Lawson for Congress

One of the most active organizations in pursuit of good government is DownsizeDC. If you haven’t visited their Web site yet, I’d encourage you to do so — their email updates are well-documented and articulate exposes of how our government serves special and corporate interests at the expense of the people.

Two of their recent releases, reprinted below, illustrate my concerns for the so-called “medical industrial complex”, and how so-called regulatory agencies serve corporate masters.

First, the Food and Drug Administration:

Subject: Stop the Killer Horse Hormones

Estrogen hormones derived from animals have dangerous side-effects. Estriol doesn’t.  But the FDA has banned Estriol in favor of the animal derived hormones. Here’s why …

Wyeth Pharmaceutical makes animal derived hormone medications. On October 6, 2005 Wyeth petitioned the FDA to prohibit the use of Estriol, a competitor to Wyeth’s “horse hormones.” Estriol is chemically identical to human estrogen, while Wyeth’s horse hormones are not. Animal derived hormones are associated with a number of health risks, such as blood clots and cancer, while Estriol is associated with a vast number of health benefits, and NO negative side-effects.

On January 9, 2008 the FDA responded to Wyeth’s petition by banning the use of Estriol.

It’s infuriating to note that the FDA’s response to the Wyeth petition calls it a citizen’s petition. It was no such thing. It was a petition from a corporation seeking government aid to prohibit a competing product at the cost of increased danger to women’s health. By contrast, 70,000 doctors, women, and other real citizens petitioned the FDA to deny Wyeth’s request, but the FDA partially sided with Wyeth anyway.

It’s even more infuriating to note that the FDA admitted in a press conference announcing the ban that it knew of no evidence of any harm associated with the use of Estriol.

The American Association for Health Freedom summarizes the case for Estriol as follows: “Compounded bio-identical hormones have been used for 50 years, are listed in the US Pharmacopoeia, are state-regulated, are available only with a doctor’s prescription, and were protected by a previous Act of Congress (FDA Modernization Act 1997).”

The FDA admits that it granted Wyeth’s request simply because Estriol has not endured the FDA’s costly and time consuming approval process. But should the estrogen that naturally flows in a woman’s body have to be approved by the FDA? Of course not. Neither then, should Estriol, which is chemically identical to that estrogen! Estriol is human estrogen.

If Estriol needs to be banned from the market then perhaps all women should report to an FDA lab to have their Estriol removed from their bodies.

We are joining with the American Association for Health Freedom to try to stop this outrage. We want to pass two resolutions in Congress: H. Con. Res. 342 and S. Con. Res. 88. Please ask your Representative and your two Senators to co-sponsor H. Con. Res. 342 and S. Con. Res. 88. You can do so here.

We would also like to note that if Downsize DC’s “Write the Laws Act” were the law of the land this FDA action would not have been possible. Please send another message in support of the “Write the Laws Act,” and use your personal comments to mention the Estriol ban as a reason why we need the “Write the Laws Act.” You can send that message here.

Next, the unexpected results of combining the American Medical Association with Justice Department bureaucrats:

SUBJECT: The AMA Writes the Laws

Should the American Medical Association (AMA) have the power to write laws? Some bureaucrats think they already do.

DownsizeDC.org proposed the “Write the Laws Act” (WTLA) to prevent unelected bureaucrats from writing regulations that have the force of law. Only elected representatives should have that power. We believe there should be “no legislation without representation.”

Sadly, we’ve just learned that the problem WTLA seeks to fix is even worse than we thought. Unelected bureaucrats in the Justice Department have now taken to treating the standards of a private organization, the AMA, as if they had the force of law.

A doctor in Kansas is facing twenty years to life for failing to conform to the standards of the American Medical Association.

Dr. Stephen J. Schneider and his wife, nurse Linda K. Schneider, are charged with illegally distributing prescription drugs, along with several counts of related fraud and illegal monetary transactions.

