March 04, 2004

The California Workers' Comp Mess

Alan Krueger writes about the California workers' comp mess:

Economic Scene: Alan Krueger: ...The central problem in California now is that the costs paid by employers are the highest in the country, while the benefits received by workers are about average - in part because many cases are disputed, which wastes resources. Total costs for California employers increased to $29 billion in 2003 - eight times the gross domestic product of Haiti - from $11 billion in 1998. By one estimate, the average employer in California pays 5.2 percent of payroll for workers' compensation insurance, more than twice the average of other states. Rates are much higher in hazardous occupations: 43 percent for loggers, 33 percent for roofers, 22 percent for carpenters and 18 percent for truck drivers.

The governor maintains that these high costs are the main reason jobs are leaving the state. But this confuses who writes the check (employers) with who bears the burden of the program (employees). Research has found that most workers' compensation costs are shifted to workers in the form of lower wages over time, so the effect on jobs is probably minimal.

Nonetheless, reducing inefficiency and administrative costs is to everyone's benefit. The main problems with California's system are: Thirty percent of claimants who miss more than a week of work hire a lawyer - much higher than in the other states - according to Robert Reville, director of the Rand Institute for Civil Justice. Lawyers are involved in three-quarters of permanent disability cases, and their legal fees averaged $8,352 in 2002, or 20 percent of combined medical and cash benefits. For a system intended to reduce litigation, these figures represent failure.

Prof. John Burton of the Rutgers School of Management and Labor Relations, widely considered the nation's leading workers' compensation scholar, traced many of California's problems to its complex system for rating permanent injuries that are only partly disabling. Such injuries account for almost 90 percent of benefit costs in California and 70 percent nationwide. Because the system gives much discretion, litigation is common for hard-to-measure medical conditions like back sprains. Furthermore, some injuries, like those to the shoulder, receive particularly low benefits compared with the wage loss workers experience. The adversarial relationship that develops between workers and employers in contested claims causes California to have one of the lowest return-to-work rates of all states.

Medical costs are high, almost as high as the cash benefits that are meant to replace lost wages. Because workers' compensation insurance pays all the bills, doctors and patients have little incentive to restrain costs. Increasingly, in California and elsewhere, health care providers are shifting medical costs to workers' compensation by prescribing more services or charging more per service. Medical costs are also high because workers and employers often hire dueling doctors to bolster their cases. Doctors selected by workers tend to rate a given injury as 34 percent more severe than doctors selected by employers or insurers; independent doctors tend to be between, but closer to employers' doctors. With this much difference of opinion, it is no wonder that so many cases are disputed.

While there is much agreement about the source of the problems, there is considerable disagreement about the solutions. Professor Burton proposes using the American Medical Association's guidelines for rating the severity of disabilities. The guidelines are used in most states and provide a more objective and more clear basis for decisions, although he acknowledges that they are imperfect and should be adjusted to reflect earnings losses associated with various injuries. He also proposes basing claimants' lawyers' fees on the difference between the amount employers offer and the award workers receive - the lawyers' value added - rather than the full amount of the award. And to foster cooperation, he suggests giving lawyers a bonus if workers return to work for a specified length of time...

Posted by DeLong at March 4, 2004 07:48 AM | TrackBack | | Other weblogs commenting on this post
Comments

"Medical costs are high, almost as high as the cash benefits that are meant to replace lost wages. Because workers' compensation insurance pays all the bills, doctors and patients have little incentive to restrain costs. Increasingly, in California and elsewhere, health care providers are shifting medical costs to workers' compensation by prescribing more services or charging more per service."

This doesn't just apply to workman's compensation, either. It applies, in spades, to both government medical insurance, and overly-comprehensive private insurance.

This quote should be tattooed on the chest of some advocates of nationalized health care.

A good article on the effect of disconnecting patients from costs, and removing market forces from medical care, can be found here:

http://www.cato.org/pubs/pas/pa211.html

Figure 4 is particularly instructive.

