Foxes Will Not Have To Go To the Statue of Liberty To Get Their Birth Control Devices

So it's not enough that an increasing number of states are forcing pharmacists to fill prescriptions against their will. Now Horrible Barbara Boxer has introduced a federal bill that would do the same. The proposed legislation gets around the question of jurisdiction by tying the requirement to permission to fill Medicare and Medicaid prescriptions (Ronald Reagan's old trick), and allows the pharmacist the option merely to refer a customer to another pharmacist who is willing to fill the prescription. And I love the feather thing Boxer's done with her hair.

Comments

[Josh]

"Bill would secure birth control rights"

Dear Lord.

[JonBuck]

I fail to see the problem, really. Many of these pharmacies were going so far as to withold the doctor's perscription slip, preventing the patient from going elsewhere. If they don't want to fill the perscription, that's fine with me. But interfering with the doctor-patient relationship like that is over the top.

[Dan]

I wouldn't have thought it possible for Boxer to do something I liked. This is a pleasant surprise.

[Tim Cavanaugh]

The hairstyle or the bill?

[Jennifer]

I know I'll be booed for saying this, but I actually support this; a pharmacist's job is to fill prescriptions, not pass judgment on whether or not the patient is worthy of receiving them.

Or, if that's too harsh, I'd settle for a situation where pharmacists are NOT required to pass out pills that hurt their widdle moral feelings, but customers who are denied drugs by holier-than-thou pharmacists can sue for damages. And in the case of refusal to give out the morning-after pill, let those damages include either child support or the cost of an abortion, whichever the woman decides.

[Josh]

"I fail to see the problem, really. Many of these pharmacies were going so far as to withold the doctor's perscription slip, preventing the patient from going elsewhere. If they don't want to fill the perscription, that's fine with me. But interfering with the doctor-patient relationship like that is over the top."

I would assume that's illegal, and if it's not it should be, but I don't see why the fact that some pharmacists are doing that is grounds to deny other law-abiding pharmacists their rights.

[thoreau]

A few things:

First, before we trot out our high principles (access to medicine, pharmacist's freedom of conscience, etc. etc.), how about we consider this:

Just how often are these incidents happening? And when they do happen, how many women are unable to get their prescription filled at another pharmacy?

I mean, I have my principle stance on this: No pharmacy owner should have to sell something that he or she doesn't want to sell, but pharmacy owners should be able to fire pharmacists who don't want to sell something that the owner wants to stock, and pharmacists who refuse to return a prescription slip are committing theft (and given how expensive it can be to obtain a prescription slip, i.e. a doctor's visit, it isn't petty theft either).

But before we go out and start passing laws on this, I want to know just how common the problem is. If the vast majority of people who get denied by a pharmacist are able to go to the pharmacy down the street, well, who cares? Odds are that they'll take all of their business (prescriptions, film developing, office supplies, aspirin, toothpaste, and all of the other things sold in drug stores nowadays) to the more tolerant pharmacist and that's the end of that.

Now, no doubt there's a handful of people in either rural areas or with really limited insurance who happen to be hostages to a mean pharmacist. If such cases are rare but concentrated in heavily rural states, well, take care of it on the state level.

I hate to sound like a mean guy who doesn't care about people being hurt, but I have a problem with the instinctive reaction of passing a federal law for every problem that gets a few anecdotal mentions in the press.

Oh, and to be fair, I should say that conservatives probably aren't helping themselves on this issue: Every time conservatives leap to the defense of an anecdotal pharmacist they help create the impression that this is a larger problem.

Prove me wrong with data and I'll change my position.

[Josh]

"pass out pills that hurt their widdle moral feelings..."

Yes, good one Jennifer. Because authority delegated to the federal government in accordance with the morality of right-thinking people never comes back to bite anyone in the ass.

[Slippery Pete]

I've had an ongoing and rather contentious debate on this matter with a friend of mine for several weeks. I'm not a libertarian, but believe coercive state power should be limited to cases where it's really needed and can be substantiated with objective evidence (like thoreau). Anecdotes don't make for good policy.

It's hard for me to believe there are enough pharmacists out there refusing to fill scripts to cause any legitimate worries about lack of access to healthcare. Within 15 minutes of my house there are probably two dozen pharmacists, and I live in Indiana. If 80% of them were bible-whacking fundies, it still wouldn't affect my access to drugs in any meaningful sense.

My buddy (name hidden to protect the innocent), however, feels there are enough rural pockets (especially in the South) to justify state laws requiring pharmacists to fill all legitimate scripts as a precondition for maintaining their license to operate.

So, again, the question is: Has anybody ever actually been effectively denied healthcare as a result of a pharmacists refusing to fill a script on moral or religious grounds?

And AMEN to the person who said this is not an issue for the federal government.

[Slippery Pete]

Incidentally, in cases like this it's helpful to ask WWSD? (What Would Somalia Do?)

[Stretch]

I can't believe this is happening...oh wait, yes I can.

Neither pharmacists or doctors are obligated to perform a service that goes against their conscience, nor should they be. If it becomes a large problem, then they will be fired. In the case of witholding a script or something of the sort, legal action should be taken.

That's the way it already is, so why do we need a new Federal Law?

The only point worth bringing up is the situation in a rural area where there is no reasonable chance to fill the script somewhere else, but I suspect that this is pretty rare.

[Jennifer]

Ideally, such drugs should be freely accessable to all, without a prescription. However, The Law has decided that women can?t get these drugs on their own, but must go through government-certified gatekeepers. All I?m saying is that the gatekeepers in question shouldn?t be allowed to inflict their moral prejudices onto other people; if The Law requires me to go through a gatekeeper, then The Law should also ensure that the gatekeeper can?t set up hurdles of his own for me to jump through.

[Slippery Pete]

For the record, "the law" (i.e., the American people and the representatives they elect) has also decided that MEN can't get drugs on their own, either.

Aside from those squibbles, I think your point is excellent, Jennifer. If the state has the right to appoint gatekeepers, and if those gatekeepers profit through rent-seeking (which is what they're doing, after all), then the state certainly may set and occasionally adjust the conditions under which the gatekeepers operate.

[drf]

welcome back SP/GG/JB (since i've never seen all three of you in a room at the same time, i'm maintaining that you three and thoreau share the same identity)

i have no numbers on this, but i do have an anecdote. my sister in law needed a script, and the person working behind the counter wouldn't fill it, although the pharmacy had filled it before. she pitched a fit, got it filled a day or two later, and got her apology for the inconvenience. she has switched pharmacies.

the problem goes beyond this. often, docs don't mark the "no substitutes" label, just kuz, and pharmacists try to push generics (yes, i saw the teva rep illegally detail the pharmacist at our third world walgreens, at lincoln and lawrence). hell, improper substitution was one of the problems that got baycol yanked.

this seems to me to be a problem of government being involved in our social conscience, health, morals, etc. the doc writes a script. you get it filled. where does the fucking government belong?

to the question in bold about being "denied [service]", you're asking for an anecdote there. my sister in law certainly had her service delayed. but that's one where the pharmacy should be able to discipline the worker. if you have a moral problem with your work, get a new fucking job.

and, low blow about somalia, guy. low blow.

[The Wine Commonsewer]

The photo with her big mouth flapping reminded me of this:

"Listening to Sen. Boxer is like having someone pump six gallons of lukewarm tea up a catheter tube. Slowly."--Lileks

Jennifer, as a good libertarian I have to disagree with you. Within the context of the employment contract, any pharmacist has a right to serve whomever he or she wants to. There is no public right to demand service or goods from anyone under any circumstances.

There are two main options to deal with a pharmacy that doesn't offer what you want:

Go to a different pharmacy or open your own pharmacy.

Rick Barton, "lipstick on a pig" had me LOL

Thow-Row & Pete,

What you said.

[Stretch]

Jennifer, you're just adding regualtion to "fix" exisiting regulation. We all know how well that turns out.

I say there is a big difference between one pharmacist refusing to fill a script and that same pharmacist actively working to prevent you from filling that script anywhere.

I've got no problem with the first case, and the law (at least in theory) already prevents the second case. Again, why does the Fed need to get involved?

[Slippery Pete]

No way, dude. Somalia is a worker's paradise. I read it in Hit & Run so it must be true. 😉

[drf]

"Within the context of the employment contract, any pharmacist has a right to serve whomever he or she wants to. There is no public right to demand service or goods from anyone under any circumstances."

please elaborate.

(and no, we don't need a law, but the squishy default to the whining moralist mentality doesn't buy anything. they have a damn job, and it's their job to do it. not to create extra hoops based on their whims. they're not MD's. they don't have Rx power. they give out the damn pills. period)

the separate but equal pharmacies becomes a bit slippery for me. if there's language in the contract that gives the poor, sensitive pharmacist the power not to dispense particular drugs, so be it, but what you're saying there would seem to suggest that it's the opposite: "unless it's specificed, they can pick and choose".

and, i didn't get my (heart) medication for a day, because a pharmacist wanted to switch me to a generic, and i refused. my md had to call. don't go to that drugstore, but here in chicago, it's easy. in mayville, it'd be a problem.

[Evan Williams]

Re: the supposed lack of choice in rural areas---this is a load of shit argument that is , in effect, the basis for all anti-free-market arguments. They say, as long as you're providing service A, then you must also provide service B. But, what if you weren't providing any services at all? Then everyone loses, because no services are available. This is akin to requiring that a rural gas station provide a car wash, just because he sells gasoline. It amazes me how transparent this argument is, yet, how pervasive it is as well.

[Slippery Pete]

Regarding anecdotes and the use thereof, you're right. I worded my question poorly. My point was simply that before policy can be considered, we need some hard objective facts about whether there's even a problem, and if so, how big and where? Because the libertarian value of allowing pharmacists (or any other businesspeople) to perform their jobs as they see fit and in line with their moral beliefs is VERY compelling. It's dangerous and harmful to throw these rights away in the name of 3 or 4 people a year (or however many) who are actually prevented from receiving timely treatment.

[drf]

ah, pete. tu es incroyable.....

and, evan, i would agree, but the anti-free market argument is also the "the overly sensitive moralist non-script writing pharmacist has an opinion" and therefore i can't get served. that's crap.

remember our french marine (engineer/journalist/historian) who's married to a jewish lady and is gay? if he was refused service because he was gay, we'd be debating the legality of that. sure a law is wrong, but defending the asshole isn't the way to attack the bad law.

