Shining a light into the dark places


When the U.S. Congress buries game-changing laws deep in the bowels of complicated acts named for other things altogether, you wonder why they can't just call things like they see 'em. For starters.


When I graduated from pharmacy school in 1992 and started counseling patients, I felt really good about doing my part to bring the federal budget deficit under control. I’ll admit I was a little skeptical at first that I could talk this nation into fiscal responsibility, but as the patients rolled in and I explained their prescriptions, I’ll be darned if each year those deficits didn’t get smaller and smaller, resulting in 1998 in the first federal balanced budget in a generation. What was perhaps the biggest change in the practice of pharmacy in our lifetime had paid off. OBRA-mandated counseling was a success.


I’m kidding, of course. I’ve never thought my gift of gab so powerful that it could turn the fiscal course of a colossus like the federal government. It is true, though, that a sea change in our profession began with an attempt to manage the government’s monetary affairs.

OBRA stands for the Omnibus Budget Reconciliation Act of 1990. Along with revenue increases and other tweaks of the tax code that would achieve the main aims of the bill’s authors, OBRA included such items as the creation of the Walter B. Jones Memorial & NOAA Excellence Awards for Coastal and Ocean Resource Management.

And deep, deep in the entrails of this document, was the provision that changed pharmacy forever, the requirement that pharmacists offer to counsel patients with each new prescription filled.

Interestingly enough, OBRA was sponsored by recently departed Secretary of Defense Leon Panetta during his tenure in the U.S. House of Representatives as Congressman for California’s central coast. Which makes me wonder whether the death of Osama Bin Laden might not have been the result of something like a new policy to evaluate the air quality on nuclear submarines, as it would seem that what Washington says and what it does can be dramatically different things. 


If you need further proof, look no further than the passage of HIPAA in 1996. If OBRA’s afterthought was the biggest change in pharmacy in our lifetimes, than it’s a safe bet that HIPAA would rank in a list of the Top 5.

You might be surprised to learn, however, that the “P” in that law’s title does not stand for “privacy.” The law’s full title is “The Health Insurance Portability and Accountability Act,” and while its privacy provisions weren’t quite the footnote pharmacy counseling was to OBRA, once again a law’s biggest legacy appears nowhere in its title.

If you were counting on monitoring seismic changes in health care law and pharmacy practice by looking at the actual titles of laws, you would have been burned twice, and I’m betting other examples wouldn’t be very hard to find.

By the way, Title II of the HIPAA law, the one in which its patient privacy provisions appear, includes the words “administrative simplification” right up front in its heading. I’ll leave it to you to decide how much HIPAA has simplified things around your pharmacy.

Call it what it is

I suppose it would be too much to expect the level of honesty that changing the title of HIPAA to “The Paper Provider and Shredder Manufacturer Stimulus Act” would provide, but is it really unrealistic to ask for some sort of connection between a law’s title and what the law actually does?

Is this really how things were designed to work? Can you imagine Thomas Jefferson making the Louisiana Purchase by inserting a provision into an Omnibus Tariff Bill? I can’t.

Evidently though, I can make my effort to keep on top of changes in the profession a little easier by just ignoring anything coming out of Congress with the word “pharmacy” in the title.   

My decision not to go to law school looks better each day. 

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