I. Introduction
Plaintiff, Empire Blue Cross & Blue Shield of New York (“Empire”), is suing major tobacco product manufacturers and related entities (“Tobacco”) for increased health care costs arising from deceptions about the effects of tobacco use on subscribers’ health. Defendants proffer evidence that Empire shifted heightened medical outlays onto its subscribers in the form of premium increases and, consequently, that it has not suffered damage. Claiming that such a “pass on” defense is inapplicable to a RICO fraud action, plaintiff moves to exclude this evidence. For "the reasons developed in part III, infra there is no pass on defense. Nevertheless, evidence of the basic facts of the insurance industry — -including pass on premium practice to cover increased costs — will be admitted. This apparent anomaly under relevancy rules 401 and 402 of the Federal Rules of Evidence will be discussed in part IV, infra. The practical realities of juror decision making must be considered. It is better to shed light on the workings of the insurance industry with appropriate legal instructions then risk sub rosa speculations by an inadequately informed jury.
II Facts
The factual allegations — fraud of defendants in denying smoking caused disease, leading to increased costs to the plaintiff— as well as Empire’s theories of recovery have been set out at length.
See Blue Cross v. Philip Morris,
Plaintiff moves in limine to bar evidence which shows that it has passed increased health care costs onto its insured in the form of higher premiums. Examples include the proposed testimony for the defendants of Dr. Robei-t Hoyt and Dr. Harvey M. Sapolsky, experts on health insurance practice. Dr. Hoyt’s testimony would counter arguments that “smoking related” costs are suffered by Empire. His conclusions appear in expert reports produced pursuant to Rule 26(a)(2)(B) of the Federal Rules of Civil Procedure:
1) “Insurance companies, [Empire] included, are financial intermediaries that set their rates so as to cover all anticipated claim costs. They function as a conduit though which health care costs for the aggregate pool of insureds are transferred.” Report at 4 (Feb. 15, 2000).
2) “Demand for both medical care and health insurance is relatively inelastic. Hence, increases in costs can be shifted to insurance consumers without significantly reducing demand. As a result, as costs increase, from whatever source, insurers can pass the majority of these costs onto the insurance buyers through subsequent premium increases.” Id. at 6.
3) There are no economic or regulatory impediments to [Empire’s] ability to pass on the costs of smoking. Report at 4 (Mar. 6, 2000).
Dr. Sapolsky would offer similar testimony. Report at 15 (Feb. 17, 2000) (“Insurance companies, [Empire] included, are largely passthroughs for hospital and physician charges. The risks, with a brief lag, are borne by the buyers. This years experience is reflected in next year’s premium.”). The notion that insurance companies pass on their costs to consumers would also be supported by defendants’ general testimony about the health insurance business, how it sets rates, and how it is financed.
Empire agrees that most of its costs are eventually passed on to subscribers through premiums. Nevertheless, it argues that under the dictates of
Hanover Shoe v. United Shoe Machinery Corp.,
A. Law
“The ‘collateral benefit’ rule of tort law rests on the belief that the wrongdoer should be made to pay- — the better to deter like conduct — whether or not the victim has providently supplied another source of compensation.”
Carter v. Berger, 777
F.2d 1173, 1175 (7th Cir.1985). Since
Hanover Shoe, Inc. v. United Shoe Machinery Corp.,
In
Hanover Shoe
the Supreme Court disallowed a defense by antitrust defendants who claimed that plaintiff was not entitled to damages for costs passed on to its customers.
Hanover Shoe, Inc. v. United Shoe Machinery Corp.,
The Court provided two reasons for the rejecting a pass on defense. First, it was unwilling to “complicate treble-damages actions” with attempts to trace the effects of an illegal overcharge on the shoe manufacturer’s “prices, sales, costs and profits, and of showing that these variables would have behaved differently without” the violation.
See Illinois Brick Co. v. Illinois,
In addition, if buyers are subjected to the passing-on defense, those who buy from them would also have to meet the challenge that they passed on the higher price to their customers. These ultimate consumers, in today’s case the buyers of single pairs of shoes, would have only a tiny stake in a lawsuit and little interest in attempting a class action. In consequence, those who violate the antitrust laws by price fixing or monopolizing would retain the fruits of their illegality because no one was available who would bring suit against them. Treble-damage actions, the importance of which the Court has many times emphasized, would be substantially reduced in effectiveness.
