Archives: 04/2014

Cost-Benefit Analysis in Nurse Practitioner Regulation

Yesterday, the New York Times ran an op-ed by Sandeep Jauhar questioning the New York state legislature’s passage of a bill allowing more independence for nurse practitioners. The author, a doctor himself, claims that allowing nurse practitioners to work independently would not save money and would result in lower quality care. In his opinion, the answer to the question of too few primary care doctors is not to allow competition from those with less education, but to raise their pay.

My forthcoming Working Papers column in the Summer issue of Regulation will describe a paper by occupational licensing expert Morris Kleiner et al. that disputes these claims. In his September 2013 paper, Kleiner et al. find that in states that allow nurse practitioners to independently practice and write prescriptions, the fees charged for services are lower while health care quality, as measured by changes in the infant mortality rate and malpractice insurance premiums, is not affected.

For more of coverage of Kleiner’s work, see here and here.

The Politics of Personal Destruction—Campaign Finance Version

The Washington Post’s Radley Balko had a great tweet this morning—“Rich progressives hold secret meeting to discuss how we can ban rich conservatives from holding secret meetings.” He linked to a long morning POLITICO piece by Kenneth P. Vogel, “Big donor secrecy: ‘Irony, but it’s not hypocrisy,’” about a gathering in Chicago this week of major Democratic Party donors that’s raised more than $30 million for liberal groups—a meeting that included a bit of strong-arming to keep unwanted reporters at bay, Vogel reports.

Secrecy aside, one of the issues I found most interesting among the many interesting things in Vogel’s piece was his discussion about what motivates big political donors—and the different perceptions liberals and conservatives have about that question. Both sides argue, he writes, that “their donations are animated by a desire to right a country headed down the wrong path.” But,

Colorado Isn’t Having a Cultural Revolution

In news that will surprise exactly no one, music and cannabis can be pretty nice together:

The cultural revolution that is making marijuana part of everyday Colorado life conquers another established front Tuesday as the Colorado Symphony Orchestra announces a series of performances sponsored by the cannabis industry.

The concerts, organized by pro-pot promoter Edible Events, will start May 23 with three bring-your-own marijuana events at the Space Gallery in Denver’s Santa Fe arts district and culminate with a large, outdoor performance at Red Rocks Amphitheatre on Sept. 13. The events are being billed as fundraisers for the CSO, which will curate a themed program of classical music for each show.

But that’s hardly a cultural revolution: The earliest written mention of marijuana was by the ancient Greek historian Herodotus, who described its users dancing and singing. The rest, as they say, is history.

What’s revolutionary here is the law, which has finally begun treating Coloradans like responsible adults rather than criminals. At least about cannabis: Our laws ought to do the same for all illegal drugs. Doing so will encourage responsible drug use, better scientific research, and better treatment for addicts.

Yes, legal cannabis means we will have to make a few adjustments. But many of them aren’t so bad: “Are drivers sober?” is not a new question, after all. Only now, it’s a question to be answered a little more honestly, and with better treatment from the law. On the whole, that’s clearly for the best.

New Frontiers in Regulatory Overreach

In most cases, excessive regulation doesn’t surprise me all that much.  It usually focuses on familiar industries, such as automobiles.  So, for example, when the National Highway Traffic Safety Administration came up with a rule mandating that all cars and light trucks sold in the United States have rearview cameras, it wasn’t a great shock.

But every now and then, regulators do something that catches me off guard.  This is from the Economist:

Vancouver’s ban on doorknobs in all new buildings, which went into effect last month, … has provoked a strong reaction from the door-opening public and set off a chain reaction across the country as other jurisdictions ponder whether to follow Vancouver’s lead. 

Wait, what?? They are banning doorknobs? I confess that this threw me when I first read it. Were they going to require some sort of Star Trek-like eyeball scanning device, along with an automatic door?

Turns out it wasn’t anything quite so techonoligcally advanced. They just want “levered doorhandles” instead. Here’s their rationale:

The war on doorknobs is part of a broader campaign to make buildings more accessible to the elderly and disabled, many of whom find levered doorhandles easier to operate than fiddly knobs. Vancouver’s code adds private homes to rules already in place in most of Canada for large buildings, stipulating wider entry doors, lower thresholds and lever-operated taps in bathrooms and kitchens.

I would have thought doorknobs were pretty easy to deal with, but OK, maybe levers are easier. But I’m not sure how you go from “some people find levers easier” to “everyone must use levers!”

Furthermore, perhaps levers are too easy:

True, elderly and disabled people find it easier to operate doors with handles. But so do bears. In British Columbia, bears have been known to scavenge for food inside cars—whose doors have handles, knob advocates point out. Pitkin County, Colorado, in the United States, has banned door levers on buildings for this very reason. One newspaper columnist in the pro-knob camp has noted that the velociraptors in “Jurassic Park” were able to open doors by their handles.