[Evan Williams]

"don't go to that drugstore, but here in chicago, it's easy. in mayville, it'd be a problem."

No more of a problem than, say, if there were no drugstore in Mayville at all. Just because there's only one drugstore in town doesn't give the government the right to tell it what it's gotta sell, considering that, without their hard work and capital, there'd be no access to that particular product/service at all.

[Johnny]

You know it's bad when the post starts off like this: "So it's not enough that an increasing number of states are forcing pharmacists to fill prescriptions against their will" and then Tim points to Kerry's article, and I assume he is making reference to the Illinois governer...

Only problem? That didn't happen. The gov of Illinois said only that "if" you carry the drugs, you must dispense them. My GF works of a Catholic hospital, and they don't have to. Only if you carry it, in other words, no games, carry it or don't, but no holding scrips hostage, if you are a chain it means you either pull it from your shelves, or find an employee that will fill it. Hmmm....is that what Tim meant? Has Tim joined Fox?

Kerry is right in the article though...these things need to be released from Gov control to begin with.

But as to Boxer? Well, if Libertarians don't step up to the plate, then the fools will.

[drf]

agreed, pete.

but it's also dangerous to get all involved in a tale where 1) laws shouldn't be involved and 2) the three or four pharmacists (chuckle) who object, might consider other fucking careers. sure. get the script filled at the hospital. but they know what their chain provides. if they have a problem, unless specifically outlined (blah blah blah, contract), they should shut up and dispense. what, refusal to sell cigarettes at a convenience store? c'mon.

[Slippery Pete]

And what's with all the snarky comments about "poor widdle pharmacists", all this mocking of people's moral beliefs? I may not share all the moral beliefs of some fundamentalist pharmacists (fundapharmacist?), but I respect their beliefs and their right to possess them. That's a pretty basic libertarian value, isn't it?

[fyodor]

Jennifer, you're just adding regualtion to "fix" exisiting regulation. We all know how well that turns out.

I understand your sentiment, but Jennifer and Slippery Pete both make a good point. For a libertarian, this is a little like having someone leave a baby on your doorstep, ie, having a responsbility thrust on you that never asked for but must now deal with. A little like the Iraq occupation in that sense too.

[thoreau]

if The Law requires me to go through a gatekeeper, then The Law should also ensure that the gatekeeper can?t set up hurdles of his own for me to jump through.

That's probably the best argument in favor of such a law. I'm just being a pragmatist and saying that anecdotes make for bad policy. Show me that this is more than anecdotal and I'll reconsider my stance. But given that most people (not all, but most) have at least 2 pharmacies to choose from, I wonder how much of a problem this really is.

Besides, the issue mainly seems to involve 2 types of medication: Oral contraceptives taken daily, and emergency contraceptives.

A quick Google search reveals that there are some very nice Canadians who would be happy to sell daily contraceptives to American women. Admittedly, they'll have to wait for the pills to arrive, but since birth control pills require a bit of planning anyway (or so it was when my wife started, please don't tell the Pope), and since they can be ordered in advance, it isn't such a big deal. (The Canucks are great about shipping me my hair loss drugs in advance so I never run out. Sadly, the drugs aren't working too well, and I may have to go the Moby route soon. I promised myself that I'd sooner shave my head like Moby than do a comb-over. But I digress.)

The sticking point is emergency contraception. With emergency contraception there is no time to wait for the nice Canadians to ship it. There are 2 choices: Either erode the power of the gatekeepers, or pass laws regulating them. I've been hearing about recent proposals to allow doctors to prescribe emergency contraception in advance for women to stock up, as well as proposals to let pharmacists dispense it without a prescription. Since such proposals are on the table, I'd rather pursue them rather than proposals for even more regulation. And if women are allowed to obtain emergency contraception in advance, to have on hand if needed unexpectedly, well, there are some nice Canadians who will sell Plan B.

Besides, with emergency contraception, what if the pharmacist is willing to sell it but the doctor isn't willing to prescribe it? Should we also have a law mandating that doctors must prescribe it?

[Jennifer]

TWC-
You comment that I could "just open my own pharmacy" ignores the fact that I CAN'T, without first spending a lot of time and money getting specially-approved licenses from the government. That's also why Evan's car-wash metaphor doesn't hold here; the law doesn't set artificial hurdles on who can wash cars, but does for pharmacies.

Like I said: I think that all drugs, except antibiotics, should be freely available. But since they're not, at the moment, those people who DO have the authority to dispense drugs shouldn't also be allowed to inflict their additional whims on those who need medicine.

[drf]

no, evan, not if the pharmacy refuses to carry a Rx. that's not a problem at all. the one in mayville (WI) i was referring to, actually, doesn't carry narcs due to security reasons. i was speaking of a chain or local pharmacy where there's an employee that refuses to give out drugs.

again, if this is the convenience store argument - white hen doesn't sell cigarettes. fine whatever. the clerk at white hen refusing to sell me cigs because he deems them bad for me. bad. no federal laws needed, but the person behind the counter should get fired or look for another job.

[Jennifer]

Oh, and Slippery Pete--I'm not mocking other's moral beliefs; I'm mocking the idea that a moral pharmacist has the right to inflict his morality on others.

[Drooling Richard]

When I look a proposed law like this, from my persective, as an engineer, the principle behind it is outrageous. What the principle says is that pharacists are servants to their customers (and the government) with no say whatsoever about whether or not they agree with a customer's request.

If this principle were applied to my field, a customer could walk into my office with a drawing or description of some gadget ( it could be a great idea or just another perpetual motion machine) and demand, by the force of law, that I build it for him.

[Sully]

I started reading this thread without a firm opinion. Jennifer has me about convinced that its reasonable to require folks who want to be licensed pharmacists to dispense all legal medications.

Now though, under the same theory, I'm trying to figure out why the state can't force a licensed doctor to do abortions or mercy killings or executions as a condition of his desire to practice medicine.

Adhering to principles is hard - I may convert to liberalism.

[drf]

pete: mocking the "morals" of an employee that wants to work at the wallgreens but refuses to do his or her job on "moral" grounds is worth a mock or two.

like the alleged feminist who refused to wear the dress/skirt (to the ankles) at a department store, in violation of the contractual dress code. she objected on "feminism" grounds. that's laughable. if those are their private views, and they consume, behave, vote, etc. in accordance with those views, i have no truck with that. but in these situations, yeah.

a funny time for you to get sensitive, too. you're usually a firebomber, grin!

drf

[Anvilwyrm]

What if the pharmacist just decides not to stock certain items? Are all pharmacist required to stock all drugs, regardless of profit, or likely need? What happens if the pharmacist just says "we don't have that in stock."

I think access to these drugs should not be restricted, but I really don't like the idea of telling people they must do something which goes against there morals. By legislating that they must we are solving the wrong problem.

Maybe a 1-800 number and fed-ex next day would be a better solution?

[The Wine Commonsewer]

drf, there isn't anything to elaborate about.

OTOH, the pharmacist switching your heart medicine isn't the same thing. In that case the pharmacy already agreed to sell you heart medicine and the pharmacist decided that he/she was smarter than you or your doctor. That's a completely different beef and you had every right to be annoyed.

[phocion]

If we're hinging the anti-pharmacist argument on public licensure, should lawyers and public accountants be allowed to refuse service to a potential client?

[Josh]

"Oh, and Slippery Pete--I'm not mocking other's moral beliefs; I'm mocking the idea that a moral pharmacist has the right to inflict his morality on others."

The right to inflict one's morality on others is, of course, reserved for the woman who wants an emergency contraceptive.

[Jennifer]

Josh-
Huh? You see no difference between taking medicine yourself, versus withholding it from someone else?

[Lewis]

I have to back Jennifer. If the goverment forces me to go to the gatekeeper to get the product, as opposed to me freely going to the manufacturer based on my doctors recommendation, and said gatekeeper is licensed to operate by government regulations, then the government already has the slimey hands all over the process and therefore should ensure the availability of said product from gatekeeper. If government would butt out, gatekeeper loses their job and I get my product directly from manufacturer or their designated distributor. If said distributor has moral problems with selling me the product, at least the manufacturer has the option of pulling product from distributor and going elsewhere.

Can you imagine if I went to REI and wanted a pair of hiking boots only to be told no chance by the sales person because hikers hurt the environment? The hiking boot company would at least get to tell REI loose the tree hugger or we pull our popular selling products and exclusively deal with Campmor.

[drf]

"What if the pharmacist just decides not to stock certain items?"

exactly. if pete, jennifer, and i own a pharmacy, and we don't, for whatever reason, choose to stock, say, flomax, we shouldnt' be forced to. or if we don't have proper security for vicodin or condoms, we shouldn't have to sell those either.

if we have an employee that refuses to dispense it (or wear the contractually (blah blah blah) required attire), we should can that person. but it's not that employee's right to make that call.

and as mr anvil notes: " By legislating that they must we are solving the wrong problem."

excellent.

cheers!
drf

[Josh]

"Josh-
Huh? You see no difference between taking medicine yourself, versus withholding it from someone else?"

The hypothetical woman isn't just taking medicine herself, she's forcing someone who doesn't want to sell it to her to do it.

[Anvilwyrm]

Another question: EC is most effective when used promptly. Should RX be required to be open 24x7? I some towns out here they close at 5 on friday and open at 8 on monday. I would venture that this restricts access more than a few RXs who will not handle EC.

[The Wine Commonsewer]

Jennifer, you're right, the Gatekeeper thing is a real problem. You also make a good point that if the law requires a gatekeeper than it should also make sure the gatekeeper has to serve everyone.

That is why all this stuff sucks so bad..we just keep piling regulation on regulation to fix the problem that the regulation started in the first place.

In my kind of society, you would not need the prescription to start with. I wouldn't expect that to be a perfect arrangement but it would certainly be an improvement.

I hate going to the doctor when I already know what is wrong. Then I tell the doctor what's wrong and what I need. He pretends to have given me a cursory exam and then pronounces his verdict and gives me what I want. Then after spending an entire morning driving, sitting, & waiting I get the antibiotics I knew I needed in the first place. I'm out $100.00 bucks, the insurance company is out another $100.00 bucks and I could have bought the prescription over-the-counter in Mexico for $15.00.

Thanks for listening. VBG

[Jennifer]

Josh-
If the pharmacist's morality is offended by the tasks required of an Official Government Drug Gatekeeper, he shouldn't have taken the job in the first place.

