With the submission of over 800,000 initiative petition signatures yesterday by Consumer Watchdog, it appears that the expensive battle between doctors and lawyers over non-economic compensation in health care cases will be thrown to the people. With rich assets on both sides, expect to hear a whole lot about greedy lawyers and irresponsible doctors.

In 1975, Governor Jerry Brown signed the Medical Insurance Compensation Reform Act (MICRA) to cap non-economic damages on pain and suffering at $250,000. The purpose of the measure was to hold down the cost of health care by limiting insurance costs on doctors.

Over the past four decades doctors and lawyers have battled over the size of the cap.

According to lawyers on the Consumer Attorneys of California website, MICRA “has undercut the rights of Californians injured by the negligent acts of our health care system.”

Not surprisingly, the California Medical Association website takes a different view on the issue. “California’s critical MICRA protections are a national success story, safeguarding patients and their access to care for almost 40 years.”

Economics is clearly at the heart of this debate. The lawyers make the point on their website: “Medical malpractice cases are long and difficult, with the costs for plaintiff’s attorneys rising to $100,000 or more. Those expenses are not recovered unless the victim prevails against the teams of insurance industry lawyers who defend negligence cases. But because of the tight caps on potential judgments, and because attorneys take the cases on a contingency fee basis, i.e. they are not paid unless they win the case, many victims are unable to find an attorney who can afford to take their cases.”

The doctors view: Trial lawyers are backing risky reforms that would impede the ability to provide critical care for California’s most vulnerable citizens. If successful, the trial attorneys’ efforts will cause malpractice rates to skyrocket, and recreate the same conditions that threatened to throw California’s health care system into crisis during the early 1970s.”

Assuming enough signatures were filed – and around 840,000 should do the trick given the required number of signatures for a statutory change is 504,760 – the ballot battle will be joined.

But there could be a wild card in the debate – the Affordable Care Act.

People are confused about the Affordable Care Act, uncertain how it will affect health care costs. A USC survey on health care released yesterday noted that, “researchers found shockingly low health insurance literacy overall, and particularly among younger and low-income Americans.”

The cost of health care discussion that has been going on since the Affordable Care Act took effect, with some arguing that “affordable” is a misnomer. How this discussion plays out could affect the MICRA ballot proposition. Because cost is such an integral part of the MICRA argument, if the cost of health care driven by the debate over the ACA continues to confuse, the argument of added cost could turn out to be a powerful political contention.