Topic: Regulatory Studies

Globalization and Food Safety

The Washington Post has an interesting story today about E. coli on lettuce. A batch of lettuce produced in California last month passed through numerous screenings and was sent to U.S. grocery stores. Some of it was also sent to Canada, and the government there found E. coli, which led to a major recall across both countries.

Here are some speculations:

  • Globalization increases the safety of American-produced goods because those goods must often pass muster in foreign markets where consumers and governments have different standards and safety procedures.
     
  • I don’t know whether American or Canadian food safety procedures are better, but a diversity of systems generates greater information, which allows producers and governments everywhere to improve quality.
     
  • Globalization doesn’t lead to a “race to the bottom” on environmental standards as critics often claim. Some countries, such as Japan, apparently have very high standards on food, and that tends to push up standards elsewhere. When Japanese importers demand strict standards from Chinese food producers, Americans consuming Chinese products also benefit.

Yet Another Reason Not to Be Too Enamored of SCHIP

The U.S. health care sector is fundamentally broken.  Yet most reform proposals, including Congress’ plan to expand the State Children’s Health Insurance Program, would just throw more money at the dysfunction without doing anything to fix it.  (Mind you, that suits the health care and insurance industries just fine.) 

Another example of what such reforms won’t fix emerged in this week’s New England Journal of Medicine.  Researchers examined the medical records of 1,500 children and found that the kids received (what the evidence suggests is) high-quality care only 47 percent of the time. 

Similar studies have found that adults receive recommended care only 55 percent of the time.  One of those studies even found that having insurance doesn’t much improve the quality of care that adults receive:

Although having insurance increases the ease of access to the health care system, it is not sufficient to ensure appropriate use of services or content of care. Indeed, within systems where access to care is more equitable … substantial gaps between observed and optimal quality remain.  In the United Kingdom, with universal coverage, a study using our methods found that the overall proportion of recommended health care that was received was similar to what we have reported.

This week’s study on the quality of pediatric care did not compare the quality of care received by insured children to that received by uninsured children.  Nonetheless, the researchers closed with an illuminating comment on the current debate over SCHIP:

Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.

Yeah … but … oh, what the hell.  Who’s up for throwing more money at the problem?

Tim Carney on SCHIP’s Bootleggers

Amid the debate over the State Children’s Health Insurance Program, author and Washington Examiner columnist Tim Carney asks the question, “Does SCHIP insure kids or subsidize savvy HMOs?”:

[W]hile Democrats are dragging children to the White House for photo ops, as if the children are the primary constituency of this bill, federal lobbying records tell a different tale.

Lobbying records from the first half of 2007 show that the health care industry spent more than $227 million lobbying Washington. Congressional Quarterly Healthbeat News reported last month: “What’s behind health care lobbyists’ spending frenzy? Most signs point to … SCHIP.”

Sure enough, the biggest lobbyists in the industry all support the Democratic bill. America’s Health Insurance Plans (AHIP), the trade association for HMOs, supports the bill, as do its biggest members, such as Blue Cross Blue Shield.

The Pharmaceutical Research and Manufacturing Association (PhRMA), one of Washington’s most powerful lobbyists, is also behind the bill. So is the American Medical Association.

Because the details of any substantial bill or regulation will be complex, the mainstream media will always portray the debate as a battle between the interested parties. In this case, the official storyline is that it’s poor children against a president overly concerned about the boogie man “government-run health care.”

But poor children don’t have clout on Capitol Hill. They’re not the reason this bill got 68 votes in the Senate and 265 votes in the House.

It’s got to be nice [for] the Democrats now. You get to do a favor for the HMOs, and everyone’s convinced it’s “for the children.”

I include the nation’s governors – who are always in favor of more federal money – in the bootleggers category.

Kudos to Tim Carney for reporting what less-rigorous reporters will not. (Why, oh, why can’t we have a better press corps?)

Regulatory Competition Leads to Better Policy in France

The Financial Times reports that France is deregulating and cutting taxes in hopes of competing with London in the financial services market. The article also notes that Switzerland and Germany also are trying to attract business by reducing the burden of government. Needless to say, these positive reforms would not happen if the bureaucrats in Brussels had the authority to create a continent-wide regulatory regime. Another threat to deregulation and better policy is IOSCO (the International Organization of Securities Commissions), which wants to impose one-size-fits-all regulation on all jurisdictions - particularly ones with a more laissez-faire approach:

The French government yesterday unveiled its plans to boost Paris as a financial centre, proposing a more lightly regulated market for companies and funds on the Euronext exchange. Several of the measures are closely modelled on UK structures, as the French capital seeks to make up ground lost to London. The new market segment would operate according to European Union minimum standards in terms of listing and disclosure. …Switzerland’s leading financial services companies launched their own campaign last month for tax cuts, a relaxation of immigration rules and other measures to turn their country into the world’s third largest financial centre after London and New York. Frankfurt launched its own more lightly regulated market segment two years ago… Ms Lagarde said the government had already shown serious commitment to financial services by cutting taxes, particularly for higher earners. France’s high taxation is one reason why so many young French bankers flock to London.

