More wingnut “small government”

The Florida Legislature, Governor, and NRA chapter know more about how to practice medicine than doctors do, so they’re going to make it illegal for pediatricians to ask their patients whether they carry guns.

Fearless prediction: None of the people who object to restricting political bribery in the form of campaign contributions, or who object to the First Lady promoting healthy eating for fear of the “nanny state,” or support free-market choice in any other context, will have any problem with this gross violation of free speech.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

28 thoughts on “More wingnut “small government””

  1. The smart play is to agree to the law as proposed and then continue to do what pedis do now: Ask the *parents* whether they have guns in the home.

  2. It is none of the doctor’s damn business whether I have secured my poisons where small children cannot get them either. If I want to keep Drano on the floor next to the sink, that is my affair, not the gummint’s.

  3. (Kleiman): “…they’re going to make it illegal for pediatricians to ask their patients whether they carry guns.
    Sounds unlikely. How many minors carry guns? Of those that do, how many would admit it? The pediatrician’s patient is a child. The pediatrician’s client is a parent. This will change, obviously, when the State pays for medical care and thr government becomes “the client”. In the current legal environment, what possible legal use could an MD make of information obtained from a child that the MD could not have obtained from that child’s parents?
    What would you think of a physician asking children: “do your parents use recreational drugs?”, “are your parents legal residents of this country?”, “where do your parents keep valuables, like jewelry?”

  4. @Malcolm, if you were interested in the facts rather than polemics, you’d jump to the link and see that, though our host chose his phrasing slightly poorly, making it infinitesimally easier to misread the intent, the law refers to asking new parents about gun ownership, so they can be reminded about the importance of gun safety. This is to be forbidden, because the NRA knows better than doctors how to advise parents about hazards in the home.

    Regarding your phrase about “the State [becoming] the client”: is that how it works now with Medicare? Do you have a source for that claim?

  5. Just remember; conservatives want the government to stay out of our personal lives and not interfere in business, unless it upsets their constituency in which case they will use the full force of the law to interfere with people’s personal lives and interfere in business.

  6. Malcolm, in the real world, gun homicide is becoming an increasingly youth-dominated business. In some neighborhoods, not asking kids about the prevalence of guns in their social surround ignores one of the biggest health risks they face. That’s in addition to asking parents about whether they’ve secured their guns so little Johnny can’t blow his sister’s head off with Daddy’s revolver.

    But the point is that Florida wants to tell your doctor what he may and may not ask. Any actual opponent of “big government” would be outraged. Why do you quibble instead?

  7. This sounds like a first amendment violation. Why wouldn’t a doctor have the right to ask a patient (or parent of patient) any question that seems relevant or even irrelevant. As they say, ‘It’s a free country’. If the patient doesn’t like the doctor’s questions they are free to leave, no?

    This has got to be headed to court. Can anyone think of a rational justification for this infringment of the right to free speech?

  8. I tend to think this a first amendment violation, even if I do find it tedious being fed fake research on the ‘dangers’ of firearms from somebody who’s supposed to be talking to me about the dangers of fried food, or some other thing he’s presumptively more qualified than ME concerning.

    OTOH, I decidedly do not want my child’s doctor asking about irrelevant aspects of our home life, or worse, trying to impose his politics on my by way of my son. I’d view that as cause for changing doctors, and I’d explain to him in excruciating detail why he’d lost my business.

    So, let’s hear it from you guys: It WOULD be a 1st amendment violation if the government started demanding that doctors talk to their patients about this or that, right?

  9. I know I shouldn’t encourage trolling, but the government demanding the doctors talk to their patients — especially the parents of pediatric patients — about some things is just fine. Any doctor who won’t tell me how my kid is doing on weight-for-age or what the standard approved vaccination schedule is, or whether or not his lungs sound clear not only won’t get my custom but shouldn’t be practicing.

    Our pediatrician’s offices has signs in every examining room warning about the dangers of talking on cell phones while driving. Good thing free speech isn’t a right like gun ownership, or those signs would clearly have to go. Oh, wait.

  10. Brett Bellmore says:

    “I tend to think this a first amendment violation, even if I do find it tedious being fed fake research on the ‘dangers’ of firearms from somebody who’s supposed to be talking to me about the dangers of fried food, or some other thing he’s presumptively more qualified than ME concerning.”

    Oh, an epidemiologist as well as an engineer.

    BTW – proof of the Constitution.

  11. @paul- I don’t think the government should be prescribing or proscribing a physician’s conversation with patients. Medical practicianers are professionals governed by a code of ethics and professional licensing boards.
    Certainly in cases of medical malpractice or professional neglegence courts may become involved. That is different from outlawing or mandating specific topics of conversation.

