With the expected shift to states, Californians 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. California ranks a poor 34 out of 50 states in a “measure of overall access to health care for each state.”
California does particularly well, however, on metrics related to pharmaceutical access and public health. Innovations in pharmaceuticals and greater over-the-counter access help health care consumers access the medicines they need and to keep costs down. California allows over-the-counter access to oral contraceptives, for example, and has less onerous rules than many states when it comes to access to medications like pseudoephedrine.
Despite allowing the use of medicinal marijuana, however, California falls short in the report’s rankings on allowing access to experimental drugs. The notion that severely ill and terminal patients are not be allowed to try experimental drugs is something a state like California should be far more willing to tolerate and test. On other public health policy metrics, like granting more access to naloxone — the drug commonly used to help break opioid addiction — California ranks first. That ranking is also helped by strong Good Samaritan laws, which provide basic legal protections for people who may help another person who is injured or in danger. Encouraging people to help others and only holding them liable for truly negligent or stupid actions simply makes sense.
California also scored well by allowing access to e-cigarettes, which are vastly less harmful than smoking tobacco and can help many people quit smoking. Alas, the punitive taxes put on e-cigarettes that will be implemented via the recently passed Proposition 56 will be a setback to this public health benefit.
Perhaps not surprisingly, California is at the bottom, 50th, in the rankings of state health care tax policies. It levies heavy taxes on doctors and medical service providers, raising their costs and thus the costs to all health care consumers. There are also heavy taxes on health savings accounts, undermining a viable alternative to the broken health insurance market.
Additionally, California 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.
The fact that California ranks first in some of the Mercatus Center’s health care metrics shows the state has some good ideas and practices. If California can get out of its own way when it comes to high taxes and over-regulation, it could soon be in the top 10 of the health care rankings.
Dr. Adrian Moore is vice president for policy of Reason Foundation.