Posted by: tbrosz on March 4, 2004 08:23 AM

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43 percent for bloggers?

Sorry, misread that.

Posted by: Jim Glass on March 4, 2004 08:23 AM

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So employers do pass through costs like SS medicare and workman's comp to the employees. I can't tell you how many times a union guy has emphatically told me the opposite.

I think Krueger misses it little though. A state like California has a view of the empoyer. If it overly burdens employer/employees with a heavy handed workers comp system then you can rest assured its other regulatory practices are probably just as heavy handed and unproductive. This SOP is what is driving businesses from California not workers comp alone.

Lets be clear. Regulation hits workers right in the pocket book. Some regulations are needed some are not but lets inform people who pays the freight.

Tbrosz, I had exactly the same thought as I was reading the article. Its amazing the parties cannot have an honest discussion of the consequences of single payer healthcare. It also shows which party plays populist politics.

I thought the article made an interesting point of offering an alternative to current lawyer compensation based on value added. I wonder which party would favor such a reform.

Posted by: Brian on March 4, 2004 08:48 AM

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has no effect on jobs?

Unless you count the effect on wages. Because worker comp is a direct labor cost, money paid for worker comp insurance by the employer is money not paid to his workers as taxable wages and salary. This is elementary -- and lower wages can cause workers to leave a state, if not their employers.

As for the solution, that's not so easy. I do know that fraudulent claims are a big -- make that enormous -- part of the problem. As a small-time employer I've seen it first-hand.

The way I dealt with it was to use a profit sharing plan -- not as a fillip to wages, but as the whole shebang. I then pointed out to my workers that any of their fellows who were faking back injuries, carnel tunnel, etc., were just ripping them off.

In my small town the workers started to keep an eye on each other. But of course this wouldn't work in impersonal California.

BTW, their real hourly wages were one and a half times that of other workers doing similar jobs in our town, which was fine by me as I was making one and a half times as much as my competitors. So maybe negotiating wages as a share of net product is the way to go.

Posted by: Luke Lea on March 4, 2004 09:13 AM

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"Eight times the gross domestic product of Haiti" -- perhaps it's time to standardize the third-world-comparison unit. For example, how does "eight times the gross domestic product of Haiti" compare to the gross domestic product of El Salvador or Sierra Leone? I have no idea.

I would suggest making a list of unquestionably third-world countries, averaging their GDP per capita, averaging their populations, and then calling the averaged result the "Standard Third-World GDP Unit". This could be recalculated every year, and certain countries could be added to or removed from the list as their conditions changed, so that you'd end up with annual "2003 Third-World GDP Unit". Then in turn these annual units could be averaged again after ten years to produce an inflation-adjusted unit for the whole decade, making the annoying little annual units unnecessary.


Posted by: zizka / John Emerson on March 4, 2004 09:14 AM

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It's not a proposal to limit lawyer's compensation; it's a proposal to limit the CLAIMANT'S lawyer's compensation. Since the claimant's lawyer gets paid a percentage at the end of the process, she has an incentive to simplify and expedite the process. Since the Insurer's lawyer get paid by the hour, he has an incentive to complicate and delay. Where do you think the problem lies?

Posted by: joe on March 4, 2004 09:18 AM

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Employers pass through ALL costs to the employee, one way or another. There is a column somewhere in the books of an employer that reads, "this is what it costs the company to hire this guy." Included in this are the benefits, worker's comp, all those marvelous goodies mandated by the government like paid family leave, employer's contribution to Social Security, and many other things.

The assumption many workers make that these things are somehow "free" is a mistake.

Posted by: tbrosz on March 4, 2004 09:26 AM

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Brian: "So employers do pass through costs like SS medicare and workman's comp to the employees. I can't tell you how many times a union guy has emphatically told me the opposite."

Well, it is somewhere in between. While employers would like to pass through as much as possible of their business costs to other parties (including their workers), they are in a competitive environment, and if wages start becoming too low, the will run into worker retention problems, which puts a limit on how much of the revenue cost they can shift to workers.

