Arnold Kling  

Structural Employment Policy

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Nick Schulz and I offer ideas, focused on the New Commanding Heights.


imagine if state governments experimented by setting up healthcare enterprise zones. These would be areas where entrepreneurs could set up healthcare delivery systems without any rules concerning what license would be required to engage in any particular activity. Perhaps medical services could be delivered by workers with fewer credentials but more rigorous on-the job training.

Read the whole thing. I wish this piece had found an outlet in a major newspaper. Unfortunately, the debt ceiling theater is getting all the attention these days.


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COMMENTS (5 to date)
Vipul Naik writes:

Patri Friedman is trying to do something similar, on a seastead off the US coast:

Video of a talk in Helsinki, May 2011 where he mentions plans to start a for-profit to offer low-cost medical services targeted as US citizens, to compete with medical tourism to India and other countries.

Warning: The video is lengthy, and he mentions these plans around the last 10 minutes or so.

Shangwen writes:

I think this is a great idea, but I cannot imagine such a proposal surviving the lobbying onslaught, if by zone you mean a geographic or jurisdictional entity.

On the other hand, I can see some situations where there might be openness to it. Suppose some employers with some risk for occupational injuries were allowed to employ health care staff that did not have full-on (and expensive) credentials. Instead of hiring a staff nurse or company doctor, they could create positions with a combination of credentials (CPR, a first-responder skill set like an EMS tech, some infection control skills) that would suit their particular needs. Since the health care worker would not have licensing from a state-ordained labor cartel, the employer would have to assess liability risks in more detail, but they would not be paying for the risk of low-probability events related to a 1998 lawsuit in another jurisdiction. When people object to this, you can point out to them that historically the biggest innovators in health care occupational categories have been the military and the VA, and they have done a pretty good job of it.

Another option might be to let different groups (regulated and unregulated) exist side-by-side, but give people a financial incentive to try the unregulated service, if they chose to.

In the long run, the problem with experimental policies is that they have to be politically survivable. "Oh well, we just thought we'd try something different" is a hard thing to get re-elected on.

John Goodman writes:

Great idea. I posted something on this at my blog a few minutes ago: http://healthblog.ncpa.org/healthcare-enterprise-zones/

R Richard Schweitzer writes:

You might take a look at the Community Health Centers programs for starters.

This can become the framwork for getting the U S out of the Medicaid business.

Joe Cushing writes:

Somebody could build a hospital/clinic ship and park it near the US. Then there could be no rules.

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