Here’s a Great Argument for Easing Up on Professional Licensing Restrictions

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Adrianna McIntyre has a fascinating little tidbit up today about how Medicaid expansion affects access to health care. Here’s the question: By increasing demand for doctors, is it likely to result in longer wait times for everyone?

A trio of researchers took a look at dental care to get an idea. Some states cover it for adults, some don’t. So what happens in states where adult Medicaid is expanded to cover dental care? The first-order answer is surprising: more dentists participate; their incomes go up; and wait times barely budge. But how is that possible? The second-order answer is even more interesting:

Dentists accomplish this mainly by making greater use of hygienists: following the expansion of public coverage, dentists employ a greater number of hygienists and hygienists provide about 5 additional visits per week. As a result, dentists’ income increases following the adoption of Medicaid adult dental benefits by approximately 7 percent. These effects are largest among dentists who practice in poor areas where Medicaid coverage is most prevalent.

We also find that these coverage expansions cause wait times to increase modestly [less than a day, on average]. However, this effect varies significantly across states with different policies towards the provision of dental services by hygienists. The increased wait times are concentrated in states with relatively restrictive scope of practice laws. We find no significant increase in wait times in states that allow hygienists greater autonomy.

Licensing and “scope of authority” restrictions are sort of a hot topic these days, and this is a pretty good example of why. I haven’t yet dived into the whole thing enough to have a settled opinion, but it’s becoming fairly common to believe that licensing restrictions are far too strict in some professions, acting more as a way of propping up salaries than as genuine public safety measures. Nurses and hygienists could be given more autonomy, for example, but this is often resisted by doctors and dentists who don’t want to give up a lucrative monopoly on the services they provide.

The arguments are sometimes arcane, but this example brings it down to earth. Ease up on the restrictions placed on hygienists, and dental practices can provide more and better service to the poor—and, in the end, do it without sacrificing income. That’s worth knowing.

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DEMOCRACY DOES NOT EXIST...

without free and fair elections, a vigorous free press, and engaged citizens to reclaim power from those who abuse it.

In this election year unlike any other—against a backdrop of a pandemic, an economic crisis, racial reckoning, and so much daily crazy—Mother Jones' journalism is driven by one simple question: Will America will move closer to, or further from, justice and equity in the years to come?

If you're able to, please join us in this mission with a donation today. Our reporting right now is focused on voting rights and election security, corruption, disinformation, racial and gender equity, and the climate crisis. We can’t do it without the support of readers like you, and we need to give it everything we've got between now and November. Thank you.

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