GOVERNMENT MAKES WAR ON DOCTORS

The current Congress has a few lame ducks, but they're still mighty busy birds - trying to push through lots of big legislation such as 1000 pages of a $338 billion omnibus spending bill. They're also hoping that little bills zip right through, below the public's radar, such as H.R. 3015 which targets physicians and pharmacists in the take-no-prisoners war on pain drugs and patients suffering chronic pain. H.R. 3015, the National All Schedules Prescription Electronic Reporting Act, the US House of Representatives in October. It's now before the Senate where it's slated for a voice vote before the current session of Congress expires on January 2, 2005. A voice vote is a way to pass a bill quickly without a record of which way each senator voted.

This bill would encourage states to establish programs requiring physicians and other providers such as pharmacists to report any and every prescription for a wide range of commonly prescribed drugs, including pain medications and anti-depressants. In addition to the medicine and dose, the doctor would have to give the government the patient's name, address and telephone number. This private prescription information would then become part of a national computer database, available to the police and also possibly to employers, newspapers, blackmailers, or anybody else curious about such information.

The patient would not even know about the release of this prescription information, much less consent to its release or review. Police would have access to personal prescription information without having probable cause to believe a crime had been committed and without convincing a judge to issue a search warrant.

Drug Enforcement Administration (DEA) agents and state licensure boards already have great powers. They currently can get information on prescriptions written for controlled substances and have sweeping authority to investigate anybody they choose and to prosecute doctors for prescribing more pain killers than agents think appropriate. HR 3015 would dramatically enhance the reach of police and DEA agents into the privacy of doctors and patients.

Some government officials liken doctors to terrorists, and want equal judicial vigor in pursuing doctors. For example, Assistant U.S. Attorney Gene Rossi declared to a reporter that "our office will try our best to root out [certain doctors] like the Taliban. Stay tuned." according to a September press release from the Association of American Physicians and Surgeons.

In opposition to the bill, Rep. Ron Paul, MD, of Texas said HR 3015 "is yet another unjustifiable attempt by the federal government to use the war on drugs as an excuse for invading the privacy and liberties of the American people and for expanding the federal government's disastrous micromanagement of medical care." He pointed out that the government is embarking on a "war on pain patients and their doctors" which "has already resulted in the harassment and prosecution of many doctors... whose only 'crime' is prescribing legal medication... to relieve their patients' pain. These prosecutions, in turn, have scared other doctors so that they are unwilling to prescribe an adequate amount of pain medication, or even any pain medication, for their suffering patients."

Could it be that government agents are going after innocent and hard-working doctors because the doctors are easy targets? Are real criminals going free because these same government agents find it too much work to break through the complicated logistic and legal defenses that real criminals sometimes build and hide behind?

Rather than giving non-medical officials more authority, power and money, congress and the president should restrain the DEA from essentially telling doctors how to practice medicine. Rather than using resources to send trained actors feigning pain to entrap doctors, the DEA and other agencies should communicate and cooperate with doctors.

To further this goal, the Association of American Physicians and Surgeons (AAPS) recently developed a 3-point "Communicate and Cooperate" proposal to encourage physicians and law enforcement to work together to prevent prescription drug abuse. The proposal includes several ways law enforcement agents can work with doctors, such as:

1. Working together to track suspected drug abusers. To balance current laws requiring doctors to provide information about suspected abusers to the government, government agencies would notify doctors about suspicious patient behavior such as contact with know drug dealers or abusers.

2. Reviewing possible cases with professional medical boards before filing charges in court. Doctors would review a physician's practice with police before non-medical prosecutors would file criminal charges. This would help prevent embarrassing errors by government agents and would prevent worsening the current shortage of doctors willing to adequately treat patients with chronic and painful medical conditions.

3. Mutual training of law enforcement and medical personnel. Law enforcement people would educate doctors about recognizing patterns of illegal activity and criminal intent; doctors would educate police about modern pain treatment.

And why is the US Senate vote scheduled for only a "Yea" or "Nay" voice vote, without recording which senator voted which way? One reason is often so that senators can't be held to account for their votes. As Rep. Paul says, "Instead of further eroding our medical privacy, Congress should take steps to protect it."

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RATIONING MEDICAL CARE COVERTLY

The US healthcare system doesn't need the burgeoning medical costs of baby boomers to make it unsustainable. It already is. With costs every year rising two percentage points faster than personal income, it's universally acknowledged that the system is broken, but no one can agree on how to fix it. The nub of the problem is that Americans refuse to accept any form of rationing in a system that accounts for 14.1per cent of GDP, the highest in the world, yet which still leaves 45 million people without insurance and the rest paying premiums averaging 8.2 per cent of gross pay.

All of this so patients can have the expensive tests they demand - but may not need - given to them by doctors who are forced, by threat of lawsuits, to practice defensive medicine. But the reality is that rationing goes on every day, mostly behind closed doors with patients left out of the loop. "You can eat up all of your profits if one or two patients linger in the intensive care unit of a hospital," says Lorraine Micheletti, head nurse at Philadelphia's Northeastern Hospital. Under management orders to cut stays to keep the hospital open, Micheletti told the Wall Street Journal she encouraged families of older patients with not much in the way of quality years left to not keep them alive.

Under a form of rationing proposed by Washington-based analyst Robert Hungate, health insurance subscribers would pay little to visit their family doctor, half of specialists' fees and then a substantial part - though it will be capped - for hospital stays and expensive procedures. "What I argue is that we have to achieve rationing by choice," he says. "That's what markets do, and markets ration better than bureaucracies."

Critics, though, say healthcare is a fundamental right and should not be determined by factors such as costs. The American Medical Association's declaration of professional responsibility says a physician's duty is to treat the sick and injured with competence and compassion, and without prejudice, says private physician David Rogers. "Without prejudice means to avoid any bias that could possibly interfere with or reduce the quality of care," he says. "In my opinion, this would include using costs when making treatment decisions."

But Annie Liebowitz, former chief medical officer of Aetna, one of the biggest health insurers in the US, asks whether it is good to burden a patient with expenses that could have been avoided, or prescribe a brand name drug when a generic drug at half the cost is equally effective. "When given the choice of two equally effective diagnostic tests, or treatment approaches or medication options, physicians must consider which is likely to cost less," Dr Liebowitz says. "Our patients' needs are our first priority, but the healthcare system we all depend on is also our patient."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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