RALEIGH – Health care reform is largely a federal issue. But that hasn’t stopped state politicians and think tanks from discussing the issue at great length and offering proposals to improve health care access, quality, and affordability.
It’s largely a federal issue because the federal tax code determines the shape of the market for health insurance, and because Congress makes most of the key decisions about Medicare, Medicaid, and other federal programs that collectively pay about half the nation’s health-care bills. The next president and Congress ought to do something about these issues, don’t you think?
However, there are some important reforms that state governments can pursue. For years, I’ve been writing about the deleterious consequences of state rules that limit patient choice and needlessly boost medical costs. Mike Munger, libertarian candidate for governor, has helped to spotlight one of these problems during his campaign appearances: occupational licensing in health care.
There are many routine medical services that nurse practitioners, physician assistants, and other non-MDs should be allowed to deliver to willing patients. The proliferation of urgent care centers and “minute clinics” has been a promising trend in recent years, one that illustrates how consumer-driven health care can improve both the provision of care and its affordability. The movement could have been even broader, however, if the licensing rules weren’t so senseless.
Shirley Svorny, an economist at Cal State Northridge, discusses the issue at length in a new report for the Cato Institute. She argues that while licensing is sold as a means of protecting patients against incompetent care, there are better alternatives for accomplishing the objective, such as tort liability and private credentialing, that don’t constitute state protection of special-interest groups.
There’s a big gap between the promise and the reality of licensing laws, Svorny contends. “Medical licensure fails to meet expectations in the area of discipline and consumer protection,” she writes. “State medical boards’ disciplinary efforts can arguably be said to protect clinicians more than consumers.” As for the performance of nurse practitioners and physician assistants, the evidence suggests that allowing patients to access alternative providers makes a great deal of sense:
By almost all accounts, the quality of services consumers get from nonphysician clinicians is at least on par with what they would get from a physician performing the same services. Dozens of peer-reviewed studies compare outcomes in situations where patients are treated by a physician, a physician assistant, or an advanced practice nurse. Outcomes appears similar – an important factor, considering that nonphysician clinicians can provide many services at a much lower cost.
None of which is to say that the state doesn’t have an important role to play in policing fraudulent behavior in medical care, or that it shouldn’t seek to make sure patients have access to the best-possible information about their providers and options. But occupational-licensing laws written decades ago, at the behest of the very professions they are supposed to regulate, represent an impediment to health care reform that state governors and lawmakers can and should remove.
Hood is president of the John Locke Foundation.