When Texas went to court last year to block President Obama's healthcare overhaul, Gov. Rick Perry pledged to do everything in his power to "protect our families, taxpayers and medical providers." Texas, he said, could manage its own healthcare. But in the 11 years the Republican presidential hopeful has been in office, working Texans increasingly have been priced out of private healthcare while the state's safety net has withered, leaving millions of state residents without medical care. "Texas just hasn't proven it can run a health system," said Dr. C. Bruce Malone III, an orthopedic surgeon and president of the historically conservative Texas Medical Assn. More than a quarter of Texans lack health insurance, the highest rate in the nation, placing a crushing burden on hospitals and doctors who treat patients unable to pay. Those costs are passed to the insured. Insurance premiums have risen more quickly in Texas than they have nationally over the last seven years. And when compared with incomes, insurance in Texas is less affordable than in every state but Mississippi, according to the nonprofit Commonwealth Fund.