Certificates of Need Not Needed

Posted on by Eric D. Dixon

Today, the St. Joseph News-Press reported about the efforts of an area doctor (also, incidentally, a Missouri representative) who is sponsoring legislation to get rid of Missouri’s Certificate of Need (CON) requirement for most health-care facilities — except for those providing long-term care:

Anyone in the hospital business wanting to set up shop in Missouri must endure a stringent application process with the state under a Certificate of Need program.

The same goes for long-term care facilities, such as nursing homes, and certain medical equipment, such as MRIs.

Rep. Dr. Rob Schaaf, R-St. Joseph, wants to take hospitals and medical equipment out of the equation.

“I’m just a believer in the free market and I don’t believe in central control,” Dr. Schaaf said.

Dr. Schaaf is in good company. Last year, we published an op-ed by Steve Bernstetter, "Taking the CON Out of Certificate of Need Laws," that argued in favor of largely the same perspective. Steve pointed out the drawbacks of CON laws here:

Proponents of maintaining current CON laws make two key arguments. First, they assert that CON laws keep prices down and assure both quality and availability of service. Evidence for these claims is spotty at best. Success with and without the program varies greatly from state to state, and it is extremely difficult to separate the differences in care created by CON laws from differences created by other variations in healthcare systems between states. Additional study is required before any solid conclusions can be drawn as to the affect of CON laws on price, quality, and availability. However, conventional economic wisdom holds that when multiple firms compete, quality rises and prices drop. There’s no reason to assume that the health care industry would be exempt from this effect.

He went on to propose an alternative model:

The ideal system provides a variety of options, in both price and quality, for all. Such a system is best achieved in a market where firms are free to specialize to meet consumer demand. Such a market depends on consumers with a variety of options making informed decisions. As such, CON law reforms should focus on increasing the transparency of the market while simultaneously fostering competitive growth within it. A balanced approach to competition, in which artificial barriers to entry, such as CON laws, are eliminated and the healthcare needs of all are well represented, offers the best chance for guaranteeing all Missourians access to affordable, quality health care.

The Joplin Globe Discusses Our Transportation Study

Posted on by David Stokes

The Joplin Globe published this editorial today about the potential for truck-only lanes and public-private partnerships for Missouri. (Thanks to Combest for the link.) I, along with intern Nick, aka the Nintern, visited the Globe last week and had a great dicussion with them about our study. We appreciate the thoughful editorial and recommend it highly.

Two Must-Read National Articles: One Hysterical, One Insightful

Posted on by David Stokes

In light of our recent study on transportation, this article in the Onion has some outstanding additional recommendations for addressing Missouri’s serious transportation needs. (A hat tip to devoted reader James "Jim" Cronin, aka "Cronin", of Fairfield, CT for alerting me to this. Because of his much- appreciated tip on the story, he and I are now officially even for the time he brutally cubed me with a hackey-sack. Or was it a tennis ball? To be honest, I only remember the agonizing pain.)

I also must recommend this amazing article about the changing political worldview of playwright David Mamet, written by Mr. Mamet as an essay in one act. While Mamet has never thrown anything at me for no reason whatsoever, I still loved the article, which briefly gets into the economics of Thomas Sowell and Milton Friedman. Link via Drudge. (Hey, Drudge, I have now linked to you, so I believe it’s your turn to link to me.)

Initiative Process Deserves Support

Posted on by Eric D. Dixon

I’ve intended for the past couple of weeks to respond to Justin Hauke’s last attack on the initiative process — specifically, his praise for a bill that would outlaw paying petitioners based on the number of signatures they gather, under the rubric of "preventing fraud." I’ve kept putting it off, though, both because other projects keep crowding my attention, and because I wanted to make sure to hone a particularly good response — initiative & referendum is worthy of a vigorous and comprehensive defense.

As it turns out, I can postpone the vigorous exercising of my argumentation skills for another day, because Paul Jacob, founder of Citizens in Charge, has made the argument for me:

Sometimes it takes money to do things. Say, to collect signatures for a petition. If you want folks to be hitting the sidewalks all day inviting support for a ballot question, you might want to pay them so they can pay the rent while they’re doing this.

Critics of citizen initiative rights often complain about paying people to gather signatures — especially if they’re paid per signature. They even try to outlaw it. If workers are paid per signature, aren’t they motivated to commit fraud? Concoct fake signatures?

Let’s think this through. If the possibility of fraud justifies outlawing a paid activity, how many paid activities could then be outlawed? Well, all of them.

