Nurse practitioners are one type of “advanced practice registered nurses” (APRNs) who have national certification and post-graduate education. Their training well equips them to deal with primary care concerns, which generally includes most basic health issues. Indeed, numerous studies have found that nurse practitioners provide similar quality of care as physicians.

Unfortunately, Missourians are not able to take full advantage of nurse practitioners. Missouri has more limitations than most other states. A recent report named Missouri the 44th most restrictive state for nurse practitioners. Seventeen states and the District of Columbia allow APRNs to practice without any physician oversight. Missouri, however, requires an APRN to work with a physician in a “collaborative practice arrangement.”

Collaborative practice arrangements exist on the theory that physician oversight is necessary to ensure quality care. However, the data has not shown that to be true. In fact, many studies show that even when nurse practitioners work independently, their patients do just as well as if doctors had treated them.

These restrictions limit the amount of care nurse practitioners can provide in Missouri. Physicians can only collaborate with three APRNs, and the doctor must regularly review a portion of the APRN’s charts — even if she has been practicing for years. The arrangements also curtail when the nurse practitioner can provide care, as the physician must be immediately available via electronic communication. Until recently, collaborating physicians also had to be within 50 miles of rural APRNs. While legislation this year loosened that requirement, collaborative practice arrangements still prevent nurses from practicing to the full extent of their training.

Nurse practitioners provide high-quality care, which makes expanding their role in Missouri obvious. The main issue for many in rural areas is having access to any care. It is not a question of doctors versus nurses, but health care versus no care. Additionally, nurse practitioners tend to move to states where there are fewer limitations. If Missouri continues to over-regulate its nurse practitioners, many rural Missourians will not have health care.

One-fifth of Missourians live in rural areas without sufficient access to primary care providers, but a solution is available. The collaborative practice arrangement rules for nurse practitioners are not protecting Missourians; instead, they are preventing affordable health care. Whether it is a mother with a sick child or a 60-year-old man seeking care, nurse practitioners are competent providers. Missouri should consider eliminating the unnecessary restrictions that help keep access to quality care from more than a million Missourians.

Caitlin Hartsell, J.D., M.P.H., was a research assistant at the Show-Me Institute, which promotes market solutions for Missouri public policy.

The post Nursing Better Health Care In Missouri appeared first on Show-Me Institute.

Supporters of the tax leave a few questions unanswered: Why a county-level tax? Supporters cite lack of federal research funds as an impetus to look for more local funds, but sales taxes typically fund public assets such as parks or public safety projects. The half-cent tax would make Kansas City’s already high sales tax rate one of the highest in the country. Do other local governments fund this type of research with specific taxes?

I could only find two comparable taxes: one in Johnson County, Kan., and one in Rochester, Minn. (If anyone knows of other like taxes, please share them in the comments.) Even these two taxes have very important differences, however, from the Jackson County proposal.

Voters in Johnson County passed a one-eighth-cent sales tax in 2008 to fund the Johnson County Education Research Triangle. The money went toward building facilities at Kansas University and Kansas State, as well as to some researcher salaries. Jackson County’s proposal, however, would divert more than half of the revenue to private medical institutions: $20 million to Children’s Mercy and $8 million to St. Luke’s Hospital.

In 2012, voters in Rochester extended a half-cent sales tax that devotes $20 million in bonds (approximately one-seventh of the revenues) to the “Destination Medical Center” (DMC). The Destination Medical Center is the Mayo Clinic’s 20-year, $5 billion project to upgrade its own facilities and the surrounding area’s infrastructure and amenities.

Importantly, the Mayo Clinic initiative uses mostly private funds for the venture — more than $5 billion in Mayo Clinic’s own funds and those of private investors. The $500 million that the state, city, and county pledged over 27 years are primarily for infrastructure and transit improvements, which are the sorts of things public tax dollars typically fund. Additionally, state funds are contingent upon private investment occurring first. Mayo Clinic President and CEO John Noseworthy said in an interview:

We are not asking for a handout. We’re asking for nothing upfront. We’re not asking the state to fund the medical facilities, the science facilities and so on as other states are doing for our competitors, by the way. We’re simply asking for, once we have grown and proven that growth, to have some of that tax revenue infused into the public infrastructure.

