While Americans are preoccupied with the political theater of the Presidential race, special interest groups toil to pass legislation that could radically transform medical care. One example is the Interstate Medical Licensure Compact, which has passed in 11 states. Pennsylvania has joined a number of others in proposing it. The proposal promises to provide “remote communities with access to high-quality care through telemedicine” and “address a shortage of medical personnel in underserved rural and urban regions,” according to an article in the Pennsylvania Business Daily.
Americans need to remember three things about proposed legislation:
- Its real purpose is likely to be very different from the stated one, and the result may be the opposite of the one that is promised.
- Especially when the same law is surfacing simultaneously in a number of states, some vested interest wants to make money from it. A lot of money—getting laws passed can be very expensive.
- There may be no way back, as the law empowers and funds interest groups that will oppose repeal.
So what does the Compact do to bring telemedicine to underserved areas? By itself, nothing. It’s about a bypass to state control of licensure, not about providing care. If telemedicine were the real object, the way to expedite it would be to define the location of medical care as the location of the doctor, not the patient. The doctor would need a license in only one state. Compact proponents oppose a telemedicine bill in Congress that would do just that.
Some physicians already hold a license in several states—they just apply to each state. Under the Compact, they would apply to a private interstate commission, which would have its own rules, possibly overriding rules of the states, and which would have no public accountability. This would add costs, not eliminate them. It could also allow doctors to evade state laws meant to protect patients. For example, a carpetbagger abortionist could fly in to do late-term abortions forbidden by the state, under his Compact license.
Only “eligible” physicians need apply. The organization spearheading the push for the Compact is the Federation of State Medical Boards (FSMB). Contrary to the implications of its name, FSMB is a private corporation, which, despite being tax-exempt, brings in tens of millions of dollars in revenue by selling forms and physician data. The Compact re-defines “physician” to mean someone who is participating in proprietary “Maintenance of Certification” (MOC).
There is no evidence that MOC improves patient care. The vast majority of physicians find it to be costly, time-devouring busywork. It also tends to indoctrinate physicians into the treatment preferences of elitist, monopolistic, self-certified “experts.” But a Compact-licensed physician instantly becomes ineligible—and even becomes a non-physician, if he misses one too many questions on an exam or fails to pay up.
So, who’s for the Compact? Purveyors of MOC. Also, hospital associations. Apparently, they want to tap into revenues from telemedicine, using compliant doctors tied into an interstate system that makes its own rules and will be heavily influenced by the big players. For them, telemedicine could be a bonanza that requires little up-front investment in facilities or personnel.
Telemedicine can order tests and referrals to entities owned or controlled by the telemed physician’s employer (the hospital). It can prescribe medicines—including the “pain pill” to nonprofitable patients. It cannot establish a personal patient-physician relationship.
The news article shows three street signs: “come,” “practice,” and “here,” with arrows going in three directions. Your “provider” could be in cyberspace with a better connection to computer protocols than to you, directing patients as dictated by the System. Your rural doctor could be out of business or even delicensed, and your local premier institution could be busy with out-of-state cyberpatients.
The Compact is about control of medicine by a centralized private entity. Once in, a state may not be able to extricate itself. The proponents aren’t waiting for the “laboratories of democracy” to come up with negative results. Hence the nationwide push to get “everybody in, nobody out” as quickly as possible.
A good rule for responsible legislators: If you don’t fully understand the implications of a bill, vote no. Wait and see how it works out elsewhere.
Dr. Jane M. Orient has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.
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