Outlawing fraud and outlawing a freedom that might be abused are two different things. All freedom can be abused. […]

There are bad guys. But we don’t criminalize all conduct, even the good, because of the possibility of bad. Instead, we make laws against bad conduct.

This deserves emphasis: It is unjustifiable to outlaw an activity just because it might provide an incentive for individual acts of fraud — especially when that activity is associated with such a crucial right as political speech. Officials should investigate and prosecute cases of fraud that have actually occurred; engaging in prior restraint based on what officials imagine could happen is a subversion of the First Amendment.

And, yes, it is a First Amendment issue. Paul goes on to mention that, less than a week ago, an Ohio appeals court overturned a similar law that had banned pay-per-signature initiative efforts. The court’s decision is rooted in basic constitutional free speech provisions:

As with the law in general, the First Amendment is a jealous mistress. It enables the people to exchange ideas (popular and unpopular alike), to assemble with the hope of changing minds, and to alter or preserve how we govern ourselves. But in return, it demands that sometimes seemingly reasonable measures enacted by our governments give way.

The State of Ohio enacted a provision making it a felony to pay anyone for gathering signatures on election-related petitions on any basis other than the time worked. It did so for the sensible purpose of reducing fraudulent signatures. The provision, however, runs afoul of the First Amendment because it creates a significant burden on a core political speech right that is not narrowly tailored. Accordingly, we affirm the district court’s grant of summary judgment against the State.

The judge recognized that the Constitution also gives government officials "the authority to determine ‘The Times, Places and Manner of holding Elections,’" but noted that this authority can’t place a significant or severe burden on individuals or groups who organize to engage in otherwise lawful political expression.

At any rate, Justin’s argument has another noteworthy hole. He, again, points out that initiatives are "responsible for terrible legislation" — a point I had already ceded in my earlier defense of the initiative process. But, as with any other phenomenon, it’s important to judge the effects of initiatives on balance, and the ratio of good initiatives that voters have passed is far, far better than the ratio of good legislation that politicians have passed.

It’s no contest, really. For all the bad that initiatives could do, they have an excellent track record of the good far outweighing the bad. That’s no small thing. In practice, the initiative process is one more check and balance on ever-growing government power.

Good News From St. Charles

Posted on by Sarah Brodsky

The St. Louis Post-Dispatch reports that St. Charles’ proposed smoking ban is going nowhere:

Councilman Laurie Feldman, 3rd Ward, said a ban would limit the personal freedom of St. Charles residents.

"They can frequent places that allow smoking if they choose to, or they can not frequent them," Feldman said. "To me, it’s all about choice."

Restaurants (and other businesses) that want the support of people who oppose smoking would do well to institute their own no-smoking policies. But some patrons want to smoke, and it would be foolish for St. Charles to drive them all into neighborhing areas. Smoke-free and smoking-allowed establishments should be able to coexist in the same city. 

Court Hears Midwifery Arguments

Posted on by Eric D. Dixon

Last week, Missouri’s Supreme Court justices heard arguments on both sides of the dispute about whether a provision legalizing midwifery should remain in the free-market health insurance reform bill, HB 818, that the General Assembly passed last year. The Missouri Medical Association contested the provision, arguing it violated the single-subject requirement for amending the state Constitution.

It looks as though the Court may base its decision on its interpretation of that requirement, rather than on any reputed benefits or drawbacks of midwifery itself. From the Post-Dispatch:

Assistant Attorney General John McManus argued that the provision indirectly related to health insurance because lawmakers could not insure midwives if the practice was illegal.

Making it legal "is the initial step," he told the court. "The Legislature can’t take any other steps with relation to health insurance and certified midwives unless they take this step."

Several judges questioned that argument on Wednesday.

"Had the title been worded, ‘An Act relating to health care services,’ there would have been no problem," said Judge Stephen Limbaugh.

Chief Justice Laura Denvir Stith said that under McManus’ argument, lawmakers could legalize almost anything in the bill. "It seems that anything that’s insurable can be put in this bill," she said.

A few months ago, I wrote an op-ed about midwifery and concluded:

Hopefully, this provision will be resurrected — either on appeal, or through a less controversial legislative action. It’s important that consumers be allowed autonomy not only in choosing insurance policies, but also in choosing what type of care they want to receive.

