The
State vs. Doctors
by Congressman Ron
Paul, MD
Note: Dr. Ron Paul was the June 2001
commencement speaker at the University of Texas-Houston Medical School.
Being invited to address you today is
indeed a particular honor for me. In seeking advice about my speech I was
told to observe three things:
1) Be
brief; no one remembers graduation speeches and too often they are boring.
Being brief is not the easiest request for a politician to fulfill. But I did
decide not to read the 80-page speech I'd written.
2) Be
positive; don't dwell on the problems medicine faces; this is to be an upbeat
event. Now that's a little more difficult for one who titles his weekly
legislative report: "Texas Straight Talk."
3) Be
non-controversial; well, that's just asking too much of a politician.
My task today is to remark on the
relationship of medicine to society from my perspective as a physician and
legislator. To me this is a very interesting task, but difficult to
accomplish in a short period.
Before I begin, let me reassure you that I
will try hard not to offend anyone, but that's probably not completely
possible. If I do offend, I apologize.
But you need not worry too much about a
disagreement you might have with what I say, because I'm an advocate of a
political philosophy that believes social and economic problems should not be
solved by passing more laws and using force, but instead, solutions should come
through freedom and persuasion.
The same events that early on motivated me
to go to medical school later motivated me to participate in politics. Clear
memories of the horrors of World War II and the Korean War and the reports of
loss of life of family, friends, and neighbors had an impact on me.
I knew very early on I never wanted to
carry a gun in a war and, with the draft in place, I realized the odds were
overwhelming that I would be called up to serve. I definitely knew at an
early age that I preferred a medical bag to a gun, healing to maiming, life
to death.
I'm sure all of your reasons to become
physicians vary, but most young people deciding on the medical profession
share the noble goals of promoting health, healing, and life.
There are two short stories I want to
tell, one medical, the other political and economic.
First, when George Washington got a
serious illness, the best physicians in the country were called in. Three of
the best consulted and agreed that bloodletting was the treatment of choice,
and the leeches were put in place.
Washington's weakened condition that was
the result of a serious respiratory infection promptly worsened and he soon
died. (There was no malpractice lawsuit filed.)
Good intentions and conventional wisdom
were not helpful in saving the life of the father of our country.
Medical
care involves more than good intentions.
Second, in 1620 the Pilgrims, under the
guidance of Governor Radford, landed at Plymouth Rock. For the first two
years the guiding principle was "from each according to ability, to each
according to need - and by force."
Starvation ensued and the colony neared
extinction. However, in the third year, Radford, in consultation with the
adults of the community, agreed on a system of private plots and
self-reliance. Results the next summer were astounding. Productivity shot up,
and a community spirit of voluntary sharing replaced the harsh laws that
guided the first two years.
Freedom
solved the problem of starvation.
The second story reminds me of one of my
early lectures in medical school. We were told that Kwashiorkor was the most
common illness in the world, killing more persons than any other.
Immediately, with delusions of grandeur, I dreamed of being the physician to
find a cure for this devastating malady.
But later in the lecture I learned that
Kwashiorkor was a different kind of illness - it is the end result of
starvation. Later it dawned on me that the solution to this problem was more
political than medical.
Because we in this country have enjoyed
the benefits of the freest society ever known, true famine has never existed
here. But a headline a few weeks ago read: "Rickets on the rise in the
U.S." I wondered at the time, could this be an early sign that something
is wrong? Have we undergone a reversal back toward the philosophy that nearly
destroyed the Plymouth colony?
Currently the method of distribution of
medical care in the United States is coming under attack by politicians,
bureaucrats, hospitals, labs, service providers, doctors, and patients. More
laws and more money are demanded from all quarters.
But could it be possible that distribution
of medical care is now being criticized because of a return to a system of
government similar to the early rules of the Plymouth colony?
Or is it possible that freedom combined
with self-reliance no longer works? A basic understanding of economics helps
one to understand why distribution of medical care today is becoming more difficult; quality is down while costs are rising; and
everyone seems dissatisfied.
We have, unfortunately, at least for
medicine, accepted the rules used in the Plymouth colonies for the first two
years ... "from each according to his ability, to each according to his
needs by force."
I'm not convinced that more regulations
and government laws - which are demanded on a daily basis - will solve this
problem any better than Congress' similar attempts to deal with most other
problems.
Managed care is not market-driven, it's
government-mandated.
It has
driven charity out of the system.
No more church-financed hospitals and free
care for the indigent. Everyone is charged the maximum, and no test is left
undone for fear attorneys will be ridiculing us in court alleging our
negligence.
And if it's not the attorneys, it's the
HCFA [Health Care Finance Administration] agents threatening us with fines
and prison if we misinterpret any of the 132,000 pages of regulations. This
system artificially pushes costs up, bringing calls for price controls, which
only mean rationing and shortages.
