California has turned itself into something of a joke over the years in large part because of their Rule by Referendum mentality. A sufficiently large group of people – and really not all that many – can get just about any idea that crosses their minds onto the ballot and have it enacted into law with a slick enough sales campaign. There are in excess of 100 of these proposals facing left coast voters this year, and one of them – Proposition 46 – seems to be pitting doctors against lawyers.

Supporters have raised only a fraction of the money that opponents have collected for their side of the battle. But the “yes” side is hoping that the attention-grabbing issue of drug testing can help surmount the cash disadvantage.

“We’re ringing the alarm bell for the public that there are quacks that like their Jack and smack, and they hurt people,” said Jamie Court, president of the advocacy group Consumer Watchdog.

The advertisements running in favor of this proposal show images of doctors who allegedly show up for work drunk or under the influence of drugs and claim that public safety will be improved if doctors are forced to submit to random drug and alcohol testing. And for all I know, that may be true. I certainly wouldn’t want the guy doing surgery on me to be as drunk as I probably was getting ready to go to the hospital.

But that’s not the real goal of Prop 46. It’s the public face they are putting on it to draw support while not making much noise about the real reason for it under the covers.

The initiative would change California’s decades-old $250,000 limit on the non-economic awards people can win in medical negligence cases. That cap dates to 1975, and supporters of the ballot measure say it has become economically unfeasible for lawyers to take many such cases.

The limit would rise to $1.1 million under Proposition 46 and would be indexed to inflation in the future.

One ad the “no” campaign has aired says the measure could cost state and local governments hundreds of millions of dollars annually. That’s the high end of an estimate by the nonpartisan Legislative Analyst’s Office, which determined that higher malpractice insurance costs for doctors could be passed on to other purchasers, such as the government.

The enthusiasm for jacking up malpractice suit limits is far lower than the number of people who obviously don’t want drunk doctors operating on them. Barely one third of respondents thought the higher limits were a good idea, and the reasons are fairly obvious. When law suit bonanzas go up, malpractice insurance premiums rise, and medical providers aren’t just going to dip in and take that out of their own pockets. Those costs will be passed on to the consumer either directly or through higher insurance costs. The only people this sort of proposal really benefits are the trial lawyers and a handful of patients.

If they manage to pull this one off it will be a truly remarkable victory in marketing. And once again the consumers of California will pick up the tab.