HOWARD PHILLIPS: Let me say one of my favorite people in the whole world, even though I barely know her, is a woman who has been the "Joan of Arc" of America in terms of saving our lives and fighting the governmentalization of American medicine.

This is a crisis issue that affects every single person — from the moment of conception until death — the question of life, the question of whether our medical care will be accountable to us, will be the product of a doctor-patient relationship or whether the government, in a manner unrelated to the checks and balances of the marketplace, will determine who shall be served, by whom they shall be served, when they'll be served, where they'll be served, at what cost they'll be served, and whether they'll be served at all.

And, when the supply of medical care is controlled by politicians and bureaucrats, and the demand for that care exceeds the supply, then individual human beings created in God's image become price factors in the eyes of medical gatekeepers — they're not even medical, they're bureaucratic gatekeepers — who determine medical decisions not on the basis of medical needs, but on the basis of bureaucratic priorities.

Dr. Jane Orient is going to talk to us today about how we can degovernmentalize American medicine. Dr. Orient, thank you so much for being here.

DR. JANE ORIENT: I would like to begin with the assumption that I think everyone in this room would share: that it would be good to get the government out of medicine. I will have to speak about that a little bit, though, because there are very few audiences in which that would be a safe assumption, particularly when they find out all of the ways in which government is involved.

Let me count the ways (this is probably not an exhaustive list). First, there is medical licensure, not only of practitioners, but of drugs, medical devices, maybe even medical procedures.

 Two, there's funding of a huge portion of the medical economy both directly through Medicare and Medicaid and indirectly through the tax code.

 Three, there's medical research; four, medical education; five, criminal law; six, medical records. And, I'm not, again, sure that that's exhaustive.

we need to seize the moral high ground. People often say we should support capitalism because it works, and people have more money, and there's more jobs, and more affluence, and so on and on. They sometimes impale themselves on their own swords because the others subtly respond that capitalism is immoral.

 What we should say first — and first we should seek the kingdom and other things will be given to us beside — we should say that free enterprise should be favored because it is the only moral way to do it, because the alternative is something rightfully called "legal plunder". So we should favor getting the government out of medicine because governmental involvement is wrong, pure and simple, it's wrong, it's immoral — even if it helped us, then we should do away with it.

 But, secondly, just like sin does seem to have consequences (like the wages of sin is death, and so on), we can point to the evil consequences of governmental involvement and how all of the good intentions really have been stood on their head when the interventions are put into practice. Let us never forget that governmental involvement is the use of force, and the use of plunder to redistribute the wealth if we are taking from one person to give to another. And I like to use this argument when people say, "But what would you do about the poor, doctor? There are people who can't afford medical care. Will you let them go without?"

 And I try to answer it this way, by saying "Look, patients do come to me, and they maybe can't afford my services, and, you know what? I am able to help them without robbing a waitress, or a ditchdigger, to help pay my fee." I haven't heard anyone try to refute that argument yet.

 There is also the conceptual basis for this — you know "medical care is a right" is accepted by politicians across the spectrum, and they actually turn white and sweat if you start to suggest that that's wrong. They know that it's wrong, but they don't dare (for political reasons) say so.

 We have the concept of "natural rights" or "God-given rights" — the right not to be denied the deprived of life, liberty, or property without due process of law. As opposed to things like the right to medical care which are "positive rights" or artificial rights conferred not by our Creator, but by our government, and which always involve taking from one in order to give to another.

 Actually, all of these positive rights such as the right to medical care amount, pure and simple, to a license to steal — using the government to do something that would be illegal if you did it yourself.

 Well, one of the ways in which government is involved — and can we really call for the repeal of such ways because all of them, of course, are theoretically well-intentioned.

 It also is a way of keeping out of the country some particularly talented physicians — there are some people even who were on the inside of AMA who will say there's a medical mafia that prevents British-trained specialists from obtaining an American license to practice because the examination is partly an oral examination that is subjectively graded and they see to it that some of the most world-renowned physicians trained in Britain can't practice in the United States and provide a competition of someone from Uga-Uga or some other place you have never heard of, but someone trained in Britain might not.

