Policymakers can reduce overdose deaths and other harms stemming from nonmedical use of opioids and other dangerous drugs by switching to a policy of “harm reduction” strategies. Harm reduction has a success record that prohibition cannot match. It involves a range of public health options. These strategies would include medication-assisted treatment, needle-exchange programs, safe injection sites, heroin-assisted treatment, deregulation of naloxone, and the decriminalization of marijuana.
Though critics have dismissed these strategies as surrendering to addiction, jurisdictions that have attempted them have found that harm reduction strategies significantly reduce overdose deaths, the spread of infectious diseases, and even the nonmedical use of dangerous drugs.
Study after study show a “misuse” rate of less than 1% in patients prescribed opioids for acute pain or chronic pain. And numerous large studies show an even lower overdose rate from opioids used in the medical setting.
Hospitals are working hard to ameliorate the situation by asking medical staff to use prescription opioid pills such as oxycodone and OxyContin instead of injectables, but many patients are unable to take oral medication due to their acute illness or post-operative condition. In those cases, hospitals use injectable acetaminophen, muscle relaxants, or non-steroidal anti-inflammatory agents, but those drugs fail to give adequate relief. Some hospitals have even resorted to asking nursing staff to manually combine smaller-dose vials of morphine or other injectable opioids that remain in-stock as a replacement for the out-of-stock larger dose vials. Dose-equivalents of different IV opioids vary and are difficult to accurately calculate. This increases the risk of human error and places patients at risk for overdose.
One way Obamacare tried to reduce the cost of health insurance was by instituting minimum requirements on the share of premiums that commercial insurers must spend on medical claims. Known as the Medical Loss Ratio (MLR), this share is a measure of the actuarial fairness of insurance.
If an insurer collects $100 in premiums in the individual market, but spends only $79 paying medical claims that year, they are required to write a $1 check to policyholders. However, the insurer must bear the full administrative cost of keeping expenditures below $80 but reaps none of the rewards. That is, minimum MLR requirements encourage higher costs, not lower.
In recent decades, policymakers have attempted to overcome zoning constraints on new development by granting special zoning exceptions in return for various developer-provided public benefits. This strategy is proving inadequate as zoning continues to suppress needed development of lower- and middle-class housing and employment. However, broader zoning reform is politically difficult because of incumbent-homeowner political coalitions.
In the new issue of Regulation, law professors Roderick M. Hills Jr. and David Schleicher recommend an unlikely cure for zoning regulations that are strangling our cities: binding, comprehensive, citywide plans. In Can ‘Planning’ Deregulate Land Use? , Hills and Schleicher propose a return to the use of comprehensive, citywide planning for land use regulation, which can only be approved or rejected, without amendment, by legislative bodies.
50 years ago today, President Lyndon B. Johnson signed legislation creating Medicare and Medicaid.
Despite their popularity with seniors, the disabled, the needy, and those who might otherwise have to care for them, Medicare and Medicaid have done enormous damage to the U.S. health care sector and to individual liberty.
Without government interference, insurance markets will naturally charge higher premiums for riskier individuals. For example, life insurance premiums vary considerably based on factors that increase the likelihood of death, such as age, gender, smoking status, and health.
Under Obamacare, many factors that influence healthcare expenditures are excluded from premiums. For example, premiums make no distinction for obesity, likelihood of having a baby, alcoholism or pre-existing conditions. One notable exception is for smokers, where premiums may be up to 50 percent higher than that for non-smokers. Cato’s Aaron Yelowitz has collected data on premiums for smokers and non-smokers in 35 states, and the data shows large variation in the extent to which smokers are charged more for their choice.
In the January issue of Cato Unbound, Christopher Snowdon reviews the efficacy and fairness of sin taxes aimed at preventing obesity. He finds that at low levels of taxation, consumers don’t change their behavior appreciably, and when they do abandon the taxed foods, it will often be in favor of other high-calorie choices. Very high levels of taxation may be needed to bring about significant public health benefits, but here the evidence is sparse, because few jurisdictions have tried taxation at these levels. Moreover, all such sin taxes are regressive; they hurt the poor disproportionately and become justly politically unpopular. Snowdon concludes that sin taxes aimed at obesity are an ineffective public policy tool, even on their proponents’ own terms.
Obesity remains a serious health problem and it is no secret that many people want to lose weight. Behavioral economists typically argue that “nudges” help individuals with various decision-making flaws to live longer, healthier, and better lives.
In an article in the new issue of Regulation, Michael L. Marlow discusses how nudging by government differs from nudging by markets, and explains why market nudging is the more promising avenue for helping citizens to lose weight.
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