Regardless of what the Court decides about the technical validity of this particular provision, there’s little question that legalizing midwifery is a good idea. Several advocates of midwifery submitted an amicus brief to the Court that provides thorough arguments about the benefits of the practice, and answers the objections of critics. An excerpt:

Contrary to the AMA’s unsupported assertions about home birth safety, the “clear preponderance of medical literature” suggests that home births, when they are planned and attended by a well-trained professional midwife, in fact, may be less dangerous for mother and baby than giving birth in a standard hospital […] Among the myriad studies on home birth, the only study cited by the AMA to support its assertion that home birth is risky is the only one to have found otherwise, yet this study has serious design flaws that undermine its validity.

Ultimately, though, determining which side has a greater degree of evidence to support its claims of health and safety is of much lesser importance than the simple question of freedom that is so often overlooked in these debates: Should you have control over your own choice of medical care, or should the choice be left to politicians?

State Symbols ? Not Just for Fourth-Graders

Posted on by Sarah Brodsky

I don’t know about you, but I’ve never visited a state because of its official state symbols. But that’s the rationale behind a new bill that would make Budweiser the official state beer:

Budweiser is a Missouri-based international icon that — if officially recognized — might even persuade more people to visit the state, said Rep. Curt Dougherty.

It’s clear that the purpose of this bill is to help out a particular company. (Perhaps in hopes of future campaign contributions?) Or maybe Rep. Dougherty just wants to help Budweiser learn about the political process!

Mailing It In

Posted on by Nicholas Loyal

The controversy over seating Democratic delegates awarded in the Florida and Michigan primaries has escalated to the point where it seems that pundits are throwing out ideas at random, only to have them be shot down a few moments later. I usually try to avoid these discussions because of the vacuum of common sense that usually emerges from them, but one idea recently caught my attention.

According to CNN, both Florida and Michigan have considered mail-in ballots as a method for tabulating votes if their respective primaries are to be redone. This method of vote tabulation — already used in Oregon for all elections and as the primary mechanism for absentee voting in most other states — has a number of benefits that are specifically tailored to the current democratic situation. An all-mail primary would cost considerably less than a traditional one, and as recognized by Democratic National Committee Chair Howard Dean, such an exercise would ease the balloting process for all:

"Every voter gets a ballot in the mail. It’s comprehensive. You get to
vote if you’re in Iraq or in a nursing home," he said on CBS’ "Face the
Nation."

Additionally, a mail-in primary could lead to more attention for the process within Missouri. In February, state Representative Jake Zimmerman introduced House Bill 2088, which would establish an all-mail election system for all elections that take place within the state. Currently, the bill has not been referred to a committee, and as reported by Suburban Journals, there is little confidence of it being given serious consideration. However, as the resident intern in favor of election reform, I’m hoping that any attention given to mail-in balloting by Florida and Michigan leads Missouri lawmakers to reconsider it as an electoral method.

Is Math Like a Missile Shield?

Posted on by Sarah Brodsky

Lee Stiff thinks so; he compared the two when he spoke about mathematics curricula in Columbia:

He said letting local districts set curricula was like having personal defense strategies. Some things are better left to the federal government.

Stiff’s metaphor continued: If you don’t like SCUD missiles, it doesn’t mean you should try to shoot down a plane with a rifle "just because that rifle worked for my grandaddy."

Here are a few ways in which math curricula differ from missile shields:

1. There’s general agreement about missile shields, not about math curricula. People might argue about military priorities and the amount of money we should spend on defense, but everyone agrees that we should protect the country. If a missile shield does that, it’s generally considered to be successful. On the other hand, there’s a lot of contention about how to teach even the most basic math concepts. People disagree about what a good math curriculum should accomplish. If the math wars had to be settled at the national level, we’d see the situation in Columbia on a much bigger scale.

2. Missile shields are expensive; math curricula are cheap. All the taxpayers in the United States together pay for a missile shield, but each school district buys its own math curricula. There’s no reason a district can’t buy a few different curricula, as Columbia does for some grades right now. Because it’s easy to buy math curricula at the local level, purchasing decisions should be made at the local level.

3. The benefits of a missile shield are dispersed; the benefits of a math curriculum are concentrated. A missile shield protects many people, all across the country. A math curriculum helps (or hurts) the particular children in a district who learn it. Although we all benefit when other people are well-educated, those benefits are not spread out evenly across the country. If a city adopts an excellent math curriculum, that city benefits from it more than any other place does. And most of the gains go directly to the students themselves.

Math curricula are not the same as missile shields. We shouldn’t institute a national math curriculum based on that false analogy.

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