Birth Center Regulations

This article in the Post-Dispatch identifies a regulatory barrier to opening birth centers in Missouri:

Another challenge in Missouri is the state’s licensing requirements for birth centers, which Henman and others are trying to change[.] Birth centers are licensed as ambulatory surgical centers even though no surgeries take place. Many of the requirements are expensive and unnecessary, says nurse midwife Rachel Williston, 34, who wants to open a birth center in Independence, Mo.

Complying with all the regulations for ambulatory surgical centers is no simple task. The regulations can make the difference between a facility being profitable enough to operate and being forced to close. This was evident in 2007, when Missouri law was changed to impose the ambulatory surgical center regulations on abortion clinics, which challenged the law in court. They argued that imposing such onerous regulations was a ploy to shut them down.

It’s unfair to regulate birth centers the same way as surgery centers, when no one performs surgery in them. Women can legally give birth at home, and their houses need not meet all the code specifications of a surgery center. Births in birth centers should be regulated more like births in homes.

Home Birth Statistics

The National Center for Health Statistics has released a report on out-of-hospital births. In 2006, 64.7 percent of such births occurred in homes. Another 28 percent took place in birthing centers.

The report includes a few maps that allow readers to compare states; one categorizes states according to percentage of home births in 2005 and 2006. Missouri’s percentage was above the national average, and ahead of all neighboring states’ percentages with the exception of Iowa. (Wisconsin and Oregon, two other states I’ve written about a lot, had higher percentages of home births than Missouri.)

The next map shows each state’s change in percentage of home births between 2003–2004 and 2005–2006. Missouri saw no significant change during this period. This is not surprising, considering that Missouri’s General Assembly didn’t pass a bill legalizing midwifery until 2007. I would expect to find an increase in Missouri’s percentage of home births after that bill’s midwifery provision finally became law in 2008.

Missouri House Holds Anti-pseudofed Hearing

Got hay fever? The state of Missouri might make your life a little more difficult, as a House committee (odd for the Kansas City start omit which one) recently held hearings on the idea of making some allergy meds that were openly sold as over-the-counter products not that long ago available by prescription only. These medications contain pseudoephedrine, which is used in the production of meth.

Law enforcement officials already got restrictions–patients now have to submit their names to a state database–but now they want to double down. Said one cop, “Every year we have enacted half-measures and partial measures.”Hey, I suppose if you’re tired of half-measures you could simply ban Sudafed and all similar products. How’s that war on drugs working out for you anyway? Gasoline is used in molotov cocktails, which, like meth, are destructive. Maybe we should make people who want to buy gas first get  the approval of an auto mechanic?

The point is, any product can be used to harm someone. Law enforcement officials want to do their job, naturally. But they don’t, and shouldn’t, get their way every time. (On a related note, we could solve a lot of crimes if we suspend the Bill of Rights, but we don’t.) The needs of patients with legitimate health concerns ought to weigh in as well. Given the number of people with seasonal allergies, I say, “Free my Sudafed!”

State Governments in Action

This has been a busy week in state governments.

In South Carolina, the Senate “approved a non-binding resolution that affirmed the state’s rights under the 2nd, 9th, 10th, and 14th amendments to the U.S. Constitution.”

In Idaho, “Gov. Butch Otter has announced his intention to sue if Congress passes a bill that increases the state’s Medicare commitments and requires people to buy health insurance.”

In addition, four state representatives introduced legislation that would declare Idahoans free “free from government compulsion in the selection of health insurance options.”

Also this week, the Missouri House of Representatives passed a similar measure, citing the Cornhusker Kickback and the cost to Missouri, among other concerns. Some Democrats who voted for the measure cited their pro-life concerns that federal health care reform would lead to taxpayer funding of abortion.

Health Care Gets a Little Less Expensive

St. Louis Made the Right Call in Giving Vaccine to Retailers

This Post-Dispatch article about the H1N1 vaccine mentions that St. Louis city sent most of its vaccine supply to hospitals and pharmacies. Some doses have been distributed for free in schools and existing public clinics, but the city didn’t open any new free vaccine clinics like the ones in other cities.