Greater understanding of freedom and
economics by the next generation of doctors would go a long way toward
heading off the approaching crisis: the day when the taxpayer has been bled
dry and no funds are available.
Even during the Great Depression, most
people received medical care because of the system. Today that system won't
function without taxpayers' money and can't function very well even with it.
The medical degree you receive today makes
you a medical doctor. A state license will legally permit you to practice.
However, it takes a lot more to be a caring physician to your patients. There
are several challenges to the practice of medicine that you, the graduating
class, will have to face in the 21st Century to achieve this goal.
Big
Challenges Ahead
Managed care is the accepted method of
delivering medical care today - to the frustration of many.
Read up!
There are 132,000 pages of
Medicare regulations, compared
with only 17,000 pages of the tax code.
A compliance plan to guard against
mistakes in filing government forms is offered by your friendly attorney for
a mere $7,000.
Additional employees are needed to file
insurance forms and keep up with regulations in operating laboratories. Even
more employees will soon be needed to implement the 1,500 pages of
regulations protecting patient privacy - regulations that in reality turn
control of all our medical records over to the US government and establish a
national medical data bank.
Fines of up to $25,000 and 10 years
imprisonment are possible for fraud and for mistakes that are hard to
distinguish from fraud.
Capitation depersonalizes medicine. FDA
regulations, though designed to help, often delay the arrival and raise the
cost of new drugs. An average new drug now requires 15 years of testing and
$500 million in costs. Many
question whether or not this process is cost-effective. A more liberalized
approach to allowing patients and doctors to use experimental medicines could
speed up the process and lower costs.
Medical privacy rules are expected to cost
$22 billion over 4 years to implement - costs that must be passed on to the
taxpayer or to the patient.
HCFA has actually requested authority to
carry guns on their audits.
Another challenge to personalized care is
the continued
influence of technology and super specialization. It's easy for the patient to be lost in the
process and become only an object in a scientific whirlwind. This challenge
is not new, but it will continue to affect the practice of medicine to an
even greater extent.
Legal challenges through lawyer-driven
lawsuits are of epidemic proportion and will continue to plague our
profession, thus driving up costs while prompting unnecessary testing.
Threats of an actual lawsuit do affect the way we all practice.
The National Practitioners Data Bank has
been set up to keep all the records of doctors' misconduct, which is also
subject to the errors of politicians, bureaucrats and spiteful lawyers.
Rectifying errors and avoiding misinterpretations in this process are
difficult, if not impossible tasks. Centralized government bureaucracy won't
solve the problems of ethics and measuring ability in medicine.
The Drug
War
The drug war will continue to affect the
way we practice medicine. Law enforcement pesters us to be their assistants
in turning over to them patients who break the drug laws.
This
encourages patients to hide rather than reveal vital information to their
physicians.
Drug laws have also caused many physicians
to inadequately treat the pain of the dying patient out of fear of the law.
Nursing care has been affected as well.
Some day, hopefully, all drug addiction
will be treated more like we treat alcoholism; as a disease or social
aberration rather than as a crime. The drug war has done more harm to our
society than the drugs themselves. The medical community should help to reeducate
the public on this serious problem.
Life and
Death
The greatest challenge young doctors face
today in their journey to becoming caring physicians is dealing with the new
attitude of our profession toward
life and our closer alliance with death. Thirty years ago, taking early life
was not a routine medical procedure; today it is. Many believe this has
coarsened society's attitude toward life.
The changes regarding abortion have
occurred in my generation and not without a lot of heated disagreements. The
debate will continue until your generation answers a perplexing question.
Let me state it: If a woman in an
automobile on her way to have an abortion is hit by another vehicle which
causes the death of her fetus, does she have the moral right to sue and win a
million dollar judgment in a "wrongful death" suit?
This is not meant to be a legal question
but one pertaining only to our understanding of life and morality. An acceptable answer to this question on both
sides of the abortion argument must be found if we ever expect the sharp
debate on this crucial issue to mellow.
In the last 30 years, the medical
profession has allowed itself to get closer to the implementation of the
death penalty than previously. In the 1880s, technology was available to
implement the death penalty by injection and was seriously considered.
Organized medicine at that time, however,
strongly objected to even the principle - believing needles and syringes
would portray medicine as a participant - and it wanted no part of it.
With the advent of electricity, the
electric chair was chosen over lethal injections. Since the resumption of the
death penalty in 1977, lethal injection has been commonly used to carry out
the death penalty, with the advice and even the presence of physicians. The
strong objections expressed by the medical community a century ago are no longer heard.
Euthanasia
Your generation will deal with euthanasia
as we have dealt with abortion. I predict a major and heated debate will
occur in the next 30 years. Already one state has legalized
"doctor-assisted suicides." I'm not talking about reasoned
restraints of heroic measures for the terminally ill at the patient's
request. Euthanasia laws as they have progressed in some European nations permit
active euthanasia.
