Medical Lobbying
(posts about)
Posted 3/15/08 ( by Travis)
States
May Warn Doctors to Follow Smoker Treatment Guidelines or be Sued for Medical Malpractice
NewsRx
^ | 03/11/2008 | PROFESSOR JOHN F. BANZHAF III
Public interest law professor John Banzhaf, whom the media has dubbed a "driving force behind the lawsuits that have cost tobacco companies billions of dollars," and the "law professor who masterminded litigation against the tobacco industry," has written to the health commissioners of the fifty states suggesting that they warn their state's doctors about such law suits based upon a recent article in a leading medical journal and an even more recent study about saving smoker lives.
The letter notes a recent study which shows that physicians are killing more than 40,000 American smokers each year by failing to follow federal guidelines which mandate that the doctor warn the smoking patient about the many dangers of smoking and provide effective medical treatment for the majority who wish to quit.
"Since physician malpractice kills over 40,000 smokers annually – more than motor vehicle or product liability accidents – it should not be surprising if antismoking lawyers, as well as those in private practice working on contingency fees, find physicians who deliberately flout federal guidelines to be a major target of litigation."
Lets us go back to July 5th, 1997, when the landmark tobacco settlement against Tobacco companies was being negotiated. The AMA (and one assumes the AOA) were in favor of the hundred billion dollar settlements, which, incidentally, turned many lawyers into multi millionaires.
Two public health groups, the Campaign for Tobacco-Free Kids and the American Medical Association, were involved in the negotiations that led to the accord.
And just two years ago:
AMA Urges Florida Supreme Court to Uphold Verdict Against Big Tobacco
CHICAGO, June 24 /PRNewswire/ -- Continuing its commitment against the dangers of cigarette smoking, the American Medical Association (AMA) this week joined several other public interest organizations in a friend-of-the-court brief reaffirming support for a Florida class-action victory against the tobacco industry.
In July 2000, the $145 billion punitive damages verdict
in Engle v. Liggett Group Inc. et al sent a strong message to tobacco companies that toying with the
health and lives of Americans can be a prohibitively expensive business. The damages awarded in this
case, however, could be overturned because an appellate court has reconsidered the case's class
certification. The AMA believes the Florida Supreme Court should overturn the appellate court's
ruling and compel the tobacco defendants to pay for the damages they continue to inflict on society.
"As long as the tobacco industry profits from business as usual, they must
bear responsibility for the human suffering and economic costs that result from tobacco-related
illnesses," said AMA Trustee Ronald M. Davis, MD. "Preserving the penalties in this case
will provide a strong incentive for tobacco companies to change their behavior."
First they went for the tobacco companies, but the doctors did not care because they disliked the tobacco companies. But when they came for the doctors no one was left to come to their aid.
Posted 10/1/07 (By Travis)
SOMA Resolution on FDA approval
This past weekend,
SOMA (Student Osteopathic Medical Organization), representing over 14,000* Medical Students, 15%* of
the total medical students in the United States, passed the following resolution (only the final
'RESOLVED' statement was officially passed, the 'WHEREAS' parts are included here only for
completeness):
Subject: SOMA Resolution on FDA approval
1) WHEREAS, New pharmacological advances have resulted in major healthcare
2)
3) advances and enabled physicians to enhance patient care (4),
4)
5) WHEREAS, This year the FDA has so far approved only 7 NCE (new
6)
7) chemical entities), down 31% from last year (1),
8)
9) WHEREAS, It takes an average of 12-10 years and $400-800 billion to
10)
11) bring a new drug from lab to marketplace, in large part due to legal and
12)
13) current regulatory compliance (2), (3),
14)
15) WHEREAS, Generic drugs take over 20 months for approval,
16)
17) increasing cost and decreasing access (6), (7), (8),
18)
19) WHEREAS, Terminally ill patients are routinely denied opportunity to
20)
21) try new or experimental drugs and therapies (5), (9), (10), (11),
22)
23) therefore be it;
24)
25) RESOLVED, SOMA recommend agencies investigate ways to: 1)
24)
25) Review, reform, and hasten the current regulatory processes regarding
26)
27) the current FDA approval process for NCE (new chemical entities). 2)
28)
29) Review, reform, and hasten the current FDA approval process for
30)
31) generic brands. 3) Review, reform, and ease the FDA rules and
32)
33) regulations for entry of properly consenting terminally ill patients into
34)
35) clinical trials. Specifically, the FDA should not be allowed to prevent a
36)
34) terminally ill, properly consenting, educated, and fully lucid adult, from
35)
36) undergoing experimental treatment(s).