 Licensure has increasingly become a club to force doctors into behavior that they would otherwise resist. Maybe Massachusetts was the first example that tied the medical license to the willingness to take government money in the form of signing a contract with Medicare to accept assignment of all Medicare patients under pain of losing their right to practice medicine at all in the state. Pennsylvania also attaches the licensure to the willingness to take government money. In several states the physician must buy a certain type of insurance in order to have a license, and doctors have actually been threatened with de-licensure if they don't kowtow.

 One family practitioner in Wisconsin actually sued them pro se and lost on Constitutional grounds. It's just very unaffordable for a doctor like him to buy this excess malpractice insurance, and what it does really is to protect the bad doctors by making everybody in the state pay for the cost of insurance that really would only be needed by those who are not practicing very good medicine. It protects bad doctors and, I might say, good lawyers, by assuring them a source of income.

 Licensure used to be primarily a state matter, and it still is, except that there are more and more trends to making a national system of licensure. In effect, if a doctor now loses his license in one state, there is a domino effect and he may not be able to practice anywhere in the United States of America. It is quite rare for a doctor to lose his license for outright incompetence or moral turpitude, but it is becoming more and more common for him to lose his license because he did an allergy test in a way that was different. In the state of Arizona there is actually a law that any physician who does chelation therapy is de-licensed. Now, whether this works or not, I don't know, but it's less likely to kill you than a coronary artery bypass. Anyway, you're not allowed to try it because you'll lose your license. And, there are doctors who are losing their license because they take pity on patients with chronic pain and prescribe adequate doses of narcotics so as to reduce the patient's desire to end his life, and they have been de-licensed, too, particularly in Washington, D.C.

 And then there is the issue of licensing the tools with which physicians provide relief to their patients — drugs, of course — pharmaceuticals. When the Food and Drug Administration first came into effect it was, of course, to protect the consumers against unsafe drugs. Well, does it do so? We'll say, no it doesn't. One of the first things we learned in medical school is that every drug is a new disease, and they are all, without exception, dangerous — even aspirin. My father lost half of his blood volume in a couple of hours because he was taking one aspirin a day because it was supposed to be good for preventing blood clots. Aspirin is a wonderful drug, I have nothing against it, but it is dangerous.

 Thalidomide was a dangerous drug — it caused birth defects — and this was discovered because women took it. It wasn't discovered in the initial testing in Europe, but was discovered only when it was in fairly wide use. And it seems to me that if you have a deformed baby because the drug is being tested on humans, or you have a deformed baby because it is being marketed to humans, it is the same deformed baby and it's the same problem. The only reason Americans were protected against this was because the FDA obstructs everything, and, therefore, they obstructed that — not because they had any particular foreknowledge that this would turn out to be a bad drug. They also prevent many drugs from going on the market for a period of decades during which patients will die,. or be ineffectively treated because of the unavailability. They also prevent safer or cheaper drugs from ever making it to the marketplace, or of even having the prospect of being marketed.

 And I understand that there's even a Polish doctor who is going to be tried in criminal court because he had the audacity to cure some cancer patients without the blessing of the FDA — at least some patients who had cancer that was supposed to be untreatable, who came to see him, got better. Their doctors agree that they got better. They are not willing to credit any of Dr. Brazinski's drugs for treatment. However the patients did get better, and he is in criminal court, and the judge will refuse to allow patients to testify in his behalf.

Well it might prejudice the jury if he allowed happy campers to testify because, after all, what's at stake is the authority of the FDA is to proscribe certain forms of treatment. We don't want the jury to be unduly sympathetic to the other side.

The medical device industry is now coming under increasing regulation by the FDA, driving most of research offshore. There are some very simple devices which are known to save lives — this thing that's kind of like a toilet plunger that can be used to resuscitate somebody instead of pumping up and down on their chest. Standard equipment on Dutch ambulances, the FDA even withdrew it from clinical trials. And so, if you find somebody down with a heart attack, be sure not to use the most effective method of resuscitating him because it might actually be a crime.

There is increased corruption in the FDA. For example, some of these new high technology lasers used in ophthalmology, it's thought that the manufacturer of the more expensive kind actually has bought off the FDA so physicians are having quite a losing struggle to bring to their patients the up to date technology that's available overseas. I told them instead of buying $250,000 for a lawyer, why don't you buy a boat (but I don't know whether they will follow that advice).

