Senate health bill could be better. | What's disparaging is not for the government to say. | CON laws harm patient health. | Instead of "ban the box" cut licensure. | What to do about North Korea.
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June 24, 2017 |
The Senate health care bill falls of short of fixing both the health insurance markets and Medicaid. The Supreme Court says it’s not the government’s job to decide what speech is disparaging. States are protecting hospitals from competition at the expense of patient health. Instead of “ban the box,” cut occupational licensure. What to do about North Korea. |
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The Senate health care bill misses some opportunities to fix problems created by Obamacare. Edmund Haislmaier, Robert Moffit, and Marie Fishpaw write: “[A] major weakness of the Senate bill is that, unlike the House bill, it does not create enough incentives for continuous coverage—either directly or by permitting states to use the waiver process to adopt such provisions on their own. Such provisions are important to limiting the adverse selection and gaming effects that have driven up premiums under Obamacare. “The Senate bill should be strengthened by at least expanding the waiver process to permit states to experiment with different approaches for incentivizing continuous coverage.” And while the Senate bill also improves the Medicaid setup, it doesn’t go far enough in addressing the weaknesses of the program. Haislmaier, Moffit, and Fishpaw recommend: “First, to ensure states have the flexibility they need, the Senate should take such steps as giving them explicit authority to set and manage eligibility for their Medicaid programs through such means as asset tests, and remove restrictions Obamacare put on states’ abilities to make such decisions. “Second, the Senate should establish a Medicaid ‘premium support’ program that would enable able-bodied Medicaid beneficiaries to enroll in private health insurance plans, and thus be able to secure access to the same doctors and medical professionals as their fellow citizens. “Many Medicaid enrollees cannot find a doctor to take care of them because the reimbursement rates and the regulatory system discourages physician participation in the program. “Moreover, low-income, able-bodied adults cycle on and off of Medicaid as their employment and incomes fluctuate, experiencing disruption in their health care coverage. “This change would have increased their access to the quality care that they so desperately need, and would have increased the number of younger and healthier persons enrolled in the nation’s private health insurance pools.” [The Daily Signal]
It’s not the government’s job to decide what speech is disparaging. On Monday the Supreme Court ruled that the government cannot engage in viewpoint discrimination when it issues trademarks. In a case brought by the Asian-American rock band, The Slants, the Court struck down a provision of federal trademark law (the Lanham Act) that bars the registration of trademarks that disparage “persons, living or dead, institutions, beliefs, or national symbols, or bring them into contempt or disrepute.” Ilya Shapiro writes that this is the right decision: “Fundamentally, this somewhat unusual case […] shows that government can’t make you choose among your rights. The Lanham Act’s disparagement clause placed an unconstitutional condition on those who consider the use of an edgy or taboo phrase to be part of their brand: either change your name or be denied the right to use it effectively. Whether you’re a musician, a politician, or a sports team—the Washington Redskins’ moniker will now be safe—it’s civil society (consumers, voters, fans) who should decide whether you’re being too offensive for polite company.” [Cato Institute]
The hospital next door might save your life—if it gets built. Patient health is endangered by state laws that protect hospitals from competition. So-called Certificate of Need Laws prevent health care providers from investing in new facilities unless they get permission from the state. These laws were originally intended to prevent health care providers making unnecessary capital investments in order to increase their cost-based reimbursement from federal health care programs. That theoretical justification went away when federal health programs switched to a prospective payment system in the 1980s. Today, CON laws survive in 34 states. The Institute for Justice has filed a federal lawsuit on behalf of a Cedar Rapids, Iowa, ophthalmologist whose surgical center has stood vacant for nearly 30 years because established facilities are able to block his Certificate of Need Application. Watch IJ’s video on the issue. [Institute for Justice]
Instead of “banning the box” to help ex-cons find a job, just get rid of unnecessary occupational licensing. There is a movement to ban employers from asking if a job applicant has a criminal history. The idea is to help ex-cons get back into the workforce so that they don’t return to a life of crime. Hans Bader points out that there is a better solution than rely on forcing employers to be ignorant of an applicant’s criminal past: “People are more likely to commit crimes if they can’t find a job after being released from prison, according to a study released by the Manhattan Institute. Occupational licensing regulations make it harder for them to find a job. Reason magazine notes that a ten-year study released last year by the Center for the Study of Economic Liberty at Arizona State University found that ‘formerly incarcerated residents are more likely to commit a new crime within three years of being released from prison if they live in a state where they’re prohibited from getting a license solely for having a criminal record.’ “Once upon a time, occupational licensing regulations only restricted access to jobs that had unique privileges (such as lawyers, who can send you a subpoena demanding your diary) or that had unique public safety implications (like a surgeon, who can kill you if unqualified). Not anymore. “Now, many occupations that pose no special risks or need for regulation are off-limits to people who have criminal convictions, or never committed a crime, but can’t afford to spend years on unnecessary training that is sometimes irrelevant or obsolete. Florida requires interior designers to undergo six years of training, including two years at a state-approved college. Other states force aspiring hair stylists to first attend exploitative beauty schools that often rip off their students. And ‘twenty-one states require a license for travel guides,’ notes the Brookings Institution. Occupational licensing has expanded from covering 5% of the workforce in the 1950s to 30% today.” [Competitive Enterprise Institute]
Options for dealing with North Korea: North Korea has killed an American, Otto Warmbier, and it holds three more Americans as prisoners. What can the United States do? Rebeccah Heinrichs: “Families of the hostages might call for restraint. But Otto’s fate demonstrates that unless the United States forces Pyongyang to assess it is not in its interest to harm them, we have no reason to think their fate will be better than Otto’s.” Heinrichs recommends: “Require — not ask — the Peoples Republic of China to comply with U.N. sanctions. Even though China has signaled it may be more willing to comply with the Trump administration’s demands than it was with the previous U.S. administration, we have seen this act before. About 90 percent of North Korea’s trade remains with China. This cannot stand. The United States must impose secondary sanctions against Chinese entities that are facilitating North Korea’s prohibited nuclear weapon and missile programs. The previous administrations failed to do this. President Trump’s should not. […] “This one will take more time, but the Trump administration must expand the U.S. missile defense (MD) deployments in the Pacific region and on the U.S. homeland. The United States has various MD systems in place in South Korea and Japan and the Ground-based Midcourse Defense (GMD) system remains the only system deployed to protect the U.S. homeland. The Obama administration significantly cut the GMD program. The Missile Defense Agency has been playing catch-up ever since. The recently released defense budget did not reflect President Trump’s public commitment to defense, let alone missile defense. This must be remedied by significantly boosting the entire defense budget, and especially missile defense, with an emphasis on homeland defense.” [Hudson Institute]
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