"Lets be clear. Regulation hits workers right in the pocket book. Some regulations are needed some are not but lets inform people who pays the freight."

The freight is always paid (in the aggregate) by the people who create the goods and services of value in the society. The cost can assume several forms -- workers getting less than a fair wage for the work out of which the system is paid, others having to pay more than a fair price for the product, and the opportunity cost of not paying for other valuable services instead.

Let's also be clear about where the more severe worker's comp activities take place -- in fields where people do often times hazardous physical labor and get hurt, either in accidents or by long-term physical wear. I suspect that neither you nor tbrosz fit that description (I don't), and we are most likely only endangered by carpal tunnel, or bad posture while sitting in the office. (And I have heard some --true-- horror stories of exactly how some people got injured.)

It is always easy to judge what others need, if you can be reasonably assured that _you_ will never need it.

Posted by: cm on March 4, 2004 09:30 AM

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in his clumsy way, tbrosz is trying to describe the demand for labor

Note also that taken to the extreme, one could infer that the supply of labor is reduced in California (especially if everyone has the "labor/wage illusion" that tbrosz lays out), resulting in persistent labor shortages in the state. What may also be implied is some adverse selection in California, leading to a labor force that is clumsier and more accident prone than the norm. We've always been told that California is a magnet for hapless weirdos -- now we know why! It's the worker's comp (corker's womp?) system!

Posted by: David on March 4, 2004 09:32 AM

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http://www.epinet.org/content.cfm/issuebriefs_ib198

Educated, experienced, and out of work: Long-term joblessness continues to plague the unemployed
By Sylvia Allegretto and Andy Stettner

Long-term unemployment—when unemployed workers have been seeking work for six months or more—is the most severe form of joblessness. The consequences of extended periods of joblessness are significant: the long-term unemployed often face financial, personal, and health care hardships as well as the loss of their unemployment insurance benefits. An analysis of long-term unemployment from 2000 to 2003 (a period spanning the recession that occurred between March and November 2001) shows that the number of people without work for six months or more has risen at the extraordinarily high rate of 198.2% over this period. Job seekers with college degrees and those age 45 and older have had an especially difficult time finding work, with long-term unemployment for those groups rising by 299.4% and 217.6%, respectively.

Since the recession ended in November 2001, elevated rates of long-term joblessness among the unemployed have persisted longer than during any similar period in the past 30 years. The long-term unemployment situation continued to worsen between 2001 and 2003 as job creation lagged....

Posted by: anne on March 4, 2004 10:46 AM

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"I suspect that neither you nor tbrosz fit that description (I don't)"

CM, What is your point. I am implying that politicians of a certain persuasion who carp on businesses for trying to get out from under regulation in order to enrich themselves are simply lieing when it is as you admit hardly as simple as that. Dem's get the labor vote while calling for vastly more stringent regulation and villainize big business in the process. I just want the tradeoff's made clear to those that it effects namely workers and consumers.

Are you trying to say California is correct in operating a system twice as expensive as others just to receive less productive system for workers and employers. Sure its a jobs program for worker's comp lawyers, but you act as if there is no alternative when the article clearly states that there is quite suitable alternatives.

Its boggling to read the posts such as yours admitting economic truths and then support politicians whose rhetoric flies in the face of such truths.

Posted by: Brian on March 4, 2004 10:54 AM

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Why is Krueger's incidence proposition upsetting some? He is making two implicit assumptions: (a) labor markets clear; and (b) a relatively inelastic supply of labor schedule. Both seem to be reasonable propositions. Does those who question his statement have evidence that his assumptions are flawed?

Posted by: Harold McClure on March 4, 2004 11:36 AM

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Luke Lea -

"Because worker comp is a direct labor cost, money paid for worker comp insurance by the employer is money not paid to his workers as taxable wages and salary. This is elementary -- and lower wages can cause workers to leave a state, if not their employers....