1) http://www.physorg.com/news106639362.html
2) http://www.allp.com/drug_dev.htm
3) http://www.fdareview.org/harm.shtml
4) http://www.telegraph.co.uk/news/main.jhtml
6) http://www.washingtonpost.com/wp-dyn/content/article/2006/02/03/AR2006020302598.html
7) http://www.medscape.com/viewarticle/421495_3
8) http://www.fda.gov/fdac/features/2003/503_drug.html
9)http://www.washingtonpost.com/wp-dyn/content/article/2007/07/05/AR2007070502149.html
10) http://reason.com/news/printer/120763.html
11) http://www.abigail-alliance.org/
This resolution will be passed onto the pertinent committee(s) at the AOA (American Osteopathic Association), which represents 52,000 DOs, 5% of the country's physicians, for their review.
Posted 4/12/07 (By Travis)
Are Mini Clinics a Good thing, State's increase their Scrutiny
5/20/06 National Conference of State Legislators
Some states regulate mini-clinics by requiring physician ownership. In Indiana, MinuteClinic acts as a kind of franchisor, selling outlets to local doctors.
The above is posted as background. Diligent readers may recall past posts (now grouped under Medical Lobbying) describing the attempts of doctor organizations to squash new upstart mini-clinics, which threaten their businesses by exposing inefficiencies in their present system. However, these attempts have unintended consequences, as seen in a recent email sent to all students and faculty of Touro University, a private Osteopathic medical school in Nevada:
Touro
University Nevada has been developing a clinical practice facility for faculty, staff, and students.
We ran into a serious obstacle in February when we discovered that non-physician owned
corporations could not provide patient care in Nevada. After extensive research, we discovered
that many states with similar laws had enacted legislation or regulations to enable private
not-for-profit medical schools to create clinical practices. At first we thought that we would have
to wait until 2009 for the next legislative session to introduce enabling legislation. However, Sen.
Joe Heck, DO graciously offered an amendment to a bill that he had introduced earlier and included
new language that would enable private-not-for-profit medical schools to deliver patient care. That
bill, S.B. 412, was passed by the Senate Commerce and Labor Committee on Good Friday, thus achieving
a very important milestone. It will next go to the full Senate and if passed by the Senate on to an
Assembly committee, etc. We are optimistic that “our bill” will become law this legislative
session.
All of us owe Sen. Heck much gratitude for his fine work and support. When you
see him, please thank him personally.
Why does the state of Nevada have the power to determine who or what 'class' of people, own certain businesses?
In article 1 section 6 of the US constitution it is written:
No title of nobility shall be granted by the United States.
This was done because many people in the United States immigrated from Europe in search of freedom, religious, and otherwise, and a place where all men were equal in the eyes of the law. In Europe there were different sets of laws, rules, and customs for the nobility as opposed to the 'common folk'. We need to ask today if we have merely substituted nomenclature. Instead of 'prince' we have 'doctor', instead of 'duke' we have 'lawyer', and instead of 'knight' we have 'manicurists'. Manicurist? Yea, even manicurist.
The point being that all these distinctive subcategories of 'classes' or 'people' are accorded special privileges solely on the basis of title. These privileges result in their enrichment and benefit, at the expense of the 'common folk' or 'those without fancy titles'.
As history has shown it is most often the 'common folk' whose productivity and innovation create the most prosperity and advances. Giving them the freedom to own medical clinics free of government coercion would certainly be a good start.
Posted 10/13/06 (By Travis)
10/10/06 Cato
It is tempting to think that Medicare's payment system exists to benefit physicians who know how to play the game. But few physicians enjoy having their practices thrown into turmoil by payment changes uttlerly unrelated to the value they provide.
A more plausible explanation is that Medicare's pricing system exists to serve Washington's political class. Politicians can use the perennial threat of payment cuts to shake down wealthy physicians for political contributions. Organizations that lobby on behalf of physicians - like the AMA and the AAFP - rake in membership fees as well. It is little wonder that, according to the watchdog group Political Money Line, the health-care industry spends more on political contributions and lobbying than any other.
This is madness. The government has no business setting prices for physicians' services. Until Congress lets the market set those prices, Medicare will continue to purchase sub-standard care and encourage shakedowns that benefit no one but politicians and lobbyists.
