Tag: State licensing

Praise (Sort of) for Latest Cato Health Care Study

Physician assistant and health policy wonk Michael Halasy blogs about Shirley Svorny’s new study on medical malpractice liability reform:

Cato has truly shocked me….stupefied really…

Well, just the other day, I received an update from Cato. Now, Michael Cannon is a good guy, and while he and I simply don’t agree on … well much of anything from a health policy perspective, his colleague, Shirley Svorny, wrote this: “…Reducing physician liability for negligent care by capping court awards, all else equal, will reduce the resources allocated to medical professional liability underwriting and oversight and make many patients worse off. Legislators who see mandatory liability caps as a cost-containment tool should look elsewhere.”

I believe that I have been consistent with this…over and over…caps on noneconomic damages DO NOT WORK.

So, I have to (gulp) swallow some pride, and tip my hat to Cato…Now I need to go take a shower. I feel a little dirty.

It’s a good reminder that libertarians do not fit neatly into the usual political categories. We oppose direct government regulation of health care quality, such as through clinician licensing. But we support indirect regulation, such as through the medical malpractice system, and defend that system from critics who want to impose top-down rules on that system like mandatory caps on noneconomic damages. We prefer bottom-up approaches, like letting free individuals choose their own med mal reforms.

You Say You Want Comparative-Effectiveness Research?

Over at CongressDaily, Julie Rovner has a great piece on the difficulties involved in generating and using comparative-effectiveness research (read: evidence that can improve the quality and reduce the cost of medical care). Rovner cites a recent New England Journal of Medicine article about the obstacles to conducting CER, and a recent article from Health Affairs that finds consumers tend to trust their doctor’s judgment more than evidence-based treatment guidelines.

In a paper titled, “A Better Way to Generate and Use Comparative-Effectiveness Research,” I explain how a string of government interventions – from state licensing of medical professionals and health insurance, to the tax preference for job-based health insurance, to Medicare and Medicaid – have reduced both patients’ demand for evidence about which medical interventions work best, as well as the market’s ability to supply that evidence.  In that paper, I predict that efforts like the CER funding in the “stimulus” bill and ObamaCare’s “Patient-Centered Outcomes Research Institute” will fail, just as all such government efforts have failed in the past.

If you want to generate evidence about which medical interventions work best, and have people use that evidence, then you need to liberalize the U.S. health care sector.

Health Care - One Way to Reduce Costs

In a debate with Larry McNeely in the L.A. Times, Cato’s Michael Cannon suggested “eliminating barriers to competition by nurse practitioners and other mid-level clinicians.”

McNeely responded, “By ending all state licensing and monitoring of physicians…not only qualified nurses but also any quack with a scalpel and some drugs would be able to set up a shingle, call himself a doctor and start cutting.”

Does McNeely pick his doctors at random? How does he know his cardiologist has any relevant experience or training? Licensing creates the impression that all licensed physicians are adequate. Not true. Ask any medical malpractice insurance underwriter.

A state medical license does not restrict a physician’s practice to any particular specialty. If McNeely wants information about a medical professional, he will have to look elsewhere.

State regulation of medical professionals does not insure quality, but does limit access to care and make health care more expensive. Not all audiologists or advanced practice nurses need a doctorate. Physician assistants and advanced practice nurses have been shown to be fully capable of taking over the majority of primary care, yet many states restrict their scope of practice.

McNeely has faith in state licensing and monitoring of physicians that can’t be substantiated with facts. The majority of consumer protection comes from non-governmental entities. Consumers are protected by the annual evaluation and continuing oversight of medical professionals by hospitals, managed care organizations, and medical malpractice insurance underwriters. Malpractice underwriters verify a physician’s training and experience, limit what risky doctors can do, penalize physicians for negligent behavior, reward risk management, and go so far as to assess whether specific equipment and techniques are up-to-date). Consumers are also protected by brand name (as with hospital chains and retail clinics). Private organizations and boards offer certification of education and experience.

More than 80 percent of physicians in the U.S. are specialty board certified; a variety of national organizations certify physician assistants, advanced practice nurses, and other medical professionals.