"The way I dealt with it was to use a profit sharing plan -- "

Excellent!

Posted by: lise on March 4, 2004 12:09 PM

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What is " over-comprehensive" private insurance?

Do I under stand this correctly, a non-liberal
commentator is opposing a completely free market
contract ?

Posted by: spencer on March 4, 2004 12:24 PM

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I actually do believe that our health system and insurance sytem are extremely inefficient and expensive.

But who is responsible for this, the govt or the
market -- especially in California.

Most of the inefficiencies I see are much more a product of the HMOs, and private insurance companies trying to "cherry-pick" the insurance pool, not the govt.

Posted by: spencer on March 4, 2004 12:30 PM

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OK -- I scanned the CATO article.

It raised more questions and provided few answers.

One quick question, how did the creation of a panel to reviews Doctors cause the costs of medical care to go up 10 years before the panel was created? I know in a true perfectly competitive model all transactions are suppose to be based on everyone knowing all the answers, but isn't this stretching the point.

A second question, as a typical consumer where am
I suppose to get the information or analysis that will allow me to select the best, most cost-
efficient course of treatment? Unless it is really something massive and unusual I am going to take the judgement of the Dr that I need a treatment and it does not matter who is paying for it. Now, DRs did use to alter their treatment if they felt the patient did not have the means to pay it -- ie, they let them die,

Isn't a comparison of pre-WW II expenditures when the level of treatment was quite different to current level somewhat unrealistic. It is like the question of why Drs. no longer make house calls. 75 years ago all the Dr. could often do was ease the pain, so a few pills in his bag allow him to give state of the art treatment.
Now, Drs. want you to come to their office or the hospital because the equipment that can treat you and most likely cure you is in that location.
The Dr does not carry a lab in his bag for house
calls.

The article provided an interesting theory, but it has little contact with reality.

Posted by: spencer on March 4, 2004 12:56 PM

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Spencer

Notice just what the large drug companies came away with from the Medicare legislation. Our health care problems are not not not caused by public administration of programs.

Posted by: anne on March 4, 2004 12:57 PM

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Partial deregulation of the industry is one of the culprits, I think. One thing that was changed was removal of a "minimum amount" you could charge for Worker's Comp. Insurance. Companies were then free to underbid each other to entice more business their way. Most carriers are now gone from the market. The ones that are left, the winners of the price wars, are raising rates to shore up their profitability.

Posted by: contrariwise on March 4, 2004 02:05 PM

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I am amazed how unaware some of these right-wing commenters here are of the good old-fashioned distinction between value and surplus-value, which is a feature of all economic systems, mutatis mutandis, not just industrial capitalism. And, yes, public expenditures are, at least in part, a form of the extraction of surplus-value, but they also provide essential conditions and regulations for the whole system of value, (i.e. "wealth"), production to function in the first place, as value is produced by the several and cooperative combination of inputs and activities and not just by the heroic genius of individuals. These commenters are inverted Proudonistes without realizing it: "Qu'est que c'est, la propriete'? C'est le vol!"

The cost of social insurance premiums, such as occupational comp, are simply a component in the prices of production that need to be balanced out between industries, since the costs of labor are a component that obviously enters into those prices, which is to say, the costs of maintaining the labor force, which would include the differential degrees of risk borne by the labor forces in different industries. But once again, I am amazed at how an obstructive and incoherent bureaucracy can make such a hash of it. But is this a necessary feature of bureaucracy? Couldn't a system of administrative magistrates, well endowed with medical expertise and industrial information, handle these matters efficiently and at relatively low transaction cost, with, of course, a right of appeal should there be some actual inequity in their decisions? Doesn't the cost-inflation and inefficiency have something to do with the pervasive environment of laissez-faire competition and litigiousness, and don't these two grow hand-in-hand? Proposals for market-based solutions and privatization, well-decked out with precise calculations for x marginal gains, often, when applied in the real world, amount to "principled" proposals for cost-shifting, and, as we all know, in this country, lawyers have a finger in every pie, and will manage to profit from every side of the case-( call it the "Bleak House" syndrome.) (Contariwise above provides some small testimony to this effect.) It is little wonder that some blue-collar workers, seeing everybody else apparently scamming the "system", will feel little compunction in attempting the same, from their limited standpoint and restricted opportunity. This needs to be controlled for, to be sure, but I doubt it is the largest part of the problem.

