their medical-tort laws still have a long way to go.

Scratch that. In at least one state, more people disapprove of “reform” now than they did before it was passed:

Arkansans oppose the overhaul of the nation’s health care system in slightly larger numbers than they did before it became law, a new poll shows.

The poll, commissioned by the Arkansas News Bureau/Stephens Media, found that 64 percent of respondents oppose the Patient Protection and Affordable Care Act, which President Obama signed into law on March 23. A similar survey conducted in January found that 58 percent opposed the measure then.

Are the numbers driven up by the effort of outside groups, as some people suggest? That’s possible. But with the effects of the law kicking in–news of higher premiums, companies writing down their financial position, and so forth–that claim just may be borne out of unfounded optimism.

The group Secure Arkansas has announced that two of its officers have filed a suit against Health and Human Services Secretary Kathleen Sebelius and other officials. This comes after the Arkansas attorney general declined to take action, calling legal efforts to derail the new law politically motivated.

McDaniel had already blocked the efforts by the group Secure Arkansas to put a question on the fall ballot. The group has said it has given up on the ballot question and will instead pursue legal action. A quick look at the group’s web site shows no such statement, but they are still trying to exclude illegal aliens from public health care programs. I suppose that as a point of law you can say that illegal aliens should in fact be excluded, but the group is going after chump change.

McDaniel has also scotched, for a second time, a ballot measure proposed by the group Secure Arkansas, which would enact the Freedom of Choice in Health Care Act. He has called the language in the proposal “ambiguous,” but also disagrees with it on legal grounds: ““Stated another way, your proposal will be either invalid or ineffective.”

One such program is ARKids, which is Arkansas’ version of SCHIP, which, roughly, is Medicaid for children. Writing about the program, the Arkansas Policy Foundation says “The state of Arkansas has never disclosed the true cost of the program to taxpayers by calculating the long-term liabilities under various eligibility scenarios using the mechanism of an independent audit.”

That sounds like pretty foolish planning.

On a related note, the Robert Woods Johnson Foundation, a fan of government health programs, praised ARKids for encouraging fraud. OK, they didn’t put it that way, but it did say the state increased enrollment by “Switching to self-declaration of families’ income (from verification of income).”

No calculation of liabilities? No verification of income?

However, the biggest problem with the Medicaid expansion in the Senate health bill is not the “Cornhusker Kickback,” but that it leverages an already flawed formula to determine federal payments to state Medicaid programs. The Senate bill would motivate states to invest more resources in recruiting higher-income residents into Medicaid, rather than traditionally eligible beneficiaries, including the blind and disabled. The Senate bill also gives richer states a bigger Medicaid bailout than lower income ones. New Hampshire, Maryland, and Connecticut get the biggest handouts, while Mississippi, West Virginia, and Arkansas are short-changed, according to my just published analysis.

The Federal Medical Assistance Percentage (FMAP) is the federal financing formula that encourages each state to spend its own taxpayers’ money irresponsibly in order to maximize its take from other states. For example, California’s FMAP was traditionally the 50 percent minimum: For every dollar California spent, the U.S. Treasury would kick in one dollar. However, the FMAP is supposed to give more federal dollars to states with more poor people. So, Mississippi has had the highest FMAP, 75.67 percent: For every dollar Mississippi spent on Medicare, the U.S. Treasury would kick in $3.11.

The Senate bill proposes a much higher FMAP, averaging 90% nationwide, in 2019. However, the higher FMAP would only apply to the relatively higher-income, able-bodied, newly eligible, beneficiaries. People eligible under the current law will still draw the previous FMAP. States with FMAPs of 50 percent would see them increased to 82.3 percent for the newly eligible beneficiaries. Imagine yourself a county public-health bureaucrat who would attract one federal dollar for every dollar spent on a blind or disabled Medicaid beneficiary, or $4.65 for every dollar spent on an able-bodied young man. Obviously, you would invest your energy in recruiting the able-bodied youth.

Furthermore, the expanded FMAP gives more federal fiscal leverage to rich states: Each thousand-dollar increase in money income per capita is associated with a one-percent increase in the FMAP under the Senate bill, and this statistically significant regression explains over one-third of the variance in the change in FMAP.

For example, New Hampshire’s money income is $68,175 per capita, which is $16,942 greater than the national average of $51,233. Its FMAP would increase from 50 percent to 82.3 percent, an increase of 65 percent. This is 18 percent greater than it would have been if higher per capita incomes did not explain the Senate’s “generosity.” On the other hand, Mississippi’s FMAP increases by only 20 percent: From the current 74.73 percent to 95 percent. This increase is 15 percent less than it would have been if the state’s low income did not explain its poor outcome in the Senate’s FMAP allocation.

Instead of leveraging the FMAP, Medicaid reform should jettison it entirely, in favor of easily understood block grants.

He cites the higher Medicare payments in McAllen, Texas, compared to El Paso as an example of how costs can vary based on how individuals receive health care. But again he undermines his own argument by recognizing that McAllen and El Paso are in the same state. If the insurers in Texas can figure out how to make a living selling policies to people in such varied cities within a state, surely at least some of them can figure out how to do that for people in different states. His example utterly undermines his contention that “variation in how care is practiced is the main reason a premium quoted in one state won’t hold in another.”

Insurance regulations, which Taylor dismisses because they do not explain the Medicare cost differential in Texas, raise the cost of insurance, not care. These regulations are indeed a significant reason insurance in North Carolina is less expensive than in the Northeast but fifty percent more expensive than a similar policy purchased in Missouri.

Even if Taylor were correct in stating that variations in the practice of medicine were the key, insurance companies still have another tool at their disposal. They build networks of doctors who are willing to take negotiated payment rates for their services. Every doctor in North Carolina would likely be out-of-network and so leave little additional downside for an insurer.

So why not give it a try? The worst outcome, if Taylor is right, is that it does not help as much as expected. The best outcome is getting insurance for as many as 15 million people who are currently uninsured at no additional cost to the other 285 million Americans. Seems to fit right in with the Hippocratic oath, unlike the Pelosi overhaul.

Americans lack the basic freedom to make their own health care decisions. The Index measures the degree to which individuals, be they patients, health professionals, entrepreneurs, or taxpayers, “own” the health care in their states.

The lack of health ownership is a real problem. Almost half of the country’s health care spending is in the hands of the government, instead of patients themselves. The other half is governed by regulations inflicted upon doctors, health plans and patients.

The Index uses 24 variables to quantify how state laws and regulations affect the liberty of citizens involved in state government health plans (primarily Medicaid), the private health-insurance market, and the provision of medical services. It also assesses the effect of medical tort on people’s freedom to engage health services.

Alabama, Montana, Nebraska, North Dakota, and New Hampshire finished in the top five, as the states that allow their citizens the highest degree of health ownership. Alabama leads the pack primarily because of a lightly regulated private insurance market, and good control of state government programs. Also, the state performs well on medical tort indicators. Alabama’s regulatory environment for providers favors competition, and government health programs run more effectively than in most states.

New York, Massachusetts, Rhode Island, Vermont, and North Carolina rounded out the bottom five, as the states in which the government has taken the most undue control of health care from its citizens. This is the second year that New York was in last place. The state suffers from government health-care programs that are out of control, a grossly overregulated private-insurance market, and almost completely uncompetitive provider markets.

A full listing of all 50 states and their rankings is contained in the Index.

The Index will give concerned citizens a good basis to demand reforms from their state politicians that will put American families in charge of American health care, instead of government and special interests.