November 21, 2004

Will Work For Laws

Sometimes when doing presentations for health providers, I joke about over-regulation of health care by asking that before participants decide to suggest new laws-- they close their eyes and imagine hordes of lawyers running through the Halls of Congress holding cardboard signs that say: Will Work For Laws. I may be joking but the reality of over-regulation is directly addressed by physician blogger Dr. Bob at The Doctor Is In who says:

When last I checked several years ago, Medicare had about 150,000 pages of regulations in the Federal Register, approximately 3 times of the volume of the IRS tax code. American medicine is more highly regulated than Soviet state industry ever was, and getting more so by the day.

He calls his post the Law of Rules, which is very distinct from the Rule of Law. A particularly cogent passage of his article is:

We often hear totalitarian regimes such as China or the former Soviet Union boast of their low crime rates and the safety of their streets. And Islamic countries and cultures often proclaim their inherently higher moral status over us libertines in the West, cutting off the hands of robbers and the like. But while it is possible in large measure to restrict behavior through law and retribution, such measures do not make a society or its individuals moral as a consequence. In fact, the effect is quite the opposite. Laws intended to restrict evil behavior often have the unintended consequence of negatively impacting those intent on good. So, for example, the law designed to discourage fraud in Medicare by the few (a worthy goal) results in less time for patient care, restriction of access to care by the needy, and the exodus of good health care providers to other professions to escape their crushing burden -- all bad outcomes affecting far more people than the few who would game the system. (emphasis added)

We are coming up on a Legislative session next year and health care associations are preparing legislative agendas. I think that as we prepare for this session, we should all go read and reflect on the words of Dr. Bob.