And consider health care. Sad to say, but the paramedics who treat our soldiers on the battlefields in Iraq and Afghanistan are not allowed to provide the same services back home for people who can’t afford, and perhaps don’t need, the attention of a physician. Although the restrictions differ from state to state, laws everywhere “protect” patients from care delivered by anyone other than a physician. This is despite studies showing that non-physician clinicians can competently provide from 60 percent to 90 percent of all primary care.
In some parts of the country, walk-in clinics in shopping malls allow nurses to give flu shots, take temperatures, prescribe antibiotics and deliver other timely, inexpensive care. But even these innovative services are often saddled with burdensome regulations. For example, in Massachusetts, regulations for clinics have such cost-increasing requirements as a separate entrance for patients, minimum size requirements for exam rooms, and a separate reception desk. When low-income families find they cannot afford private care, what’s the alternative? Community health centers and the emergency rooms of safety net hospitals. Yet these care sites often involve crowding and waiting, which limits access to care.
Child care is another basic service needed by many low-income families. In fact, low-income families spend about a third of their income on child care, as much as a typical middle-income family might spend on a home. In recent years, state and local governments have been making child care ever more costly, however. All manner of regulations are emerging, including the licensing of day care workers. Did you know that in most places, it’s illegal for a neighbor down the street to oversee children from the neighborhood for pay? Again, what’s the alternative? Low-income mothers must seriously consider abandoning the labor market altogether and rely solely on the welfare state.
Even a basic activity like keeping the neighborhood safe runs into regulatory barriers. In response to inadequate public police protection, an increasingly popular alternative is private police. In the United States, private security guards actually outnumber public police officers by a ratio of three to one; and they can perform most, if not all, of the necessary law enforcement tasks. Yet, government regulation has created substantial barriers for would-be security firms, including criminal background checks, examinations, training requirements, and insurance and bonding minimums.
A task force report produced by the National Center for Policy analysis calls for an end to these senseless policies, and advocates allowing our lowest-income citizens access to the benefits of the free market. I’ll write about it in a future column.