As the “Medicare for All” movement gains momentum, discussions of incremental reform have been drowned out by calls for a more sweeping overhaul of the healthcare system. But proponents would do well to find places to trim the fat in the U.S. healthcare system, if for no other reason than to reduce the sticker shock of their proposals, that prevent Americans, especially those in rural areas, from receiving affordable healthcare in a timely and cost-efficient manner.
To identify discrete, piecemeal reforms that would complement any healthcare system, the Mercatus Center’s Healthcare Openness and Access Project identifies the regulations standing in the way of accessible and affordable rural healthcare:
“The Mercatus Center’s Healthcare Openness and Access Project (HOAP) quantifies and compares healthcare openness and accessibility by providing state-by-state datasets… State policymakers can view HOAP’s 38 indicators—ranging from how states reimburse telemedicine providers to the scope of practice afforded to nurse practitioners—to see how their own states’ openness compares to the rest of the country. State health policies that are more open and accessible tend to better serve the care needs of their populations.”
Accompanying HOAP, they have targeted three potential areas of reform that would remove burdensome regulations and improve health outcomes.
The first two recommendations focus on reducing the barriers to examination caused by extreme geographical scarcity of doctors. First, removing the red tape around telemedicine, which utilizes the internet to allow for remote examinations, would reduce the inconvenience of driving miles to the nearest doctor. Second, expanding scope of practice laws would increase the number of medical practitioners within a geographical area.
Their third policy recommendation involves paring back or eliminating certificate of need laws:
“Healthcare providers cannot legally provide new services (e.g., more beds in a hospital, a new CT scanner, an ambulance service) until their state’s department of health approves what is called a “certificate of need” (CON) based on whether those authorities perceive a “tangible need” for expanded care.”
These ironically-named CON laws are a cousin of occupational licensing. Much like licensing boards that reduce the supply of qualified practitioners through occupational licensing, the supply of medical services is artificially capped by state officials, sometimes with fatal results.
Allowing providers to make business decisions for themselves would reintroduce an element of market forces into the economy, which can help improve efficiency in the healthcare market.