It was a smart move on the city’s part. Offering free vaccines is a recipe for shortages. Charging for the cost of administering the vaccine — as pharmacies do — prevents demand from skyrocketing and depleting the vaccine supply. And allowing people to buy the vaccine at their local retail pharmacies is better than forcing everyone to come to a few central clinics. People are used to going to those retailers for prescriptions or other vaccines, so they don’t have to go out of their way to find a clinic they’ve never been to before.

And, while it’s true that taxpayers paid for the H1N1 vaccine, as the people quoted in the article stated, that doesn’t mean that they should all receive it for free. Administering the vaccine would require the city to hire nurses. Taxpayers shouldn’t be made to incur yet another flu-related expense, especially considering that new H1N1 cases have been declining for weeks.

Prosecutor Says: You Don’t Need Pseudoephedrine

The “war on drugs” will claim more victims in Missouri, by making it more difficult for allergy sufferers to get the medications they seek for relief. “State lawmakers have filed several bills for the 2010 session that would require a doctor’s prescription to get certain cold and allergy medications that currently can be bought over the counter,” says the Kansas City Star.

This comes after the state has already imposed restrictions, such as making people sign a register to buy the drugs.

This legislation would actually increase health-care costs, since getting a new prescription requires an office visit to the doctor. It would also encourage people to purchase these drugs through insurance plans rather than as cash transactions. This is the opposite direction we ought to be taking when it comes to routine, minor, and predictable expenses.

That the “war on drugs” has turned into a war on patients is evident in the fact that local prosecutors are now, in effect, practicing medicine by declaring what’s useful medication and what isn’t. Speaking of drugs that contain pseudoephedrine, a prosecutor in Oregon–which has already imposed a “go see your doctor first” requirement–said “It’s unnecessary, it doesn’t cure cancer, it doesn’t cure anything. It’s about a decongestant, and there are plenty of alternatives.”

Pharmaceuticals Won’t Speak for Themselves

Missouri Legislators Seek to Protect Health Freedom

Some Missouri legislators are seeking to advance legislation to make sure that their state’s residents have the right to opt out of a government health plan.

Here’s a press release about an upcoming hearing on the matter, from the American Legislative Exchange Council (ALEC):

JEFFERSON CITY — State Sen. Jane Cunningham, R-Chesterfield, Sen. Jim Lembke, R-St. Louis, and Representatives Tim Jones, R-Eureka, and Brian Nieves, R-Washington, will announce corresponding legislation designed to protect health care freedom of choice for Missourians.

Senator Cunningham earlier this month pre-filed a proposed state constitutional amendment that would protect Missourians from federal health care mandates and guarantee they can choose their own health care and insurance options. Senator Cunningham’s proposed Senate Joint Resolution 25, co-sponsored by Sen. Lembke, and similar legislation to be filed by Rep. Tim Jones (House Joint Resolution 48) would also protect small business owners from fines for declining to participate in government health care mandates.

“We want to let Missouri voters decide with a constitutional amendment whether or not selection of doctors and participation in an insurance plan should remain a personal decision without interference from the federal government,” Sen. Cunningham said.

The proposed legislation would add Missouri to a list of dozens of states calling for legislation or state constitutional amendments to guard citizens against attempts to socialize health care through the “public option” health care mandate currently under consideration by Congress. Arizona already has such a measure on its 2010 ballot.

Who: Sen. Jane Cunningham, Sen. Jim Lembke, Rep. Tim Jones, Rep. Brian Nieves, and St. Louis-Area Doctors
What: Briefing on proposed Health Care Freedom Act for Missourians
When: Wednesday, Dec. 9th, from 10 to 11 a.m.

Autism Mandates Show Power of Politics

Once government gets involved in an issue, including health care, everything about it becomes a political football. Witness the recent controversy over mammograms, smoking bans, menu-disclosure requirements and of course the question of what services will be paid for by insurance. (Such requirements are known as “mandated benefits.”)

The political powerhouse these days is the autism lobby, with more and more states requiring insurance companies (read: policy holders) to pay for autism treatment–and in some cases, specifying WHICH form of autism treatment shall be paid for.

As if often the case, a personal experience is behind the drive for a new law. Ron Richard, the the Speaker of the Missouri House, has vowed that the state will pass an autism mandate next year.

Richard said that his brother’s son has autism, “So I understand.”

Some autism treatment could be carried out by schools or social service agencies. But that would require making autism services compete with other services for tax dollars. On the other hand, it’s fairly easy to seek the money from insurance companies