Equipping and Protecting from Legislator Personal Interest
In healthcare, the only treasure equal to a healthy outcome is receiving an individual’s trust in the system.
Congresspersons do not work in healthcare; they work in Congress. Lawmakers in other countries are similarly preoccupied. Sometimes these politicians may have difficulty valuing the ultimate treasures in healthcare. And, unlike medicine’s businessworld, there is no public competition or reimbursement scheme to help their value priorities along.
There is no place for trust in a system where laws are made by those with significant personal ties to health companies. So there should be no place for grey ethics, no place for personal ties, in lawmaking. If something’s gotta give, it should never be precious, fragile trust.
A recent study noted that about a third of Congresspersons hold healthcare-related assets, and those assets totaled $64 million in 2014. This is a number that doubled in 10-11 years [1]. It is a telling metric and, when spoken alongside the potential impact of public perception on medicine, an indescribable one.
We can and should equip ourselves, the public, as well as Congresspersons, with protection from their personal interests. It is not enough for some in Congress to hold ethics high. All lawmakers, heavily involved in the very public system that is United States healthcare, should assure a distrustful public of basic integrity. Laws, public oversight and the oft-feared, oft-negated consequences should be mandated.
Newspapers, journalists, legal scholars and political scientists may weigh in, yet the only customer with a health outcome affected is the public.
*Measure the public opinion, public trust and public knowledge over legislator personal ties to healthcare and medicine consistently. The tools, reporting, sample size and wording should be consistent, too.
*Measure the impact that legislator personal interest in healthcare has on the public’s medical actions. The amount of sway that legislator ethics in healthcare has on the public’s health actions should be measured. Whether or not a distrustful public refuses pharmaceuticals based on lawmaker personal interest perception matters.
*Measure the impact that legislator personal interest has on the public’s health, objectively and consistently. If a Medicare contract provides biomedical equipment that a person would otherwise go without, support the positive with data. If a Medicare contract has bypassed equipment known to provide better outcomes, support the negative with data. If a VA program could only see a small percentage of veterans, and eligibility was reshaped, and many individuals have suffered without care as a result, describe the data. And, sectors outside of healthcare should have metrics to public health impact; these metrics should be consistent. Whether or not the agricultural industry or energy company assets have influenced a law that impacts public health should be measured and publicly available.
*Publicly report the votes and actions a lawmaker takes, alongside all financial and personal interest in health companies. Use consistent methodology to report on personal interest persuasion in current legislative periods. It is not good enough for researchers to report on historical data. Current lawmaker personal interests should be a continuous, public report.
*Resolve limitations to data. When studies report that there is no searchable database of lawmaker healthcare company assets, because the hand written disclosures are filed as pdfs [1], solutions should involve better Congressional data management.
*Identify best tools and methods on insider trading research, review the literature for the methodologies [2] , and utilize these tools in consistent, publicly available reports. Let the public know what Congress is trading and how it relates to our health [3].
*Get specific on personal assets that Congresspersons hold in healthcare. Congresspersons have person assets in healthcare areas inclusive of: a) healthcare, biotech, life sciences, pharmaceuticals, biologicals, chemical and molecular diagnostics, b) medical devices, instruments and supplies, c)health insurance carriers and pharmacy benefit managers, d) pharmacies and wholesale drug distributors, e) healthcare services such as hospitals, dialysis, ambulatory care, laboratories and doctors offices, f) administrative services like IT, g)real estate, SNF and long-term care, and h) miscellaneous arenas including contract research organizations. What is the distribution of their assets and interests, and how do this compare to lobbyist visits, and how does it all compare to their votes? And, how much effort has the lawmaker placed on mirroring their constituents versus attempting to persuade their constituents that the constituents want some specific decision?
*Assign mandatory minimum consequences for personal interest violations and legislator insider trading with healthcare. The consequences for the public, including mistrust in the healthcare system, are far greater than the fear of holding Congress accountable.
*Consider early intervention programs for Congresspersons with potential personal interest misconduct. Utilize any early analysis tools for insider trading and other violations. As soon as grey becomes apparent, require intervention and new public disclosure for the Congressperson.
*Allow for greater public challenge to a Congressperson’s personal interest in healthcare. Information, ties, trading information and other issues should be a priority of focus when the public calls a Congressperson out. These concerns should not await a political Department of Justice, and these concerns should not await the FBI. The public is the boss, and the public should be able to demand accountability at any time.
*Review and solve for failures of the Stock Act and accountability in Congress. Report on personal interest in healthcare as a separate issue than misconduct alone. Encourage data to drive any laws or lawmaker changes to address Stock Act failures, noting that data will drive change one way or another in the long run.
*Utilize the data and metrics gathered to shape future laws on lawmaker personal interest in healthcare. Prioritize considerations such as removing those with personal health company interests from health committees , or limitations in types of trading that a Congressperson trading can do, or limitations on when persons in Congress can trade [4]. Solutions continue to present, and none of these solutions champions the status quo.
Treasuring healthy outcomes, and treasuring trust in healthcare, are not shared values. When these values are not shared by lawmakers, there is no accountability. The best path forward requires serious attention to legislator personal interest in healthcare.
Equipping our country with the right tools and confidence can protect from legislator personal interest in healthcare.
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