All Commentary
Tuesday, February 28, 2017

Healthcare Licensing and Barriers Are Sickening

They're keeping healthcare expensive and inaccessible.

I’m probably one of the few libertarians who would say that you have a right to health care (although not in the sense that progressives mean). I also believe that the ninth amendment protects that right. Let me explain.

Getting over a licensing barrier can be very costly in time and money.

We all know that the first amendment protects freedom of the press, and while you have the right to write, print, and publish or access the tools to do so, you do not have the right to compel others to do the same for you. The situation is similar to health care. You have the right to access care but do not have the right to compel others to provide it for you. However, when it comes to health care, the government has erected numerous barriers that limit your access. The most difficult are the licensing laws.

In the spirit of Richard Cobden and John Bright, we need to remove those barriers. Doing so should lower costs while improving quality. Those of us who promote free markets should be leading the way.

Barriers to Healthcare

The regulatory barriers erected by the states are just as harmful as tariffs and other trade barriers. You can pay a tariff but getting over a licensing barrier can be much more costly, in time and money.

As the nation ages and costs of that aging impacts government, the policy makers may find one of the best ways to provide care will be to reduce the licensing regulations on midwives, nurse practitioners, and others.

Research shows patients are just as satisfied with the quality of care provided by nurse practitioners as by physicians.

These barriers deprive expectant mothers of a choice in birth attendants and harm them and their children; especially African-Americans and Native-Americans, who have historically experienced higher rates of infant mortality.

Regarding the different classifications of midwives, the regulations vary from state to state. Nurse-Midwives are legal nationwide but different states have different regulations that cover what they may do, if they can work independently of a doctor, or if they must be supervised by one.

Certified Professional Midwives (CPMs) have been to a school for training but are not nurses. Twenty-six states allow CPMs to practice with some variations in what they legally can do.

Direct entry midwives typically study as an apprentice under someone else before beginning their individual practice, and their practice varies from state to state. Their legal standing is not clear in some states.

Since Medicaid pays for almost 50% of all births, midwives offer the nation an opportunity to save tax dollars while providing mothers with another choice.

Nurse Practitioners

It isn’t just the barriers to Midwives that have created problems for patients. Other workers have seen their professions restricted as well, and with that comes physical and financial harm to patients. Nurse practitioners should be at the top of any list of professionals allowed to work without restrictions nationwide.

Nurse practitioners are an often overlooked source of health care and, according to Kaiser Family Foundation, can “manage 80-90% of care provided by primary care physicians.” Research shows that patients are just as satisfied with the quality of care provided by nurse practitioners as by primary care physicians.

With the aging of society, we will see an increase in the need for improved dental and eye care.

An Institute of Medicine Report, from 2011, The Future of Nursing: Leading Change, Advancing Health, states that “what nurse practitioners can do once they graduate varies widely for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work.”

Twenty states allow nurse practitioners to work independently of physicians to diagnose and treat patients. Twelve states require physicians to supervise nurse practitioners. Nineteen states allow them to practice as long as they have an agreement to work in collaboration with a physician. Other laws limit their scope of practice, for example, by not allowing practitioners to prescribe drugs.

Vision and Teeth

With the aging of society, we will see an increase in the need for improved dental and eye care, two issues that have seen legislative struggles in the recent past.

When it comes to teeth, denturists, who make and repair dentures, and dentists are in some degree of conflict. Denturists in the U.S. are limited by legal restrictions to practicing in only a few states, while north of the border, they are allowed to practice in all of Canada.

Over the years, two other professions that have fought each other are optometrists and ophthalmologists. In some states, an optometrist may do procedures that only ophthalmologists can legally do in others.

Taking Control

Advance Directives and Living Wills are more tools we should all use to our advantage. Be sure to find out the legal issues with these documents since different states may have different regulations regarding them.

These are choices we should be able to make on our own, but in some states, the laws restrict our freedom to make that choice.

While they don’t seem to be controversial, sometimes doctors will try to avoid them. In its conclusion, a recent study commented, “Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.”

If you are incapacitated because you have fallen off a ladder at the frat house or are lying on death’s door in a senior-living home, an advance directive or living will may keep medical people from violating you, by subjecting you to unwanted procedures.

By filling out these documents ahead of time, you may get to control your final moments. You might also save some tax dollars as well.

Doctor Atul Gawande, in his book Being Mortal, mentions La Crosse, Wisconsin where the end of life hospital cost was half the national average, “[b]y 1996, 85 percent of La Crosse residents who died had a written advance directive…”

Without adequate documentation, you or a relative may end up on drugs you might wish to avoid. That seems to be a growing trend that needs our attention.

These are choices we should be able to make on our own, but in some states, the laws restrict or don’t protect our freedom to make that choice.

Removing these barriers should not be difficult and the benefits favor an open market. Let’s lead the way!

  • Michael H. Wilson; I have a BA from The Evergreen State College and do freelance research on urban issues.