Dr. Ron Paul was the June 2001 commencement speaker at the University
of Texas-Houston Medical School.
State vs. Doctors
Congressman Ron Paul, MD
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:
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 Iíd
Be positive; donít dwell on the problems medicine faces; this is
to be an upbeat event. Now thatís a little more difficult for one
who titles his weekly legislative report: "Texas Straight Talk."
Be non-controversial; well, thatís just asking too much of a politician.
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
I begin, let me reassure you that I will try hard not to offend
anyone, but thatís 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 Iím 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.
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.
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.
are two short stories I want to tell, one medical, the other political
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. Washingtonís weakened condition that was the result
of a serious respiratory infection promptly worsened and he soon
died. (There was no malpractice lawsuit filed.)
intentions and conventional wisdom were not helpful in saving the
life of the father of our country. Medical care involves more than
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.
solved the problem of starvation.
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.
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?
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
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." Iím not convinced that more regulations and government
laws which are demanded on a daily basis will solve
this problem any better than Congressí similar attempts to deal
with most other problems.
care is not market-driven, itís 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 itís not the attorneys,
itís 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
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 wonít
function without taxpayersí money and canít function very well
even with it.
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.
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.
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
of up to $25,000 and 10 years imprisonment are possible for fraud
and for mistakes that are hard to distinguish from fraud.
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.
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.
has actually requested authority to carry guns on their audits.
challenge to personalized care is the continued influence of technology
and super specialization. Itís 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.
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 doctorsí 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 wonít solve the problems of ethics and measuring
ability in medicine.
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.
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.
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 societyís attitude
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.
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.
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.
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."
Iím not talking about reasoned restraints of heroic measures for
the terminally ill at the patientís request. Euthanasia laws as
they have progressed in some European nations permit active euthanasia.
already have the Dr. Kevorkians and angels of death leading the
charge in a dangerous and illegal fashion in this country. Itís
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.
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.
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. Itís surely not
an issue of know-how, and we need not give it credibility by pretending
itís 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.
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.
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.
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
canít escape it even total non-participation in the debate
is taking a position.
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 thatís a noble ambition that
should never be forgotten.
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.
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 physicianís ability to heal.
These Thoughts With You
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.
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.
productive. Medicine has discouraged many in the past years and
too many are retiring in their prime thatís disappointing.
Itís expected that one-third of all the nurses are likely to quit
practicing in the next year due to problems in medicine.
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 itís 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.
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 Washingtonís doctors, will not
suffice they will only make our problems worse.
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.
Ron Paul is a Republican member of Congress from Texas.