Tbrosz' claim that excessive insurance costs coming implicitly out of wages will drive workers from the state of CA, (leaving out all the ceterus in the paribus), ignores the fact that the resulting labor shortage would drive up wages, (c.p.), reversing the alleged effect. Economic thinking is, at least, supposed to be "Newtonian" in its consideration of effects.

Zitka:

I, too, was struck by that gratuitous Haiti comparison. Since it's in the news nowadays, I can tell you the Haiti is recorded as having the 4th lowest per capita GDP in the world.

Posted by: john c. halasz on March 4, 2004 03:44 PM

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John you say "Couldn't a system of administrative magistrates, well endowed with medical expertise and industrial information, handle these matters efficiently and at relatively low transaction cost"

What bureaucratic organization do you know that exhibits such traits? Can such a system efficiently balance the interests of workers and employers? Ahh, why do some project a capacity in gov't to effectively accumulate, colate, evaluate and act on information. I recently heard Bill Gates comparing Japanese and American efforts to encourage advancement in AI research. Japan takes the heavy handed approach of gov't funding and coordination versus the US gov't method of simply spreading money around to individuals and Universities. In his opinion, we are beating the pants off of them.

John, you go on the say tbrosz " ignores the fact that the resulting labor shortage would drive up wages".

You are the one who ignores the fact workers comp. is hardly the only area of California's inefficient regulation. While workers may be leaving, it is probably in order to chase the companies who have already left California first. Less jobs and less workers = no wage inflation.

Posted by: Brian on March 4, 2004 04:19 PM

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Brian:

I'm not a Californian and wouldn't know how to straighten out the mess that is CA politics. But that doesn't effect anything I posted, on principle. The solution to ineffective and inefficient regulation is often better, more effective regulation and modes of regulation, rather than relying on the supposed "miracle" to be wrought by free markets. For example, rather than have OSHA expand it's parallel bureaucracy to enforce occupational safety and reduce industrial accident risks, wouldn't it perhaps be better to have OSHA, especially in the case of large concerns, to contract with firms, provided the workers of the firm were fully party to the contract and its implementation, such that the firm would be responsible for the finding of ways and means to meet its obligations and goals within the context of its internal operations, while OSHA could confine itself to rigorous supervision and enforcement of such contracts, including large, court-enforced fines for failures of compliance, instead of the niggling fines currently meted out by understaffed inpectors for irrelevant oversights? On the other hand, there is no need to stigmatize government bureaucrats and other workers: they are aften competent, knowledgeable and dedicated people. The problems tend to emerge from government operations becoming a political football for politicians, especially those that gain and retain their power by financing from various rent-seeking interests. The decrying of "excessive" regulation, rather than debating ways and means, often belies the question about the need for regulation in the first place. As an empirical example, I refer you to a recent article in the "New Yorker"-(Feb. 9, I think)- about the PPP initiative for the London "tube"; sometimes it is best to leave well enough alone, rather than fantasizing that markets are always a source of efficiency and progress, qua net gains in social wealth.

If some CA businesses flee the state due to excessive regulatory costs, then the reason that most do not is because of the large density of both population and business opportunities, a version of the standard increasing returns to scale argument. I did offer the standard "c.p." caveat. But, being a native of Chicago, I can't help myself from enjoying seeing Californians flail about a bit in their self-induced paradisiacal bubbles.