Hanover Shoe,
In
Illinois Brick
the Supreme Court addressed a corollary problem, the “offen
Although plaintiffs were two distribution links on the distribution chain away from the manufacturers, they claimed that an overcharge of some three million dollars had been passed on to them by the subcontractors through the general contractors.
Id.
at 727,
The Court dismissed the claim holding that indirect purchasers may not sue for antitrust damages.
Id.
at 736,
Dissenting in
Illinois Brick,
Justice Brennan argued that the risk of multiple liability could be avoided by bringing all potentially injured parties into the same court.
See id.
at 762-63,
Permitting the use of pass-on theories ... essentially would transform treble-damages actions into massive efforts to apportion the recovery among all potential plaintiffs that would have absorbed part of the overcharge — from direct purchasers to middlemen to ultimate consumers. However appealing this attempt to allocate the overcharge might seem in theory, it would add whole new dimensions of complexity to treble-damages suits and seriously undermine their effectiveness.
Id. at 737,
The Supreme Court has repeatedly emphasized that
Hanover
Shoe’s prohibition of the pass on defense is a rule of general applicability.
See generally Kansas v. UtiliCorp United Inc.,
B. Application
Defendants object to the rejection of a pass on defense for two reasons. First, they contend that because plaintiffs subro-gation claim is akin to a pass on theory, the “judicially consistent” course, expressed in Illinois Brick, permits the defense. Second, defendants argue that none of the policy factors underlying the pass on ban are present here, and thus this case is an exception to the Hanover Shoe rule. These arguments are not persuasive.
Defendants’ first argument over-reads
Illinois Brick.
Defendants suggest that because plaintiff asserts both subrogated and direct claims, the doctrine of
Hanover Shoe
— Illinois
Brick
allows defendants to introduce evidence of pass on to defend against Empire’s direct claims. Defendants note that the
Illinois Brick
Court held that “whatever rule is to be adopted regarding pass-on ... it must apply with equally to plaintiffs and defendants.”
Illinois Brick,
Illinois Brick
cannot be broadly read to suggest that a pass on defense is available when a single plaintiff prays for relief on alternative legal theories. The rule of
Illinois Brick
is more pointed: pass on damages will only rarely be permitted offensively or defensively.
See, e.g., Kansas v. UtiliCorp United Inc.,
Empire’s subrogation claim is not an offensive pass on suit under the RICO statute. In addition to its direct RICO claim, plaintiffs assert the rights of subscriber-subrogors on the theory that they incurred medical expenses which in fact the plaintiff paid (usually directly to the providers of the services). Plaintiffs sub-rogation claim is similar to that of an insurer which sues to recover medical expenses of a subscriber injured by a negligent automobile driver. Such a subrogat-ed action is not predicated on the idea that costs may have been passed on to its insured in higher premiums. It is an independent action in which equitable principles are applied to shift a loss, for which the insurer has already paid compensation, to the one who caused the loss and whose equitable position is inferior to that of the insurer.
See Teichman v. Community Hospital of Western Suffolk,
This is not to say that there is no merit to defendants’ argument. While an individual subscriber suing in his own right the party which injured him would not be entitled to medical expenses as damages, under New York Insurance law, he would be permitted to recover premiums laid out for the prior two years and for sometime into the future. See N.Y. C.P.L.R. § 4545(c)(McKinney 2000); see also New York Pattern Jury Instruction 3:301 Comment (2000). To the extent that those recoverable premiums may include costs that were passed on, there may be some overlap in damages. Nevertheless, the subrogation action is not a simple proxy for pass on damages. Higher premiums because of smoking related injuries have been born by all subscribers, not simply smoker-subrogors. Plaintiffs subrogation claim is, moreover, but one of two alternative legal theories advanced by plaintiff to recover medical costs it has already assumed due to Tobacco’s alleged fraud.
It is highly unlikely that these medical costs or increased premiums could be recovered in a direct action against Tobacco by millions of Empire’s subscribers. The somewhat remote and attenuated risk of a partial double recovery against defendants is worth taking in order to strengthen the force of RICO as a matter of public policy.
Defendants’ second argument, that this case is an exception to the general rule in
Hanover Shoe
is equally unavailing. The Supreme Court has been reluctant to permit exceptions to the
Hanover Shoe
rule.