Did the Schneiders sell illegal drugs? No. They simply prescribed FDA-approved medications to people in pain. Now they face years in prison simply because the Justice Department disagrees with their medical judgments.

That’s bad enough, but there’s more . . .

While the Schneiders are charged with violating the Controlled Substances Act (CSA), the Schneiders didn’t actually violate any specific provision in it. Instead, the Justice Department accuses the Schneiders of violating . . .

• The policies of the Health Care Benefit Providers (HCBP’s) whom they billed — if true, then the HCBP’s should sue the Schneiders in civil court.
• Kansas state law  — if true, then Kansas should prosecute them, not the federal government.
• “Industry principles” — but those “principles” aren’t encoded in federal law, and if the Schneiders violated them, they should instead be investigated by medical licensing boards.
• The Current Procedural Terminology (CPT) code book, a “privately written, trademarked and copyrighted publication of a commercial affiliate of the American Medical Association.”

The AMA, of course, is a private organization, and while the CPT is used by the government, it is not law.

It’s important to recognize that Justice Department bureaucrats want to imprison the Schneiders because they disagree with the Schneider’s medical judgments, NOT because the Schneider’s broke the law. Mere bureaucrats are treating the guidelines of private organizations as if they were laws. Like a six year-old in a playground game, the bureaucrats are “making it up as they go along.”

This prosecution threatens all doctors — and their patients, including you.

The Schneider’s case, and others like it, will encourage doctors to let their patients suffer in agony rather than risk a prison sentence. But . . .

Under WTLA the Schneider’s case would be dismissed, because the couple isn’t being accused of violating any law enacted by Congress. According to the WTLA, this would constitute a complete defense.

Thomas More is right: if the Devil breaks the law he should be prosecuted, but not before then. The same should go for doctors and everyone else. This is a fundamental principle of free society. Our constitution says that the only valid laws are those enacted by Congress, not those written by unelected bureaucrats or lifted from the guidelines of private organizations by tyrannical prosecutors.

Tell your Representative and Senators to introduce the “Write the Laws Act.” In your personal comments, tell them about the Schneider case and how the Justice Department is treating AMA rules as if they had the force of law. Tell them the WTLA would prevent such a legal travesty from ever occurring again. You can send your message here.

Publicizing these absurdities, worthy of Joseph Heller, would once have been the domain of a vigorous and free press. In the age of media consolidation and endless celebrity scandals, however, it’s up to concerned citizens to ask questions, and reveal the threats we face.

As your Congressman, I will work for a government that respects the Constitution, serves the people, and rejects predatory corporatism. The status quo doesn’t work for us any more — join me and folks at Downsize DC as we work to restore good government this November.

Americans consider our country one of the freest on earth, yet national incarceration rates beg to differ. More than half of all federal prisoners are not murderers, rapists or even thieves; they are people who have forcibly hurt no one except themselves. More than half of all federal prisoners are non-violent drug offenders.

America now has the highest prison population in the world in terms of both percentage of the population and overall prisoners with one in every one hundred Americans imprisoned. Furthermore Hispanics and Blacks are unequally affected, as the New York Times reports:

One in 36 Hispanic adults is behind bars, based on Justice Department figures for 2006. One in 15 black adults is, too, as is one in nine black men between the ages of 20 and 34.

In a time of economic stagnation and resource-driven inflation why are we spending so much on imprisoning these non-violent offenders? The New York Times elaborates on this point, writing:

It cost an average of $23,876 dollars to imprison someone in 2005, the most recent year for which data were available. But state spending varies widely, from $45,000 a year in Rhode Island to $13,000 in Louisiana.

The cost of medical care is growing by 10 percent annually, the report said, and will accelerate as the prison population ages.

About one in nine state government employees works in corrections, and some states are finding it hard to fill those jobs. California spent more than $500 million on overtime alone in 2006.

$23,876 is quite a large sum. Money that could go to a doctor’s salary to treat drug users rather than a guard’s salary to watch them.