Well, we get to the second issue. That's just the first issue of licensing and of the Federal government regulating the practice of medicine.

Well, I have some testimony from our Association before Congress at the time Medicare was passed predicting exactly what happened, and it's predictable from the ironclad laws of economics — no one could have expected any differently. In many hospitals, the price of treatment for the poor tripled overnight because Medicare went into effect.

It now costs $4,000 for every man, woman, and child enrolled into the program — for a family of four, that's $16,000 — you can buy a lot of medical care or medical insurance for $16,000 — but, it was an automatic cash cow to these managed care organizations so they could gear up their marketing plans and had a tremendous advantage over private doctors. I think it's one of the reasons why Arizona has one of the heaviest penetrations of managed care of any place in the country.

Then there's the issue of medical research. Almost all medical research, by some means or other, is under the thumb of the Federal government. Even the research by the private pharmaceutical companies has to look at the specter of recovering costs because of the FDA. But, most Federal funding is now — like the NIH for research — dependent upon a politically motivated review process. And even at institutions that have a generous private endowment, the fact that they do get some Federal money means that there's a damper placed on freedom of expression in the whole department. If somebody in your department is doing research that says that global warming, for example, is a hoax, then his colleagues may put pressure on him to shut up because the Federal government could shut off the funding to the entire department.

It also means that the whole motivation of research is now to work at the problem rather than to solve the problem; it's to get a grant for the next year. To get a grant you have to work at the politically correct problems by the politically correct method. Back in the days when we had individual scientists deciding what they wanted to do — like Jonas Salk, his goal was to wipe out polio — and guess what he did? Well, the March of Dimes has been smarter since then; they now go for birth defects, which they know will never be wiped out, so they can continue to rely on this source of funding.

 And look at AIDS research. Eight billion dollars, or however many billion dollars, in an area for which there is very, very little to show. If it ever turns out that the Federal government is chasing the wrong hypothesis for the cause of HIV, or of AIDS, which actually became the accepted fact as a result of a press conference rather than as a result of any scientific proof, then we may see the whole establishment being brought down. I'm not here to tell you that I know what the cause of AIDS is — I don't — but I can just say that the establishment is completely capable of making a mistake that serious.

 The self-correcting mechanism of scientists completely derailed when a scientist who speaks up against the going ideology can find that his funding is cut, or ended forever.

 Medical education — I can just say that that protects the incompetent medical student. It now is practically a federal case to flunk anybody out of medical school. It used to be if somebody knew enough anatomy to pass you asked the anatomy professor. Now the faculty meets all night long trying to decide if they have got enough documentation to say this person does not deserve to pass.

Actually it appeared on television, these provisions that have really Draconian penalties for making a mistake in coding or for doing something so outrageous as to provide a "medically unnecessary service" — and what's that? I don't know. I don't think anybody knows. It's an undefined term that is undefinable.

I know there is an ophthalmologist in California who was sentenced to 11.25 years in Federal prison, where he is now, for doing too many cataract operations. His patients said they saw better after the surgery, but, of course, you don't need to see better in order to live. The judge would not allow the patients to testify. He is in prison and he's just one example. I think all the other doctors will be very hesitant to provide certain services because of this possibility.

In addition, the so-called administrative simplification provisions of this bill set up a Federal infrastructure for collecting data about everybody every time they go to a doctor. There is no possible medical use for this kind of information. The sinister uses are the only ones that make any sense to me of anything other than a bureaucratic boondoggle. Of course, it's being sold to people, they say — well, if you ever go to the emergency room we'll have your records on line. And I can tell you that if you ever go to the emergency room and you can't give a history, your old medical history are the last thing that are going to be on the doctor's mind.

Well, what can we do to change all of this? As I am sure you are all well aware, once a Federal program is in effect, it becomes very, very difficult to get rid of it because of all of the vested interests, all of the people who are getting money from it.

And so, the question comes up, well couldn't we do it in reverse — couldn't we have incremental freedom? I think that's a strategy worth considering, except that, as you know, a salami slicer only works one way. It's a little bit hard to put the salami back together after you've taken off all the various pieces.

