Topic: Health Care & Welfare

Suppressing Competition from Migrant Doctors

The claim for physician licensure is that it protects consumers from “quacks;”  it is just a coincidence that licensure also reduces competition and raises doctors’ incomes!  In this case, the strength of licensing should be similar across states, and licensure requirements should determine whether a prospective doctor is competent, not whether a U.S. native or a migrant.

Recent research by Brenton Peterson, Sonal Pandya, and David Leblang (University of Virginia), however, finds the opposite: 

Licensure regulations ostensibly serve the public interest by certifying competence, but they can simultaneously be formidable barriers to entry by skilled migrants. From a collective action perspective, skilled natives can more easily secure sub-national, occupation-specific policies than influence national immigration policy. We exploit the unique structure of the American medical profession that allows us to distinguish between public interest and protectionist motives for migrant physician licensure regulations. We show that over the 1973–2010 period, states with greater physician control over licensure requirements imposed more stringent requirements for migrant physician licensure and, as a consequence, received fewer new migrant physicians. By our estimates over a third of all US states could reduce their physician shortages by at least 10 percent within 5 years just by equalizing migrant and native licensure requirements.

Little evidence suggests that professonal licensure promotes quality or protects the public, but arbitrary discrimination against migrant physicians (many trained in the United States!) is particularly insane.  As are all restrictions on high-skill (or other) immigration.

Progressivism Is Bad for Your Health

The American citizenry is already used to our progressive friends taxing the hell out of everything they don’t like: smoking, drinking, fatty foods, etc. But now, apparently, the hyper-progressive and very cash-strapped D.C. Council is seriously considering slapping a 5.75 percent tax on health club memberships. That is riveting stuff, considering how many progressives out there are urging the unwashed masses rest of us to eat our broccoli and get on that treadmill.

The nation’s capital is, of course, a temporary home to that most progressive and fittest of couples: POTUS and FLOTUS. There is a government website with a catchy name “Let’s move.” It features many a picture of our First Lady in a variety of physical activities. What fun!

Not to be outdone, the Exerciser in Chief can take pride in “The President’s Challenge,” which is “the premier program of the President’s Council on Fitness, Sports, and Nutrition.” The President’s Challenge, its website tells us, “helps people of all ages and abilities increase their physical activity and improve their fitness through research-based information, easy-to-use tools, and friendly motivation.”

The former British Prime Minister Margaret Thatcher used to say that “the problem with socialism is that eventually you run out of other people’s money.” And so it is with the D.C. council, which in its perpetual quest for more revenue might very well end up discouraging behavior that progressives claim to want to encourage.

Welcome to Absurdistan on the Potomac!

Veterans Need Choice in Choosing Health Care

Medical care for veterans has become Washington’s latest scandal du jour.  Those injured while serving their country deserve prompt, quality medical attention. 

Everyone agrees that forcing veterans to wait, and possibly die waiting, for medical care is outrageous.  But what to do?

Caring for veterans isn’t cheap.  Promiscuous war-making over the last decade has generated an influx of patients, many with debilitating injuries. This year VA is expected to spend roughly $151 billion. 

The government has a solemn duty to care for those injured in war.  Yet VA estimated that it has a case-processing backlog of 344,000.  On average it takes vets 160 days to become eligible for benefits. 

After being declared eligible vets had to wait an average of 115 days for a primary care appointment at the VA’s Phoenix facility.  As many as 40 vets may have died waiting.

The IG found such practices to be “systemic.”  In numerous communities VA employees apparently manipulated data and falsified reports to hide patient deaths as well as delays. 

However, the more basic problem is rationing care to meet budget targets.  The agency is short hundreds of primary care physicians.  The pharmaceutical formulary has roughly one-third of the drugs available to Medicare patients.  Available psychiatric services have declined in recent years.

Unfortunately, better management alone cannot fix the agency’s problems.  In 1994 former Rep. Robert E. Bauman wrote:  “the VA is the quintessential government bureaucracy—administratively officious, laden with red tape and meddlesome regulatory minutia destructive of both quality care and staff conduct.”  Quality obviously suffered. 

The Clinton administration put Kenneth Kizer in charge of the department and he made dramatic improvements.  But his success didn’t last.  After leaving Kizer complained that “The culture of the VA has become rather toxic, intolerant of dissenting view and contradictory opinions.  They have lost their commitment to transparency.”

Even today the VA doesn’t do everything badly.  But access is fundamental. 

Complained Hal Scherz, a doctor who served in VA hospitals in San Antonio and San Diego:  “patients were seen in clinics that were understaffed and overscheduled.  Appointments for X-rays and other tests had to be scheduled months in advance, and longer for surgery.” 

Veterans’ organizations such as Veterans of Foreign Wars traditionally backed a specialized system for vets.  However, many veterans’ health problems are not unusual.  Indeed, the longest waits today are for primary care.  Moreover, there is no reason that only VA facilities can serve patients suffering from combat trauma. 

