Carolina Journal Radio No. 775: Reforming graduate medical education to boost health care

To current and the largest city in the statehouse into the schoolhouse Carolina Journal radio your weekly news magazine discussing North Carolina's most public policy events and issues welcome to Carolina Journal radio why Michiko got during the next hour, Donna Martinez and I will explore some major issues affecting our state.

The U.S. Constitution was designed as a anticorruption tool that's the argument of George Mason University professor makes in the recent book Republic of virtue Euler body means speaking at a national conservative conference. Our Raleigh entrepreneur touts the benefits of the recent federal tax reform you'll hear why Duke University recently hosted a scholar who explains why the original political progressives pursued some very illiberal goals that will examine details of proposed legislation dubbed the right to earn a living act. Those topics are just ahead. First, Donna Martinez joins us and she has the Carolina Journal headline when were sick. We expect to call the doctor's office. Make an appointment and have timely access to quality medical care. Those of us on the patient's side of this transaction never really question that a trained physician will be there to help us. Some healthcare analysts however are getting concerned North Carolina is losing many of the doctors that train here. Catherine Restrepo is one of the analysts looking at the issue of graduate medical education. She of course the John Locke foundation's director of healthcare policy Catherine welcome back think things happen. Are we in danger of not having enough doctors, nurses, etc. in this state yet.

That's a great question and a couple last month. There was this whole subcommittee on graduate medical education. It talks about that very issue. And people think and I thought that North Carolina had a shortage of physicians, but it's really a physician maldistribution area so you don't have enough doctors practicing in less populated areas and rural areas more practicing in urban metropolitan areas of the state.

If you live. For example, in the Charlotte Mecklenburg area, perhaps around the Triad, Winston-Salem, Greensboro and Raleigh, Durham, Chapel Hill, probably not have a problem outside of those areas. However, could be an issue yes very much the unassuming people are traveling 2 to 3 hours just to see a specialist in Orange County where Chapel Hill is that there out more in the rural western parts of the state. So this this is an issue and some of the researchers that came in who really on no other experts in healthcare workforce data and trends in where people are located where physicians are practicing across the state and they really delved into know-how. As taxpayers since were talking on graduate medical education a lot.

Most graduate medical eight education is funded by taxpayers. So how can taxpayers get a better value for what were paying otherwise how can we bring doctors into more rural parts of the state that the fascinating thing you just said because I can tell you I had no idea that we as taxpayers were helping to pay for the training of doctors and so I apologize for my ignorance on that.

But will even realize that a lot of people don't realize that in fact it mean Congress never really started appropriating money for graduate medical education. That is where physicians go for residency training in clinical education at hospitals after they complete medical school. This all really start happening after the World War II era and for the most part beforehand.

Hospitals pay for residency thoughts themselves and actually this funding was supposed to be temporary until World War II is has three temporary, and the veterans health administration.

They also provide some graduate medical education fund sodas and other federal agencies as well enough federal money for the most part most graduate medical education money comes from Medicare. However, when were talking about the subcommittees that were held last month on no first state for state taxpayers to get better value for Hauer's that he needs graduate medical education dollars.

Some of it also comes from Medicaid and and that's where were looking at how taxpayers can get better value at the state level because that is jointly funded by the state and federal government.

How is it determined then it it almost sounds like you know is there some room where people are sitting down and saying okay this hospitals can have this many slots and here's the money for that and here's organ to train these people in Houston actually yeah yeah those are the details. I still need to look into bite mean certain certain on teaching hospital depending where you're located get more funds than other hospitals and so once there's more transparency in the process. This is actually sparked your triggered legislators at the state level, no calling for reforms. Here's having more transparency of where these funds are going.

You know, is it equitably distributed and in fact is this money aligning with the healthcare workforce needs. In all these unmet patient needs.

In fact, you've written a lot about the fact that we have a primary care doctor maldistribution yes what you call a shortage of nearly 25 counties don't have an OB/GYN mean 14% of North Carolina's population is living in areas where there's no not enough physicians per 10,000 people and in those areas. One would think that there would be some sort of distribution of funds to try to meet those particular needs. Is there a legitimate role. Then for state policymakers to say, look, you know you maybe need to be moving this money around, absolutely and and there has been an mean it's not some teaching hospitals are good at trying to align the graduate medical funds they get with workforce needs. So some are really adamant about creating more family medicine residency programs on community-based programs where doctors are trained out in rural areas, and you know that based on their statistics.

