JLF Memo
May. 2nd, 2011: - johnlocke.org

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A conflict of visions
By Joseph Coletti

The King's Speech
Somehow I missed the policy implications in The King's Speech until seeing the movie this past weekend. A newspaper of the time called Lionel Logue "the quack who saved a king," because Logue had no credentials in speech therapy. This man with no formal training was able to help Prince Albert become King George VI, and the king then used his improved public speaking to help the British Empire through World War II.

So why does North Carolina not only license medical professionals, but also limit their scope of practice? All the evidence suggests that this is a waste of time, toil, and talents. There is no improvement in health, less access to care, and higher costs for the care that is available. We have detailed some of the problems with occupational licensing in general and have offered ways to deregulate the medical professions.

The state's budget
The House will pass its budget bill this week. We'll look at three notable areas of difference from Gov. Perdue's budget in HHS.

  1. The House would spend 25 percent less than the governor to run the department, mainly by reducing funding for non-profit organizations and eliminating vacant positions.
  2. The House saves $217 million in Medicaid with $90 million more savings from the Community Care North Carolina managed care system, plus $109 million in lower reimbursement rates for providers and inflationary adjustments.
  3. The House also reduces Mental Health Spending by $120 million, though just $48 million of that is on-budget. It rolls back a $75 million deposit to the Mental Health Trust Fund, then has one-time savings of $45 million through less state funding of community services. Of that, $25 million may be offset by local mental health care managers dipping into their $65 million undesignated/unreserved fund balances.

A conflict of visions
Donald Berwick, the lame-duck head of Medicare and Medicaid, wrote in the Wall Street Journal last week about how government edicts can make health care as efficient as other areas of the economy where markets are allowed to work. Berwick is "romantic about the [British] National Health Service" and thinks we should "ration with our eyes open," which means "at some point we might say nationally, regionally, or locally that we wish we could afford it, but we can't." He almost never acknowledges a role for a personal decision on what is affordable and worthwhile. He defends ObamaCare saying, " The alternative [to national rationing] would limit services and shift onerous burdens to the people who need care the most." I highlighted Paul Krugman's take on this last week.

Doug Perednia has a thorough response to Krugman. Mark Pauly in the journal Health Affairs finds that market-driven "disruptive innovation" could accomplish all the stated goals of ObamaCare as consumers choose the best value proposition for care in terms of convenience, cost, and quality. "An example would be to provide lower-cost substitutes for some aspects of primary physician care, in the form of care at a retail clinic. Consumers might not perceive a clinic as a perfect substitute for physician care, but they might prefer the greater convenience and lower cost. Perhaps a little less quality for a lot less money might be acceptable to consumers and taxpayers, as we work to keep medical spending from siphoning off funds required for other needs."

Click here for the Health Care Update archive.


ObamaCare and Doctors

A winning combination according to U.S. News and World Report: Shift to primary care, see more patients, get paid less.

Persecuting Solomon

The Wall Street Journal editorial board also made the connection between Kathleen Sebelius and Elliot Spitzer.

Companies look to private exchanges

These exchanges won't survive in ObamaCare exchanges.

Levin & Ponnuru offer an alternative

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Monday, May. 9th, 2011 at 12:00 p.m.
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If Great Schools Are So Important, Then Why the Glacial Pace for School Reform?

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What the Founders and the State Ratification Conventions
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