There’s an old saying in politics that it’s not your enemies who cause you the most trouble, it’s your friends. Such was the case when Rick Perry issued his executive order requiring that all girls entering the sixth grade receive a new vaccine for cervical cancer marketed by Merck, touching off the proverbial firestorm of protest. It strains credulity to believe that Perry’s longtime political ally, close friend, and megalobbyist Mike Toomey, who represents Merck, did not have a major role in the decision. Not that there is anything wrong with lobbyists plying their trade; it is an essential part of the process. Had Perry asked the Legislature to pass legislation as part of his State of the State message later today, no one would have found it unusual. But the proposal would have had a tough time getting through a conservative Legislature in which mandatory vaccinations are a hot-button issue, and particularly so when the disease can be transmitted through sexual activity. The executive order was an end run around the legislative process to benefit a crony.
This is not the first time that Perry has used executive orders to tread on legislative turf. In 2005, he directed the Texas Education Agency to implement a requirement that 65% of education dollars be spent in the classroom. While the goal was desirable, the bypassing of the Legislature was not. The legislative process, unwieldy though it may be, ensures that all stakeholders have a seat at the table, that the debate will take place in public, and that the public will be able to hold the decision makers accountable for their votes. Governing by executive order usurps the constitutional role of the Legislature.
The mandatory vaccination program was particularly unsuitable for an executive order. Various media stories have raised many questions about the vaccine. Cost of the shots? Extremely high, as much as $600. Availability? Not so good: reimbursement by insurance companies to doctors is so low that many doctors do not even offer the shots. Length of time that the vaccine is effective? Not clear. Cost of the program? I have seen estimates that range from $60 million to $600 million. At the risk of sounding hard-hearted, we should also ask whether the benefit is worth the cost. The average annual death rate from cervical cancer in Texas is 390. If the program costs $60 million, the cost per life saved is $153,846. If the program costs $600 million, the cost per life saved is $1.53 million. While preventing cervical cancer is certainly a worthwhile endeavor, there are many other needs in the health care area that affect many more people: providing coverage to the uninsured, restoring the funding for CHIP, and restoring the cuts that were made for doctors and hospitals in Medicaid reimbursement, to name a few. This is not the governor’s decision to make. It is the Legislature’s, and it is about time that somebody in the Legislature–thank you Jane Nelson–stepped forward to say so.