Legislating Health Care

Legislating Health Care

There are many current tragedies in the world. The rising number of deaths from overdoses is a national crisis, an emergency that has to be dealt with. It is hitting our young and has risen to the leading cause of accidental death in 2010 among ages 25-64, surpassing motor vehicle accidents.

As a result, the Pennsylvania legislature wanted to “do something” and, of course, they thought that passing some laws would do the trick.

State legislatures have recently enacted several laws that regulate the delivery of health care. The Pennsylvania Breast Density Act, and continuing attempts (some successful) at legislating requirements around abortion, gun ownership and other issues continue throughout the United States.

Good ideas or bad ones?

Well, the legislators want to solve a problem. They see a problem, and armed with the hammer they have, they want to pass laws that hopefully will fix the problem. There are some challenges to that approach, especially when applied to medical practice. Practice changes. What is good practice today may in three years be the wrong thing to do, and it is difficult to change what has been enacted into law.

As painful as it sometimes can be to get a law passed, repealing it can be even more difficult. Equally important are the details. What cutoff do you set as too much narcotic for physicians to prescribe? For whatever level you might want to legislate, there will always be exceptional patients who should have more. General rules don’t always apply to individuals, especially in medicine.

But the lawmakers’ response is that people are dying every day from overdoses, from prescriptions written by physicians, and something needs to be done.

What is the solution? Prescribed education, mandatory of course, for physicians? But what about physicians who never or rarely write for narcotics? Does a well-trained, appropriately using physician need mandatory training? We have enough time demands now from legislatively mandated CME (patient safety credits as an example).

The Pennsylvania Medical Society offers free training on appropriate narcotic prescribing.

When approached by the legislature and asked what kind of law does Pennsylvania need to reduce prescription drug abuse, PAMED responded. We assembled a panel of our own medical experts, and in collaboration with the state and other experts, we are working on guidance, not a rigid law, that will be both useful and easily updated as practice standards evolve.

Coupled with a controlled substances database bill to help stop pill scammers, we can reduce abuse and misuse of prescription drugs.

We must, however, be vigilant, and continue to guide legislators as they try to solve the problems they see with the tools they have. We must also police our ranks. There are pills mills that need to be stopped. There are earnest but misguided physicians who don’t see they are being scammed again and again, and we need to help them get the education they need.

Do you know someone in your town who seems to be an inappropriate prescriber of controlled substances? What do we do about them, before the legislators return for another solution? What other problems do we need to solve before the legislators approach us for a solution – or do it on their own?

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