Jackson County voters, unlike those in Rochester, are facing a different request. The translational medical research tax is a unique proposal that taxes citizens to fund buildings and salaries for researchers at primarily private institutions, in a field that private investment traditionally funds.

Being on the cutting edge of implementing new and higher taxes is not the right kind of innovation for Kansas City.

The post Why Should County Taxpayers Fund Private Medical Research? appeared first on Show-Me Institute.

A better education reform strategy, according to education experts Rick Hess, director of education policy studies at the American Enterprise Institute, and Eric Hanushek, senior fellow at the Hoover Institution at Stanford University, is to allow free competition among schools for students. Such competition would allow schools that provide a quality education to flourish while punishing schools that provide a poor education.

A review of all available empirical studies of school voucher programs — a school choice policy that allows students to take public dollars with them to schools that they choose — found that the majority of studies showed that voucher programs improved student outcomes and public schools. Unfortunately, education vouchers are not a viable option in Missouri because they might violate the state constitution’s Blaine Amendment.

Increased choice frequently produces cost savings. In Washington D.C., for example, charter school students are outperforming traditional public schools while operating at a per-pupil cost of $11,000, compared to the $17,000 per-pupil expenditure of traditional public schools. Options are limited in Missouri because state law restricts the creation of charter schools to the cities of Saint Louis and Kansas City.

Furthermore, Missouri has many rural areas without a critical mass of students to support the infrastructure of multiple schools. In fact, two-thirds of Missouri’s school districts have fewer than 1,000 students.

For students whose educational choices are limited by geography, restrictive laws, financial constraints, or some combination of the three, a new approach is necessary to give them the benefits of educational competition and course diversity. Virtual schools and distance learning can offer these benefits to nearly all of Missouri’s students.

Related Links

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In this video, Show-Me Institute staff and interns illustrate a functioning market by scalping St. Louis Cardinals tickets at Busch stadium. Free-market lessons are interspersed throughout the video as the teams show how market transactions can make both parties better off. The video was filmed Aug. 4, 2010, in front of Busch Stadium.

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The W.K. Kellogg Institute released a study yesterday evaluating the success of the Alaskan dental therapist program over the past two years. The results reflected both high patient satisfaction and quality of care. Dental therapists — a topic we’ve discussed on Show-Me Daily before — are mid-level dental professionals that can provide basic and preventive oral health care at a lower cost than traditional dentists. Alaska’s recent results add to a growing body of research showing that deregulation in dental care can improve health by bringing quality care to underserved areas.

For Missouri, this is just further proof that loosening the restrictions on dental practitioners could be beneficial. Of Missouri’s 114 counties, 50 have a shortage of dental professionals, a problem that is most profound in rural areas. This has led to fewer Missourians receiving dental care: Missouri was ranked 47th in the nation for the percentage of its adult population who visited the dentist during the past year.

While rural Alaska reaps the benefits of this dental deregulation, Missouri still only allows dentists certified by the American Dental Association to perform even basic dental care. With the benefits of mid-level practitioners becoming increasingly apparent, Missourians stand to gain from a reconsideration of state dental regulations.

The post Healthier Smiles, One Dental Therapist at a Time appeared first on Show-Me Institute.

Some will argue the money could be better spent on education, health care, you name it. Indeed, there are many needs but these federal funds were designated for broadband. The state’s in-kind contribution does not impact the dire budgetary situation or projected $600 million shortfall.

Only the Show-Me Institute, the ultraconservative think tank, finds a reason to object. Research analyst Christine Harbin commented: “If an individual desires faster Internet service, he or she can either pay the market rate for the service or relocate to a larger town in order to access a broadband connection that’s less expensive.”

Of course, we received Ms. Harbin’s remarks via a high-speed Internet connection, and we certainly would not have wanted to miss sharing them with you.

The Business Journal could not have illustrated Christine’s point more succinctly. She, and the Business Journal, have both chosen to locate in the city of St. Louis. This decision entails extra costs, like the earnings tax and a higher cost of living, but it also has some cost-saving benefits, like less-expensive broadband access.