[fyodor]

Drooling Richard,

If you were taking adavantage of a protectionist regime that allowed you to operate and not just anybody but under the condition that you honor all reasonable requests, would you maybe think differently?

thoreau,

That's an interesting idea. Better to deal with the problem by allowing things rather than disallowing things. Naturally, there's still the situation in which a woman (or a couple, if you prefer) hasn't planned ahead, and we all know the arguments on both sides of that.

Sully,

You raise an interesting question, but don't revert to liberalism! 🙂 It's the creation of regulations in the first place that has created this problem, the baby on the doorstep, if you will.

[thoreau]

EC is most effective when used promptly. Should RX be required to be open 24x7?

Excellent point.

Really, there's only one medication that I'm aware of that is both time sensitive and controversial (at least to some pharmacists): Emergency contraception. Given the number of possible bottlenecks (doctor not available, or doctor unwilling, or pharmacy closed, or pharmacist unwilling, or pharmacist simply doesn't have any in stock), it makes no sense to focus on one particular bottleneck. Instead, we should work on removing bottlenecks.

Indeed, I have heard proposals to allow specially-trained pharmacists to dispense emergency contraception without a prescription, as well as proposals to allow women to stock up on it (and if the local pharmacist won't help them stock up, they can always order from Canada). Now, the first proposal still requires a willing pharmacist and an open pharmacy, and the second proposal requires a willing doctor, but the point is that efforts are being made to remove bottlenecks. I'd rather encourage those efforts. Also, regulations like Boxer is proposing are more likely to galvanize opposition to emergency contraception than efforts to remove bottlenecks. Beware of unintended political consequences, as well as unintended regulatory consequences.

(And yes, I know, regular contraceptive pills are also time-sensitive in that they have to be taken on a schedule, but there are very nice people in Canada who will ship you those pills and you can plan ahead.)

[The Wine Commonsewer]

the other point that comes to mind is this:

Why the hell didn't Boxer just propose a federal law to make Birth Control available over the counter?

Point Two, didya see the big news night before last?

Target is moving all the cold remedies with psudoephedrine behind the counter. What a bunch of dopes.

[Slippery Pete]

Yeah, I'm trying to be less of a firebomber now. Plus, right at this moment, I'm not drinking. Which helps.

When I speak of "pharmacists" I am speaking of the pharmacy owners. I wasn't clear there either. Obviously is some schlub clerk is making decisions on whom to serve and how and he's not even the owner of the store, then he should be reprimanded or fired. I was speaking, in other words, of pharmacy policy and not the whims and preferences of individual desk clerks whether they're pharmacists or just...desk clerks.

[Tim Cavanaugh]

and then Tim points to Kerry's article, and I assume he is making reference to the Illinois governer...

The article mentions legislation in various states, not just Illinois. Your quibble may be applicable to Illinois, but is not applicable to California and other states; in any event it's really a minor quibble.

[Anvilwyrm]

If the pharmacist's morality is offended by the tasks required of an Official Government Drug Gatekeeper, he shouldn't have taken the job in the first place.

I am willing to be that most of the RXs who object became RXs long before EC existed.

[phocion]

If the pharmacist's morality is offended by the tasks required of an Official Government Drug Gatekeeper, he shouldn't have taken the job in the first place.

The task you refer to (dispensing any drug, even if against one's morality) was not part of the Official Government Drug Gatekeeper's job at the time he or she got into the career. You want to make it so, however.

[Josh]

"Josh-
If the pharmacist's morality is offended by the tasks required of an Official Government Drug Gatekeeper, he shouldn't have taken the job in the first place."

You're making an argument that's been torn apart here a few times.

1) Doctors and surgeons are Official Govt Healthcare Gatekeepers, do we require all of the to perform abortions or (in 75 years) euthanasia? Boob jobs? Penis enlargements?

2) If the problem is that the government is artificially reducing supply through discriminatory law, the solution is not to further artificially reduce that supply.

[thoreau]

Naturally, there's still the situation in which a woman (or a couple, if you prefer) hasn't planned ahead, and we all know the arguments on both sides of that.

At the risk of sounding insensitive, I have no interest in crafting a policy that will solve the problems of every single person in every conceivable situation. What I want to do is remove the bottlenecks that affect the vast majority of people. We can worry about the handful of remaining cases later.

Anecdotes rarely make for good policy.

[Slippery Pete]

Wine -

What's wrong with Target, a private entity, freely choosing how to sell its products?

[The Wine Commonsewer]

Phocion, in answer to your question (good point),

I have been known to refuse service to certain people. Jerks and those I know are trying to scam people by having me prepare what I am pretty sure (but can't prove) are false financial statements.

[Stretch]

"Now though, under the same theory, I'm trying to figure out why the state can't force a licensed doctor to do abortions or mercy killings or executions as a condition of his desire to practice medicine."

It's only a matter of time before they do. After all, if the state forces me to go to a gatekeeper, ie a licensed doctor, then they automatically have the right to force the gatekeeper to serve me, right?

It's a perfectly just use of power for the state to limit my choices as a consumer and then to "fix" that problem by further limiting the choices of others, right?

Yes, that makes sense, because now we're both limited equally by the state, and we all want to be equal, right?

Really, I understand the argument that says since the state won't stop requiring and licensing pharmacists, that the fair thing is force those pharmacists to serve everyone.

But, truthfully, that viewpoint is saying that state control of individual actions is permissible as long as you're the one benefitting from the coercion.

[mac]

And here I thought the pharmacies already have the right to fire the sorry asses of people who won't do their jobs.

The bit about holding back prescriptions is something else; it is probably already illegal under theft & fraud laws.

I'm a left-lib on this issue: do away with prescriptions except for

* antibiotics/antivirals (where misuse does harm to others, not just yourself)
* genuinely poisonous drugs (chemo, liver-damaging, etc)

let them all-especially birth control--be freely available on the internet.

[drf]

nice pete! 🙂

that's a nice call: we were talking about different levels of pharmacist: you were talking about the owner, who owns the place and decides what to sell without interference, and i had it confused with my wallgreens where there's a schmo behind the counter whose job it is to fill the little bottle.

indeed, there's a huge difference. good call. and of course, no laws should be needed. like the convenience store. or the lipstick on the pig. (polish a turd...) 🙂

and T Wine C: in the light of "does this particular pharmacy have to sell an Rx it doesn't want to" - no. then your point is well taken.

my point was that the employee's morals don't have a place, and if i can get my meds at this pharmacy, but due to the whim of this idiot behind the counter, i can't, you bet i'm annoyed! so it was at a different level of employment.

and i've used your "pinot more" joke to great effect. thanks!

cheers,
drf

[swami]

wow, this thread is shocking. These theocratic thugs are trying to impose their will on all Americans and the "libertarians" are defending them. No wonder nobody votes for libertarians, your solution to everything is to let the most powerful individuals, organizations and corporations impose their will on the least powerful. If these moralist, asshiole pharmacist will not do their job as the state as licensenced them to exclusively do then they should be stripped of their license.

[The Wine Commonsewer]

Slip, nothing wrong with Target freely choosing how to sell it's products (but I'm still allowed to freely make fun of them).

It's just a silly PR thing that makes them appear to care about the meth problem in the bad parts of town.

It also represents a cave-in to the feds who have been pushing this kind of thing on the basis that Sudafed can be used to make speed--which is what all those bikers making meth in Aguanga are doing. They're raiding all the Target pharmacies in Temecula and Hemet every night and cleaning out the Sudafed.

[Johnny]

I don't know Tim, if we don't like were Barb is going...then maybe we should applaud when a gov goes in the right direction...letting those pharmacists that have a moral objection have it, so that woman can exercise their free-market rights to only frequent stores that they agree with.

Seems to me, the only solution is to do as thoreau suggests, eliminate the bottle neck, issues like gatekeepers, or being able to get it via long distance fedex, and support the moral objection of fundi pharm store owners. Barbs step is away from that, towards increase government micromanagement, Blags seems to one strictly relating to fraud (a pharm store that will except the scrip but refuse to fill it) and a step towards freedom for all involved. But maybe it is just a small quibble.

[thoreau]

These theocratic thugs are trying to impose their will on all Americans and the "libertarians" are defending them.

Actually, some of us are arguing that we should remove the laws that empower these guys.

No wonder nobody votes for libertarians, your solution to everything is to let the most powerful individuals, organizations and corporations impose their will on the least powerful.

Sadly, you are right about some libertarians.

[Josh]

"your solution to everything is to let the most powerful individuals, organizations and corporations impose their will on the least powerful"

I just did a quick check and I'm pretty sure fundie pharmacists from the sticks are not high on my list of "most powerful individuals."

[Jennifer]

Swami-
You must be new here. You should have read the post where most people argued that employers have a right to sexually harass their employees, unless their employment contracts specifically stated otherwise!

[drf]

josh - check between squirrels and quakers (courtsey of joe, below)

🙂

what thoreau said.

(people tend to lean to one or the other side, and they'll be more sympathetic to that side, whether it's the religious type or the social type. we see this across the board)

[Johnny]

Josh, check out one of those sub-urban or rural super-churches with thousands of members coming from hours away, I was taken to one last summer, and I have to admit, it scared me and gave me new found respect for the power they "potentially" wield.

[drf]

jennifer - i should have gone with my original post (right after yours) where i talked about bullying. there are some who would side with the religious side of the argument, regardless. but there are those who would side with the social equality side, too.

it'd be interesting to see the breakdown of people's views based on that harassment/iraq/un/kyoto/abortion/guns/reduced gov't, etc.

🙂

[The Wine Commonsewer]

drf, thanks, and pee no more.

If it was me, I'd be flaming if I was you on that heart med swap. And I guess you were. G

And I agree, the individual pharmacist does not have a right to refuse to sell a particular drug that his/her employer offers for sale to the general public. It is the same argument, the pharmacist can take a different job or can open another pharmacy.

[drf]

🙂

we just had an "end-of-vintage" (whatever that means) vietti 1998 barbera d'alba from castiglione falletto (barolo area). it's unfiltered. very tasty with whatever the hell we were eating...

if you've tried it, what do you think, and all that 🙂

cheers,
drf

[The Wine Commonsewer]

Swami, libertarians enjoy watching people starve on the streets as well.

[B.D.]

Jennifer and Thoreau raise excellent points.

Given the prevelency of mail order and internet pharmacies, even rural areas are not without service. They may be without service on demand, for emergency contraception for instance, but they are not without service.

I'd much prefer to see the laws changed to allow birth control and emergency contraception available without prescription on a state by state basis.