  12. I’d view that as cause for changing doctors, and I’d explain to him in excruciating detail why he’d lost my business.

    I’m sure that once you finished the sentence “I’m changing doctors,” the rest would quickly become either boring enough or threatening enough for him to call the police and remove your trespassing ass from his premises. Once he’s not your doctor, you have no business being in his office. Write a letter.

  13. If Voltaire had teabags for brains:

    I may not agree with what you say, and I will defend to the death my right to stop you from saying it.

  14. Phil, unlike the public (Government) sector, where people can be sublimely indifferent to why their customers are abandoning them, because their customers will be paying them even if they refuse the service, in the private sector, businesses usually have at least some interest in why customers decide to leave them. As a result, in the private sector, if you tell somebody you’re leaving them for the competition, they usually WILL listen to an explanation as to why, instead of siccing security on you.

  15. Brett, thank you for the missive from Bedford Falls. Here in the real world, AT&T doesn’t much care why you are switching to Sprint, Time Warner doesn’t much care why you are switching to AT&T, and – especially – oversubscribed primary-care doctors, with patients funneled to them by (private) health insurers and waiting lists for patients to sign up with them or any other nearby “in-network” physician, don’t necessarily greatly care why one patient has left their rolls. Actually, the only people who are paid to care about why your child is losing access to health care are … government employees.

    Oh, and have you found that videotape of the drafting of the Constitution yet? Remember, it has to be the long-form videotape.

  16. Actually, in the private sector, if you tell someone, “I am not going to be your customer anymore,” then stand around and explain why in “excruciating detail” rather than leave the premises, they will sic security on you, and none too quickly. Go give it a whirl at Best Buy and see what happens. I’ll wait here.

    I’d think a libertarian would understand that, if you have no legal business to conduct on someone else’s property, you are trespassing, but you are a particularly doltish example of the species.

  17. I don’t see the First Amendement issue as a close question. To justify a content based restriction upon speech, the State would need to show that the restriction furthers a compelling governmental interest that cannot be achieved by means less restrictive of constitutionally protected speech.

    Patients and parents of minor patients who do not wish to be asked about firearms in the home can simply decline to answer or (in most cases) can find another physician.

    And Brett is right. It would be a First Amendment violation, absent extraordinary circumstances, to compel doctors to discuss firearms with their patients. At least that is so where the doctor is not employed by the government. The government, in its capacity as employer, has broader latitude.

  18. I haven’t seen that many of my fellow wingnuts defend this abomination. It’s almost as preposterous as forbidding pharmacists from asking patients why they want “Plan B” birth control.

  19. (Foster): “Malcolm, if you were interested in the facts rather than polemics, you’d jump to the link and see that, though our host chose his phrasing slightly poorly, making it infinitesimally easier to misread the intent, the law refers to asking new parents about gun ownership, so they can be reminded about the importance of gun safety. This is to be forbidden, because the NRA knows better than doctors how to advise parents about hazards in the home.
    Foster, go “polemics” yourself. Mark’s comment accords with the NPR link:

    Florida Gov. Rick Scott is expected to sign a bill that will make the state the first in the nation to prohibit doctors from asking patients if they own guns. The bill is aimed particularly at pediatricians, who routinely ask new parents if they have guns at home and if they’re stored safely.

    Now, if Mark’s post refers to “new parents”, why ask infant patients if they carry weapons?
    (Mark): “Malcolm, in the real world, gun homicide is becoming an increasingly youth-dominated business. In some neighborhoods, not asking kids about the prevalence of guns in their social surround ignores one of the biggest health risks they face. That’s in addition to asking parents about whether they’ve secured their guns so little Johnny can’t blow his sister’s head off with Daddy’s revolver. But the point is that Florida wants to tell your doctor what he may and may not ask. Any actual opponent of “big government” would be outraged. Why do you quibble instead?
    First, get it straight. I’m not responsible for Professor Kleiman’s gross misrepresentation. Second, if kids are at risk of other kids’ illegal firearms (that “gun homicide is a youth-dominated business” business) that has almost nothing to do with their parents’ firearms. Third, the frequency of firearm injury to infants is very low. Fourth, if the goal is to make new parents aware of the risks, simply handing to new parents a chart of mortality and injury statistics by age would accomplish more than questions about gun ownership. Drowning in the bathtub is a greater threat to infants. Swimming pools and electrical outlets are greater threats than firearms.

    There’s something going on here that Professor Kleiman and NPR don’t address.

  20. “This is to be forbidden, because the NRA knows better than doctors how to advise parents about hazards in the home.””