Posted 10/13/06 (By Travis)
In-Store Clinic Update
19/13/06 Neoperspectives.com
I wrote the president of the AOA (American Osteopathic Medical Association), Dr. John Strosnider a few months ago on his blog:
Recently, I've been following the exponential growth of so-called
'in-store clinics' with great interest. They seem to offer great access, lower costs, and benefits
to patients and by some estimates are on the verge of revolutionizing health care. However, I've
been concerned with the response of the AMA, which seems to be seeking to limit them via regulation
and engage in 'turf protection', licensing wars etc...
I was wondering what the AOA’s position is on this, and was rather hoping it
would be different from the AMA's. In my humble opinion, I think it should be the consumers of
healthcare, rather than politicians or doctor organizations who determine whether these in-store
clinics thrive or perish. In the end, I feel this approach will also benefit DOs, as we have a lot
to offer patients in our own right.
Dr. Stro responded:
Thanks for your thoughts, I agree with you in many
ways, however quality should be the hallmark of any practice location.
In store clinics are convenient, usually less expensive and usually limited in
what they will see. They are usually manned by a nurse practicioner or Physician Assistant. Some
with physician oversight, however in many states this is not required.
It has been said that we are our own worse enemies, and in this case, especially
for primary care physicians it is probably true. With limited office hours, no weekend hours, no
night call, the public will rebel and seek alternatives. They do not, as you would not, want to just
be referred to a local emergency room by a recording at the doctor's office, after work at 4:30 or
5:00 pm, or in the evening or on Saturday morning. ERs are many times impersonal, expensive and time
consuming, especially for more minor ailments or concerns. No wonder the public seeks help
elsewhere.
I think that most people would rather see their physician, however when the
physician is not available, or makes it such a hassle to see them, I don't blame them for going
elsewhere.
I can tell you that when I practiced, our group had evening hours, sometimes to
seven or eight in the evening. We were open every Saturday, and there were many times when on call
for the week, I would meet patients at the office - after hours, or on Sunday to suture, cast, or
check other complaints.
I do not know where you live, but I do not see much if any of that here in
eastern Kentucky.
As an osteopathic physician, I hope you remember this when you practice. Our
patients' time is valuable, they seek help when they are concerned or hurting, not just between 9:00
am and 4:00 pm Monday through Friday.
I commend Dr. Stro for his response, especially his emphasis on making doctors more
competitive. In fact, this is the key end result of increases in freedom, liberty, and the stemming
entrepreneurship. Whether it is school choice, medical
choice, or 'voting with your feet' ie location, it has been
government monopolies, licensing or otherwise, which encourage stagnation and limit innovation. When
those monopolies are broken, when freedom is unleashed, positive results are attained. Dr. Stro did
mention his concern for the 'quality' of the in-store clinics, often a code word for increasing the
regulatory burden on these stores, but since we don't know this for certain, I'll refrain from
jumping to judgment on, IMHO, an otherwise excellent response.
Posted 7/27/06 (By Travis)
The Rise of the Walk-in Clinic
7/2/506 Newsweek A look at a new explosive phenomena that is sweeping the nation. These medical clinics are providing affordable, convenient access to healthcare. Previously, in 'AOA Advocacy' (4/8/06) I described the reaction of the medical community, which was, rather predictably, hostile. But, special interests need to provide cover for corrupt politicians to use the power of government to shut down upstart competitors and retain monopolies. 'Public Safety' is typically the slogan of choice used in the licensing/regulatory wars of the healthcare industry:
A report issued by the American Medical Association in June expressed concerns about the impact that clinics would have on physicians' practices and on patient care.
Dr. Larry Fields, president of the American Academy of Family Physicians, says his group's members have also been able to weather the competition, so far though some have adapted their practices to accommodate more patients. Last month, the AAFP issued a list of "desired attributes" for retail clinic practices, recommending the use of referrals for more serious cases, electronic medical records (which can be transmitted to the patient's primary provider) and a clearly defined—and limited—scope of services. "To the credit of many of these clinics, they've endorsed the guidelines," says Fields.
Still, he worries that the walk-in clinics may be tempted to expand the range of their services as they grow. "They may want a bigger piece of the market and that's a concern," he says. "In today's complex world of healthcare, patients really need to have a medical home."
Patients need to be left to make their own choices free from coercion and condescension from Doctor organizations.
Posted 6/14/06 (by Dobber)
6/14/06 Chicago Sun Times
Doctors are mad that Americans are making decisions that they don't agree with.