HOWARD PHILLIPS: Let me use the prerogatives of the chair to reinforce your observation. My sincere belief is that one of the greatest mistakes made by conservatives is to assume that incrementalism works for our side. Water runs downhill by itself, but it doesn't run uphill as easily. The reason incrementalism works for the Left is because they have established the predicate for their action. Their principle has been accepted. And, therefore, once the principle has been conceded by the Republicans or whoever, they can take their time in having the principle implemented by degree, but, as long as we are still operating on their principle that the government is in control of medical care, for example, we can't undo it, bit-by-bit. We have to overturn the principle in order to succeed, and only once the principle is overturned can we then get somewhere.

There is much evidence that can be provided. Recently, I argued in Congress that the Legal Services program should be completely defunded and zeroed out. The Republicans said, no, we think it's a rotten program, but we're going to deal with it incrementally. We'll cut it by so much this year, so much the next year, and we'll put restrictions on it. Well, they first year they cut it by so much, the next year they put the money back, and now, the restrictions they sought to impose have been overturned in the courts.

Basically, whether you're speaking about the National Endowment for the Arts, or the Legal Services Corporation, or Planned Parenthood, the courts have ruled that of course it's Constitutional for Congress to zero out the money, but it's not Constitutional (by some perverse logic) for them to determine the manner in which the money will be expended. In other words, you can't say that money to Planned Parenthood will be restricted. You can't say that Federally funded Legal Services lawyers may not take "x, y, or z" case. You can't say that the National Endowment for the Arts is prohibited from funding this or that piece of cultural garbage.

So I thoroughly endorse your observation, on which I hope you will elaborate, that if we are going to undo the damage that has been done, we must, in one felled swoop, at least overcome the principle to which we have succumbed over time.

If everybody would stop stealing from everybody else instead of just stopping the ones who are stopping me from stealing from you, but not stop you from stealing from me — that doesn't work. And this is also the key, eventually, for peace in society, as Hans Sennholz likes to point out.

Just listen to both sides of the political aisle. They're talking about using force; they're talking about war. Pitting one group of citizens against another: the old against the young, the welfare mothers against the working people, because it's always a matter of plundering from Peter to pay Paul and it kind of goes around in a circle.

Will very many people want to pay their doctors when they can get the government to pay? Probably not, not as long as they can get it otherwise, but that little escape hatch must be kept open. The socialists know how important that is. They need to seal off all the exits, they need to have us all in it together. They'll say, if you let some of the rich people out then all the waiting rooms are going to be like bus stations, whereas if the rich people have to come there too they'll all be better for everybody — which is just pure nonsense, it never works that way. But anyway, it makes a good story.

Socialism is plunder; Communism is complete plunder.

QUESTIONER: Bastiat said in that book, when plunder becomes a way of life in a society that society will develop a legal code which justifies and a moral code which glorifies it — and that's what we have.

JANE ORIENT: We shouldn't be mortgaging our grandchildren — that's kind of the ultimate form of taxation without representation.

Always, always we should emphasize the effect on the little guy, on the middle class, that we're depriving them of the fruit of their labor, we're making it impossible for them to get ahead — all for the benefit of this new parasitic class that wants to dictate every detail of our lives.

I think shining the light of truth on them is the most important weapon that we have. I think that, if we do that, we have a chance of winning in the long run.

And some of them even say it is an act of supreme love to take a human life — in black and white. These are fairly recent things by very prominent physicians that are ...

JANE ORIENT: Oh yes. The Oath of Hippocrates says, "If something comes to my knowledge in my intercourse with men that ought not to be known abroad, I will keep it secret and never reveal it."

HOWARD PHILLIPS: That's now illegal.

JANE ORIENT: What could be plainer than that? Yes, it is illegal — well, actually, you could not write it down. "Confidential" means not written down, in my opinion. But the newer oaths say, "I will have respect for my patients' confidences", but there is always that implication that if the government needs the information, they can have it.

JANE ORIENT: There are three big growth industries in the United States: one of them is gambling, one of them is temporary help because it's too threatening to hire an employee, and the third one is prison construction, new prison construction. These things that are crimes are mistakes. One of our members even called it the "KGB Plus" rule.

The KGB said "Show me the man and I will name his crime." But now it is "Show me the man, and I will invent his crime." Because, literally, they make up the rules as they go along. They do not know what the rules are.