It is more expensive to provide Internet access to rural areas. This does not mean that rural areas should not have Internet access, only that they should shoulder the steeper costs of this service if they want to use it. When Internet access is subsidized, it distorts the market because the lower price leads people to consume more without seeing the true cost. If someone opts for the lower general cost of living in a rural town, she should accept that urban amenities may not be available at as low of a price as they are in more populated urban areas. In the same way that rural areas may be loathe to subsidize an urban area’s mass transit, it is reasonable for urban areas to be loathe to subsidize a rural area’s broadband Internet.

People should be allowed to live where they choose, but that doesn’t mean that everyone else should subsidize them.

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If you are in Sedalia, stop by the exhibition hall between corn dogs to talk to us about free markets. For those of you who haven’t had a chance to stop by, here is a picture of our booth!

* Title quote: Lenny at the State Fair, from That Thing You Do.

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We assembled into four teams, starting out with either Cardinals tickets (two tickets normally valued at $39, although we bought them for $20 each) or money ($60). We each competed to try to improve our situation by engaging in voluntary market transactions.

Even ticket scalping can leave both parties better off! Without giving too much away, the video demonstrates a few key economics lessons, like information asymmetry — where one party has better information than the other. In this case, the experienced sellers understood the market much better than some of our teams did. Another lesson that comes up in the video is the idea of value: A ticket’s face value does not necessarily reflect how another party will value it, and thus it may be difficult to recoup a ticket’s nominal “worth” when selling it. Issues of supply and demand also came into play, as we were at a game on a hot day when tickets were not sold out.

Further lessons can be gleaned from the free-market explanations interspersed throughout the video. I encourage you to watch it!

The post Free-Market Field Trip! appeared first on Show-Me Institute.

President [Barack] Obama said in his speech that just a few years ago, the U-S accounted for 25% of the world’s economy, but was only making 2% of the world’s advanced batteries for hybrid and electric vehicles.

“But thanks to our new focus on clean energy and the work that’s taking place in plants like this one, we could have as much as 40% of the world’s market by 2014,” Obama said.

It is true that if we devote a large amount of our resources to clean energy, we could expand our share of the world’s market. If we wanted to, in fact, I’m sure we could devote exorbitant sums to clean energy and capture 80 percent of the world’s market.

Does that mean that it would be a good investment for the U.S. government? When someone invests her own money, she has a stake in that investment working out. Investors who make wise investments have more money to make additional wise investments. No matter how vital government officials think it is to invest in clean energy, they do not have that feedback; whether they invest wisely or not, their cash inflow is not affected. The government does not have the right competitive mechanisms in place, and thus may create more problems for clean energy than they solve.

Why is that? When the government favors certain types of clean energy over others (perhaps yet undiscovered) energy sources, they change the dynamic. As a result, those energy producers make money not because they efficiently produce energy, but because they have curried political favor. Energy producers who receive government monies are also restrained by government regulation and procedure, which stifles innovation.

From the aforementioned speech (emphasis added):

“[…] But my answer to those who don’t have confidence in our future, who want to stop, my answer is come right here to Kansas City see what’s going on at Smith Electric. I think they’re gonna be hard pressed to tell you that you’re not better off than you would be if we hadn’t made the investments in this plant,” Obama said.

I beg to differ. In the cases where clean energy is as good an investment as some proponents claim, private individuals will be willing to put money toward the venture. Many companies want to use efficient, environmentally friendly energy because consumers appreciate that. Clean energy, at its best, will lower costs, a condition necessary for it to become a primary energy source. Cutting the tax rate for all businesses would better promote the move toward clean energy sources than targeting incentives toward specific clean energy plants. If clean energy production is to become sustainable, it needs further exposure to market forces so that the most efficient product can succeed.

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Now, in the latest effort to transform the bedraggled Kansas City, Mo. schools, the district is about to become what reform experts say is the largest one to try the approach. Starting this fall officials will begin switching 17,000 students to the new system to turnaround trailing schools and increase abysmal tests scores.

Richard Innes at the Bluegrass Institute in Kentucky points out that this was, in fact, tried in Kentucky during the 1990s, in a school district five times the size of Kansas City’s district. He reports that it was generally unsuccessful, with only 25 percent of Kentucky schools still in “ungraded primaries” — although it is still on the books:

Even KERA’s most enthusiastic cheer leader, the Prichard Committee for Academic Excellence, now admits that Primary just didn’t work out.