One thought that has occurred to me since I first read up on this controversy (having worked in a pharmacy at one point) was how many of these pharmacists are also taking such stances on other substances, such as cocaine, morphine, marijuana, et al, which must also bother their socially conservative sensitivities when dispensed (the pharmacy I worked at did dispense these substances).

[thoreau]

Another thing:

As I said before, the main controversy seems to involve contraception. What I worry about is a blanket law that says "any prescription must be filled" or something to that effect. I don't claim to know what sort of unintended consequences could arise, but to the extent that pharmacists have some sort of discretion, I'd like them to be able to use it in most cases.

Yes, I know, they are government-appointed gatekeepers, but they are at least educated gatekeepers, and if there are occasional instances where they make important decisions, well, better to let them make those decisions.

I guess what I'm saying is that when you have a problem that seems to involve a handful of medications, and you start passing laws that say "any" or "all", well, there's the very real possibility of unintended consequences. Maybe I'm wrong. Maybe in this case the role of the pharmacist is a limited one and the law won't significantly change things. But I'd rather not find out the hard way. If there's going to be a law, can we at least make sure it's narrowly targeted at the cases that are prompting the outcry, rather than take the gamble of unforeseen consequences?

[The Wine Commonsewer]

drf, wish I'd tried it.....

[The Wine Commonsewer]

Stretch, well said.

I used to know a guy named Slouch. You related?

[B.D.]

thoreau: correct about absolutism in the law. For instance, what happens if the pharmacist notices a conflict of interest in medications submitted by more than one doctor. Must she then dispense the medication albeit with the caveat that this may be harmful to the user? Does she first have to dispense the medication to the abuser before she notifies authorities? If the change in the law were narrowly tailored, then it would be more palatable, but I suspect that the real change would be to take the gatekeeper out of this particular equation.

[joe]

I know what you're all thinking - what does joe think about this?

joe doesn't think the issue should be federalized. The feds have no right to tell Oregan whether the practice of medicine includes allowing the sale of medicinal marijuana, or to tell Illinois whether the practice of medicine involves requiring the sale of contraception. Let the states adopt their own rules, even if they conflict. It may suck for women in Mississippi, but the proper gatekeeper is the states.

joe also thinks it's just fine and dandy for the states to proscribe the practice of medicine. If they want to require docs to perform abortions or boob jobs, that's within their power. It's not a very good idea, however.

Finally, joe thinks there are an awful lot of libertarians willing to let the perfect be the enemy of other people's good. I'm certainly persuadable that the prescription regime should be curtailed, but if you start out by asserting a pseudo-lenninist "worse is better" strategy of only making unreasonable demands, and holding other people hostage to your all or nothing position, I'm not inclined to give you the benefit of the doubt.

[phocion]

And I agree, the individual pharmacist does not have a right to refuse to sell a particular drug that his/her employer offers for sale to the general public.

I agree. Then it becomes a matter of an employee not fulfilling their contract to do their job. Unless the pharmacy has an agreement with the specific employee in place. There should be no specific government protection of the employee's job, just as there should be no specific government forcing of the store to can the employee. But isn't that what we have now?

[Stretch]

Slouch? Sure, he's my evil twin. Actually, I have to goatee so you might see it differently.

I absolutely think those pharmacists who refuse to fill a script are wrong. I think they should be fired. I think that if they go further than a simple refusal, that they should be prosecuted. I don't think the federal government needs to get even more involved than it already is. It seems totally unnecessary to me.

Hey, maybe this problem is so widespread, and the availability of these drugs is so limited that it really does require Federal intervention, but I have yet to see any evidence of that. In the end, I'm not going to complain overmuch should this happen, because as I stated above, this particular intervention somewhat benefits me (at least in the short term). That doesn't make it right, though.

[kmw]

Joe, that was a marvelous Bob Dole impression.

[Drooling Richard]

I absolutely think those pharmacists who refuse to fill a script are wrong. I think they
should be fired.

Fired by who ? You sound like my mother. A pharmacy is a business. You have to own a business and hire an employee before you can fire anyone.

[Happy Jack]

phocion,

I believe it's illegal to fire someone based on their religion,ie, moral right to refuse contraception.

[UncleKenny]

Can we get back to her hairstyle, please? It is more relevant and interesting than most of the bickering comments. We can even talk about man-hands, if you like.

[fyodor]

joe,

Finally, joe thinks there are an awful lot of libertarians willing to let the perfect be the enemy of other people's good.

Flowery language, but has anyone here argued that coercing pharmacists is really a good thing but we shouldn't do it just because it's not the "perfect" solution?

No, rather we simply find using state coercion to make an individual do something he doesn't want to do (when he hasn't already violated someone else's rights) a rather noxious thing to do. And we think the harm that would ensue from such coercion to likely be greater than the harm it might reduce.

Think about this joe: the exact same argument could be made about your opposition to federal legislation on the matter. Ie, you could be accused of allowing the "perfect" of allowing states to handle the matter get in the way of the "good" of federal legislation.

[Drooling Richard]

UncleKenny,

Barbara Boxer, Nancy Pelosi, and Gloria Allred go the same hair stylist, if they're not same person.

[Tim Cavanaugh]

has anyone here argued that coercing pharmacists is really a good thing but we shouldn't do it just because it's not the "perfect" solution?

I think joe means the opposite: Coercing pharmacists is not the perfect solution but it's better than not having access to contraception, esp. considering that the ideal solution-ending the prescription requirement-is unlikely to come to pass. But after waiting hours to find out which way joe was going to lean on this one, I shouldn't be interpreting his statements, except through a strict originalist filter.

[Rick]

Since the pharmacist is in effect sharing in a governmentally-mandated monopoly, isn't there a duty for the pharmacy to provide services without regard to the pharmacist's own moral beliefs (as distinguished from a true free-market situation where any old Joe can sell whatever pills he has)?

[thoreau]

I shouldn't be interpreting his statements, except through a strict originalist filter.

I prefer the "living joe" approach myself. I look at his penumbras to see what ideas might be emanating. In some distant day, when joe passes away, I'll have to abandon the "living joe" approach and consult his entrails.

[fyodor]

Tim,

I agree on what joe meant. I was saying that no one was using the argument he was criticizing. Ie, we (or those arguing this way; I'm undecided based on the notion that government has created this problem in the first place) simply see forcing pharmacists' hands as being more imperfect because that is such a noxious thing to do.

[Stretch]

"Fired by who ? You sound like my mother. A pharmacy is a business. You have to own a business and hire an employee before you can fire anyone."

Drooling Richard, I think they should be fired by the owners, of course. If one of my employees was refusing to meet the needs of my customers, I would fire them...wouldn't you?

I've already stated many times that I don't think the gov't should be involved, and that I am against this legislation.

And there's no need to bring your mother into this 😉

[saw-whet]

UncleKenny, All I could think of was, "And the girls who try to look pretty" - BTO.

[Damien]

Because medicines are tightly regulated, and pharmacist are licensed by the state, they should absolutely be required to fill prescriptions. Of course, not at the federal level.

If drugs were indeed sold in a free market, then I'd be upset if they tell pharmacists what they can and can't sell. But it's not a free market.

[fyodor]

Good one, thoreau!

Rick, I don't know how much of this thread you've read, but that's essntially the primary counter-argument that some of us here have accepted. Suffice to say it's problematic at best as it adds coercion rather than reduces it. And as long as the current prescription system is the law, it's not like pharmacists are entering into this monopoly willingly. Not that they can't refuse to be pharmacists, but they can't choose to be pharmacists without partnering with this government enforced monopoly.

[Selfish Genes]

I think pharmacies that refuse to distribute certain medications should be required to post the medications they will not distribute plainly on their front door. This would spare patients the humiliation of having their proscriptions denied on moral ground in public in front to snickering housewives, classmates, their fifth grade teachers, an whomever else happened to be in the pharmacy at the time. It would also tell everyone in the community the politics of the pharmacy and give those who respect a women?s right to chose and those who generally support individual liberty or the doctor patient relationship an opportunity to shop elsewhere.

[Seamus]

"I'm not mocking other's moral beliefs; I'm mocking the idea that a moral pharmacist has the right to inflict his morality on others."

The pharmacist isn't inflicting his morality on others, unless he's stealing the prescription and preventing the patient from going to another pharmacy. But Barbar Boxer *is* inflicting her morality on the pharmacists, by requiring them to cooperate with what they believe to be evil. So much for her claiming to be "pro-choice."

[Seamus]

I'm wondering whether Boxer's bill would grant the pharmacists immunity from tort liability arising out of their forced sale of prescription drugs.

[linguist]

drf...

"(yes, i saw the teva rep illegally detail the pharmacist at our third world walgreens, at lincoln and lawrence)."

Huh. That never happens at the one at Clark & Wilson. 🙂

[fyodor]

I was just thinking (sound the alarm!), and it occured to me that if someone who owned a pharmacy didn't want to fill a particular prescription, they wouldn't likely carry it (maybe some posts I've skimmed over covered this already?). In which case this kind of leglislation would force pharmacies to always have EC in stock. And if they didn't have it in stock when someone wanted it, their trial would revolve around whether they intended to not have it in stock or didn't have it in stock by accident? Oy vey....

[Drooling Richard]

Drooling Richard, I think they should be fired by the owners, of course. If one of my employees was refusing to meet the needs of my customers, I would fire them...wouldn't you?

No ! The business owner should hire and fire employees based on whether or not the employee is providing value in attaining the owner's goals. Business are not run by customers, they are run by the owner. A business that does not provide value to its customers will fail. You don't have to worry about the details.

[deron]

fyodor,

That's the thing I keep wondering about. Are these pharmacists carrying the drug, and refusing to dispense it? This is a very strange business practice.

As to the one refusing to dispense being the owner... Other metropolitan areas may be different, but here in Denver you'd be very hard pressed to find a pharmacy that isn't owned by a corporation. Maybe there's some sort of leasing agreement, but even then the space in, for example, a grocery store probably assumes the customers needs will be met.

This whole thing just goes to show that if you give anyone control over anything they will use that control to be a pain in the ass.

[Stretch]

DR, I don't disagree. Obviously, many of those refusing pharmacists are not being fired, and the state has no right to mandate that. I would say that those pharmacists are lowering value to customers, though.

You're right that if it's a widespread problem, then the business will fail or the owner will adapt. Let me sum up:

1.I disagree with these moral decisions.

