John Locke Update / Research Newsletter (Archive)

5 Ways States Can Improve Health Care

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States are still the best place to reform health care. ObamaCare’s supporters have given up on its ability to cut costs and reduce the deficit; they are back to demanding a fully government-run program. Employers, employees, and individuals still face rising premiums and health care costs. There are also concerns that there will not be enough health care providers to deal with the anticipated surge in demand. My new policy report provides some practical solutions states can implement themselves.

1. End licensing of health professionals: There is little evidence that state limits on who provides care do anything but increase costs and lead to more people treating themselves. Whatever safety gains exist for people who see regulated professionals are offset by the loss of access for those who cannot afford higher costs. Independent midwives and naturopaths in North Carolina provide safe services to numerous people but are forced to operate in a legal gray zone.

2. Expand scope of practice: State rules prevent nurse anesthetists and other licensed professionals from acting independently or from doing everything they have been trained to do. This is a waste of talent, a waste of time, and a waste of money for patients and providers alike. It also cuts off innovative care models that could improve outcomes.

3. Accept private accreditation: Most professions, and every medical profession, provide additional training and certification through the professional association. To the extent federal rules demand state licensing for reimbursement, states can recognize membership or accreditation by the professional group as a license. Private groups have more incentive and ability to police members than state regulatory boards.

4. End certificate of need: Imagine if state regulators could decide how many coffee shops were needed in your town. Starbucks might not have become a global brand. Even if you do not like Starbucks coffee, you have benefited from the company’s revolutionary business model. Certificate of need laws make a similar revolution in health care unlikely — it’s time for repeal.

5. Eliminate mandated insurance benefits: People are more likely to see a chiropractor, naturopath, or pedorthist if insurance will pay a portion of their visit. Insurers would continue to provide useful benefits without a mandate. Other benefits mainly act as a tax that increases insurance premiums by about 5 percent and drives up health care prices.


As Senior Fellow, Joe examines fiscal and tax policy. He previously headed the North Carolina Government Efficiency and Reform initiative within the Office of State Budget and Management, which led to changes in automotive fleet management, natural and… ...

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