The fact that the education “reform experts” were unaware that this had been tried before, on a large scale, does not bode well. It didn’t work in Kentucky. Can it work in Missouri?

Lessons can be learned from these failed attempts. After all, the reform itself could have some merit when implemented on a small scale, and some states like Alaska and Colorado have had success with the program. Theoretically, it makes sense: A student may have advanced math skills, but need extra time to practice reading. If implemented appropriately, that student could devote more time to skills that need improvement.

Kentucky’s problems may have fallen upon the difficulty of implementation. Innes suggested, in a phone call yesterday, that the teachers would have needed “Solomonic wisdom” to successfully implement the program. Indeed, a skill progression is a difficult thing for a teacher to assess for a few dozen students in multiple subject areas. A 2002 study by CREDE found that the primary program had varied implementation, which might explain some of Kentucky’s problems:

“The study of the implementation and effects of the nongraded primary program in Kentucky revealed that when teachers fully implemented the program, they were also practicing the CREDE standards fully. Teachers across the state, however, implemented the program in a variety of ways, some of which were not philosophically aligned with the original intent.”

Perhaps the advent of more advanced technology will provide the piece that was missing in Kentucky. Some virtual school courses have a modular structure that allow students to progress at their own pace, which might create an easier way to assess a student’s skill progression and readiness to move on to the next subject.

Whatever the case may be, I hope that Kansas City looks at all the research — the successes and failures — before they attempt such a large transformation.

The post Try, Try, Try Again? Not Always a Good Idea appeared first on Show-Me Institute.

This can be seen as a form of Pigovian tax, which raises the costs of certain activities in order to correct for social costs or negative externalities that are not covered in the market price. In this case though, the externalities of tanning beds are internalized: If I choose to tan, I accept the increased risk that I may get skin cancer. If that were to happen, my insurance company and I would have to pay for the cost of treatment. (And it could be that my insurance company chooses to raise my premium if I indulge in risky behaviors, which is their prerogative.) One could argue that a hypothetical person with tanning bed–induced skin cancer could end up costing others in medical bills, but if that were the issue, the problem would lie in the structure of health care provision, not natural externalities.

What’s next? Should we impose more taxes on roller blades, lest I skin my knee or break my ankle? Or junk food? If we want to really get to the root of what causes skin cancer, shouldn’t we be placing the blame where much of it belongs: the sun? It wouldn’t be the first time someone proposed legislation against the sun.

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Economic development tax incentives, no matter how they are packaged, are not effective. They allow government officials, who have no special knowledge of how to maximize growth, to pick winners and losers in the market. As Show-Me Institute Executive Vice President Joseph Haslag has written before, lowering broad tax rates is a much more efficient method of stimulating the economy than targeted tax credits. This allows everyone to benefit, rather than a few select industries chosen by the state.

Empirically, studies analyzing the benefits that development tax credits deliver in comparison to their costs show that such tax credits have not worked. A recent Missouri state audit report found that tax credits are less effective (and more expensive) than their proponents claim. Yesterday, St. Louis Public Radio broadcast a segment featuring a study that examined another form of tax incentives in Missouri, tax increment financing (TIF). Kenneth Thomas, a political science professor at the University of Missouri–St. Louis, recently coauthored a study that found the use of TIF is not effective in most cases. He noted that the St. Louis area uses TIF more than nearly every other area in the nation. In the interview with St. Louis Public Radio’s Matt Sepic:

Sepic: That’s one longstanding criticism, is that TIF pits communities against one another. A prime example is that tussle between Bridgeton and St. Anne over a Walmart. Is that a bigger problem in the St. Louis area than elsewhere, with this panoply of municipalities that we have here?

Thomas: Oh, yes, certainly having more municipalities makes the competition more intense.