One of our members was threatened with a $50,000 fine because he was doing, or documenting, or coding for allergy tests according to the new regulations, as he understood it, as they were written down in black and white. They said, "well, that's not what we meant." He's gone to Baltimore where they keep all these regulations. They don't have any regulations.

Dr. Rutgard, the man who is in prison for 11 years, his lawyers asked the United States to please cite the rule that Dr. Rutgard violated, and they refused to do it. We don't have to say that. There is nothing in the books that says how you have to do a cataract test. He claimed he was doing it under high glare testing because people in southern California, when they drive, this mimics the conditions of the light in their eyes, and, if they can't see under high-glare conditions, then they are handicapped. Well, there's nothing in the book that says you have to do it, but, because he consistently did it that way, that was considered fraud.

HOWARD PHILLIPS: And this has been voted for by Jesse Helms, by Trent Lott ... by Jon Kyl, everybody.

JANE ORIENT: Well, I think we've got a big problem because we've got a number of elderly people, through no fault of their own, dependent upon the Medicare system. But, I think we have to stop talking about saving Medicare because it simply can't be done. That is a lie by both sides. It will come crashing down, and my generation is going to kill it. We just are. They are going to have to be sending people off to be turned into — what do they call it, that green stuff? Soylent green? — because they can't afford to pay for our bills because the younger generation is not going to put up with confiscatory taxation.

HOWARD PHILLIPS: Remember, as Charlton Heston said, "Soylent green is people."

JANE ORIENT: Yes. Of course. We want to save medicine. We want to save medical care for the elderly. We cannot do this by saving Medicare, but I think the first thing to do is to get everybody out of it who is willing and able to leave. We need to get the younger generation (which, of course, is my generation — we're young now) to be given the ability to provide for ourselves and not become dependent upon Medicare. If we did that, then if we had on the system only those who truly needed it, it would sure last a whole lot longer and would not bring the whole structure of private medicine in the United States crashing down with it. But, of course, the first thing they want to do is pretend that it's illegal actually for a patient to pay a doctor outside the Medicare system.

QUESTIONER: Do you have any incremental way of helping to solve the problem? ... troublemaker ... I mean, fundamentally, we are dealing with the issue: what is the role of government? When you've excused some of these lawmakers, these Senators, you say because the bill wasn't properly linked. That's not a good excuse.

JANE ORIENT: I knew they knew it was in there because I wrote to every single one of them.

QUESTIONER: The point is they know, they should know, the people on our side, what the role of government is. And this is the Trent Lott, the Jesse Helms, the rest of them. You know, I've been around these people long enough, so, what they should do is just vote against it automatically like H.R. Gross used to do, or Congressman McDonald.

JAY PARKER: It's like government housing. I think you throw everybody out in the street five minute ago. Then you automatically turn the property over to somebody for a dollar. Jon Utley knows how to manage property. And he's not going to run empty buildings, he'll bring proper people in there who will behave themselves, will pay their rent.

JANE ORIENT: You said "they should have known better" — if you do something wrong, and you should have known better — especially if you are a professional, like a doctor — $10,000 per instance, which can add up really fast. If they should have known better, they get reelected. It's really sort of a contrast ...

JAY PARKER: I was around these people before they were elected, and they used to talk about principle. Somehow they've forgotten principle, standards, and values. And we need to call them to account for this, that's all.

HOWARD PHILLIPS: Well, we haven't done our job of leadership. People are influenced by the company they keep, and they keep the wrong company in Congress. It's a rowdy bunch, and not of the highest character. We need to supervise our employees in public office, we need to be very careful about the people we send there. And I would agree: rotation in office is a solid principle. There are ways of achieving it where we might have some disagreements, but I think we can look at particular people now in Congress who are not nearly so good as they were when they first arrived simply because their constituency is now in Washington rather than in their home state.

PEG LUKSIK: In talking about educating people in the war of words, perhaps. Your stories were excellent, but if I were debating this politically, I wouldn't tell stories of doctors who were victimized. I would tell stories of poor patients, because you take away from them the ability then to say: Well, that's a rich person, then give me your rich house.