Millions of upper-income Americans refuse to buy health insurance because they're young and healthy and figure they don't need it.
Seems reasonable to me. Poor people in Kansas don't buy hurricane insurance. Probably a good decision on their part. Well, who am I to judge, it's their decision.
But now the American Medical Association wants to force them to buy coverage.
At its annual meeting in Chicago on Tuesday, the nation's largest doctors' group called for mandatory health insurance for anyone who makes more than five times the poverty level. That works out to $49,000 for an individual and $100,000 for a family of four.
No one would go to jail for refusing to buy coverage. The AMA instead suggested using the tax code to force compliance. There would be incentives such as tax credits for people who buy insurance and higher taxes for those who don't.
Hmm, an annual meeting of the American Medical Association, eh? I would have thought that they would be talking about better ways to provide medical care, cutting edge technologies, funding operating room stories. For some reason, they're talking about TAXES. Of course, this is just a symptom of the problem of ever-increasing size of federal government. The federal government should not be meddling with medicine. If that were the case, the AMA could spend more of its time working on medicine, because healthcare would be so affordable, everyone could enjoy its benefits.
Posted 5/2/06
This past week/weekend I attended the AOA (American Osteopathic Association) sponsored 'DO (Doctor of Osteopathy) Day on the Hill' and the SOMA (Student Osteopathic Medical Association) convention in Washington DC. It was a great experience and we had a blast. I thought some of you might find a little write-up on it interesting and, since this is largely a political site, I'll stick to that aspect of it. :)
I have been to DC before, curtesy of ABC (Alternative Break Corps), lobbying on behalf of the National Homeless Coalition, which was somewhat of an irony considering that our experiences, sleeping on the streets etc..., only served to solidify my belief that a good initial measure to combat homelessness in this country would be to eliminate the National Homeless Coalition, a bloated taxpayer funded agency with a socialist agenda that, in my opinion, perpetuates and increases homelessness rather than reducing it. They did not take too kindly to our not supporting their bills.
However, the AOA was much more welcoming and presented us with a number of bills they supported and then gave us the leeway and choice to lobby our representatives on the bills and issues we were passionate about. Shawn Martin, our head lobbyist, gave us good information about the bills, is a great guy, and works hard to represent DOs on Capital Hill.
The night before our 'DO day on the Hill' we heard from a number of great speakers, including Tom Price, MD (R-GA), who spoke eloquently about the problems resulting from government control of physician salaries and of medicine in general.
Another interesting speaker was William Prentice, Associate Executive Lobbyist from the American Dental Association. He spoke with pride about how dentists in the United States, unlike those of, say, Great Britain, are lucky enough to be the least regulated of all health care professionals: patients typically pay out of pocket for a high percentage of their bill, dentists have little to do with Medicare and Medicaid, and consequently, the result being, in his and my concurrent opinion, increased access and quality of care, along with low costs for patients and high salaries for dentists. Indeed, our friends on the Left often seek to chisel cohabiting groups into artificial categories: rich against poor, worker against business, doctor against patient, without the understanding that the end result of a policy generally affects all involved parties similarly, with little exception. What is good for docs is good for patients and vice versa. I would like to learn more about how the free market and dentistry have resulted in such positive results. I rather wish the AOA and the AMA would follow in their footsteps.
But, I must say I was disappointed to hear some of our lobbyists extol the virtues of the free market and capitalism, but then begin to hedge their opinions with regard to Healthcare. A common statement I always hear is, "Healthcare is too important to be left to market forces." In reality, precisely the opposite is true, Healthcare is too important not to be left to market forces.
There was one common theme I heard over and over throughout the week, from every single doctor, every single lobbyist, and every single politician, Democrat or Republican. They all agreed that Medicare and Medicaid were broken, especially that the physician payment/reimbursement formula was convoluted, contradicting and ultimately, unworkable.
Now, I doubt this is any surprise to regular readers of this site, who probably yawningly view this as merely another predicable government debacle, but I was a bit surprised at how willing those with Liberal leanings were to admit this. But, most surprising of all was that no one, well, perhaps besides the dentists, seemed to comprehend that these problems were only the natural result of socialism. By definition, the system has to be broken! Yet, what we heard was the need for new formulas, smarter calculations, and the 'proper adjustments' and, even with all of these 'patches', they all admitted none of the fixes could make the system 'properly functional'.