The study argues that, although many economists have found TIF to be ineffective, this method of funding continues to be used because of the competitive nature of tax incentives. When one area offers a tax incentive, other areas nearby often try to “win” a company’s business by offering competitive tax incentives. The result is a bidding war in which the taxpayers lose. This can be seen in the Claycomo Ford tax credit situation, as well — other states, like Kentucky, have offered tax incentives to Ford in an effort to persuade them to relocate their plant. In order to compete, Missouri would have to offer a better deal, while recognizing that this game will be played again the next time the credits run out.

Later in the interview, Thomas notes an important misunderstanding — the idea that tax incentives like TIF “create” jobs:

Thomas: [T]hose estimates never take into account the fact that, well, yes, we are going to create 200 jobs here, but what’s going to happen is we’re going to knock out 180 in the next mall over.

Tax credits and TIF tend to shift economic activity from one area to another, without creating wealth. Missouri’s tax dollars would be much better spent in the hands of individual Missourians than on enticements for companies like Walmart or Ford.

As Milton Friedman pointed out on his PBS TV series “Free to Choose,” even if other nations, states, or localities offer tax incentives to lure businesses, we’re better off if we don’t do the same — because we benefit from the lower prices their subsidy creates. Missouri will experience better economic growth if it unilaterally removes itself from the tax incentive bidding wars.

The post Tax Incentives Are a Game We Can’t Win appeared first on Show-Me Institute.

First, some of the data relies on physician and patient surveys. Individuals in different countries have different expectations for their health care systems, an important factor that the study’s authors admit might have affected the ratings:

Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

One of the categories I find most objectionable is “long, healthy, and productive lives,” which has a rather ambiguous meaning. The authors used three indicators to determine what constituted a “long, healthy and productive life.” (Table data excerpted from the study):

Exhibit 8. Long, Healthy, and Productive Lives Measures

These three indicators do not fully capture “productive” or “healthy” lives. There are more relevant measures of productivity and quality of life, such as statistics about morbidity, the amount of time spent ill, or disability-adjusted life years (DALYs), which account for degree of sickness as well as length of life. These are sometimes difficult to calculate, but they are standard measures used by the World Health Organization (WHO) and far more relevant for a category about “healthy” and “productive” lives.

The indicators used do not capture the fact that someone waiting 18.3 weeks for surgery in Canada may also be losing four months of work productivity, as well as spending a long time with an impaired quality of life. The United States ranked first in wait times for specialists and nonemergency surgeries. When one includes those factors, a different story emerges from the data.

For the indicator “Health life expectancy at age 60” the United States ranks sixth, but a closer look at the raw percentages shows a very small range from first to last; whether these differences are even statistically significant was not addressed in the study. Nor does the category capture that Americans work longer — both in their work week and in their lifespan — than the other countries listed, which could explain the slight difference in the raw percentages. American work ethic is a cultural issue, not an implication of the health care system.

Also, infant mortality is a contentious indicator for the success of a health care system. Different countries use different measurements to calculate the statistic. The United States strictly follows WHO guidelines by counting all babies that have shown any sign of life, whereas Germany, for instance, only counts babies that weigh at least one pound at birth. Other countries do not count births earlier than 26 weeks. This disparity in measures of reporting artificially skews the rates, without factoring in cultural differences, like teen births, that also contribute to higher infant mortality.

In developed countries, a large portion of the increase in life expectancy is not attributable to the health care system. During the past century, the average life expectancy in the United States has increased by 30 years; modern medicine can only account for five of those years, while public health measures account for the other 25. Attributing small changes in mortality to medical care is very tricky. Lifestyles can affect health outcomes as much — if not more — than health care. The obesity rates in the United States are much higher than the other countries listed. Holding health care systems equal, that one factor would lead the United States to have lower health outcomes. Again, this is a cultural issue, and not an indication that a universal system would improve U.S. results.

A conclusion some may reach after reading the study is that universal health care is the solution to perceived disparity; this seems to be the conclusion the authors hoped to make. In fact, the study actually suggests that the new federal health care legislation will improve U.S. outcomes:

Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.

Incentives need to be realigned, but that has more to do with the disconnect between patient and physician — the health care wedge, explained in the Show-Me Institute study “Prognosis for National Health Insurance: A Missouri Perspective.”