Obviously, bears don’t vote (nor do velociraptors), so we probably can’t attribute these developments to regulatory capture by the bear lobby, which wants easier access to people food (are campers getting more careful with their “pic-a-nic” baskets these days?). Nevertheless, something seems a little off in the regulatory process in Vancouver.

Adaptation to Extreme Heat

Global Science Report is a feature from the Center for the Study of Science, where we highlight one or two important new items in the scientific literature or the popular media. For broader and more technical perspectives, consult our monthly “Current Wisdom.”

Last fall, the press pounced on the results of a new study that found that global climate change was leading to an increasing frequency of heat waves and thus resulting in greater heat-related mortality. Finally a scientific study showing that global warming is killing us after all! See all you climate change optimists have been wrong all along, human-caused global warming is a threat to our health and welfare.

Not so fast.

Upon closer inspection, it turns out that the authors of that study—which examined heat-related mortality in Stockholm, Sweden—failed to include the impacts of adaptation in their analysis as well as the possibility that some of the temperature rise which has taken place in Stockholm is not from “global” climate change but rather local and regional processes not at all related to human greenhouse gas emissions.

What the researchers Daniel Oustin Åström and his colleagues left out of their original analysis, we (Chip Knappenberger, Pat Michaels, and Anthony Watts) factored in. And when we did so, we arrived at the distinct possibility that global warming actually led to a reduction in the rate of heat-related mortality in Stockholm.

Our findings have just been published in the scientific journal Nature Climate Change as a Comment on the original Oustin Åström paper (which was published in the same journal).

We were immediately skeptical because the original Oustin Åström results run contrary to a solid body of scientific evidence (including our own) that shows that heat-related mortality and the population’s sensitivity to heat waves was been declining in major cities across America and Europe as people take adaptive measures to protect themselves from the rising heat.

The Legalization Juggernaut

Former Drug Czar Bill Bennett has co-authored an article in the Weekly Standard, “The Legalization Juggernaut.”  Bennett is upset about voter approval for the marijuana legalization initiatives in Colorado and Washington and recent polls showing “for the first time that a clear majority of Americans (58 percent) support marijuana legalization.”  Bennett can hardly believe that we have reached this “dangerous and absurd moment.”   It is absurd because, to Bennett, the policy question boils down to this: “Do we need a dumber country?”   If the debate can be framed that way, Bennett and his co-author, Christopher Beach, are convinced that “this headlong rush into disaster can be stopped.”  If.

Some readers of Cato@Liberty might need reminding that when Bennett was a high-ranking government official, he once said executing drug dealers was morally justifiable. Given that stance, it must bewilder him to see marijuana stores opening in Denver, Seattle, and other cities.  For the moment, all Bennett wants are a few political leaders to “speak out on marijuana.”   Hmm.  That’s another telling indication of the changing political climate with respect to drug policy.

More here, here, and here.

All Aboard the Privatization Train

With the expiration of the current federal highway bill in a few months, the infrastructure issue is heating up. Newspapers are ginning up interest with stories about deficient and falling down bridges (e.g. here and here).

Diane Rehm kindly invited me to her NPR show this morning to discuss how we should move ahead with financing infrastructure. I pointed to the advantages of devolving funding to state governments and the private sector. America should embrace the global movement towards privatization and public-private partnerships for highways, bridges, airports, and other facilities.

Even Japan—previously known for its pork-barrel infrastructure spending—is beginning to embrace privatization, notes this piece at (h/t Nick Zaiac):

Over a 15-year period starting in 1987, the Japanese government undertook one of the most ambitious privatizations in history, moving its most heavily traveled railways from public ownership into private hands. The privatization of Japanese National Railways – whose assets on Honshu (Japan’s main island) were split into three separate companies (JR East, Central and West, each centered around one of Japan’s three major metropolitan areas) – was a roaring business success. JR East, which runs commuter, intercity and Shinkansen lines in Tokyo and the surrounding region, doubled its revenue over the 15-year period, cut its payroll by a third, upped its per-capita passenger-miles by two-thirds, all while cutting the number of accidents by nearly 60 percent and keeping fares more or less flat.

Now Osaka, Japan is looking to repeat the magic, but this time on its city subway network – which, if successful, would be the first government subway system in the country to be sold off.

… The move follows on the heels of the sale of another one of the prefecture’s railways, the … Semboku Rapid Railway.

… Not to be outdone, the Tokyo Metropolitan Government is considering selling its 46.6 percent stake in Tokyo Metro.