Americans have long adopted an approach that is tough on crime. This toughness is laudable in some cases — with increased sentencing, violent crime has fallen by about 25 percent. Drugs have not followed this trend, however.  In many ways being tough on crime works, but shouldn’t we be more than tough?  Should we not also be smart? Since Nixon declared the federal “War on Drugs”, drug availability has remained essentially unchanged. Few would object to tough sentencing laws that keep violent criminals off the street and prevent violent crime. Should we not save incarceration for when it is a solution, however, rather than just a burden?

Whatever your opinion on the use of drugs, we should question the appropriateness of enforcing laws that are in contradiction to our nation’s highest law, the Constitution. At least with alcohol prohibition in the early 1900s, we had the intellectual honesty to recognize that federal alcohol prohibition required a Constitutional amendment. Today, however, we tolerate unconstitutional expansion of government power.

In one such excess, Gonzales v. Raich (2005), Federal authorities were affirmed in their efforts to criminalize the local, intrastate cultivation and distribution of medical marijuana.  Not only does this imprison people who sought to relieve the suffering of the sick, but as Clarence Thomas writes:

If the majority is to be taken seriously, the Federal Government may now regulate quilting bees, clothes drives, and potluck suppers throughout the 50 States. This makes a mockery of Madison’s assurance to the people of New York that the “powers delegated” to the Federal Government are “few and defined,” while those of the States are “numerous and indefinite.” The Federalist No. 45, at 313 (J. Madison).

The federal drug war must be rethought, and we must adopt a rational drug policy that not only pays attention to social mores but also respects empirical evidence and, most importantly, obeys our Constitution.

William Griffin is a rising Junior studying Political Science and Economics at the University of North Carolina at Chapel Hill. He is a policy intern with Lawson for Congress.

There’s no question our healthcare system is a study in contrasts. On one hand, we lead the world in diagnostic and therapeutic research. On the other hand, healthcare is now an industry dominated by warring bureaucracies — both corporate and governmental. As providers fight to bill as much as possible, and payers fight to pay as little as possible, the doctor-patient (or more generally provider-patient) relationship is becoming a curious historical relic.

I ran across a document some time ago that captures our healthcare system’s problems with amazing clarity. Written in the style of the Declaration of Independence, it accurately reports the history of our government intervention in healthcare, and the resulting unintended consequences:

1601 N. Tucson Blvd. Suite 9 Tucson, AZ 85716-3450 Phone: (800) 635-1196 Hotline: (800) 419-4777 Association of American Physicians and Surgeons, Inc. A Voice for Private Physicians Since 1943 Omnia pro aegroto The Physicians’ Declaration of Independence July 4, 2004 When in the Course of human events, it becomes necessary for one Profession to dissolve the Financial Arrangements which have connected them with Medicare, Medicaid, assorted Health Maintenance Organizations, and diverse Third Party Payers and to assume among the other Professions of the Earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of Mankind requires that they should declare the causes which impel them to the separation. We hold these truths to be self-evident: that the Physician’s primary responsibility is toward the Patient; that to assure the sanctity of this relationship, payment for service should be decided between Physician and Patient, and that, as in all transactions in a free society, this payment be mutually agreeable. Only such a Financial Arrangement will guarantee the highest level of Commitment and Service of the Physician to the Patient, restrain Outside Influence on Decision-Making, and assure that all information be kept strictly confidential. When a Third Party dictates payment for the Physician’s service, it exercises effective control over the Decision-Making of the Physician, which may not always be in the best interest of the Patient. The Third Party then intrudes heavily into the sacred Patient-Physician relationship and demands to inspect the Medical Record in a self-serving attempt to satisfy itself that its money is being spent in accordance with its own pre-ordained accounting principles. The Financial Arrangements between Physicians and the Third Parties have become so destructive to the Patient-Physician relationship, and to the Medical Profession as a whole, that it is the Right, and Obligation, of the Members of the Profession to abolish them. Prudence will dictate that arrangements long established should not be changed for light and transient causes; and accordingly all experience has shown, that Physicians are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations evinces a design to reduce them under absolute Despotism, it is their Right; it is their Duty, to throw off such arrangements, and to provide new Guards for their future security. Such has been the patient sufferance of this Profession; and such is now the necessity that constrains them to alter their former Financial Arrangements. The history of the present system is a history of repeated injuries and usurpations, all having in direct effect the establishment of an absolute Tyranny over the Medical Profession. To prove this, let Facts be submitted to a candid world. Controls, were forced to lure workers by offering Health Insurance Benefits. This benefit, in lieu of cash, received favorable tax treatment and was allowed to continue after the War, even with the removal of the Wage and Price Controls. This system created a strong incentive to use Health Care and set the stage for massive Health Care Cost Inflation. Slowly, insurance changed into payment for all Health Expenses, minus a small and shrinking deductible, which led to further Inflation, and a call to control costs. The Government decreed that Employers must offer Employees the option of a Health Maintenance Organization. Thus were born the HMOs: Private Insurance Entities designed to ration Health Care for their Members. These Organizations received Tax-favored treatment that allowed them to survive in spite of their horrendously flawed concept. The Government, in 1965, in its Infinite Wisdom, decreed that the Poor and The Elderly should receive Health Care Benefits funded entirely by the Taxpayer. Thus came into existence Medicaid and Medicare. Medicaid, from the Conception, paid Physicians such a lowly wage that few participated, thereby creating a Two-Tiered System. Medicare payments to Physicians were initially fair and reasonable, and many Physicians participated in Medicare. Both Systems flooded the Health Care Marketplace with Money, which fueled Inflation even more. Alarmed by the Health Care Cost Inflation that it had engendered, the Government set out to restrain costs, principally by limiting fees to Physicians. These Price Controls had the effect of increasing Health Care Inflation, as Volume of Services went up, and Quality went down. With each new round of Controls, Regulations and Paperwork multiplied many fold. This caused Physicians great Anguish, and took more time away from the Patients, with attendant loss of Quality and increase in Health Care Inflation. Government policies continued to favor the HMO, which were turned to in the hope they would tame Inflation. These Organizations simply skimmed Money off the Premiums as Profit, but which they called “Savings.” They spent less on Health Care by denying or limiting access to Specialists, Procedures, Hospitals, and High Technology. Since this strategy mostly delayed care, it was ultimately more expensive. Thus did the Premiums again start to rise. The HMOs paid the Physician by Capitation; Physicians could stay profitable by having large numbers of Capitated Patients, which they would see rarely, if at all! There were other Financial Incentives to Physicians to limit their Patients’ access to Tertiary Care. These incentives set Patient against Physician, thus destroying this sacred trust. Remuneration for Physician services by the Government and the HMOs has dwindled to the point of Unprofitability and has compelled the Bankruptcy of increasing numbers of Practices, and the search for Other Sources of Income by Physicians. No other Profession in the United States is denied the ability to raise fees to cover increasing costs of doing business. The Government, becoming increasingly desperate that all its strategies to control costs had failed (because they themselves were the cause of Cost Inflation!) resorted to Criminal Prosecutions of Individual Physicians and Hospitals for alleged Fraud. The Regulations being so Arcane and Vague, a simple Billing Error could be interpreted as Fraud. Most of those so pursued, being financially unable to defend themselves, simply capitulated and paid Huge Sums to the Government. Some were imprisoned. In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A System whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a Free Profession. We, therefore, the undersigned Physicians of the United States of America, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name of our Patients solemnly publish and declare, that we will withdraw our participation in all above-described Third Party Payment Systems. Henceforth and Forever, we shall agree to provide our services directly to our Patients, and be compensated directly by them, in accordance with the ancient customs of our Profession. As has always been true of our Profession, our charges will be adjusted to reflect the Patients’ ability to render payment. Nothing prevents any patient from purchasing and using Insurance. The Patients’ medical interactions with us will remain completely confidential. We pledge the highest level of Service and Dedication to their Well-Being. And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.