The Antitrust Religion

Many successful American businesses have been accused of anti-competitive practices. In The Antitrust Religion, a new book published by the Cato Institute, attorney and author Edwin S. Rockefeller argues that much of the conventional wisdom about antitrust is wrong. Drawing on 50 years of experience with U.S. antitrust laws, Rockefeller sheds light on why lawmakers, bureaucrats, academics, and journalists use arbitrary and irrational laws and enforcement mechanisms to punish capitalists rather than promote competition.

Rockefeller also participated in a Cato daily podcast about the book.

Legal Trends in Bioethics

Starting with the fall issue of The Journal of Clinical Ethics, my “Legal Trends in Bioethics” column will be available on the Cato website at time of publication instead of only several months later. That means the information provided will be more up-to-date and relevant for anyone interested in tracking legal issues in bioethics.

For those not familiar with the column, it tracks bioethics related issue through all stages of litigation, legislation, and regulation at both the federal and state levels, as well as occasionally mentioning exceptional legal developments in other countries. The topics covered are not always exactly the same, but usually there are sections on informed consent, abortion, children’s rights, vaccines, organ procurement, HIV, mental illness, medical privacy, unconventional treatment, right-to-die, stem-cell research and other new technologies, among other topics depending on what bioethics topics are of legal concern in the U.S.

The column tries to be comprehensive as far as reporting the most relevant developments at each level of government and in each topic area. It is a very useful tool for doing exactly what its name implies – tracking the “Legal Trends in Bioethics.” The following is the introduction to the fall column which will be published in The Journal Clinical Ethics and simultaneously become available on the Cato website next month:

The most troubling development in this quarter is the extent to which legislators continue to intervene in the patient/physician relationship by trying to regulate the relationship down to the smallest specifics of what is said and done. These developments are a great threat to both physician and patient autonomy, but while there have been many attempts to pass such invasive legislation, at this point, few of such bills have actually made it into law. It will be important to watch the next two issues of Legal Trends if someone is interested in seeing how many of such bills actually do end up as laws.

The issue of medical tourism is not new to bioethics, but it is on the brink of attracting more attention in U.S. courts and legislatures. There is no separate heading in “Legal Trends” for “medical tourism,” but it is important for anyone interested in the subject to regularly check the “Legal Trends’ subheading dealing with interesting developments in other countries. In this issue, for example, some Canadians are seeking a police investigation into an assisted suicide in Switzerland. Physician assisted suicide is legal in Switzerland, but illegal in Canada. At issue is whether Canadians have a legal right under Canadian law to travel to Switzerland to avail themselves of a practice that is illegal in their own country. In the United States there is a constitutional right to travel which would make it legal for the patient seeking physician assisted suicide to go to Switzerland (there is no case directly on point but the basic principle is well-established in U.S. constitutional jurisprudence), but even in the U.S., as in Canada, it may be possible to prosecute someone who assists that person in getting to Switzerland. This could be considered aiding and abetting a suicide. The Canadian suit has not even been filed yet, and no such case exists in the U.S., but it is an interesting issue to watch. It may come up as it did in Canada with respect to traveling to Switzerland where it is legal for physicians to assist foreigners in committing suicide (this is not true in the Netherlands); it is also likely to come up in connection with people suffering from kidney disease traveling to Iran, the only country where it is legal to purchase kidneys, and in other situations where the legality of the activity is not the issue but the price of medical treatment.

The “Legal Trends” from earlier this year are available on the Cato website or directly from The Journal of Clinical Ethics.

Upcoming Cato Forum on the Rights of Terminally Ill Patients

In 2006, a panel of the D.C. Circuit Court of Appeals ruled that terminally ill patients have a constitutionally protected right to purchase and use experimental drug treatments not yet approved by the federal government. 

On August 7 of this year, the full D.C. Circuit overturned the panel ruling, holding that terminally ill patients have no such constitutional right.

On September 25, this coming Tuesday, the Cato Institute will host a policy forum titled, “Should the Government Insert Itself between Dying Patients and Unproven Therapies?“ 

Debating the rights of terminally ill patients will be Scott Ballenger, the lead counsel for the plaintiffs in that case; Ezekiel Emanuel, a bioethicist with the National Institutes of Health and a leading critic of the panel’s ruling; and yours truly.

The forum will be from 12-1:30pm, followed by a luncheon.  Register here.