Gastroenterology physicians in the state of Alaska are forming an organization to represent our interests. The drive behind the move is political.

Reluctantly, I gave $50 over to the formation of the organization. It is not that I am against organizing but it is shameful that organizations have become the only way to push for things in this country.

It can be difficult to navigate what is right and wrong in a world where motives can be questioned.

An example in gastroenterology is Medicare payments to ambulatory surgery centers (ASC). The centers tend to be more cost effective and efficient than hospitals. They also tend to be owned by the physicians.

Medicare is in the process of gradually putting in a schedule that pays 65% of the fee paid to a hospital for a gastroenterology procedure if it is performed in a ASC. Now, I am not going to get into the arguments on the sides of the issue because of the potential appearance of being self-serving.

The people who understand an issue the best are the ones who will be affected by legislation. Lobbyists get a bad rap but they are often the best source of information for legislators. Many good ideas have to start with an advocate somewhere.

Of course, one man's good idea is anything but to somebody else.

Individuals and groups try to gain their influence before somebody is elected. It is in the form of campaign contributions.

Attempts have been made over the years to limit how individuals and organizations can contribute to politicians. It ends up being similar to the tax code where the crafty figure out the loopholes.

The recent decision by The Supreme Court of The United States which will allow corporations and unions to spend unlimited funds in support of campaigns has come under fire. The concern is the undue influence these organizations may now have.

The truth is that influence is already everywhere. It simply comes down to who is the best at evading the rules.

Nobody wants to give the voter any credit for being able to see through the agendas that are being pushed in campaigns. Unfortunately, this ends up being a reasonable conclusion.

Influence goes well beyond what is in the campaigns. The media controls the debate by what it chooses to report. Hollywood controls the debate by what topics it addresses. Music artists have been pushing political messages for years. None of this is regulated.

Inaccurate and incomplete information can infiltrate all of these sources.

There will never be a situation where each and every voter will examine all that is out there. There will also never be a situation where they will know the motives of everything that is placed in front of them.

As with most things, the real defect here is at the citizen level. Individuals should take their duty as voters more seriously.

The First Amendment guarantees freedom of speech. Speech can be limited depending on whether it conflicts with other rights. There are legal theories out there on how restrictions on speech should be applied.

There is no way that the playing field will ever be level as long as voters choose to be partially informed. That will be true whether laws to limit the influence are passed or not.

The only way to make it work would to not only limit corporations and unions. The press would also have to be regulated. The entertainment industry would have to be regulated. One could argue religious organizations and what they produce would have to be regulated.

It is not that there is not a problem. It is that laws with their loopholes will create a new problem where certain special interests can be favored.

There will be consequences of the SCOTUS decision. The consequences could be far greater if we forget the First Amendment. That was the message here.

The Constitution implicitly trusts the ability of the individual to decide for themselves. As with everything else the fate of the country lies with personal responsibility to make informed decisions.

The country has a cultural flaw when it comes to responsibility. The legislative and executive branch are unable to fix it. The judiciary branch understands that they cannot fix it either.

It is up to us as individuals to fix it and no law or SCOTUS decision is ever going to change that.