Each decision about care would mean millions or billions of dollars for interest groups that pressure legislators with all the means at their disposal. Already the physician lobby — led by the American Medical Association — dominates Medicare reimbursement decisions in this country. Physicians control the codes that are used for reimbursement and the committee that determines Medicare reimbursement rates.
Put the federal government in charge of deciding what is appropriate care, and special‐ interest groups will fight long and hard for a place on the list.
Politics, not patient needs or the need for increased access to care, will determine which procedures are covered.
Evidence of political influence in health care abounds, mostly at the state level, because that is where health care has been regulated. Increasing regulatory power at the federal level will bring out lobbyists’ big guns, as any win is much bigger than it is at the state level.
If you want to see how corrupt government oversight can get and how it can work to produce outcomes that raise costs and reduce access, look to the various states.
At the state level, special‐interest influence can be seen in regulations that limit the entry of medical professionals with unnecessary education requirements, define what medical professionals are allowed to do (scope‐of‐practice turf wars pit groups against one another fighting for legislative support), dictate benefits that health insurance must cover whether consumers want them or not, tie the hands of providers with rules like nurse‐patient ratios, and restrict health maintenance organizations from being able to channel patients to physicians who agree to lower prices and other cost‐saving behaviors.
These public policies are all the result of politicians yielding to pressures from special‐interest groups. In each case, the result is that providers cannot experiment with cost‐efficient methods of care. Health care is costly because state governments require it, even when there is absolutely no evidence to support the restrictions imposed on providers.
Because of a strong nurse lobby, Mississippi was the last state to allow physician assistants to practice. Physician assistants have prescribing authority over controlled drugs in 36 states, yet Alabama, Florida, Kentucky and Missouri don’t allow them to prescribe any controlled substances.
Lobbyists have been successful in raising education requirements for many health professionals. All certified diabetic educators must have a master’s degree. Advanced practice nurses and physician assistants have managed to get states to require that all new entrants have a master’s degree, and we are on our way to a world in which doctorates will be required for advanced practice nurses, audiologists and other politically powerful groups.
This is no way to make health care accessible or affordable or, the evidence suggests, even safer.
The stronger the physician lobby in a state, the fewer options for care available to patients. Despite the progress made in incorporating midlevel clinicians, licensing and scope‐of‐practice rules still restrict providers’ ability to employ medical professionals to their full competence. Licensing unnecessarily restricts nurse practitioners and other midlevel clinicians whose competence exceeds the legislatively imposed scope of practice.
The American Medical Association has a Scope of Practice Partnership designed explicitly to lobby for restrictions on the practice of other clearly qualified health care professionals. Expect more of the same when the Democrats’ proposed plan gives a federal agency the power to decide who gets care and what services will be standard.
The way to lower the cost of health care and try innovative solutions to increase access is to reduce government intervention, not increase it. Expanding the authority of the federal government, as the Democrats propose, will lock us into the same inefficient methods of producing care we’ve used for the last 40 years.
The American Hospital Association and other groups have shown their strength at the state level, we see it in current negotiations at the federal level as well. These groups benefit from the status quo and from policies that limit competition.
As consumers, we would be foolish to support legislation that shifts more power to special interests by increasing federal oversight and regulation of the health care industry. We should be moving to limit state regulation instead of expanding the regulatory power at the federal level.