Despite all this, the AOA and, I'm assuming the AMA (American Medical Association), and most of the Medical Students in attendance went out and lobbied for increases in Medicare and Medicaid reimbursement. To be perfectly frank, and in my opinion, this whole approach is a useless and counterproductive exercise. The pervasive socialism of the Healthcare industry must be ended, pulled out by its roots. Medicaid and Medicare must be abolished. By abolished, I mean 'phased out', because, misguided thought they were, government promises need to be honored for current enrollees of these programs. Even such 'drastic' and 'extreme' measures as totally ridding ourselves of these harmful programs are really only the first step in reducing the massive government entrenchment and hurtful involvements in Healthcare.
As previously mentioned, Medicare is an especially egregious program, considering it is essentially a government sponsored, mandatory, pyramid scheme, which increasingly takes money from younger people, who tend to be poorer, and gives it to older people, who are, demographically, the richest segment of society.
My grandparents' generation thought being on the government dole was a disgraceful, a blight on the family honor. Today's senior citizens blithely cannibalize their grandchildren because they have a right [to as much] 'free' stuff as the political system will permit them to extract.
- CA Justice Janice Rogers Brown
However, the arguments against Medicaid, the health program for the poor are the most insidious, as opponents usually state as fact that poorer citizens will loose their health care and die or become ill and then the debate often shifts from a rational policy discussion to an evaluation of your personal intentions. Of course, this was the same line used with welfare reform and in fact, as documented, the repealing of socialism and the taking away of government benefits from the poorest Americans resulted in an increase in their prosperity, not a decline. In fact, the well intentioned government programs were found to be the very reason for the poverty!
In addition, both Medicare and Medicaid, being government programs, are racked with fraud, theft, waste, and, being government programs, offer incentives for poor care and disincentives for excellence, entrepreneurialship, and humane care.
In arguing for increasing physician reimbursement rates for both Medicaid and Medicare (H.R. 3617), the AOA tells lawmakers that physicians will stop accepting Medicaid and Medicare patients, thus decreasing patient access, if the compensation is not increased. Do you see the problem with this? Imagine if instead the AOA encouraged its members not to accept Medicaid and Medicare programs and urged Congress to phase out the programs. Don't hold your breath on that one... :)
Another bill we could choose to advocate for was a bill (H.R. 1380) which would help us lower our rather substantial debt as we emerge from medical school. It involves special tax breaks and more subsidies and who knows what other forms of measures that are, in my opinion, nothing less than outright theft. Unfortunately, as one can imagine, this was a relatively popular topic among many of the students. Most times, this brought smiles of understanding and something along the lines of "We'd like to work with you on that." or, "I understand that is quite a burden.", from the various legislative aides and/or Congressmen we met with.
The correct rebuttal came from, Senator Tom Coburn, MD (R-OK), incidentally my favorite Senator, who, according to second hand information, tartly asked a student: "Ok. So who do you want to pay for this?"
Of course, Senator Coburn's refreshing response is the correct response; as William E. Simon said:
If you would not confront your neighbor and demand his money at a point of a gun to solve every new problem that may appear in your life, you should not allow the government to do it for you.
In fact, the government already subsidizes our tuition and loans through various programs. But, more importantly, it also dramatically increases our tuition, via the aggregate effect of the massive regulation and meddling the government inserts throughout all US Medical Education, from the beginning of medical school all the way through residency and CME (Continuing Medical Education) programs. Yet, again, our lobbying focus appears to be in the wrong place. The battle is not being fought with government in the proper role as enemy, but rather as some sort of corrupting friend, who, with a wink and a nod, will help us loot the American people.
Another bill (H.R. 4403/S 2071) actually did address some of this, and tried to remove some of the regulation of residency programs from rural health care programs. I commend the AOA for their work on this bill.
Proponents of the subsidized tuition bill sometimes opined that a doctor's education needed subsidizing because their work was much more important and critical than a lawyer's or engineer's or psychologist's, or any other graduate program, or, apparently, any other education program. First, I'm not sure how one judges how 'important' someone's work is; we certainly don't want government to be doing this sort of 'evaluating'. Secondly, even if a doctor's work is that much more important, than it is all the more critical that government be kept out of the profession. Again, these constant attempts to treat medicine differently than other businesses has, in my humble opinion, resulted in the very problems which more hurtful government expansion has been proposed to treat.