Instead, find the senior citizen — when we were debating this in Pennsylvania, I found an old person who was not told there was treatment for the cancer that they had and was instead sent to a hospice, even though treatment was available. And that blew a number of minds on Capitol Hill, because the patient, the one that they are supposed to be protecting, was in fact the one being victimized. That's the kind of story, just in the war of words — I would find those people and let them tell their story and I would re-tell it. That's the story you tell the press.

When they were doing the ABC bill, the child care bill, which is a different issue but one that I was intimately involved in stopping — they told the story about a child who had a teen-age babysitter and the babysitter looked the other way and they put the child in the dryer, and the child was horribly burned. And that was the story that they told, and it surfaced again and again, and no matter what office I was in, I heard the story about this child.

So I started digging, and I came back with this story of a day-care center that had left the child in a van on a very hot summer day, and the three-year-old died! Because they had so many children in warehouse care — nobody meant to do it, they just counted wrong, and the little one went to sleep, and they didn't notice that she wasn't there until several hours later, and by then it was too late. And so, my story beat their story, so to speak.

So, don't tell doctor stories, tell patient stories. Tell about the people who were denied the care they needed because it was cheaper, because the government said. Find those kinds of stories so that your victims are people, that the politicians, then, can tell those stories and survive in the press. This is just a suggestion, perhaps.

JANE ORIENT: A lot of the time, I'm trying to wake up the doctors — but it's also to wake up the public. If they can do this to doctors, they can do this to you. And, along with the doctor story you might bring in the patient story. And for these doctors, there were patients behind them. Patients who were actually brow-beaten by Federal investigators saying, you'd better testify against this doctor, because if she isn't guilty of fraud, you are.

BILL BALL: Two things. Number one, you talked about the problem of semantics, and I think this is extremely important. If we're going to make this case with the public, you have to use the "kiss" principle and keep it simple. I think you have to construct the arguments, too, I agree, you have to take the gloves off. A lot of times we get into these debates, and if it's very complex for the voting public out there not really understand the points that you try to make; that this is not a productive process to allow the government to do. You're going to have to have your numbers and your figures together and be able to document as to what Medicaid and Medicare have cost since its initiative in, what '65, '66? And the benefits for eliminating it, but it's going to have to be very simple statements that have to be thought out carefully so it can be understood by the general public. So often the debates come up on Meet the Press or Brinkley and get lost in a haze of rhetoric.

We hope to have an impact on this debate through the Constitutional budget on which Charles Orndorff and our staff have been working, and our premise in the Constitutional budget is that nothing should be in the budget unless there is specific language authorizing it in the Constitution. We've already got it cut down below $500 billion, excluding Social Security which would be privatized, and debt interest, which would be otherwise covered. So we could have a much smaller government if we follow the Constitution.

About Jane M. Orient, M.D., F.A.C.P.

Dr. Jane M. Orient received her B.A. in chemistry and her B.S. in mathematics from the University of Arizona in 1967.

She graduated as a Medical Doctor from the Columbia University College of Physicians and Surgeons in 1974, subsequent to which time she had a straight internal medicine residency at Parkland Memorial Hospital in Dallas, Texas and at the University of Arizona Affiliated Hospitals until 1977.

She was certified with the American Board of Internal Medicine in 1977.

Prior to becoming a physician, she was a high school teacher of physics, chemistry, biology, general science, and mathematics in Spencer, South Dakota.

From 1977 to 1980, she served on the faculty of the University of Arizona College of Medicine, rising from instructor to assistant professor.

Since 1981, Dr. Orient has been in private practice as a solo practitioner. She has also been an Assistant Clinical Lecturer in Internal Medicine at the University of Arizona College of Medicine, Director of Continuing Medical Education at Carondelet St. Joseph's Hospital in Tucson since 1990, Chairman of the Department of Medicine at Carondelet St. Joseph's Hospital, 1992-1993.

Since 1989, Dr. Orient has been Executive Director of the Association of American Physicians and Surgeons, continuing as editor of the AAPS News, in which post she began in 1986.

Since 1993, she has also been Professor of Clinical Medicine at the Oregon Institute of Science and Medicine.

She has published more than 100 articles in scientific journals and lay publications on subjects including medical diagnosis and treatment, environmental risk assessment, medical economics, ethics, and civil defense.