If a physician goes to medical school and completes the residency training in North Carolina, they're more likely to stay in practice in North Carolina so it's sort of like when you're looking at that pipeline, you know, a lot of these experts are saying that it's a leaky pipeline because overall we only retain 40% of physicians is that how can we keep more physicians in state and how can we incentivize them to practice in rural areas.

That's really curious so you're saying that of every 10 physicians that are trained through these federal and state funds for of them stay in North Carolina but since I believe yes yes overall. We are a net importer of physicians when we do about that. Well, I think they just again and need to be way more transparency with how these funds are allocated because right now is it's hard to track the amount and where these funds are going because they're tied on to Mimi's Medicare payments it's embedded in Medicare payments with hospital claims on hospital submit the claim on GME are Medicare pays them. You know an add on percentage and that equates to graduate medical education is they want to hear her just as you describe it in and one can only imagine if you are, for example, state legislator or frankly remember of the US on the North Carolina congressional delegation you got me scratching your head and yank how we even began. As I was funded through out on payments enter into governmental transfers. Others, like there's really not a lot of transparency here, but I think the best way is to just completely separate this into its own separate pool for funding and then have state be more flexible in have more control over how to manage that funding since so much of it comes from the federal government is better for states to have more control of this dollars Catherine, how is it that this has become a subject of of interest and important to state let you all this all goes back to that widening disparity of rural urban healthcare. I mean that such a critical issue that lawmakers are focusing on right now so it's not just graduate medical education of trying to provide incentives for physicians to locate rural areas of the state where they are needed, but also looking at all these other policies where you can know not, you can take away Supply for Healthcare Services and Healthcare Needs Any Looking at Scope of Practice Reform Letting Nurse Practitioners Practice Where They Once You without Having to Be Tied to Where a Physician Is Because They Currently If They Want to Treat Patients.

They Have To Have This Contractual Right Contractual Agreement with the Physician. So in Some Cases, That Sort of Hinders Where They May Want to Practice across the State for Liability Reasons for Sure. Catherine and Her Remaining Moments Here. How Is the Medical Field, Reacting to This Is Interest from Policymakers. Are They Welcoming This or They Little Bit Kind of Imaging That I Think I Mean You Have People Who like the Way That It's Currently Been Because Some Hospitals Enough. They Specialize in Certain Services Know They Can Use That Graduate Medical Education Funding for Their Own Interests Rather Than Aligning It with What the Patient Actually Really Need across the State. So You Have That Sort of Battle Going on but I Think for the Most Part There's Is Growing Consensus That There Needs to Be a Call for Reform. Catherine, the Director of Healthcare Policy for, Foundation Thanks Very Much and Can Say with This Much More Carolina Journal Radio to Come in Just a Moment Government Plays a Key Role in Your Life Affecting Your Paycheck Will You Educate Your Kids the Way You Do Business. How Can You Tell If Government Is Doing a Good Job Making the Right Choices. Spending Tax Dollars Wisely.

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Our next guest points to one particular goal of that document the creation of an anticorruption covenant explains what he means within the book the Republic of virtue how we tried to ban corruption failed and what we can do about it, the author of that book is F. H. Frank Buckley foundation Prof. at the Schooley law school at George Mason University, welcome back. The program expects to be back so why is the U.S. Constitution in your review and anticorruption covenant will are two stories. The first story is the whatever we might've thought about the British we admire their Constitution, except for one thing it was to spend most of corruption communicating was essentially bribing members of Parliament devoted his word.

Otis accepted was part of the story.

Part of it is better product differentiation, and we like the Brits but we don't like the corruption of the other part of it has to do with the story behind the way the convention worked and we we going to have this feeling that oh inches how to work out that way but it didn't mean we nearly fell apart a minute, there was nearly a walkout lid. I think by Madison and one crucial point one delegate got up and said gentlemen if you want anticorruption government. Here is what we have to do in the name of the fellows Gouverneur Morris news one of the uncontrolled heroes logo of the convention and so what he persuaded people to do which I think was the most momentous decision, Weldon was to have a structure for electing the president, which turned out in the fullness of time to be popular election that was supposed to cure corruption so that's how we got our Constitution about how it was supposed to be an anticorruption covenant.

So this was back in 1787. At the start of the process as the subtitle of your book says that we tried to ban corruption and the second part is sealed how the endothelial well I think a lot of people would agree we feel "fairly controversial contract.