2.The gov't should not regulate these decisions.

3.As a business owner, I would probably fire an employee who was hurting my business. After all, if refusing to serve customers this particular medication was against my goals, then I wouldn't carry the meds in the first place.

[Drooling Richard]

This whole thing just goes to show that if you give anyone control over anything they will use that control to be a pain in the ass.

Please control your bodily fluids.

[Dan]

However, The Law has decided that women can?t get these drugs on their own, but must go through government-certified gatekeepers. All I?m saying is that the gatekeepers in question shouldn?t be allowed to inflict their moral prejudices onto other people

That's it exactly. The prescription-filling role of pharmacists is entirely a creation of federal legislation. I'd be all for letting pharmacists "obey their conscience" if I had the option to simply reach around them, pluck the drugs I want off the shelf, and take them to the check-out line. But so long as they're working for the federal government -- and don't kid yourself, that's what they're doing -- they can damned well do as they're told. If they don't like it they can quit.

[Johnny]

This was the first case I had heard of...

Pharmacist rebuked

"Noesen...(the pharmacist)... refused to transfer the prescription. Despite trying again that Sunday to have the prescription filled, Phiede had to wait until another pharmacist returned to the store Monday, meaning she missed one of her doses."

As in Illinois, it is not the refusal to stock the pill, nor is it an issue to refuse to fulfill a prescription ( the Illinois emergency order only applies to pharmacies that stock the pills), it is the intervention in the individuals right to obtain the pill from someone else. It is fine to refuse (personal freedom), but not to block.

[Russ D]

Thoreau,

If there's going to be a law, can we at least make sure it's narrowly targeted at the cases that are prompting the outcry, rather than take the gamble of unforeseen consequences?

Are you assuming that there are no unintended consequences with narrowly targeted laws? Sheesh, the main consequence of narrowly targeted laws is the persistent cries of "How about a narrowly targeted law for me and my pet peeves?" And of course we get those laws too, and the subsequent confusing array of regulations and puzzlement of why the law is so illogical.
The end result is six of one, half a dozen of the other.

[Drooling Richard]

I would say that those pharmacists are lowering value to customers, though.

O.K. I am not terribly concerned about pharmacists. I suspect they are mostly overpayed pill-counters and data-entry technicians. A pharmacy is, however, a business. Businesses should have the choice to do whatever the owner regards as valuable.

Let's say you want start a pharamacy business that specializes in oncology medications. That is what you want to do and you take time to study up on this subject. This specialization is bound to annoy potential customers of reproductive medications. Forcing this business to dispense birth control medicines is absurd.

[Russ D]

fyodor,

And as long as the current prescription system is the law, it's not like pharmacists are entering into this monopoly willingly. Not that they can't refuse to be pharmacists, but they can't choose to be pharmacists without partnering with this government enforced monopoly.

Good point! The pharmacists I know tend to passionately enjoy the "pharmacological consultation" with patients, that is the part where they actually feel like they are helping patients and adding value; it's the damned "Government Drug Dispenser" part of the job they hate but that is the part that brings them most of their patients. 95% of the customers would rather not have to deal with the middle man, but if not for that 95% then 95% of the pharmacists wouldn't be employed as pharmacists.

[thoreau]

Russ-

Good point. I guess my only point was that the broader the law the more potential for even bigger unintended consequences.

[joe]

Sorry about the emenations. I had Mexican for lunch.

[db]

But since they're not, at the moment, those people who DO have the authority to dispense drugs shouldn't also be allowed to inflict their additional whims on those who need medicine.

Jennifer, I hate to say this, since I usually tend to agree with you on many things, but you're wrong here. What gives the government the right to force a morality (you must provide contraceptives to anyone) on an individual? Regardless of whether the statement is positively or negatively worded, it's still coercing behavior in opposition to the will of the coerced.

[thoreau]

Sorry about the emenations. I had Mexican for lunch.

joe, you just made me spray over my computer monitor!

[joe]

But db, since the patients are, themselves, being coerced by the government to go to the pharmacists, any extra hurdles the Rxers put up are, themselves, government coercion.

[Jennifer]

DB-
I'll admit this law has its imperfections (and want to stress again that *I* think all drugs except antibiotics should be freely available to any adults who want them), but I want to repeat here something I've often said when explaining why I'm not a Compleat Libertarian despite the fact that I agree with the philosophy far more so than with the two major parties:

Governments are not the only organizations, and heads of state not the only individuals, whose power over those beneath them must be kept in check to ensure a free and well-functioning society.

Because of the way the law is now, the pharmacist has actual power over his customers--he has legal access to medicine they need, and they do not. And so when he is at work and exercising that power, I don't think that his desire to indulge his feelings of sexual squeamishness should be done at the expense of those over whom he has been granted this power.

[metalgrid]

My libertarianish position on this is as follows:

Unless the contractual agreement between the pharmacy owner and the pharmacist states that the pharmacists belief system rather than their pharmacological education and certification dictates their customer interaction, the pharmacist should be obliged to provide the medication.

The idea that one's beliefs should dictate such a matter over the employee/employer contract is hogwash. A pharmacist could state that their belief system prevents them from providing any medication at all and all ills could be cured by prayer to some fairy and thus not do any work at all. And the person going in to fill their prescription for allergy medication would be SOL.

If a pharmacy stocks a particular medication (be it EC or otherwise) is a clear indication that it is meant for sale, and as such, the pharmacist's contract would oblige them to sell such medication unless they had a prior agreement with their employer. Doing otherwise would be a violation of their employment contract and would be grounds for dismissal, regardless of their belief system.

I don't see how getting government involved in this is going to help any of the 3 parties involved (the consumer, the pharmacist or the business owner). If the pharmacist doesn't like the policies of the owner, they can always go elsewhere. It's tantamount to a supermarket salesclark not letting customers buy meat because she is a vegetarian.

[Mo]

Channeling Cathy Young:

The depressing thing about this issue is that it seems like both sides are trying to impose equally unfair laws. Those on the left want to force pharmacists to dispense drugs against their will (though I do lean towards agreeing with Jennifer's gov't enforced gatekeeper reasoning). However, and I haven't seen this mentioned in the thread yet, those on the right are pushing for protections of pharmacists that refuse to dole out these drugs from being fired from their employers for this. Neither is a good solution, but as I stated earlier, The former is preferable due to the exclusive gatekeeper status given by the state.

[Mo]

Oh and is drf the long missing gaius? He seems to have gaius' distaste for capitalization.

[thoreau]

Mo-

Are there any cases of pharmacists being fired for not dispensing birth control? I would think that a pharmacist who refuses to dispense one of the most commonly prescribed classes of pills around would be in trouble. Especially since the women who decide to go elsewhere will probably take the rest of their purchases with them as well (over the counter drugs, toothpaste, soap, snacks, birthday cards, photography, and all of the other things sold at drug stores). I just can't see a pharmacy owner being happy about such a significant loss of business.

If so, has the right called for legislation defending those pharmacists?

[Jennifer]

Thoreau-
Yes, the right has pushed and is pushing for such 'conscience' laws.

[Mo]

thoreau,
I've read a few posts on NR (not out of mainstream conservatism) touting such a move. Not sure if there are as many anecdotes as pharmacists removing, but I'm sure a lot of owners of Walgreens aren't happy that they're losing a cash cow. I don't think anyone would be bringing it up, unless it happened (based on Mo Observation #315 - If there's a law or rule against something, it means that somewhere, somehow, someone already did it).

[fyodor]

those on the right are pushing for protections of pharmacists that refuse to dole out these drugs from being fired from their employers for this.

If there's one thing most everyone here probably agrees on it's to oppose such laws.

[Rick Barton]

Mo,

I'm almost positive that drf and gaius are different people. Then again, for a while I thought that GG and JB weren't the same. But on this one, I'm quite sure.

[thoreau]

The only similarity between drf and gm is the boycott of capital letters. gm would be blaming the contraceptive controversy on Nietzsche and populism or something.

[rob]

Wow... This is just a beautiful proof of how confusing an issue with onerous gov't regulation can make it tough to determine where you stand on an issue. Lots of people are going in directions I'd never have guessed they'd go because of how dorked up the whole scenario is. Even joe is suddenly finding he's a strict constructionist in favor of minimizing federal power - at least on this topic.

Pharmacists get paid to dispense medications prescribed by doctors. Both doctors and pharmacists are gov't licensed and sanctioned. This screws up the whole deal, in my opinion. But to any pharmacist who had moral problems dispensing something a doctor had prescribed, my response would be "Fill my prescription. If you don't I'm going to complain loudly and longly to your boss. If I don't get satisfaction from your boss (or if you are your own boss) I'm hiring a lawyer. Get ready to waste lots of your time unemployed or in civil court dealing with an unending pile of legal nonsense instead of here in your nifty white lab coat."

Bottom line: If you are a gov't apparatchik, get to apparatchiking. Or get a job in the private sector that suits your delicate morals.

[biologist]

is it OK for a Roman Catholic cashier to refuse to ring up the contraceptives in order for the customer to purchase them?

I don't see how that differs significantly from the pharmacist refusing to dispense, and the cashier doesn't have to have governmental licensure.

[Drooling Richard]

I would think that a pharmacist who refuses to dispense one of the most commonly prescribed classes of pills around would be in trouble
Are there any cases of pharmacists being fired for not dispensing birth control? I would think that a pharmacist who refuses to dispense one of the most commonly prescribed classes of pills around would be in trouble.

thoreau,

Take a look at this way:

I demand that you tell me, and I'll pay for it, from what angle and height I should toss my annoying Aunt Esther off a balcony to be reasonably certain her skull will crushed and I will receive her inheritance sooner than nature would allow. Heck, I'll split it with you.

You're a physicist and, therefore, you must know how to solve my problem (or how to go about it). I am your customer, therefore, I have the right to know.

You have to tell me how to kill my Aunt Esther, the government says so.

My Aunt Esther is evil, by the way, well at least I think she is.

[thoreau]

You have to tell me how to kill my Aunt Esther, the government says so.

Richard-

I don't quite get your point. I wasn't saying that the pharmacist would get in trouble with the government, I was implying that the pharmacy owner (e.g. Walgreens Inc.) would be pissed off at somebody who turned away large numbers of customers.

I do see why you use the murder analogy: Some pharmacists believe, however rightly or wrongly, that emergency contraception is murder. But I wasn't suggesting that any pharmacist should be forced by law to sell it. I was suggesting that pharmacists who refused to sell birth control pills might find themselves out of a job.