This powerful document should be studied by anyone who believes so-called “Universal Health Care” (either with a single provider system, single payer system, or “mandatory health insurance”) is a good idea. As our national debt continues to increase, and our currency becomes increasingly fragile on international markets, the question remains how we can even consider printing and borrowing the money necessary to make our current model of expensive “corporatecare” a “right”. And do you really want more corporatecare, or is it time to change the system?

Perhaps my biggest concern is our current fascination with mandatory health “insurance”. As the declaration above so eloquently states, “Slowly, insurance changed into payment for all Health Expenses, minus a small and shrinking deductible, which led to further Inflation, and a call to control costs.” You see, health insurance isn’t really insurance anymore. Insurance, by definition, is pooling risk for unexpected and often catastrophic occurrences. Health insurance that gives you unlimited access to providers and treatments with a $15 copay isn’t insurance at all.

Think about it — if you’re a homeowner with homeowner’s insurance, do you expect the insurance to cover new carpeting or a new coat of paint? What would your insurer say if you burned down your house because you liked having campfires on the living room floor to roast marshmallows with your kids? They sure wouldn’t build a new house for a $15 copay. And how much would “fix anything, no questions asked” homeowner’s insurance cost?

For those who still think that “Universal Health Care” is a panacea, a couple of articles from Canada are also worth considering. Manitobans with colon cancer don’t have access to Avastin, a drug shown to increase survival in colorectal cancer:

CancerCare Manitoba claims the cost of the drug is too high and they cannot afford it. Yet the drug Herceptin, given to breast cancer patients, is more expensive. Patients who received Avastin through CancerCare had approximately six to 10 treatments, at an average cost of $2,000 per treatment. Granted, some chemotherapies have been deemed more effective in maintaining life for a longer period of time and perhaps the cost/benefit seems to be greater. But why discriminate against colon cancer victims, especially since the health system has a “duty of care” to these patients. There has been no major effort to implement a screening process for colon cancer, even though the provinces agreed to do so in 2002. Manitoba announced it would begin screening in the spring of this year. Where is it?

Do you still want unaccountable federal and state bureaucracies making decisions about what prevention strategies or therapies are available for you?

Also consider this CMAJ editorial from the year 2000, which while obviously in favor of Canada’s single payer system, acknowledges the precipice they are walking by rationing care:

If we want to maintain universal and comprehensive medicare we can do one of 2 things: increase funding, or ration services. If we want to maintain comprehensiveness without increasing spending, then “medically necessary services” will have to be rationed. And with rationing there are only 2 options: rationing by exclusion on the Oregon model, or by “delay and dilution”. We favor frank discussion about the former. We are already doing the latter and it doesn’t work.

Sounds like they’re choosing between the frying pan and the fire — trying to meet unlimited needs with limited resources is always an economic impossibility.

So what do we do? How about freeing the market for health insurance so people can buy as much, or as little, coverage as they need? How about removing the irrational coupling of healthcare and employment? How about eliminating all taxes on saving for healthcare, without arbitrary restrictions on contribution limits? (Well, we need to eliminate all taxes on income and savings, and not just for healthcare… but that’s another story.)

Those three simple steps would allow people to start saving for healthcare expenses, and purchase insurance coverage for truly catastrophic events. More patients would then be truly “shopping” for routine healthcare, looking for the providers who would provide the best value for their healthcare dollar. And providers could again truly engage with their patients as individuals, and help choose which treatments and therapies are best given their individual preferences and priorities.

The system will not change overnight, and we can’t suddenly eliminate the current “safety net” of government support, but we can take aggressive steps to move in a better direction.