There are people who run those studies of how corrupt is your country and interviewed local people and we don't. You know sometimes people say, well golly we know were America, how can it be a marginal bully ever heard of this place called Louisiana Illinois to Mexico. Okay, but truthfully, I think the problem is is a Washington problem was and truthfully the problem is swamp their number of reasons for the one of them is the president suits an all-powerful institution, member checks and balances which were supposed to prevent the president from being too powerful failed turned out to be a cloak with which he could hide it soon from the obvious example was Obama's presidency of the IRS scandal. For example, he serves noted mismanagement of evidence and of all one word we are speaking with Frank Buckley foundation Prof. at the Schooley law school at George Mason University also author of the book, the Republic of virtue how we tried to ban corruption failed and what we can do about it. Were going to get to the what we can do about it coming up in just a bit, but are there elements of the Constitution. The original plan that did work or or working that we ought to preserve all will on the big one is federalism coming.

The point about federalism is when power is chiefly located in straight government. If a state happens to be corrupt you, God, an exit option and if you don't like Illinois, you can move to Texas or maybe better still, North Carolina's reluctance to cure the problem.

But the more the power centralized from the foods the harder it is to exercise them, scrape out your new can escape from Illinois, but not so easily escape from Washington so restoring federalism would be a big answer to it to know about apart. There are some smaller things we could do would try to be really really useful, but were not going to know what absolutely ban corruption. The optimal level of corruption is not zero. Because that would take a Robespierre to drop off some codes with a 1 foot you I already got into this but the last part of the good of the prescription in the subtitle is what we can do about it.

Restoring federalism is important. Are there other things we really need to look at whether or not I mention two things. The first start of a negative thing we have all these campaign-finance laws in regards to talk about corruption typically are on the left, mostly well you know the answer is you get the scandal of money out of politics, but which more mostly domains. Let's get the scandal of Republican money out of politics right because of a low-calorie outspoken trump by 650% lost time around so that they know how to spend money they got tons of money to a good Mormon and we but that's fine no more power to them. The problem with her campaign-finance laws. Is there like a minute that has a curious feature that the big fish swim through in the small fish got caught on the small fish often are people with inconvenient political news. So it's a good tool for persecuting your opponents. In addition to all the when you have to disclose who your donors are you and Lucius at present in the Aleutian Internet mob where they post your name and your address and your kids and where you go jogging and all of minutes it just it's an invitation to an assault and of course about these days adding monsters of their word only too happy to do that so I would die were just junk all we have out there in terms of campaign-finance laws. There are no limits on expenditures by virtue of the Supreme Court. I would get rid of conscript contribution limits are basically eliminated for smart people with lawyers and I'd love people do it anonymously. What I do positively as I concentrate on the lobbyists. There you can do something.

What about the lobbyists, will you know I'm here visiting North Carolina from the DC area. I'm right in the middle of the swamp.

The swamp is composed of a lot of you know smart good role lawyers working in the district and influencing legislators with in part, that's a good thing I'm in. They are educating people often arrive in Congress, not knowing what's going on but at the same time, they should be able to give money to the Congressman and outright gifts of been down, but right now Congressman can receive campaign-finance contributions, lobbyists and bloggers can organize these meetings for Congressman.

I get that part of the money out of it.

They have good intellectual resources lobbyists let them inform Congressman about what bills are all about your good at that. What they don't have to do is give them their monetary contributions. How convinced are you that we can and will do something about this is this wishful thinking, or is it likely that we can actually accomplish something that will fix the system well.

I have high hopes. I don't want to predict the future in any way shape or form but I think a lot of people will recognize that we had a real problem with corruption. The election in 2016 was I think a rep importantly a referendum on the whatever you might think about trump by think many of your listeners will have pretty clear ideas about what Hillary Clinton was all about me when you when you walk into politics and you end up making a ton of money that sort of tells you something so it was a moment where we discovered rediscovered corruption trumpets plans to drain the swamp as he puts it well you know where you're into it and were still waiting will see what's going to happen numbing. I think the instincts were right but you know there was this French guy Cheryl put you in line about those who says everything begins and mystique and ends in politics, we can learn much more about this topic by reading the book titled the Republic of virtue how we tried to ban corruption failed and what we can do about it. It's author is FH Buckley Frank Buckley foundation Prof. at the Schooley law school at George Mason University joints.

