Audacity of list-making

According to this morning’s New York Times, three Harvard child psychiatrists were paid more than $1 million each by pharmaceutical companies between 2000 and 2007, and failed to report most of the payments to the university, as they were obliged to. The omissions were uncovered by Charles E. Grassley, a Republican senator from Iowa, who has sponsored legislation that might help to solve the problem: He proposes a national registry of payments to doctors by pharmaceutical companies. This sounds like a wonderful idea to me, but my first thought as I read the article was, Of course it’ll never happen. Over the last eight years, I’ve learned to hope for no more than the occasional quashing of a really pernicious innovation (Cf. the privatization of Social Security). On second thought, however, I realized that my pessimism is a trained response, and that I am capable of unlearning it. In fact, I could start unlearning it now, because the Bush administration is about to be canned. I seem, after all, to have been carrying around in my head a list of regulatory and legislative changes that I’ve been hoping the next administration would put into effect. Herewith, in the spirit of very amateur punditry, in no particular order:

1. A national registry of payments, in cash and in kind, to doctors by pharmaceutical companies and medical-device manufacturers, to be made publicly accessible in a searchable online database.
2. Health care reform. My own personal horror story, with a creepy postscript: A couple of years ago, I woke up at 3am with excruciating pain. It was midwinter, and sleet was coming down outside. Seeing me curled up on the floor howling as I have never howled before, Peter called 9-1-1, and an ambulance soon arrived and took me to a nearby emergency room. It turned out that I was passing a kidney stone. Months later, our insurer, Blue Cross Blue Shield of Illinois, refused to pay for the ambulance ride, which cost slightly less than $500. They weren’t trying to claim that I hadn’t needed an ambulance. They were claiming that the ambulance I rode in was an out-of-network provider. I called them up and asked whether, as an Illinois-based company, they considered any ambulances in New York City to be in-network providers, because if they didn’t, they had no right to be offering insurance to companies located here. Oh yes, they said, they did have New York City ambulances in their network. Just not the one that took me. The name of the fly-by-night ambulance service I used? The Fire Department of New York. I tried arguing, in my appeal, that Peter wasn’t at 3am in any mental state to sort through which ambulance providers were in and out of network, that it probably wouldn’t have been medically appropriate to take the time to do that anyway, and that it wasn’t at all clear to me that New York City 9-1-1 operators let you specify which ambulance will come pick you up. They didn’t buy it; I had to pay out of pocket. Fast forward to 2008, when the city is considering a new program to send special ambulances to pick up people who’ve just died, so their organs will reach the hospital fresher (more on the concept here). A University of Pennsylvania bioethicist explained to the New York Times a potential objection:

   “There are a lot of Americans who have a hard time getting into a hospital because they don’t have insurance or they have poor insurance,” Dr. Caplan noted. “They will not necessarily find it a good thing when they find out that they can’t get into the hospital, but that a hospital will send a special ambulance to bring their body to the hospital when they’re dead.”

   My case is less dramatic, because I had no trouble getting into the emergency room and didn’t die. Still, if I had died, and such a program had been in operation, the ambulance would have been paid for. To make an unnecessarily long story short: The morality of not providing for health care for everyone will become more and more dodgy as medicine advances into such domains as high-speed organ recycling.

3. A ban on the sale of sweetened drinks (including juices) and candy from all schools, and a ban on advertising food to children in print or on television.
4. A national bully-pulpit campaign to urge energy conservation.
5. The elimination of ethanol subsidies, because the math doesn’t add up on growing corn with natural-gas-produced artificial fertilizers in order to make a gasoline substitute. It’s an agribusiness boondoggle.
6. The reform of U.S. farm policy generally. Drastic reform, if not elimination, of subsidies for corn, wheat, and soybeans. Failing that, support for the cultivation of fruits and vegetables at levels comparable to the support for commodity crops.
7. A continued acceleration of fuel-efficiency standards for cars and trucks.
8. A national commission to investigate all acts of torture perpetrated by U.S. agents or at their behest since 2001, to be modeled on the 9/11 Commission, with borrowings from South Africa’s Truth and Reconciliation Commission as necessary.
9. The repeal of the Military Commissions Act, the shuttering of Guantánamo Bay and all secret U.S.-run prisons abroad, the end of the practice of rendition, and the closure of the military tribunal alternative justice system. The restoration of habeas corpus.
10. The taxation of carbon.
11. An end to obstruction by the Environmental Protection Agency, which should be enforcing laws that require coal-burning fuel plants to reduce their mercury emissions.
12. More and safer bike lanes.
13. The establishment of a national Financial Product Safety Commission, so that people may feel as confident when taking out a credit card or a mortgage as they do when buying a toaster.
14. A Bill of Rights for non-citizens. Sixty-six immigrants died in detention between 2004 and 2007, according to the New York Times, which recently reported on one of them, Boubacar Bah, “a 52-year-old tailor from Guinea who had overstayed a tourist visa.” Bah suffered a head injury in detention, and when he came to, he yelled in his native language and threw up. His guards decided he was a “behavior problem,” put him in shackles, and took him to solitary confinement. His family didn’t hear of the accident until four days later, by which time he was in a coma, from which he never emerged.
15. The repeal of the Defense of Marriage Act.
16. Canadian-style packaging on cigarettes.
17. An end to state-run lotteries, which are a tax on the poor. Yes, many of them give a portion of their income to state arts agencies, but that’s not a good thing: it’s a blatant and for some reason not transparent effort to buy the compliance of the intellectual class.