See generally Kansas v. UtiliCorp United Inc.,
Defendants suggest that the deterrence concerns of Hanover Shoe are served by the fraud subrogation action, and there is thus no need to create a greater incentive to sue by barring the pass on defense against plaintiffs direct claims. The availability of a subrogated fraud action does not serve as an effective alternative to the private enforcement of the federal RICO statute which trebles damage awards. In most states, subrogated fraud claims redress different interests and offer less in damages. Cf Blue Cross & Blue Shield of N.J. v. Philip Morris, 113 F.Supp.2d at 381 (separate accrual rule of statute of limitations applied when each subscriber discovered injury, not on later date when insurer paid claims). Concerns about double recovery can be resolved if and when they arise.
Defendants also argue that unlike Hanover Shoe, there is no difficulty in determining how much is passed on to the downstream customer. This subrogation claim is not sufficiently analogous to a pass on claim to allow easy apportionment. There are no differential premiums for smokers and non-smokers in New York. Increased premiums were born by all subscribers and are projected into the future. The complexities that the Hanover Shoe — Illi nois Brick rule meant to contain are avoided by denying these defendants a pass on defense.
As already noted, under the collateral source rule of New York, when the cost of medical services are paid by a source like
In the event of a judgment favoring Empire, it would be appropriate for the recovery to be shared in the form of reduced future premiums or increased health services on behalf of all insureds. This is the plan of Empire as revealed at argument. The fact that a turnover in subscribers will provide benefits to those who did not pay the higher premiums is one of life’s minor unfairnesses that the law cannot completely cure.
See, e.g., County of Suffolk v. LILCO,
IV. Admissibility Of Evidence
A. Laio
Under a classic approach to Rules 401 and 402 of the Federal Rules of Evidence governing relevancy, information about pass on insurance premium practice would be excluded. Only evidence which tends to prove or disprove a “material proposition of fact” is admitted as evidence-in-chief (or as bearing on the credibility of a witness or probative force of other relevant evidence). A “material proposition of fact,” also referred to among other terms as an “ultimate material fact,” a “proposition of ultimate fact,” an “operative fact,” a “factual element of the cause of action or defense in the case,” and in Rule 401 of the Federal Rules of Evidence, as “any fact that is of consequence to the determination of the action,” are factual examples of the general elements of the rule of law applicable to the case. Such material propositions of fact are required to be proved true to some level of probability in order to warrant a judicial remedy— or in the case of a defense, to avoid a remedy. For example, the legal element of “fraud” in the instant case is sought to be established in part by the factual proposition that defendants made misleading statements to potential smokers that “cigarettes are not known to cause disease.”
If a proposition of fact is not required to be proved under the applicable rale of substantive law, and thus is not material, any evidence introduced solely to prove or disprove it, directly or indirectly, is irrelevant and inadmissable; an evidentiary proposition is considered “relevant” only if it is logically related, either directly or through an inferential chain of proof, to at least one of the formal elements of the charges made or defenses raised in the case — e.g., a material proposition of fact.
See, e.g.,
Fed.R.Evid. 401, 402 (2001);
U.S. v. Malpeso,
The horn-book requirement for admitting evidence is based on the premise that jurors will evaluate evidence rationally, by applying it logically to one material proposition after another, in determining whether the elements of the cause of action have been proved to the requisite degree of probability. See, e.g., Graham B. Strong, The Lawyer’s Left Hand; Non-Analytical Thought in the Practice of Law, 69 U. Colo. L.Rev. 759, 788 n. 140 (1998) (“American law schools still teach predominantly through variants of the case method that [Christopher] Langdell popularized, and through that method focus principally upon the development of analytical thinking among their lawyers-in-training”); George F. James, Relvancy, Probability and the Law, 29 Cal. L.Rev. 689 (1941).
Traditional theory assumes that a jury will decide the relationship between the law and the facts of the case as if solving a puzzle in logic — viewing evidence in pieces and discretely evaluating their connection through formal principles.