The federal government should separate the functions of guaranteeing from providing vet access to health care.  As I pointed out in my column on Forbes online:  “Uncle Sam has a sacred obligation to ensure that they receive treatment on their return.  That does not, however, mean the VA must build the hospitals, hire the doctors, and provide the services.”

Government should put money into veterans’ hands to purchase insurance tailored to their special needs.  Existing VA facilities could either be privatized or focused on combat-related ailments common to vets. 

This would be no jump into the unknown.  Specific services are outsourced locally when they are unavailable at a VA facility.  Moreover, only 16 percent of vets rely on the system as their principle caregiver. 

Sen. John McCain, a Vietnam vet, argued:  “Let’s let our veterans choose the health care that they need and want the most and not have to be bound to just going to the VA.”  House Veterans Affairs Chairman Jeff Miller suggested that the VA at least allow vets who have to wait for more than 30 days to go outside for care at government expense.

Business as usual is not an acceptable response to the latest VA scandal.  We should transform how the government cares for those who performed the toughest service of all.

David Hyman on PPACA Implementation

David A. Hyman is the H. Ross & Helen Workman Chair in Law and director of the Epstein Program in Health Law and Policy at the University of Illinois Urbana-Champaign, as well as an adjunct scholar at the Cato Institute.

Earlier this month, Hyman gave the following erudite presentation on the implementation of the Patient Protection and Affordable Care Act – which he calls PPACA, not “ObamaCare” or “the Affordable Care Act” – at a faculty seminar hosted by the University of Chicago’s MacLean Center for Clinical Medical Ethics.

Hyman’s remarks begin at about 5:00.

Be sure to read Hyman’s excellent satire, Medicare Meets Mephistopheles.

Number of VA Employees

After my blogpost yesterday about Department of Veterans Affairs spending, my research assistant Nick created the chart below on the number of VA employees. Wow, you don’t often see bureaucracies expand that rapidly! A 56 percent increase in just 13 years, from 219,000 to 341,000 employees. The VA has 100,000 new employees just since 2006.

The data is from this OPM website, which also provides a breakdown for agencies within departments. About 90 percent of VA employees are in the Veterans Health Administration, which is currently in the news for its horrendous mismanagement.   

Why Measles Outbreak Is Newsworthy

A small measles outbreak recently made national news, yet another testament to our progress in eradicating disease. Measles is serious stuff. It leads to hacking cough, a spotty rash, and sometimes, death. The disease is so contagious that it will infect nine out of ten unvaccinated people exposed. The outbreak started when a Christian mission brought the disease back from the Philippines. The infected passed it along to several Americans who refused to get vaccinated or those too young to be vaccinated.

Contagious, deadly diseases like measles were once common, even among the wealthiest. For example, King Louis XIV of France lost his son, grandson, great-grandson, and brother to smallpox. Smallpox used to kill some 400,000 Europeans annually in the late 18th century, and in the 20th century alone, it claimed hundreds of millions of lives across the globe.

Now, these diseases are rare and cause far fewer deaths:

 

In this recent measles outbreak, only 68 people were infected. Despite the low number, that constitutes an 18-year high of measles infections in the United States. And that number may have been lower if doctors hadn’t misdiagnosed their patients, which occurred because the disease is so unusual nowadays. This is all good news. That such a small outbreak makes national news and constitutes an 18-year high is a testament to the human progress we have made in eradicating disease.

More Competition Would Lower Health Insurance Premiums

I know, not exactly a shocking revelation! Nevertheless, here’s an article from today’s Washington Post:

With much of the focus on Obamacare now on how much individual premiums could increase next year, a new analysis suggests there’s one way to keep them in check — more competition. That’s the conclusion of a new report from economists Leemore Dafny, Christopher Ody and Obamacare architect Jonathan Gruber.

If every insurer that had sold individual policies in 2011 participated in Affordable Care Act insurance marketplaces this past year, average premiums for a benchmark exchange health plan would have been 11.1 percent lower in 2014, the economists found.

Big insurance companies generally took a cautious approach to the new exchanges in 2014, limiting their participation in the health-care law’s first year amid concerns about too many sick patients signing up for coverage. The Affordable Care Act exchanges were created as a way for people to buy their own insurance if they couldn’t find affordable options elsewhere, like through an employer.

The Affordable Care Act exchanges are supposed to fuel competition in the individual market, which hasn’t traditionally been all that competitive. Before the health-care law, a single insurer covered more than half of the individual market in 30 states, according to the Robert Wood Johnson Foundation.

A point I’ve been trying to make for a while is that there is a large untapped source of competition out there which could help lower prices: foreign insurance companies.  With or without ObamaCare, American consumers would be better off with more companies in the market, and the nationality of those companies does not matter.  Unfortunately, my sense is that foreign companies are not all that interested in entering the U.S. health insurance market.  Maybe it’s too daunting a prospect (it’s a highly regulated market), or maybe they just haven’t thought of it.  In case it’s the latter, I’m going to keep putting the idea out there, in the hopes that it reaches the right person.