[kevrob]

drf isn't gaius. That would be obvious to anyone familiar with his stated hometown. Here's a Turing test: hey, drf, what's the local public high school's nickname for its teams?

drf might be thoreau, who might know the answer to my question. 🙂

The "conscience clause" only becomes a problem when a business is too small. If a hospital in a state with such a law performs elective abortions, a replacement for a nurse or doctor who refuses to participate in such procedures on moral grounds can usually be found. If Osco Drugs or Walgreens only has one pharmacist on duty at a time, the customer can't be so accommodated. Such establishments should be able to require their staff to agree to dispense everything they sell as a condition of employment. If Ye Olde Apothecary Shoppe is owned by the local grand-poobah of the Knights of Columbus, then, no, you shouldn't expect to get an EC prescription filled there, and the government shouldn't demand that, either.

As for pharmacies where more than one professional is on duty at the same time, I suppose a conscience clause wouldn't inconvenience any of their customers. It might suck to be the pharmacist stuck with all the hormone-pill scrips, though. BTW, does anyone shop at a pharmacy that does enough business to have two or more pill-wranglers, no waiting?

Kevin

[biologist]

Please control your bodily fluids.

Comment by: Drooling Richard at April 20, 2005 04:08 PM

should someone named Drooling Richard really be demanding others control their bodily fluids? didn't Jesus say something about wiping up your own bodily fluids with extra-absorbent Bounty paper towels before criticizing your brother's lack of control over his fluids? 🙂

anyway, attempting to kill your Aunt Esther is plainly illegal, so your comparison is inapposite to the discussion at hand

[Drooling Richard]

I don't quite get your point. I wasn't saying that the pharmacist would get in trouble with the government, I was implying that the pharmacy owner (e.g. Walgreens Inc.) would be pissed off at somebody who turned away large numbers of customers.

Walgreens sells what Walgreens wants to sell. Walgreens chooses not sell many things.

I am not Sam, Sam I'm not. But like Sam, I have a business and choose what I want to sell. I am frequently approached by customers who want me to sell them my wares. I often say "no". I say "no" a for number of reasons: I don't the time, It's not worth my while, It's not my ballywick (sp?), I can't do that with level of support I choose to maintain, I don't have the money to finance it, the supplier is a dickhead, etc.

I am only saying that is craziness to insist that a customer can walk up to a counter and demand to be sold a product that he thinks the store should have. Having the gubmint make the store sell it to him is even crazier.

[Mo]

I guess after facetious accusations of multiple identities, I should put a :). I don?t seriously think drf is gaius, different writing styles, philosophies and not calling people mr. ___ is the tip-off. Unlike our gay, married French marine from Alabama (I still wonder which, if any of those identities is true).

I wonder how the battle lines would shift if the controversial drugs were pain killers rather than birth control (not a far-fetched scenario). I agree if any government body should do the regulating in this situation, it should be the states (since they set the licensing requirements for their pharmacists anyways, how is this more onerous than any of the other dozens of requirements), but that conscientious objectors should be free to not hand out the pills and also fired. Of course, in my ideal world, anything except antibiotics would be free for distribution, but that ain?t going to happen. Would I be upset if states forced people to dole out these drugs? In principle, yes, but I wouldn?t be heartbroken either.

[alkali]

Two thoughts:

(1) Those who point out that emergency contraception is available by mail need clarification on the meaning of the term "emergency."

(2) The suggestion that Sen. Boxer should have sought to make birth control available OTC has its heart in the right place, but ignores certain political realities. (Picture, if you will, the Christian right having a collective stroke.)

[Dan]

Boo fuckity hoo for the poor pharmacists.

Pharmacists enjoy a government-established monopoly. They can damned well follow the government's orders. If that upsets them they can lobby for the government to abolish the monopoly and let everyone freely buy the drugs of their choice. But they aren't going to do that, because almost all of them would be out of a job.

So long as the guy behind the counter is enjoying his power as a legal gatekeeper for the medications I need, he can fucking well give them to me whether he wants to or not. Last I checked the drones at the DMV can't just arbitrarily refuse to grant licenses to homosexuals, the fire department can't just decide to let black people's houses burn down, and the city planners can't just decide that they don't feel like processing the building permits of Muslims. So why the fuck should pharmacists get to pick which drugs pass a religious test?

[B.D.]

Another source of power not discussed in this debate is the health insurer. While a person may be able to go down the road to get her prescription filled, she may not be able to get her insurer to cover it at a competing pharmacy and therefore, may not be able to afford it. This is further bastardization of the free market concept.

[Johnny]

In reading the comments on this thread, I realize that most must not have read the article. It actually protects pharmacists who object to filling scrips that the find morally objectionable.

It provides for the step of not carrying the medications. Perhaps, as the fundi groups point out, insisting on the referral is a bit much, but that seems to be the only problem.

But the bill does state that a pharmacist cannot prevent a patient from having the scrip filled.

I could see a libertarian having trouble with the referal portion, BUT...

When did Hit n Run turn into the Corner?

You know things are bad when Boxer becomes Libertarian, and the Libertarians become Neo-cons.

[Rick Barton]

The general case...

Jennifer at 05:36 PM:

Governments are not the only organizations, and heads of state not the only individuals, whose power over those beneath them must be kept in check to ensure a free and well-functioning society.

But if these organizations are "kept it check" i.e. restricted from any non-coercive activity, then we have in fact ensured that we will NOT have a free and well-functioning society! Also, the only organizations that wield real power are governments and coercive criminal organizations and their beneficiaries.

Jennifer, can you think of an example of an organization that hasn't been granted state privilege that you would condone using government to restrict? Or perhaps, that's the only type of case, like that of the pharmacies, that you consider the use of government force. But even if you limit it to those types, you most certainly are ensuring a NON-FREE society.

[Rick Barton]

The case of restricting organizations that have received government privilege, such as the pharmacies...

Rick at 03:20 PM:

Since the pharmacist is in effect sharing in a governmentally-mandated monopoly, isn't there a duty for the pharmacy to provide services without regard to the pharmacist's own moral beliefs (as distinguished from a true free-market situation where any old Joe can sell whatever pills he has)?

If the government coercion that forces customers to go to a licensed pharmacy where they may purchase drugs that it is legal for the pharmacies to sell, (but not those that it is illegal to sell) is wrong, how can forcing the pharmacy to sell other drugs be right? What is ethically superior about the customers desire to buy a certain drug vs. a pharmacy's desire not to sell it? Nothing. We are just adding another unwarranted government restriction onto a situation where the only fair thing to do is to reduce those government restrictions.

joe at 05:03 PM:

...since the patients are, themselves, being coerced by the government to go to the pharmacists, any extra hurdles the Rxers put up are, themselves, government coercion.

It adds inconvenience to the customer that would certainly not obtain in a free market but this is not more government coercion, since not all pharmacies have to follow suit. And very likely won't...

Practical considerations of this case:

The desire for profit will make some pharmacies satisfy consumer demand where others refuse. And the ones that want to sell certain products will no doubt do a better job of it (product use advice, etc) than those who don't.

fyodor at 03:45 PM notes the kind of legal Hell that can ensue when laws of the Boxer type are added to an already over-regulated area:

...this kind of leglislation would force pharmacies to always have EC in stock. And if they didn't have it in stock when someone wanted it, their trial would revolve around whether they intended to not have it in stock or didn't have it in stock by accident? Oy vey....

[Johnny]

Rick Barton,

"how can forcing the pharmacy to sell other drugs be right?" You are right, and this proposed law does not do that, it actually protects both the pharmacists and the pharmacies. It allows them to NOT stock the drugs in question. Are you deliberately mis-representing this?

"...this kind of leglislation would force pharmacies to always have EC in stock." Nope, it leaves the pharmacy the option of not stocking it.

What the law does say is that these drugs are legal, and you don't have the right to except the scrip but refuse to fill it (it basically just extends basic contract law to females).

Now, the referal bit might be too much...

But, the increased legislation? When libertarians fail to leap into the breach to defend the free market, is it any surprise we get crap like this law, and Ms Boxer?

[Rick Barton]

A further practical argument against Boxer's proposal:

A significant amount dollars from religious parishioners wind up providing medical care in this country. This is the case because this money is not taxed. Now, if the government starts mandating things be done with this money that these folks object to on their moral grounds, they will be inclined not to give it for those ends and it could result in a "killing the goose that lays the golden egg" effect.

[Johnny]

Rick Barton,

Could you please direct me to the part where they are going to mandate anything but contract honesty?

[Rick Barton]

Johnny,

If I, (and quite a number of other commenters) have the particulars of Boxer's idiot proposal wrong, please infer my comments against the mandatory referral stipulation. They will all obtain against that as well.

[Rick Barton]

Johnny,

From the article:

"Boxer's proposal would require all pharmacies to fill all prescriptions or refer customers to someone who will, despite pharmacists' religious or ethical objections to the nature of the prescription."

[Johnny]

Well, I left myself open on that one, BUT...It also says "But the bill doesn't require pharmacies to stock contraceptives."

I have a problem with the referal too...but...one would think from reading your posts that they would be forced, "mandated" into carrying EC or BC, which they would not.

I can understand the opposition to the referal part, but I cannot understand the opposition to part where they have to decide whether or not they carry it. The case in Wis which I link to above came about because the phamacist both refused to fill it (and was fired) and he held on to the scrip itself and refused to let her fill it somewhere else.

[Strat]

I have enjoyed reading some of the thoughtful, yet statist arguments in this thread. I must digress to pay homage to the title of this article.

I did a double take when I read the title. If I hadn't been reveling in 70's memorabilia at the time, the "foxes" allusion would have escaped me.

Brilliant.

[Serafina]

Eh, many of these objecting pharmacists sound like crusading whackos to me rather than responsible professionals. Oral contraceptives are proscribed for reasons other than birth control, and it seems silly that they should think they have the right to know what a particular prescription is being prescribed to treat. If the pharmacy stocks the medication, they should fill the prescription, which a doctor has deemed medically appropriate. If they can't live with the demands of their profession, they should find a new profession. What's next? Pharmacists refusing to fill prescriptions to treat STIs because they only encourage people in their immoral lifestyles?

[Serafina]

Even the American Pharmacy Association's ethics stance that recognizes a pharmacist's right not to fill prescriptions asserts that pharmacies have the obligation to ensure the patient's access to the drugs.

[Rick Barton]

What do mean "obligation to *ensure* the patient's access to the drugs"?

