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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is the first thing despots go after. An unwavering commitment to it is probably what draws you to Mother Jones' journalism. And as we're seeing in the US and the world around, authoritarians seek to poison the discourse and the way we relate to each other because they can't stand people coming together around a shared sense of the truth—it's a huge threat to them.

Which is also a pretty great way to describe Mother Jones' mission: People coming together around the truth to hold power accountable.

And right now, we need to raise about $400,000 from our online readers over the next two months to hit our annual goal and make good on that mission. Read more about the information war we find ourselves in and how people-powered, independent reporting can and must rise to the challenge—and please support our team's truth-telling journalism with a donation if you can right now.

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