See, e.g.,
Todd E. Pettys,
Evidentiary Relevance, Morally Reasonable Verdicts, and Jury Nullification,
86 Iowa L.Rev. 467, 474-75
&
ns. 31-36 (2001) (describing traditional views of relevance); Michael S. Prado, Comment,
Juridical Proof, Evidence, and Pragmatic Meaning: Toward Evidentiary Holism,
95 Nw. U.L.Rev. 399, 400 (2000); John H. Wigmore,
Evidence In Trials At Common Law
§ 28, at 969 (Peter Tillers ed., 1983); Jerome Michael
&
Mortimer Adler,
The Trial of an Issue of Fact: I and II,
34 Colum.L.Rev. 1224, 1252, 1462 (1934);
see also U.S. v. Shonubi,
Yet, there are dangers in this more relaxed view. In Old Chief, for example, the more detailed criminal history of defendant there suggested presents a risk that the jury would reason that since the defendant who had previously been convicted of a serious crime was a bad person, he or she was more likely to have committed the bad act charged — a forbidden inference— or that it did not make as much difference if they convicted an innocent defendant because the defendant probably deserved punishment anyway. There is also the increased possibility that jurors fixed on story-telling will be less willing to responsibly address the precise substantive-legal-factual issues for which they were empaneled. A jury deliberation is not a coffee klatch.
The Supreme Court has wavered between expansive and restrictive interpretations of what constitutes relevant evidence. It has excluded contextual information that
Old Chief v. United States
has generated significant controversy. Some commentators have suggested that it lays the groundwork for introducing evidence as relevant even when it raises issues of consequences outside the courtroom.
See
Todd E. Pettys,
Evidentiary Relevance, Morally Reasonable Verdicts, and Jury Nullification,
86 Iowa L.Rev. at 467; Graham B. Strong,
The Lawyer’s Left Hand: Non-Analytical Thought in the Practice of Law,
69 U. Colo. L.Rev. 759, 788 n. 140 (1998) (stating
Old Chief
endorsed a concept of relevance that appears to go well beyond a narrow, rational model of relevance and incorporate what may be termed ‘aesthetic considerations.’). At bottom,
Old Chief
suggests that evidentia-ry inquiries into relevancy should relate to the way people learn and should permit jurors to “draw inferences, whatever they may be, necessary to reach a correct verdict.”
Old Chief v. United States,
The Federal Rules, for similar reasons, assume leeway in the introduction of demonstrative and background evidence. The Advisory Committee notes to Rule 401 of the Federal Rules of Evidence approves some looseness. It reads:
Evidence which is essentially background in nature can scarcely be said to involve disputed matter, yet it is universally offered and admitted as an aid to understanding. Charts, photographs, views of real estate, murder weapons, and many other items of evidence fall into this category. A rule limiting admissibility to evidence directed to a controversial point would invite the exclusion of this helpful evidence, or at least the raising of endless questions over its admission.
Fed R. Evid. 401 advisory committee’s note;
see also
Berger,
Evidence, supra
¶ 401 [405] (“Evidence that serves as background information about persons, subjects, or things in a trial is generally admissible although it may not relate to a consequential fact.”); John H Mansfield, Norman Abrahams, and Margaret Berger et al.,
Evidence Rules Statutes and Case Supplement
23 (1998). Demonstrative evi
A less obvious form of non-admitted evidence available under the Rules is a juror’s “background” knowledge.
See
Richard M. Fraher,
Adjudicative Facts, and Permissible Jury Background Information,
62 Ind. I.J. 338 (1987). Every juror brings values and information into a courtroom, that shapes how' the evidence will be interpreted.
See, e.g.,
Peter Tñlers,
Webs of Things in the Mind: A New Science of Evidence,
87 Mich.L.Rev. 1225, 1226 (1989) (“[Theory of relevancy and inference ... put [s] great emphasis on the role of experience and on generalizations based on experience.”). The Federal Rules attempt to screen out some of this “non-relevant” information, but recognize that jurors must come into the courtroom with enough experience to provide the hypotheses from real life necessary to decide issues of fact.
See, e.g., Bibbins v. Dalsheim,
At the outset of the trial potential jurors can be excluded for cause if they possess background knowledge or beliefs that are particularly relevant to the issues or parties in the case and this mental baggage presents a serious risk that they will not be able to evaluate the evidence at the trial fairly, or that, with their specialized knowledge, they may intimidate or mislead other jurors.
There is no clear rule defining what is or is not permissible background information.
