Columnist Jon Ralston: The clash of special interests

Jon Ralston hosts the public affairs program Face to Face on Las Vegas ONE and also publishes the Ralston Report. Ralston can be reached at [email protected] or (702) 870-7997.

BEYOND the manifest crisis of doctors bolting their doors and leaving for greener (literally and figuratively) pastures because of an insurance crisis, there lies a complex political dynamic that reveals the usual and incestuous tangle of relationships and players.

You have one perennially potent special interest -- the trial lawyers -- that already has powered up with a propaganda booklet as the bogeyman of tort reform looms. You have one perennially inept special interest -- the doctors -- that has organized like never before and retained influential consultants to press its case. And you have a third special interest -- the insurance companies -- that has been content in the past to smile from the sidelines as the doctors and lawyers slice up each other, but now must worry about being brought into this bloodsport.

Oh, yes, I almost forgot 64 other players on the stage -- the 63 legislators whom voters license to practice politics every other year for four months and a governor who has friends on all sides. And then there is one more important special interest that could determine the outcome -- labor, which usually sides with the trial lawyers but will be heavily courted by doctors and could change this mercurial political matrix. "If labor stays with its partners (trial lawyers), this thing is over," declared one knowledgeable insider.

As patients fret about losing their OB/GYNs and other specialists to other cities, most people don't realize that once the short-term problem is addressed, a longer term fix will still be needed. Before Session '03 commences next February, Gov. Kenny Guinn and Insurance Commissioner Alice Molasky will attempt to bridge the gap.

The doctors surely will form their own insurance company. But until they do, expect the governor to guarantee their coverage -- some physicians can't afford insurance as of June 1, others just can't get it at all. And when he makes an announcement this week, also expect the governor to talk about the longer term issues that need to be addressed -- fixing procedures at a state screening panel, which is supposed to winnow frivolous cases before they get to court; ensuring that patients have access to information about doctors and lawyers; and, of course, the possibility of tort reform. Don't expect Guinn to take positions, but to outline the debate.

And that's when the real politics begin. To wit:

The trial lawyers already have an advantage because they are professional persuaders and have put out a booklet titled, "The Facts About Medical Malpractice Insurance in Nevada." In it, they argue that the crisis here was caused by an insurance company -- St. Paul -- that gambled poorly in the stock market (hello Enron) and had inept underwriters.

The lawyers have effective advocates with the likes of Bill Bradley and Dean Hardy. And they are being counseled by well-connected consultant Billy Vassiliadis, who isn't being paid but who has many relationships he can bring to bear. One of those is with uberlobbyist Harvey Whittemore, a fellow gaming advocate who is nearly always on the same side as Vassiliadis.

The doctors, who are almost never a force to be reckoned with because they have never been organized, have retooled. They have two consultants, Pete Ernaut and Mark Brown, who are close to the governor, and another, Scott Craigie, who is a former chief of staff to Democratic Gov. Bob Miller. The doctors appear unified for the first time after years of having various splinter groups. And some are willing to go the referendum route on tort reform if they can't get legislative commitments.

Beyond the trial lawyers' inherent clout, the doctors also must confront an Assembly that is almost certain to remain Democratic. Assembly Majority Leader Barbara Buckley, who is chairing an interim committee on the subject, thrives on health care issues and now has a forum and the power to guide this debate.

Buckley and Guinn have clashed over these kinds of issues before -- most notably last session on SeniorRx, which eventually resulted in a compromise. This issue may, at some point next year, be decided between those two again -- with a lobbyist or two in the back room, too.

Until then, the campaign begins. Labor will be courted by the doctors, who will insist that tort reform could bring down union health care costs. The insurance companies have traditionally survived by relying on federal, institutional protections on their business and a "If you try anything, we'll just leave the state" attitude. It's a game of brinkmanship that has worked in the past because of fears of unavailability of insurance.

Legislators and Carson City candidates will have their feet held to a fire that will only burn more intensely. And the elections could mean everything. If the Senate stays Republican and the Assembly remains strongly Democratic, it's hard to believe much will happen. But what if the Republicans cut into the Democratic margin in the Assembly or by some miracle the Democrats take the Senate?

The only guarantee here is that the same players influencing the debate during 2002 will be there making the deals in 2003.

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