The Commonwealth Fund study admits that none of the other nations considered have “ideal” health care systems, and makes some questionable comparisons in order to “prove” that universal health care is the best way to solve problems in health care. Show-Me Institute staff and scholars have discussed better solutions for health care reform in blog entries, op-eds, and policy studies.

The Commonwealth Fund study notes that the largest problem in the U.S. system is affordability of health care; the study thus concludes that universal health care is the solution, rather than making health care more affordable. The Congressional Budget Office has calculated that the recent legislation, lauded in this study, will actually increase the cost of health care. The Commonwealth Fund study suggests a solution that will bring the exact opposite of the problem it anticipated: Health care will become too expensive for some people.

Just because a few countries are getting (questionably) better results by some carefully selected measures under universal health care systems does not negate the fact that market-based solutions are a better solution for Missouri and the whole United States.

The post Questionable Comparisons, Questionable Conclusions appeared first on Show-Me Institute.

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The Daily RFT blog picked up on her post, but didn’t seemed particularly swayed by an argument for liberty. I had a conversation yesterday morning with my coworker Abhi Sivasailam, who suggested an efficiency argument against taxation, and pointed me to a National Bureau of Economic Research working paper titled “Cigarette Taxation and the Social Consequences of Smoking.” An argument that many people make in their attempts to justify cigarette taxes is that such a tax helps to internalize the additional costs of smokers — but this study concludes that the societal cost is already internalized.

From the study’s abstract:

Detailed calculations of the financial externalities of smoking indicate that the financial savings from premature mortality in terms of lower nursing home costs and retirement pensions exceed the higher medical care and life insurance costs generated. The costs of environmental tobacco smoke are highly uncertain, but of potentially substantial magnitude. Even with recognition of these costs, current cigarette taxes exceed the magnitude of the estimated net externalities.

So, if the costs of smoking are already largely internalized, imposing additional taxes on cigarettes is inefficient. It’s also worth pointing out that cigarette taxes are regressive, and any argument that holds the state should appropriate money from smokers to pay for other programs places an undue burden on a vulnerable group.

Is it horrible that people die from smoking cigarettes? Yes. Is it horrible that people die in automobile accidents? Yes, but that doesn’t constitute a rationale for taxing cars out of existence, or cupcakes, or the many other things that people use and enjoy that can also contribute to future poor health. If free, consenting adults choose to smoke, despite the known risks, it is their prerogative.

The post Smoke Screen Arguments appeared first on Show-Me Institute.

As of 2009, Missouri had 41 mandates for health insurance. Considered singly, no individual mandate had a large impact on premium costs, but they each had a marginal impact. Every incremental increase in the cost of health insurance premiums leads to the possibility that some unknown number of individuals and businesses are no longer able to afford their previous coverage.

Here is a look at mandates in Missouri (data compiled from the Council for Affordable Health Insurance):

As we’ve discussed before here at Show-Me Daily, injecting competition into the insurance market is really the only long-term solution that will both increase coverage and lower health care costs. Sarah Brodsky has also suggested tuition tax credits for autistic children as another alternative to insurance mandates.

Regardless of how one looks at the issue, mandates do not serve as a solution. The list provided by CAHI contained 130 different mandates throughout all of the states and Washington, D.C. Health insurance would be prohibitively expensive for far more people if every policy had to cover all 130 items, and there will still be many other conditions or diseases that are not covered. Does every 20-year-old want insurance against Alzheimer’s disease? Does every 60-year-old want insurance against autism?

With more choice in the insurance market, people can better choose for which illnesses or conditions they wish to be insured. Eliminating the way in which insurance is tied to employment and encouraging health savings accounts would allow individuals to purchase portable, cost-effective policies, saving for foreseeable health-related expenses while hedging against unknown future risk.

The post Missouri’s Many Health Insurance Mandates appeared first on Show-Me Institute.

The goal, said Arthur J. Culbert, president and CEO of Health Literacy Missouri, is that “information needed to make healthy decisions is available to all, and is easy to understand.”

But, he told a Thursday afternoon news conference, the new national plan is based on an understanding that “nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our health care facilities, retail outlets, media and communities.”

The low health literacy in Missouri is a result of two systemic breakdowns: one in education, and one in health care.