So, seeing as I disagreed with the AOA's approach on many of these bills I did not bring them up in conversation. But, the bill or subject I discussed with nearly all the legislators I met, and indeed, was stated as the highest priority for the AOA, was a Medical Malpractice bill (S. 22), sponsored by Senator John Ensign (R-NV), who, by the way, has a great Senior Health Policy aide in Michelle Spence. :) Basically, this bill would nationally place a cap on non-economic damages in Medical Malpractice cases. There was some confusion about what exactly this bill does, as we heard variously that if States had a cap that was below this, then the State cap would stand, but higher State caps would be preempted by the new Federal law, and we were also told by different sources that this new national bill would only apply to states that did not have some form, with higher or lower caps, of Medical Malpractice reform. So, I tried not to get into the meat of this, and mostly just talked generally about the need to reduce Medical Malpractice.
Interestingly, did you know there is no such thing as 'Lawyer Malpractice'? There is no 'standard of care' that car mechanics are held to. Neither are engineers or electricians or any other non-health profession. Also, all are free, unfortunately only within 'reason', to make legally binding contracts with their customers. Yet, health care is different we say, lives are at stake we say, the free market cannot properly regulate health care we say. A bunch of rot I say. :)
One of the funniest moments, although to remain polite, I didn't laugh, came when a Democratic staffer brought up State's Rights as reason enough to vote against this national Medical Malpractice law. Now, I wasn't laughing at their argument; it was actually relatively sensible; I don't believe Federal power should be expanded except in what was previously termed, "negative power", whereby the Federal Government limits the power of the States, preventing them from committing acts of tyranny on their citizens, yet it, the Federal Government, is not empowered to garner 'positive power' or 'do anything' itself. I'm not sure quite where Malpractice falls in this framework, however, I suspect upon closer analysis we might find the root of the Malpractice problem is related to government's violation of one of the most basic human rights: the right to freely contract. All States currently do not allow a patient, if they so choose, to waive their right to partake in the current Medical Malpractice legal system. In other words, even if a patient wants to, they cannot sign a legally binding contract pledging not to sue their doctor, regardless of medical outcome. From my perspective, this is a violation of the Constitution, the right to liberty, and States that willfully violate the liberty of their citizens in this way, should be subject to Federal oversight.
In any case, returning to the moment of humor, my inner laughter was directed at the capricious irony of a Democrat talking about State's Rights regarding Medical Malpractice, when they are simultaneously in favor of expanding the Federal Government into nearly all other areas. Let's talk about State's Rights with Medicare or Medicaid! Just give us somewhere to run!
Another argument we frequently encountered was less humorous, as it was more indicative of a fundamental ignorance: the attacks on the companies that insure doctors for Medical Malpractice. Just like Big Phrama, Big Oil, and Big Wal-Mart, Big Insurance has been delegated resident villain by those on the Left, and demonized as responsible for at least some of the Medical Malpractice woes (same with workers comp). However, the facts are that insurance companies flee states with skyrocketing Malpractice verdicts, and flock to those with lower more stable rates, giving doctors greater choice of provider. The idea that insurance companies would just increase their profits, leaving rates unchanged if Malpractice reforms were enacted, can be dismissed even before checking the validating historical record. If an insurance company, or group of insurance companies, conspired to do such a thing, their profit margins would be high for only a very short amount of time, as their actions would create ample incentives for new insurance company startups, or for existing outside companies, to enter the market in order to take market share from the 'excessively profiting' companies. Incidentally, this same sort of reasoning will show why there can be no such thing as price gouging, or monopolizing.
In conclusion, I wouldn't want to leave out the highlight of the trip, which was meeting Rep. Ron Paul, MD, (R-TX), the utmost defender of liberty in all of Congress, an unabashed libertarian, and whom I didn't even know was also a doctor until just now.
We were walking the halls of Congress and we passed by his office and I thought, "Wow, Ron Paul's office, I wonder if he's in." So, later on we went back and asked his staff if we could steal just a minute or so of his time to meet him and maybe get a quick picture. It turned out he was in and he came out and shook our hands and posed for some quick pics:
I mentioned to him I had run across and appreciated his accurate root diagnosis of the campaign finance reform debacle and had even found a prominent space (required reading) for it on my blog.
As we were leaving, I told him I was very glad to meet him as he was the only politician I knew who actually worked to shrink their own power.
His response?
"Damn right." *(ok, maybe it was "that's right") :)
For more pics from this trip click here and scroll down.