    Actually, the NRA DOES know better than doctors how to advise parents about firearms safety. Much like carpenters know more about rotten joists than doctors, even if falling through your floor into the basement could have medical implications.

    Unless my doctor is also a firearms instructor, I’ve got no reason so suppose he knows anything more about guns than I do, and I just don’t want to hear from him about it. I don’t want lectures from him on proper engine maintainance, how often to defrost the refrigerator, or whether my plaid shorts clash with my Hawaiian shirt, either.

    In fact, I might even be MORE open to discussing those topics with him, because, so far as I know, there hasn’t been any serious drive to encourage doctors to feed their patients propaganda on the subject of fashion or car maintainance, while I know quite well that the AMA is rather politicized on the subject of gun control, and is encouraging doctors to feed their patients propaganda on the subject.

  21. This has nothing to do with how much MD’s know or don’t know about firearms safety.

    This law is a blatant First Amendment violation, not to mention an unwarranted intrusion into doctor-patient relationships – passed by a GOP legislature and to be signed by a GOP governor. These are the people who want “small government,” remember. So why is this any of their business? Well, it’s not, but the NRA wants it (the NRA lobbyist actually claims that even asking infringes on Second Amendment rights), so the NRA gets it.

    What a bunch of jackasses.

  22. An infringement on Second Amendment rights? Where is the state action?

    I suspect that that NRA lobbyist has too much time on his hands (or is scared shitless of having to actually, you know, go to work for a living).

  23. Mark — I hope you don’t really believe that NONE of the pro-free-market (anti-nanny-state, anti-campaign-finance-restriction) crowd would object. Obviously I object, and I’d expect that most of the libertarian side would object too.

    Note that this isn’t the first time the gun crowd goes too far, in my view: when I lived in Virginia, they had supported a law that made it illegal for employers to prevent employees from keeping guns in their cars when parked in employer-provided parking lots. (I think the law passed, but maybe it was just a bill, I can’t remember.) Keeping guns in your car was legal in Virginia (just like having guns is legal in Florida), yet (parts of) the gun crowd favored violating contract/property rights (preventing employers from restricting it on their property), just like (parts of) the gun crowd favor violating free speech rights in this case.

    This was part of the reason I voted for Democrats in statewide elections when I lived in Virginia.

  24. Sasha, glad to have you on my side. But perhaps the Volokh Conspiracy readership needs to hear about this more than the RBC readership does. Can you find any post on a pro-gun-rights blog complaining about what seems to me a clear outrage?

    (Malcolm, on my planet not all of the patients of pediatricians are “infants.” What color is the sky on your planet?)

  25. Mark, I try to make an argument without insults. Why don’t you? There’s something strange about the NPR account. You spoke of “new parents”. That makes patients infants. Infants are not carrying firearms and infants cannot answer doctors’ questions. Older kids could provide information when doctors ask kids about their parents’ firearms, but doctors abuse their relationship if they ask questions that parents would not want answered. Parents are the paying clients. I wonder what legitimate use doctors would have for information gleaned from teens that they could not make of information gleaned from parents.

  26. “This law is a blatant First Amendment violation, not to mention an unwarranted intrusion into doctor-patient relationships”

    I agree, and I’m a life member of the NRA. I’m merely defending the proposition that it’s reasonable to object to doctors getting into this topic, because they DON’T, actually, have any special qualifications on the subject, and have a track record of being used as a conduit for propaganda by a politicized AMA. Meaning that their advice on the subject is, frequently, bad advice.

    But propaganda is constitutionally protected speech, and the appropriate response is for the doctors’ customers to tell them to drop the topic, or be dropped themselves. I’d likewise oppose laws demanding that doctors refrain from fashion advice, or any other topic they have no expertise in.

    “Note that this isn’t the first time the gun crowd goes too far, in my view: when I lived in Virginia, they had supported a law that made it illegal for employers to prevent employees from keeping guns in their cars when parked in employer-provided parking lots.”

    Why would you find this objectionable? Certainly, as property owners, businesses are entitled to impose all sorts of arbitrary restrictions on anybody who enters their property, and to issue arbitrary decrees as to what their employees may do, even in their private lives, if they wish to continue drawing a pay check. But, is this a position liberals endorse?

    No, of course it isn’t. You’d have no problem AT ALL with laws imposing all manner of restrictions on the property rights of businesses, in the name of public policy.

    Well, by that principle, if the government decides that it’s in the interest of public policy that people carry guns around, what’s the problem? Just, I suspect, that the government has decided that it’s in the interest of public policy that people carry guns around. Ordering businesses to not exercise their property rights in ways that inconvenience an activity the government has decided should be protected? At that level of generality, I don’t think you’ve got a beef.

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