Are they supposed to to drive them to another drug store? 🙂

[Serafina]

That's the American Pharmacy Association's language, and from what I understand, they mean that pharmacists who won't dispense must still meet the ethical demands of their profession and refer patients to a source that will fill it in a timely fashion.

Though I certainly wouldn't mind if the renegade pharmacist were forced to give me a ride to another drug store. That could be kind of fun... 🙂

[Ken]

I can't think of another situation where government forces a business to sell a specific item. Maybe there are some. Governments are more active in detailing how things may be sold if you do choose to sell them.

Pharmacists certainly have no right to seize a scrip or impede anyone. And owners certainly can fire employees who disobey legal instuctions.

The idea that pharmacists are somehow government employees who better obey (or else) seems silly. Anyone in business is in the same situation. Just try selling hamburgers without a dozen business and health licenses.

What I haven't seen discussed is the relationship between doctor, patient, and pharmacist. Is the doctor who writes a scrip issuing a command? If so that command is not to the patient - they do as they wish about taking medicine. Is the scrip a command to pharmacists? If so, to all, or some, or one? Actually a scrip seems not to be a command at all. It is a permission.

Since the pharmacist aren't (presently)commanded by the patient or doctor the government seems to be making entire new law.

If the government wants products to be available and others do not want to sell them then let the government dispense them. It certainly does this with low-income housing, health clinics, and welfare payments. Why not toss in medicines?

[Serafina]

>I can't think of another situation where government forces a business to sell a specific item.

The health care industry in the US is highly regulated. Hospitals are required to sell medical care to the people who come to their EDs, regardless of the customer's ability to pay, or refer them for access elsewhere when the hospital is unable to provide the needed care. Insurance companies are required to sell coverage for particular medical conditions or types of treatment in order to conduct business at all.

[thoreau]

(1) Those who point out that emergency contraception is available by mail need clarification on the meaning of the term "emergency."

Not really. I have bandages in my house in case of a medical emergency. Doctors could prescribe Plan B for women to have on hand in case they had unprotected sex for one reason or another. I've seen articles in the local paper about moves in that direction in California. Canadian pharmacies already have it available online (I checked before posting in this thread), but I don't know what the rules are for doctors in the US who want to write the prescription.

(2) The suggestion that Sen. Boxer should have sought to make birth control available OTC has its heart in the right place, but ignores certain political realities. (Picture, if you will, the Christian right having a collective stroke.)

You act as though that's a bad thing.... ;->

To be serious, though, are non-Catholic religious conservatives against birth control? I know a family of fundamentalists, and they've said that birth control is fine...as long as the woman is having sex within the confines of marriage, yadda yadda. The point is that to many religious conservatives there's nothing immoral about contraception. And even a lot of Catholics (the liberal and moderate ones) would concur.

So I don't know how many religious conservatives would be upset about OTC birth control.

[Don]

Ideally, such drugs should be freely accessable to all, without a prescription.

Can't agree here, since no one has a right to something produced by another. I'm open to removing the government-mandated prescription, but beyond that you should be at the mercy of the market.

However, The Law has decided that women can't get these drugs on their own, but must go through government-certified gatekeepers. All I'm saying is that the gatekeepers in question shouldn't be allowed to inflict their moral prejudices onto other people; if The Law requires me to go through a gatekeeper, then The Law should also ensure that the gatekeeper can't set up hurdles of his own for me to jump through.

Basically you think one wrong (prescriptions) justifies another (forcing pharmacies to behave according to your wishes). Can't agree with you here. For one thing, you can use that logic to justify any number of government intrusions (i.e., a little regulation calls for more).

[Don]

If the pharmacy stocks the medication, they should fill the prescription, which a doctor has deemed medically appropriate. If they can't live with the demands of their profession, they should find a new profession.

The "demands of the profession" should be making a profit in the free market.

Of course, as you pointed out, medical care isn't a free market. But that doesn't change the fact that medical care should be a freer market, not a less free one.

Do you really consider yourself a libertarian?

[Don]

To add to the above, pharmacists often know more about medicine than the prescribing doctor; and it is possible that they have additional information. It seems reasonable to me that they might have valid medical reasons to refuse filling a prescription.

[Just a question]

Ahem, did someone here bother pondering whether Babsy Boxy's proposal has even a snowball-in-hell's chance to become the law of the land -- I mean in the real world of Congress, where, at least to my knowledge, Democrats are nowhere near a majority, nor will be, in the foreseeable future?

So, why would you people deign making 150 odd posts about a piece of run of the mill congressional grandstanding? Too much time at your hands?

[Jennifer]

Don-
When I said medicines should be "freely available to all" I didn't mean they should be free, just that there should be no artificial obstacles getting in the way of the free market. Right now there ARE such obstacles, and that's bad enough without allowing the pharmacist's whims to also stand between the patient and the medicine. As for your statement about pharmacists having valid medical reasons to refuse a prescription--maybe, but the pharmacists in this case weren't refusing birth control on the grounds that it would endanger a woman's health, but on the grounds that they felt it was immoral.

A pharmacist who has ethical objections to passing out prescribed pills is in the wrong job.

[joe]

"Also, the only organizations that wield real power are governments and coercive criminal organizations and their beneficiaries."

Ah, Rick. I wish I'd lived a life that allowed me to draw such a conclusion.

[Russ D]

I've been wondering if refusal to fill a prescription AND refusing to give the patient the prescription slip isn't malpractice on the part of the pharmacist. The danger of the proposed legislation is that it's OKing a certain type of malpractice.

And if this type of practice is allowed by pharmacists, does it not give doctors like Hurwitz some kind of defense or at least make the pharmacists who choose to fill his prescriptions willing accomplices?

Eventually we'll all just be going to the DEA office to get our prescriptions written and filled.

[joe]

"It adds inconvenience to the customer that would certainly not obtain in a free market but this is not more government coercion, since not all pharmacies have to follow suit."

"Inconvenience" "not all pharmacies"

Conservatives love to use the word "inconvenience" to minimize the costs their policies impose on people's lives. Have to carry your rapist uncle's fetus to term? An inconvenience. Blacklisted from every decent paying job in your city for trying to form a union? An inconvenience. Have to drive halfway across Idaho to get emergency birth control, because some asshat pharmacist refuses to do his job, and maybe the extra time causes the medication not to work? A mere inconvenience.

On the other hand, a government action that so much as requires a company to put a 10 cent valve on its pool drains is an intrustive coercion into individual liberty that threatens the foundations of a free society.

[drf]

hey Linguist - i think it's closed and a staples is moving in. plus we now go to the one across from the multiplex/union station, right on the river.

mo - nope. not gaius. 1) i couldn't channel that type without punching myself and 2) although i did make fun of my lack of caps on a post yesterday (wed).

hell, i thought that s. pete was gg was jb was thoreau... 🙂

"As for your statement about pharmacists having valid medical reasons to refuse a prescription--maybe, but the pharmacists in this case weren't refusing birth control on the grounds that it would endanger a woman's health, but on the grounds that they felt it was immoral."

pharmacists are not trained for medical advice. if they know something, it's like what the rest of us know. it is not their place to give advice. remember, they advertise fad diet bars, herbal placeboes, etc. they probably would have grounds to contact the MD with a question, but i don't think they ethically can interfere with the MD/ patient course of treatment.

that's way overstepping their bounds.

people don't like most doctors ("assholes with tongue depressors"), but they also don't want to comply with md advice ("eat less, exercise"). you know, go to heaven. don't wanna die.

cheers,
drf

[Rick Barton]

Ah, Rick. I wish I'd lived a life that allowed me to draw such a conclusion.

joe, just name me an organization that wields power anything like governments and coercive criminal organizations and their beneficiaries.

[Jennifer]

Rick-
How about the Roman Catholic Church? Or pretty much any large corporation.

[Rick Barton]

joe:

Conservatives love to use the word "inconvenience" to minimize the costs their policies impose on people's lives

A libertarian argument is, as I said: "It (a pharmacist's choice not to fill) adds inconvenience to the customer that would certainly not obtain in a *free market*". A free market in drugs would vastly aid consumers.

Also, forcing a pharmacy to do things that the owners consider immoral would likely impose other costs on the consumer, such as inferior and incomplete product use advice, etc.

[Russ D]

pharmacists are not trained for medical advice

And doctors aren't trained for drug advice. They get their knowledge from journals (if they read them) and what other doctors say and what the pharma sales rep tell them. Just like the rest of us.

[Rick Barton]

Jennifer,

With the Roman Catholic Church and with large corporations (not granted government monopoly protection), we have the *choice* to affiliate or not. Try choosing not to pay your taxes.

[drf]

russ - get some better doctors. who leads the trials? rx-ing is different from med advice, anyhow. and it's very different from dx-ing. so you can't even compare those two. really, get a better doctor.

[dhex]

related to taxation, any large company which buys favors with the government - wal-mart getting subsidies for parking, etc - essentially rents the power of the state to fuck with all of us.

joe has a good point, in this case, about "inconvenience" and how easily it's tossed about.

[joe]

"joe, just name me an organization that wields power anything like governments and coercive criminal organizations and their beneficiaries."

Virtually every large manufacturing company, at least in their own home turf, prior to the adoption of Progressive-era and New Deal labor policies.

Standard Oil, 1899. Ford Motor Company, 1921. Hell, NewsCorp 2005.

[Rick Barton]

dhex:

any large company which buys favors with the government...essentially rents the power of the state to fuck with all of us.

Right, that's the "beneficiaries" part of: "The only organizations that wield real power governments and coercive criminal organizations and their beneficiaries."

[Rick Barton]

joe,

Some how wage rates continued to be bid up even before the New Deal. If these corps had anything like government power, that wouldn't have happened. The fact that we're talking about wages being *bid* up indicates that they did not weild government power.

On the progressive era:

Gabriel Kolko (a lefty,BTW), in his history of the progressive era: The Triumph of Conservatism (Kolko meant "conservatism" as big business, not a political philosophy), noted that the dominant trend in the last three decades of the nineteenth century and the first two of the twentieth was not towards increasing centralization, but rather was:

"toward growing competition. Competition was unacceptable to many key business and financial leaders, and the merger movement was to a large extent a reflection of voluntary, unsuccessful business efforts to bring irresistible trends under control. As new competitors sprang up, and as economic power was diffused throughout an expanding nation, it became apparent to many important businessmen that only the national government could [control and stabilize] the economy. ? Ironically, it was not the existence of monopoly which caused the federal government to intervene in the economy, but the lack of it."

http://www.amazon.com/exec/obidos/ASIN/0029166500/reasonmagazinea-20/

[Rick Barton]

dhex,

Of course that should have been: "The only organizations that wield real power *are* governments and coercive criminal organizations and their beneficiaries."