See, e.g.,
John H. Mansfield,
Jury Notice,
74 Geo.L.J. 395 (1985) (“Surprisingly little attention has been given in decisions and commentary to the question of what information not formally introduced into evidence a jury may use as background information for the purpose of
Consideration of these pragmatic factors in decision-making suggests that there are occasions for admitting evidence not in accord with rigid standards of Rule 401 relevance. This includes times when admitting evidence is necessary as a “preemptive measure” — revealing information that jurors should not consider, but inevitably will because of their background knowledge and prejudices, and then reducing its sting with an appropriate legal instruction. Fed.R.Evid. 105;
see also
Berger,
Evidence
§ 107.02 (discussing Supreme Court Standard Rule 107 which permits judicial comment on evidence); David Crump,
On The Uses Of Irrelevant Evidence,
34 Hous. L.Rev. 1, 45 (1997) (“it may make sense in appropriate instances to receive otherwise immaterial evidence for the limited purpose of demonstrating its irrelevance”); Jody Armour,
Stereotypes and Prejudice: Helping Legal Decisionmakers Break the Prejudice Habit,
83 Cal. L.Rev. 733, 734-35 (1995) (suggesting a similar procedure to mitigate racial bias). Preemptively exposing such evidence has the benefit of discouraging jurors from making subrosa determinations about the propriety of a penalty or damage award, and encouraging them to determine facts responsibly within the law as charged.
Note, The Power and Duty of Federal Judges to Marshall and Comment on the Evidence in Jury Trials and Some Suggestions on Charging Juries,
Curative instructions are not foolproof. Admission of peripheral evidence must be balanced against time concerns and risks of undue prejudice under Rule 403.
See
Fed.R.Evid. 105, 403;
Bruton v. United States,
Given the sophistication of the evidence presented, erring on the side of openness is often needed in complex cases with strong public policy concerns. Federal Judicial Center, Manual for Complex Litigation § 22.433 (2000) (importance in using interim instructions to focus jury on what it must decide and how decisions are reached); Note, Considering Jury Nullification: When May Jurors Reject the Law To Do Justice, 30 Am.Crim. L.Rev. at 244-45 (“There are useful things that a court can say ... Although we can trust jurors to make accurate assessments of credibility ... most jurors have not encountered situations when so much is at stake”); J. Cecil, E. Lind, & G. Barmant, Jury Service in Lengthy Civil Trials 39, Federal Judicial Center (1987) (discussing difficulty jurors have in understanding technical information in complex antitrust litigation); Cf. Warren Burger, Can Jures Cope With Multimonth Trials?, 3 American Journal of Trial Advocacy 448 (1980) (arguing for abandoning lay jury in complex cases given sophistication of the testimony).
B. Application
This is a difficult and significant case. It will last forty to fifty trial days with scores of expert and lay witnesses, many statistical studies, and thousands of documents. Each juror, despite an exhaustive voir dire by questionnaire and oral examination to eliminate those with prejudicial preconceptions, will have some pretrial view on health care, insurance, and the tobacco industry. Inevitably, some will entertain views that the insurance companies are able to recoup their costs through increasing premiums — and, in turn, this information may skew calculations of liability and damages. Although outside the traditional scope of relevancy, admitting evidence of pass on in the form of higher premiums and pass back through future lower premiums to dispel them as factors to be considered during deliberation is likely to have the positive effect of ensuring that the jury makes lawful findings, without conscious or unconscious formulations distorting the verdict. A charge on their irrelevance in deciding damages will be given. Having observed this responsible and dedicated jury during selection and over some fifteen trial days, the court is convinced that in this case the benefits of the proposed course outweigh its risks.
It is, of course, remotely possible that none of the jurors may have considered these economic possibilities until they were raised in the courtroom. The introduction of evidence, along with an explanatory juror charge could possibly prejudice the parties. Notwithstanding, the public import and sophistication of this case — including technical descriptions of medical causation, damage models, and other statistical evidence presented by many experts — suggest that it is best to err on the side of openness. Limited descriptions of how the health, tobacco, and insurance industries work, accompanied by proper legal instructions, should ultimately assist the trier of fact in making a proper judgment according to the substantive law governing the case.
IV. Conclusion
The classical way of approaching courtroom problems, proeedurally and eviden-tially, is to proceed step-by-step, proposition by proposition, to establish by sharply limited relevant evidence whether each material proposition has been proven. The courts now take a broader view of
Plaintiffs motion is denied in part and granted in part.
SO ORDERED
