The problems with the Affordable Care Act or Obamacare as it is known in the media are all too obvious. Sadly over the last 150 years of regulations most of the problems start with regulations passed at the state level of government and not at the national level. If anything the government should have worked at reducing and repealing the regulations passed by the states instead of beginning with a top down approach. To that end we suggest these steps as a beginning for reform.
Let’s be
clear the Libertarian People supports a free and open market in health care and
believes that you should have the right to choose the type of care you want
whether it is traditional Asian, Western medical care or another variation.
Repeal the
Occupational Licensing Laws. These laws do not protect patients but are
there to protect the profession from competition. Occupational Licensing Laws and
other regulations have deprived midwives, denturists, optometrists and others
of an opportunity to practice and they deprive patients of a choice.
Historically occupational licensing laws can be traced back to the Hammurabi
Code of 1700 B.C. In the U.S. occupational licensing laws were used to keep
newly freed slaves from competing against whites after the Civil War.
Sixteen
states allow for Advance Nurse Practitioners to set up their own practices
independent of doctors. In the others they are required to be supervised by an
MD. Expanding the role that Advance Nurse Practitioners are allowed play will
save many more tax dollars. Let’s repeal the laws in the states that restrict
Advance Nurse Practitioners and give the public a few more choices. [1]
Nurse
midwives are recognized in all states but direct entry midwives, which are
those who did not study nursing, are prohibited from practicing in many states.
Direct entry midwives may have learned
this craft through an apprenticeship or by attending a college that trains
people for this occupation. Approximately twenty-six states have some form of
laws permitting direct entry midwives. In the other states direct entry
midwives are outlawed thus depriving mothers of a choice. [2] Midwives deliver
about eight percent of births in the nation. [3] Studies have shown midwives to
be as safe as doctors and offer mothers and infants care that is as good and
sometimes better.[4]Such a change would be especially beneficial to Native
Americans and African-Americans who have some of the highest rate of infant
mortality due to lack of prenatal care. Child birth in the U.S. costs about
$8000 and up [5] for an MD to deliver but $2500 to $4000 for a Midwife and
often lower. With forty percent of
births nationally being paid for by Medicaid and 50% in Washington State expanding
the opportunities for midwives would save significant tax dollars and result in
healthier children at birth.
Abolish the state medical boards. In the
fifty states the state medical boards are controlled by the professions and are
a classic example of what is known as regulatory capture where the board is run
for the benefit of the profession and not the patients. If the idea of equality
before the law means anything then no profession should be treated any
different than the general population. [6]
Repeal
the Certificate of Need Laws on the books in many states. These are laws
were originally intended to reduce alternatives to established services, but do
little more than increase the costs and deprive patients of another choice.
With this law those who want to open a new hospital or another facility need to
prove that there is need. [7]
Repeal
the Corporate Practice of Medicine of
Laws, regulations and court decisions. These laws and related court
decisions were used by the medical profession to fight the growth of prepaid
medical groups in the late 1940s and later years. Today the laws may be
preventing the growth of retail health clinics in some states. Retail health
clinics offer a viable low cost alternative to people needing immediate care instead of running to
an expensive emergency room. Retail health clinics have grown significantly
since 2006 when there were about 200 nationwide, today there are about 1300
nationwide. [8]
Abolish
the FDA. There is no reason that the functions performed by the FDFA could
not be done by a private organization such as Consumer Union or Underwriters
Laboratory quicker and with better results for consumers and do away with the
need for a prescription. If nothing else we should let pharmacists prescribe
medicine as they did prior to 1938. [9]
Adopt No
Fault medical malpractice Insurance. With $250 billion spent on medical malpractice
business and about 200,000 deaths annually [10] from medical errors and
infections most of which are never compensated we need to find a way to fix
this system and a no fault system may be a practical approach. [11]
Repeal the
McCarran-Ferguson Act. This law passed in 1945 restricts the
insurance companies from selling across state lines and has balkanized the
insurance industry to the disadvantage of consumers. [12]
& http://www.scientificamerican.com/blog/post.cfm?id=deaths-from-avoidable-medical-error-2009-08-10
& a very good article from the WSJ http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html
[11] I am not sure how no fault medical malpractice
insurance fits into the libertarian mold because people should never be denied
an opportunity to take the case to a jury.
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