We already have the Dr. Kevorkians and
angels of death leading the charge in a dangerous and illegal fashion in this
country. It's interesting that the promoters of euthanasia always want the
doctors involved.
This is for a precise purpose, and that is
to gain moral sanction not otherwise available. You never hear about having
attorney or judge-assisted suicides, but they can figure out the details as
well as the medical profession.
This trend is fraught with great danger.
Once physicians
embark on making decisions over death, rather than always opting for life,
they invite too many mistakes.
Subjugation to social pressure and family
squabbles can affect decisions.
The government now assumes nearly a
complete role in regulating and paying for health care; economic factors will
surely play a role in this decision-making as time goes on. Already we have
seen managed care and government regulations dictate rules that are not
always fair as to who gets the organ transplant or some other expensive
treatment.
Regardless of the law in dealing with
these issues, I see no reason why the medical profession has to grant moral
approval to the process. Let someone else deal with it and carry out the
deed. It’s surely not an issue of know-how, and we need not give it
credibility by pretending it’s part of our responsibility to heal.
Society needs and demands our endorsement
to make it a medical procedure, which it is not. Our endorsement only
prevents others from considering the morality of the issue.
Already a well-known former governor is
strongly advocating active euthanasia, saying "the elderly have an
obligation to die" and should not hang on to life that offers little.
The US Congress, although technically it
has no jurisdiction to do so, has tried to undermine the Oregon law (the
first state to pass a law that permits physician-assisted suicide) with
proposed legislation that would severely micromanage the care of dying
patients.
This attempt to do what some see as
"the right thing to do" will only cause more problems by
intimidating physicians in their efforts to relieve the pain of dying
patients. New restraints by government on prescribing for the dying will
prove to be an unnecessary aggravation. This is not the answer to a society moving
toward euthanasia.
This subject will be with us for a long
while. Your generation of physicians will have no choice but to deal with it
one way or another. You can’t escape it – even total non-participation in the
debate is taking a position.
Obviously, problems do exist in medicine,
but the profession you have chosen is the best of all. It is a noble calling
to enter medicine. You have learned the science, you will get your license,
and the only task left before you is to become a caring physician. I am sure
that nearly every one of you thought of service to your fellow man when
deciding on a medical career. And that’s a noble ambition that should never
be forgotten.
The true physician draws on this and must
be reminded of it throughout his or her life. This is what makes us approach
our patients with kindness, gentleness, caring, and concern. Being a good
listener is essential. Someday, a sincere thank you or a small gift will
remind you of this, and at times it will even surpass in value the fee that you
have received for your services.
Good intentions can kill any patient, just
as they did George Washington. Good science, without compassion and
understanding,will not allow you to practice great medicine. Compassion and
care and good science will make you become the physician you dreamed of
being. This will require tolerance for alternative medical options – since
some may actually work – and a recognition that faith and prayer have a
healing quality. Intolerance of this view will not enhance a physician’s
ability to heal.
Carry
These Thoughts With You
A few simple but important reminders are
in order. Always remain inquisitive, studying and keeping up with new medical
knowledge. This is your easiest task. You have proven your ability just by
being here today.
But also be inquisitive in other areas.
Economics, politics, and the arts (that you so far have had little time for)
are vital subjects that can provide satisfaction and challenge us.
Remain productive. Medicine has
discouraged many in the past years and too many are retiring in their prime –
that’s disappointing. It’s expected that one-third of all the nurses are
likely to quit practicing in the next year due to problems in medicine.
But regardless of the system, a physician
should always be willing to practice the art of medicine for as long as
possible in some capacity. We have all heard about the "greatest
generation." You are joining the "greatest profession."
There can be no better job than being a
physician in that it’s always possible and easier for you and others to
follow the adage "it is better to light a candle than curse the
darkness." Every patient facing illness, death, or stress deserves your
lighting a candle.
I’m convinced that the freer the society
is the better this job can be done, and that can only be achieved through
education and political action. Freedom is never automatic. Without due
vigilance, the only thing that is automatic is that the good intentions of
the politicians, like the good intentions of George Washington’s doctors,
will not suffice – they will only make our problems worse.
In politics, always opt for freedom.
Today, this country is starved for a greater faith in freedom and less
dependency on government and management of our lives and our medical system.
LewRockwell.com August,
16, 2001
DR. MERCOLA'S
COMMENT:
Congressman
Ron Paul is one of the few physicians in the US Congress. Although he is
not a natural medicine physician, I admire and agree whole-heartedly with his
position on decreasing government's involvement in medicine.
That is one of the reasons why I belong
to the Association of American Physicians
and Surgeons. If you are a medical doctor and share similar views, I
would encourage you to join this organization which actively promotes Dr.
Paul's viewpoints in the real world.
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