Excuse me please.

[fyodor]

Power shmower. Let's define our terms, eh? When I have something you want, that gives me a form of power of you. Corporations have the resources and incentives to give workers the jobs they desire. They create the products or provide the services that their costumors desire. This is a form of power, granted. But it is power based purely on consensual interaction, even if sometimes consensual players rue their inability to dictate the terms of the interaction as well as they would like. However powerful corporations may seem because they have what other people want, they do not have the power to (legally) coerce others. This is the power we grant to government and which is why we try to keep it under wraps. Yes, actually all of us are interested in keeping it under wraps in one way or another, even if most wouldn't restrict it as much as libertoids would. Since the power of government is based on us saying it's "okay" for it to be coercive, libertarians believe that power should be limited to cases where coercion is already involved. And I mean actual coercion, not just being bummed that the entities that have what one wants would give you more of it without asking as much in return. This is what it all boils down to. Vague comparisons of total amount of "power" are completey besides the point.

[fyodor]

Damn, maybe I'm going senile, but my posts seem to increasingly be in need of the editing they're not always getting. Well, sorry, but I think you know what I mean!

[Anonymous]

"joe, just name me an organization that wields power anything like governments and coercive criminal organizations and their beneficiaries."

Virtually every large manufacturing company, at least in their own home turf, prior to the adoption of Progressive-era and New Deal labor policies.

Standard Oil, 1899. Ford Motor Company, 1921. Hell, NewsCorp 2005.

I will file that with another posters's "America was founded as a Christian Nation" and "Abraham Lincoln was a Racist" myths.

[Don]

Don-
When I said medicines should be "freely available to all" I didn't mean they should be free, just that there should be no artificial obstacles getting in the way of the free market.

I knew what you meant.

Still, you have no right to something produced by another. Part of the free market is not coercing those who produce or provide services.

Right now there ARE such obstacles, and that's bad enough without allowing the pharmacist's whims to also stand between the patient and the medicine.

The pharmacist has a right to his whims. If those cost him in the marketplace, fine, but you have no right imposing on him the coercive power of the government to force the outcomes you desire.

As for your statement about pharmacists having valid medical reasons to refuse a prescription--maybe, but the pharmacists in this case weren't refusing birth control on the grounds that it would endanger a woman's health, but on the grounds that they felt it was immoral.

Yes, I understand. I was raising a seperate point, suggesting unintended consequences to restricting the actions of pharmacists. How many women are denied morning after pills and how many lives are saved by pharmacists applying discretion?

Yet another unintended consequence is reducing pharmacy as a favored career, by overregulation (kinda like Medicare is doing with doctors).

A pharmacist who has ethical objections to passing out prescribed pills is in the wrong job.

Perhaps. I'd prefer that the market decide that, not some Senator bitch.

[Don]

Some how wage rates continued to be bid up even before the New Deal. If these corps had anything like government power, that wouldn't have happened. The fact that we're talking about wages being *bid* up indicates that they did not weild government power.

Hell, taxes show that the gov wields more power than corporations. Corporations make money by producing something consumers want. Government, on the other hand, simply takes the money it wants, then provides what it wants to provide to keep the masses happy enough they don't begin "voting from the rooftops".

[Don]

"The only organizations that wield real power *are* governments and coercive criminal organizations and their beneficiaries."

Really, criminal gangs are just primitive governments that fill the gaps left when the "real" government bans some "thing" or "activity" altogether. The "thing" is often drugs, guns or alcohol, the "activity" is often sex for money or gambling.

[Jennifer]

Don-
The point has already been made here that there is NOT a free market when it comes to medicine; no matter how much money I have, I can't get mdeicine without the say-so of a governmentally-approved gatekeeper. Just to clarify: if these medications were non-prescription, I wouldn't care who did or did not sell them. But since I can only get them through a government-certified individual, then he shouldn't be able to add his own preferences on top of that. Kind of like the way here, in Connecticut, I have to get my car "emission tested" every couple of years. The testing is done at private shops with government certification, and I don't think the emissions testers should be allowed to discriminate, either. If they want to discriminate against people for regular car repairs, that's fine, but NOT in cases where they are given power by the government.

[rob]

I dunno, fyodor, you said that pretty darn well in my opinion. Corporations are only as strong as the deals they can make with their employees and customers.

Gov't only has the restricitions placed upon it by our legal system and the checks and balances inherent in the Constitution as the contract in which citizens agreed to cede authority over themselves and their future generations. Which has more power? Obviously the gov't.

Cyberpunk anti-capitalist conceits about global corporations taking over the world by usurping the role of gov't are just that - conceits. When was the last time a corporation won a head-to-head dispute with the feds?

[Jennifer]

Rob-
Corporations don't go head-to-head with the Feds anymore; the two work together.

[Don]

The point has already been made here that there is NOT a free market when it comes to medicine;

Jennifer, yes, I understand your point. It amounts to "some regulation" demands "further regulation" to get an outcome you prefer.

I prefer less regulation in any case. The fact remains that you have no right to something produced by another, and the fact that existing regulations impact you doesn't change that.

One of the stong points of free markets is that even semi-free markets work pretty well. I'll always push towards more freedom in the marketplace.

[rob]

Jennifer: Really? So that whole Enron/Arthur Anderson flap and the Microsoft anti-trust suits are just upkeep on the illusion that the gov't isn't as powerful as corporations?

When was the last time a corporation declared war on another corporation? Even with old examples of rough-and-tumble monopoly "battles," I doubt you can find an example where a corporation took on the US military...

I'd argue that the regulatory agencies of the Executive Branch pretty much exist to ensure that corporations never forget that it's gov't that has the REAL power.

Not to say that when gov't has wants to accomplish something through corporations that it hasn't so happened that the gov't and the corp don't work hand-in-glove, but let's be realistic about who dictates the terms of those "partnerships." Gov't is the hand, corps are occasionally the glove. (Recently the new twist is faith-based initiatives, in which various religious org's and charities are the glove.)

[rob]

Wow, I cut and pasted that last paragraph into insensibility.

Not to say that when gov't wants to accomplish something it hasn't used corporations to do it. But even when the gov't and the corp work hand-in-glove, let's be realistic about who dictates the terms of those "partnerships." Gov't is the hand, corps are occasionally the glove. (Recently the new twist is faith-based initiatives, in which various religious org's and charities are the glove.)

Hopefully this is somewhat more intelligible.

[Jennifer]

Rob-
I promise I will never again be flippant in response to you.

[rob]

Well, I guess that'll teach you! (Seriously, I'm sorry for going off. In my defense I was still in "respond to joe" mode...)

And I believe you have a good point everytime I look at the amazing list of organizations that the gov't subsidizes.

[Jennifer]

Rob-
I'll tell you one thing in seriousness--I work for a defense industry consulting firm (until I find something better) and with all the reports I read of the huge "cost-plus-fixed-fee" contracts, with the government giving HUGE amounts of money to the same corporations over and over and over again, combined with some of the laws passed recently. . . .well, I didn't literally mean that earlier comment, but in a few years things seriously might be different. Only it's not "Corporations;" it's "SOME corporations" that work hand-in-hand with the Feds.

[rob]

Jennifer - Now we're TOTALLY on the same sheet of music. The military industrial complex, for instance, in which Boeing, Lockheed-Martin and Halliburton sometimes come pretty close to being privately owned arms of the gov't.

Although I suspect that oftentimes it's a way to get gov't influence into corps as much as it is a desire by the corp's to get federal contracts/dollars. I suspect it takes both sides getting something out of the deal, but it's still pretty creepy.

[Jennifer]

Certainly they both get something out of the deal--when the administration approved the sale of fighter jets to Pakistan, (you know, the Ally of Freedom) it talked about the jobs that would be created at. . .Lockheed, I think. Translation: the company gets serious money, and the government gets shiny, sexy toys which incidentally kill a lot of people.

Meanwhile, the actual troops grouse that they can't get basic equipment, like armor and other rather low-tech supplies, while the government gives INSANE amounts of money for the Future Force Warrior and other blue-sky programs. But there's some scary, high-tech Orwellian shit that I never would have known about if not for my job; the stuff isn't classified, it's just never mentioned in the mainstream media.

[Don]

You guys need to keep in mind that it is always the consumer that's in control in the marketplace.

In the case of the defense industry, the consumer is the government.

In defense, the gov stipulates requirements, kicks contractor butt when it doesn't like the costs (although those costs are often requirement driven, and made worse by the gov's funding schedules), etc.

Defense contractors also jump through all the gov hoops relating to "diversity", "sexual harrasement", "ethics", and so on.

It is absolutly clear to me who is in control in the defense contractor / gov relationship.

[Don]

Meanwhile, the actual troops grouse that they can't get basic equipment, like armor and other rather low-tech supplies, . . .

In part, this is probably due to funding processes that favor outfitting a current project, but don't account for lifecycle issues.

Further, there are valid reasons why these sorts of things don't work out quite like we would like. The lack of armor in Humvees in Iraq, for example, was something that required manufacturing to ramp up to solve the problem. Before it became a real problem, other more pressing issues no doubt dominated.

[rob]

Hmmm... Since the jets Pakistan gets aren't exactly state of the art avionics packages, I'm thinking that this is just a bone thrown to satisfy a gov't whose bases we're using to get to Afghanistan. The gov't throws a bone to both the Pakistanians and Lockheed, without disrupting the power balance with India and Lockheed (one of the few outfits that is industrially big enough to handle military aircraft contracts) gets something to buoy its bottom line.

Orwellian - Are you talking about the "Non-Lethal Weapons" initiatives?

My best friend hates the Future Force Warrior stuff. He's an old-school Infantry Capt who just got back from Iraq 6 months ago. But the high-tech edge and great training is what keeps the US the most potent military on the planet. Infantry troops rarely like innovations, but like the M-16 they eventually get used to them and learn to appreciate the advances. OTOH, for tech-driven military aviation, if you're not the bleeding edge you're just plain bleeding. Hence the push for the Joint Strike Fighter and the F-22 Raptor (not to mention the constant avionics pupgrades for existing aircraft).

Uh... what were we talking about?