Posted by: john c. halasz on March 4, 2004 05:22 PM

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John

I am not an advocate of dismantling workers comp only to leave such matters to be settled in court. I do believe more decisive language in defining injuries and compensation would be better for society than creating more bureaucracy. For instance, I believe the Dept. of Education would better serve communities as a clearinghouse for information to educators rather than a funder and policy making entity. Communities will make good decisions if they have good data and information on say different regimes for teaching reading in grade school. This would not require a large bureaucracy just a helpful one.

We are both former Chicagoans. California has much going for it as we both know from our winters in Chicago.

Posted by: Brian on March 4, 2004 06:31 PM

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It was one of the few real pleasures to be derived from those Chicago winters. But I now live in Vermont, so my nostalgia for such pleasures has grown all the greater.

Posted by: john c. halasz on March 4, 2004 07:02 PM

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Brian: "Its boggling to read the posts such as yours admitting economic truths and then support politicians whose rhetoric flies in the face of such truths."

No offense please. When reading comments, I'm always reading a bit between the lines, taking into account what the same individuals have written earlier or in other places.

My point was that your and tbrosz's contributions _here_ kind of imply (without stating it explicitly) that you are opposed to programs (that can perhaps be broadly described as mandated insurance) into which you pay and from which (allegedly) other people benefit. It is not that clear from your post, but from stuff tbrosz has been posting here and elsewhere.

I wanted to point out that the people who benefit from the programs (which I believe would not exist to this extent if not mandated) are mostly people who are laboring physically in often times dangerous environment.

But I'm all for disclosure. Certainly disclosing the cost structure publicly will only help. Neither am I supporting lying politicians or other lying peddlers of agendas. And neither do I think I'm "admitting" anything. I am not trying to withhold or misrepresent something as to be in a position to admit.

Nevertheless, I believe that most regulation does not come from various people's desire to regulate, but from the realization that things don't work out as they should without regulations. Often
times the regulation is botched as well. But then you should honestly ask whether this country would really be a better place without the numerous regulations or unions (horrors!).

Many of the things people take for granted have been created by collective bargaining (as in "unions"), by explicit regulation, or by people otherwise having fought for it. For a while we may get a free ride when a regulation is removed, as things have become a custom and inertia keeps them around. But be assured that many things that are routinely provided to all employees and some contractors are provided only because it is illegal or impractical to discriminate.

And before anybody dismisses worker's comp as bloated and inefficient (which to a large extent it undoubtedly is), consider the alternative that when you're injured on the job, you hear "well screw you, and by the way you're fired".

Posted by: cm on March 4, 2004 09:08 PM

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CM

Regulation is necessary. It should be a last resort considering our form of gov't and system of economics. Designing less complicated and intrusive systems in achieving similar ends should always be the goal. Inovative systems like trading emissions credits can leverage free market efficiency in containing externalities. It could also have been done with endless regulations. I know which I prefer. I don't think we would disagree.

I see liberal voices rejecting say individual accounts for SS out of hand. It seems any attempt to remove gov't even partially is met with knee jerk skepticism. Now we can disagree on how harsh life should be and how nurturing a gov't is desirable.

Collective bargaining has been the driving force in many positive and negative things in the workplace. In a world of competitive forces, it seems we do better when accepting and working in an honest way to deal with those forces. To me its better to educate the worker in investment/economics than to remove him from the equation as SS does. Removing the patient from the costs in healcare seems antithetical to reducing or controlling costs.

I think we are probably not so far appart our inclinations just seem to be different in solving problems.

Posted by: Brian on March 5, 2004 12:15 PM

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Brian: This thread is effectively dead, but one short remark that I should have made earlier.

I think you expressed your inclinations well enough, but I'm not at all convinced that mediating "socialized" or "global" programs through trading systems actually works.

In the current social order, government action/legislation is the only way to express social consensus or ethical standards in a binding way (at least that's the theory). Under an unfavorable-conduct-rights trading scheme, companies or individuals may buy their way out of the regulation, today they spend the money on lawsuits to buy themselves out (sometimes). This will also not address corruption and lack of oversight; if a company buys a "right" to emit X tons of carbon dioxide, who will enforce they are not exceeding the quota?

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