How "Missing Middle" Health Care Reforms can reduce costs across Texas

"So not only is this trade of ours in danger of falling into disrepute, but also the temple of the great goddess Diana may be despised and her magnificence destroyed, whom all Asia and the world worship.”
Acts 19:27

On the final day of TPPF's Policy Orientation, we attended a panel "Mid-Level Medical Providers Could Improve Care Shortages."  That's a longwinded way of saying that not every medical issue needs to be treated by a licensed physician.  As a website that often works on housing issues at the local level, we found this discussion very similar to the conversation about "Missing Middle" housing.

Texas currently has a shortage of health care providers across the state.  36 counties have zero physicians.  80 counties have five physicians or fewer.  While this is often a problem in rural areas, there are parts of the cities that aren't much better.  East Austin and East Houston are the two most obvious examples.

Given the geographically dispersed nature of the issue, a broad based coalition is emerging to promote "scope of practice" reform.  TPPF has been joined by the AARP and the left-leaning Center for Public Policy Priorities.  The proposed reforms would enable nurse practitioners to perform many functions currently limited to licensed physicians.

Supporters made fairly standard free-market arguments in favor of the reforms.  Fewer regulations will mean more providers.  More providers means more competition which means more options at lower prices for health care consumers.

Rep. Tom Oliverson, a licensed physician, spoke against the proposal.  Oliverson spoke about an alleged need for "training requirements" that were comparable between physicians and nurse practitioners.  Oliverson also spoke about the need to "standardize" training across the practitioner field.  This was all to be done to protect public safety.  To be honest, Rep. Oliverson's arguments sounded very similar to the types of complaints cab companies make against Uber, a point we raised during Q&A.

We continued the conversation with Oliverson after the panel concluded.  Oliverson spoke about health care as a special case where we need to "get it right in advance."  We remain unconvinced, as we believe decentralized consumers can digest far more information far more efficiently than a government licensing board (*).  Nevertheless, we appreciate Rep. Oliverson's candor and willingness to engage the issue.

Bottom Line: There is a politically created shortage of medical providers across this state.  This shortage drives up costs, which accrues to the benefit of current providers.  Scope of practice reform will help alleviate that shortage, which will in turn lower costs and increase options for consumers.

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* -- It's also worth pointing out that nurse practitioners are still pretty heavily regulated, they're just not as heavily regulated as licensed physicians.