Posted 4/8/06
This weekend I attended an advocacy conference for the AOA (American Osteopathic Association), here in Nevada. Mostly, it was an interesting and motivating conference about how to approach legislators and lobby for public change. There is a lot of good the AOA does representing physicians and I enjoyed meeting the various people who attended the conference.
However, I must admit I was a bit disheartened by some of what the AOA, and we can assume their counterparts their at the AMA (American Medical Association), advocate for. I learned that the AOA is working to restrict the right of psychologists to prescribe medications, working to restrict the right of pharmacies to offer immunizations and monitor medications, working to restrict in store clinics offered by companies such as wal-mart, working to restrict the rights of RNs (nurses), and they, the AOA, were just shocked :), that Oklahoma optometrists can now perform surgeries which had previously been restricted to ophthalmologists. Of course, in the AOA's defense, some of these legislative battles are fought to defend our practice rights from the various groups that want to take them away.
However, it does appear to me that the AOA is fighting many non-defensive territorial wars of regulation, using government to sustain a monopoly against market forces, ironically, in the same way that MDs once used government to shut out Osteopaths. Recall it was Mark Twain who testified before the New York General Assembly:
"I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven's been able to sleep."
Well, I for one don't want any part of it. Good intentions aside, I don't see why an organization needs to spend so much effort tearing down other professional groups, stomping on entrepreneurs, restricting patient choice, and, at least in this sense, and in my opinion, becoming part of the problem, rather than the solution to health care in America. In an indirect sort of way it is almost lessening the value it subscribes its own members.
During these debates about immigration, it has often been claimed that illegal immigrants are 'taking American jobs'. I always counter that if you need government to protect your job, if your own skill, hard work, diligence, and talent do not intrinsically define your individual value in a position of employment, than you don't deserve the job in the first place. Similarly, if given the freedom to choose, doctors are hemorrhaging patients, then docs better, government permitting, shape up or ship out.
Another contradiction can be found in the AOA position on keeping the status quo regarding the medical socialism perpetrated on the people of the United States via Medicare and Medicaid. The AOA appears to believe the proper position is not to cut these programs, or reduce dependency on government, but rather to keep reimbursements 'high', so more people are served as doctors can afford to keep seeing these patients. Of course, this sounds quite laudable, but it doesn't address the root of the problem or ask the ever pertinent question: Why do doctors want government to control their salaries in the first place? Why place your livelihood at the whim of whatever political forces happen to hold office?
Again, why do we need government to prop up the value of our labor? Why can it not stand alone, self-evident in its merit? Or, what if it turns out that this government meddling is actually lowering reimbursements for certain procedures to below market prices? In fact, we learned that private insurance used to pay much higher prices for procedures than what government offered, but had recently fallen to mirror the government mandates. Interestingly, an analysis of key differences between the procedures covered by private insurance and those covered by government programs appear clustered around preventative care and screenings, much of which only private plans cover. Why is this? It turns out improving the health of the patient also saves money for the private insurance companies. Whodathunk? :) With government programs, these feedback loops are absent. One would think this would sink home most in the Osteopathic profession, which does have an emphasis on preventative medicine and whole body care, especially those practicing OMM.
The truth is that government cannot know, despite its best efforts, what certain procedures are worth to patients to receive, or doctors to perform. The value of your skill as a physician should, in my opinion, be set by your patients and the market, and thus reflect the pride in your individual ability.
But, returning to the contradiction, the AOA advocating increasing these government payments in the name of 'increasing patient access', does not seem to match with their rhetoric on these so-called 'in store clinics'. 'In stores clinics' are sort of 'fast food' doctors' offices set up in stores like Wal-Mart or Target. 'Increasing access' is exactly what they do. They perform quick lab tests, physicals, immunizations, and can prescribe certain medications. Occasionally they are staffed by physicians, but mostly by RNs, PAs, or some other combination of health care worker. These clinics provide fast, cheap care, targeted especially at the poorest Americans and those without health insurance. In fact, family members of more than one classmate of mine have used these clinics with great acclaim and upon occasion, great necessity.
The AOA is against these clinics, or at least wants to make sure only physicians can operate them and, at minimum, favors increasing the regulatory burden upon them.
Collectively, my impression of all of this is that it appears the interchangeable arguments of 'access', 'quality', and 'public safety' are empty shells, representing whatever is politically feasible to sell the goal of turf protection to politicians and the public. But then again, how can this be surprising to readers of this site? We've seen this sort of pattern play out in every special interest group from Social Workers to Manicurists to Public School Teachers.
