Power to the doctors

Republican leadership and President Donald Trump say repealing the Affordable Care Act is a top priority this year. Whether that means simply repealing Obamacare, or replacing it with a new plan is still murky. But major health care policy changes are expected, and whatever emerges from Congress is probably going to put more responsibility on individuals and state governments.

With the expected shift to states, Florida should be looking closely at the new rankings of state health care policies published by the Health Openness and Access Project at the Mercatus Institute at George Mason University. Florida ranks a poor No. 32 out of 50 states in a “measure of overall access to health care for each state.” That is a disturbing status for a state in which health care is so important.

Florida does well in some metrics of health care access, especially pharmaceutical access and direct primary care. Innovations in pharmaceuticals and greater over-the-counter access help health care consumers access the medicines they need and keep costs down. Florida allows access to experimental drugs, a crucial matter for severely ill and terminal patients for whom the risks are much lower.
The state also has less onerous rules than many states when it comes to access to medications like pseudoephedrine, and it now allows access to medicinal marijuana.

Florida ranks sixth in the nation in openness to direct primary care model, in which doctors can create an alternative to standard insurance billing by charging patients or families a fee each month or year that gives each member access to primary care services.

This model provides a much-needed alternative to the dominant insurance model for some individuals and families and doctors, and allows patients and doctors to once again work together to make medical decisions and encourages doctors to once again be in primary care.

It is also worth noting that Florida ranks a middling 18th on taxation of health care, with tax policies friendly to health savings accounts and with average levels of taxation on health care providers and on medical devices. Given that Florida is a top state in so many aspects of taxation policy, reducing taxes on health care would be a natural improvement.

Additionally, Florida ranks poorly in letting entrepreneurs help the health care system. The state gets poor rankings in allowing “business to employ licensed (health care) professionals” and allowing “nurse practitioners broad scope of practice.”

In recent decades, the notion that doctors and patients should control medical decisions has morphed into a complex maze of federal and state bureaucracies that get in the way far more than they protect patients. Doctors, nurses, and entrepreneurs should be empowered to innovate in the health care industry. Whether it is the way they set up and run clinics or how they provide actual care, the more control that health care professionals have over the process, the more efficient and effective medical operations are likely to become.

Florida, while getting high marks for recent reforms to medical malpractice laws, still ranks poorly there with doctors facing much more than average malpractice lawsuits and regulatory actions and paying much higher malpractice insurance premiums, all of which make health care more expensive for Floridians.

The same is true of the state's lousy ranking on so called “certificate of need” regulations, which reduce competition in health care by requiring clinics and hospitals to get permission and prove they are “needed” before opening up to serve patients. Existing hospitals and clinics inevitably lobby against approval of any new competition. As a result, Florida has less than the market would provide, and we all pay higher costs.

Finally, while Florida's Medicaid policies are friendly to telemedicine, the state ranks 39th on overall telemedicine access.

Regulations on telemedicine are much higher than in other states, and the state Medicaid program reimburses poorly for “remote monitoring” that allows patients to be at home but still receive full-time medical monitoring and observation. Telemedicine is a crucial means by which some patients and their doctors can keep down costs, and Florida should be allowing and encouraging it.

The fact that Florida ranks highly in some of the Mercatus Center's health care metrics shows the state has some good ideas and practices. If Florida legislators would reduce costly and unnecessary regulations on health care, make some modest tax reductions on health care providers and continue to grapple with malpractice problem, the state could soon be in the top 10 of the health care rankings.