DO Day on the Hill

Posted 4/30/07 (By Travis)

4/30/07 Neoperspectives.com

We just returned from DO Day on the Hill, an annual convention of Osteopathic students and physicians who converge on Washington DC to lobby our representatives and become politically involved in the AOA (American Osteopathic Association), which represents the Osteopathic profession. This is my second year attending this great event, my post from last year can be found here.

The event began the night before with speeches by AOA lobbyists, including head lobbyist Shawn Martin, and members of the AOA, including the president elect Dr. Ajulini. We also heard a fun speech by NV congresswoman Shelly Berkely (D), who, incidentally, is married to an adjunct professor at our school, Dr. Lehrner a nephrologist, who, if I'm not mistaken, is a libertarian of sorts. He was the voice of reason at an organ transplant conference I attended at UNLV where he argued for a market based, contract based approach to solve the organ donor shortage. In other words, he was the only participant who started with the, in my opinion self evident, premise that we own our own bodies.

However, I must admit, I was somewhat torn and conflicted during our day of lobbying. The AOA is quite professional in their approach to lobbying, recommending only to pick a topic/bill(s) you are passionate about and presenting students a variety of choices. For example, last year I was happy to stick to discussing malpractice reform (here is a great interview by Shawn Martin on the subject).

But this year I cannot honestly say I was in great favor of any of the legislation we were supposed to lobby for, as every law expanded the power, spending, and reach of the Federal Government. In my view, government is the problem, not the solution to issues in healthcare.

The first bill was to raise/restore physician payments for Medicare. My feelings regarding the expansive, convoluted, and increasingly insolvent Medicare program is summed up in this previously posted article.

The second legislative priority was to expand SCHIP, a federal children's health program. One might wonder why there is even a need for this, since Medicaid, another questionable massive Federal program, already covers poor children. Well, it turns out there were folks 'falling through the cracks', a seemingly never ending phenomena when it comes to expanding or creating government programs. In fact, in New York a family of four with an income of up to $82,600 is considered 'falling through the cracks'. Another occurrence, also not of great surprise, was the tendency of states to expand of eligibilities to expand coverage to pregnant women and adults, and turn the program into an entitlement rather than a grant to the states.

Yet, it appears some form of this will pass as how can a politician be against anything that is 'for the children'? But more importantly, how will the outcomes of these children's health programs be any different from the outcomes of other welfare programs? Elimination, well reductions, in programs designed to help populations appeared to fulfill the very goals of the programs! In other words do anti-poverty programs increase poverty? Although initially counterintuitive, investigations appear to validate this conclusion. The reasons are multifaceted, but the negative reinforcement applied when benefits are taken away may increasingly perpetuate poverty cycles and discourage attempts to escape it.

The last bill (S. 588, H.R. 1093) was a graduate medical education bill, designed to increase the number of residencies for physicians in states that have caps on federally funded slots and shortages of residencies. Nevada is one such state. I was most familiar with this subject, having just completed, Medical Education in Nevada, a Tale of Two Medical Schools, which deals in large part with the residency situation in Nevada. Nonetheless, despite attractive aspects of this bill, it was still impossible to evade the conclusion that the GME system is rotten at its core, that government control over residencies and graduate medical education accomplishes far more harm than good, and is in fact responsible for the current shortages, that government control harms the quality of GME, and that, like Medicare and Medicaid, solutions which seem initially attractive to physicians conclude in the biting of the hand which feeds them. Even if such a program were a benefit to physicians and the medical community, it would still be difficult to justify the importance of the medical profession over others and the confiscation of other peoples' property to support such measures.

We were able to meet briefly with our NV senators, Reid and Ensign, and Congressman Porter, but more importantly, were also able to spend significant time with members of their staff, all of whom were quite wonderful. We met with Allana Porter (Porter's health policy aide), Katherine Oh (Reid's health policy aide), and Michelle Spence (Ensign's health policy aide). Katherine recognized us from our discussions last year, and was more than welcoming, knowledgeable, and interested in hearing from us. Porter's office and Reid's office supported the general concepts behind all three of our bills.

However, in my personal opinion, the highlight of the trip was our interactions with the staff of Senator Ensign. Pamela Thiessen, Legislative Director for Senator Ensign, was a real breath of fresh air as we discussed the values of a free market health care system and the damage done by government interference. But our meeting with Michelle was really a pleasure. It is, perhaps, the tendency of politicians and their staff to say what visiting folks want to hear; certainly the easy road to reelection. Yet, Michelle asked hard questions of our group; in fact, her objections mirrored my own on all three bills. Additionally, she was correct in her inference that practice conditions in any given state are far more important than any shortages, perceived or otherwise, in state residency spots in attracting physicians. Nationally, less than 50% of graduating residents stay in the states they trained in. In Pennsylvania the number was less than 8% in 2004!

In fact, the same argument holds true for eliminating state funding to state medical schools:

For an extreme example, in Haiti it was documented that at one point out of 264 medical doctors who graduated from a Haitian medical school all but three left the country, mostly for the United States. (98), (99)

And so the discussions went. However, in all this I attempted to sit in relative silence, out of courtesy to my fellow students and our hosts at the AOA. Luckily, there did arise some good opportunity to profess some strong opinions against the FDA, hopefully without overdosing, so to speak, on relish. :)

In other news we attended SOMA meetings (Student Osteopathic Medical Association representing nearly all the +13,000* Osteopathic Medical Students), accomplishing a great deal and were exposed to some very interesting speakers. Additionally, I had the honor of being selected for a National Board position, 'National Director of Political Affairs'. This will be very exciting and is also a great responsibility.

Thus, by the necessity of time constraints, this site, or at least my contributing part, will increasingly be directed towards health policy. Of course, before I scare anyone too much :), it goes without saying this position is a nonpartisan position and my duties will mostly consist of increasing medical student participation and understanding of the political process, working to increase cooperation with OPAC and the AOA, and additional projects. Although, of course, I am always more than happy to share any opinions. :)

Touro University Nevada School Of Osteopathic Medicine Students with:

Rep. Berkely (D NV) Senator's Ensign (R NV) and Reid (D NV) Rep Porter (R NV)