In education:

“[M]ost medical information is written at a 12th-grade level or higher,” Culbert explained, “and the average reading level in the United States is somewhere around sixth to seventh grade.”

The low reading level in America is in part a result of students remaining in failing schools, which is something that the school choice and educational reform movements are hoping to remedy. Beyond improving health literacy, improving functional literacy will improve a person’s job prospects and quality of life.

Even if one’s reading ability is sufficiently developed, understanding the jargon and complex structures of the health care system still confuses most people. The bureaucratic muddle that is our health care system is a large part of the reason that health literacy is difficult for many. That complexity is only increased by the wide array of types and levels of governmental involvement in the health care system.

Improving education and reducing the complexities in the health care system are vital to any efforts to truly improve health literacy in the United States. Health literacy is important, but focusing only on the symptoms of a systemic problem is not a long-term solution.

The post Health Literacy Programs Only Treat Symptoms appeared first on Show-Me Institute.

There has been a lot of charged rhetoric on the topic of autism mandates, and I’m positive that its proponents have had the best of intentions. (In fact, I played softball last weekend with one of the sponsors of the bill, Sen. Eric Schmitt, and he seemed like a great guy.)

It’s important, though, to understand the economic mechanisms behind mandates. Insurance becomes prohibitively expensive if the government attempts to mandate coverage of everything that could happen to anyone. As I’ve mentioned before, high-deductible health savings accounts are one of the best ways to handle these sorts of issues; once the policy owner exceeds a certain deductible, their insurance can cover the cost of treatment. The high deductible helps to minimize costs by reducing the health care wedge between patient and doctor, as well as reserving insurance for its intended purpose: large, catastrophic costs. Market competition is a more effective way to bring health coverage to all children with autism and other conditions, and not just a select few.

(Also, a quick thanks to John Combest for linking to my op-ed in the Springfield News-Leader! My op-ed will also be available in the Sunday edition of the Joplin Globe.)

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Gov. Jay Nixon’s desk no doubt holds many bills with supporters eager to see them passed, although one of them will raise the cost of health insurance in Missouri when it is signed. The Autism Spectrum Disorder Coverage bill, H.B. 1311, requires state-regulated private health insurance companies — those that cover small and medium-sized businesses — to cover up to $40,000 annually for screenings and therapy for children with autism spectrum disorders. Although well-intentioned, this mandate will necessarily raise the cost of premiums for Missourians, making it more difficult for individuals and small businesses to keep their health insurance plans.

Autism is a problem in Missouri, and it is easy to be swept up by the heart-wrenching stories of families with autistic children. But there are many disorders and diseases that afflict people — children and adults alike — and mandated coverage of all or even most of these problems would make insurance prohibitively expensive for everyone, especially for those who have diseases that are not given state protection.

A mandate of any amount increases health insurance costs, and this bill’s substantial commitment would assuredly have a noticeable effect. Small businesses are particularly cost-sensitive, and the autism bill will increase the cost of doing business in Missouri — although estimates of how much costs would increase vary, depending on who is doing the calculation. This bill would exempt small businesses if the provisions demonstrably raised their premiums by more than 2.5 percent, but any increase would likely price some marginal number of businesses out of the insurance market, forcing them either to cut coverage or reduce hiring. At the same time, these costs bring only a relatively small gain for Missouri families; an independent report estimated that the bill would only help up to 350 families.

The bill also raises the cost of autism therapy by increasing licensing requirements. It establishes a board to certify applied behavior analysts, the professionals who administer the type of expensive therapy that the bill covers. This regulation will add an extra barrier to entry in becoming an analyst, reducing competition in the field. For families not covered under the mandate, this will raise their therapy costs.

State mandates raise health insurance costs across the board, and decrease people’s access to affordable coverage. In the long run, the most effective solution for families with autistic children — or any other disorder — is for officials to open the insurance market to further competition, giving providers a practical economic incentive to cater to niche health care markets. Despite the good intentions of those aiming to help some families with autistic children by supporting this insurance mandate, it will simultaneously hurt other Missourians who could face significant cost increases or even the potential loss of their own health insurance coverage.

Caitlin Hartsell is a research assistant with the Show-Me Institute and a graduate student in public health at Washington University.

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