A couple of years ago, James Joyn­er, a pro­fess­or at the Mar­ine Corps Com­mand and Staff Col­lege, shared a story about how his doc­tor ad­vised him to treat a catar­act. “My sur­geon sug­ges­ted that, if I were will­ing to wait a couple of months and were will­ing to pay a couple thou­sand dol­lars out of pock­et, a re­volu­tion­ary new lens that had been in use in Europe for years would be ap­proved by the FDA,” he wrote. “The ex­pec­ted ap­prov­al didn’t come but we agreed to wait an­oth­er six months. Still, no ap­prov­al. Mean­while, the catar­act has got­ten con­sid­er­ably more ad­vanced and we’re in agree­ment that wait­ing around for the FDA no longer makes sense.”

He got the in­feri­or lens, but he wasn’t happy about it. “The ab­surdity of a lens that’s in wide­spread use in Sweden and Ger­many not be­ing avail­able be­cause the FDA hasn’t got­ten around to it is mind-bog­gling,” he com­plained. “We’re not talk­ing about a back al­ley in Tijuana or Mar­rakesh; these are at least com­par­ably ad­vanced coun­tries.” Mus­ing that it could have as eas­ily been a bet­ter heart valve or can­cer drug, he reasoned, “Surely, pool­ing our com­bined know­ledge is mu­tu­ally be­ne­fi­cial.”

That is a ma­jor premise be­hind a bill to over­haul the FDA ap­prov­al pro­cess that Sens. Ted Cruz and Mike Lee have in­tro­duced. Ap­prov­al in a “trus­ted coun­try” would give doc­tors and pa­tients here the abil­ity to use a drug or med­ic­al device.

Liber­tari­ans have long the­or­ized that per­ni­cious in­cent­ives would cause bur­eau­crats to be too cau­tious in ap­prov­ing new drugs and treat­ments—ap­prov­ing a dan­ger­ous drug would cost them their ca­reer, where­as with­hold­ing a good or even lifesav­ing drug from the pub­lic would have no cost at all. The lost lives would be in­vis­ible.

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