Posted 8/6/05
For a more political angle (as customary on this site :) ) of Allopathic, Osteopathic, and medicine in general:
For the first 100+ years of US history the government didn't 'meddle' in health care licensing and regulation. However, as government assumed more power, eventually Allopathic Doctors were the only ones licensed to do certain kinds of procedures and government (state and federal) passed overarching regulations and restrictions designed to keep Osteopaths and other troublesome groups (Midwives etc..) out of the Allopathic 'territory' (mob and gang pun intended). Basically, the M.D.s resorted to using government for their profit, to prevent people from making their own health care choices. The M.D.s donated heavily to politicians who passed these laws in the name of 'public safety' or 'the children' yadda yadda... With a government granted monopoly, the M.D.s, naturally, restricted their members and thus raised their salaries. This pattern is repeated throughout society and history (for another example covered on this site read about social workers).
In the late 1800s/early 1900s, Osteopathy was legalized in most states, or the legislatures included it as being 'legal' in their newfound ability to legislate medical standards. I ran across a brief history of this, though the eyes of Mark Twain, called, 'The Pre-Flexnerian Report: Mark Twain's criticism of Medicine in the United States' in the Annals of Internal Medicine
In 1901, he [Mark Twain] told the Committee on Public Health of the New York General Assembly that "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven's been able to sleep."
"Now what I contend is that my body is my own, at least, I have always so regarded it. If I do it harm through my experimenting it is I who suffer, not the state. And if I indulge in dangerous experiments the state don't die. I attend to that."
"So I want liberty to do as I choose with my physical body...."
Of course, since Twain does not have the freedom to do what he wants with his own physical body, we must assume that government believes it owns at least a portion of it (or maybe it rents or leases a portion of his body to him... :) ). Today he would have even less freedom than he had back in 1901. However, I do not mean to limit my criticism towards the A.M.A. (American Medical Association, which represented the M.D.s). The Osteopaths have since joined the Allopaths in lobbying to keep everyone else out of the 'doctors business'. D.O.s and M.D.s are the only people that can legally treat illness, operate, prescribe medicines etc... (we'll return to this later).
Feb 2001 PostGraduate Medicine More evidence of Doctors attempting to limit their numbers in order to raise their salaries:
Of its [Pew Health Professionals Commission] recommendations, three were key:
Shut down enough medical schools to trim at least 20% of first-year slots by 2005
Limit the number of residency positions to the number of US medical school graduates plus 10%
Tighten visa restrictions on IMGs to encourage them to return to their native lands
Response to the Pew report came from several fronts, including formal replies from the Association of American Medical Colleges (AAMC) and the American Academy of Family Physicians (AAFP). Both organizations agreed with the premise that the United States was headed toward a serious oversupply of physicians, but they differed in their solutions to the problem.
Recent recommendations from the AMA propose limiting the number of medical school graduates to match the class of 1997 (1). That year, 17,907 medical students graduated from US schools and 24,516 physicians filled first-year residency slots--a number equivalent to 137% of graduates. US graduates filled 74% of those slots and IMGs the remaining 26%. The AMA also is recommending that entry-level resident slots be gradually cut to 120% of the number of 1997 graduates. Such a reduction would cut about 3,000 positions.
The author concludes:
Efforts to limit numbers of physicians and their specialties must continue to receive careful consideration and critical review and to be amenable to changes in the nation's healthcare systems.
Why is the AMA, AAMC, AAFP, Pew Health Professionals Commission, and our government so worried about all of this? Obviously, no one can predict the number of physicians that will be 'needed'. Personally, I am a bit more worried about how many bureaucrats, commissioners, and politicians there are in government! Seems there are quite a few more than are 'needed'.
How many physicians there will be and how much they will be paid should be determined by the market, not by interest groups and certainly not by government. If too many people decide to become doctors then doctor's wages will fall - good for patients and too bad for doctors! If too few people decide to become docs then the salaries of docs will go up until more people choose to go into the field because of the higher salaries. Irregardless, market forces should choose the 'right' number of physicians and these physicians should be paid according to the value attributed to them by their customers - the public.
Subdivided into 'DO Day on the Hill' and 'AOA Advocacy'
See also, 'DO Day on the Hill, Round 2'
See also 'New Leadership on HealthCare: a Presidential Forum'
See also 'FDA Tyranny'
See also 'Government Health'
See also 'British Healthcare'
See also 'Canadian Healthcare'