Thank you Mitch for more on Carolina journal radio just if you have freedom we got great news to share with you now. You can find the latest news, views, and research from conservative groups across North Carolina all in one place North Carolina conservative.com it's one stop shopping. North Carolina's freedom movement and North Carolina conservative.com. You'll find links to John Locke foundation blogs on the days news Carolina journal.com reporting and quick takes Carolina journal radio interviews TV interviews featuring CJ reporters and Locke foundation analyst opinion pieces and reports on higher education from the James Dean Martin, Center for academic renewal, commentary and polling data from the scimitar's Institute and news and views from the North Carolina family policy Council. That's right, all in one place North Carolina conservative.com that's North Carolina spelled out conservative.com North Carolina conservative.com. Try it today. North Carolina is changing not just day-to-day but outward to our minute to minute and 2nd to 2nd, how can you keep up with the changes, especially the ones that affect you, your family, your home, your job, make the John Locke foundation and Carolina journal part of your social media diet on Facebook like the John Locke foundation like Carolina. Journal follow us on Twitter at John Locke in the sea and at Carolina journal news, insights and analysis you'll find nowhere else.

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It's that easy. So now not only will you enjoy what you buy will also support freedom. Don't forget log on to smile.amazon.com today by something nice and help defend freedom. Support the John Locke foundation for Québec Carolina journal radio why Muskoka how big a deal as the recent federal tax-cut Raleigh entrepreneur Bob Levy shared his thoughts during the recent national conservative political action conference trump corporate income tax cut is probably the most for an economic tool that we could ever have in this country is going to energize on printers and have more doors were going to have more job creation, more technologies and more investment which increases productivity, higher GDP in a much better country. What he says tax rates could be even lower if you go back to Calvin Coolidge 1925. Taxes were reduced to 25% in his biggest worry is that the government would collect too much money. So when taxes are low. People willingly pay the tax when taxes are highly try to avoid one of the biggest problems for small businesses just figuring out how to pay your taxes so their payroll taxes and then in many cases they have to pay their taxes before they've even collected the money so taxes are a cost and or major cost to small business and are also a major cost in terms of time because they don't have the cash flow so this is going to energize a whole range of small business people. I went also, so these small business people are training workers who don't have jobs who need skills so the increasing the family there training workers and many of them are going to fall too much. Our careers over time. What else could Congress do want taxes. The main thing they could do a simplified because taxes are extraordinarily complex. Again, if we have a simple tax code in a low relative tax people are willing to pay the taxes, not a burden to our tax code is a conundrum first-class. There has been some talk about raising the federal gas tax levy doesn't like it I think is a terrible idea.

The Swampscott plenty of money, the more money we give him the more troubling because the more the regulators and the more they give it to their political bodies. I say no more taxes what he says.

Conservatives need to keep fighting against higher taxes, government is always short of money.

So the idea that the government needs more money. We have to have more taxes is a terrible idea.

I think we need to reinforce that when we have tax cuts. We put money in the hands of entrepreneurs.

Those entrepreneurs are capital allocators and they're the best count killers in this country.

That's really the key message that drives productivity jobs technologies in our economy and Congress could learn lessons from North Carolina.

North Carolina's tax cuts were because we controlled spending federal spending is totally out of control. We need to drive that message of these congressmen and senators every single day because they have an addiction to spending and if we don't solve it. Interest rates are going to go sky high, you see evidence already.

That's Raleigh entrepreneur Bob Levy speaking at the recent national conservative political action conference and will return with more Carolina journal radio with a moment really influence you either have it or you don't and at the John Locke foundation. We do, and that's not bluster in a private survey of more than 250 North Carolina political insiders 87% said we influence them either a great deal a good amount.

So while others talk and complain. We get to work providing research solutions and help our team analyzes the pressing issues of the day jobs, healthcare, education, and more. We look for effective ways to give you more freedom, more options, more control. Our goal is to transform North Carolina into a growing, thriving economic powerhouse that is the envy of every other state are researchers actually help policymakers make decisions and ensure you keep more of what you earn. Expand your choice of schools for your kids. Widen your job opportunities and improve your access to doctors. The recipe for stability and a bright future. The John Locke foundation were dedicated to making North Carolina first and freedom were dedicated to you will Québec Carolina journal radio why Muskoka some people use the words liberal and progressive interchangeably, but that's a mistake. Especially if you're talking about the original American progressives of the late 19th and early 20th centuries, Princeton University research scholar Thomas Leonard tells their story in a book titled liberal reformers he discussed it recently at Duke University.

One part of the story.

Economists became professionals. When economists turn pro you have to remember laissez-faire is a really lousy strategy for professionalizing how much expertise is required to repeat in every situation.

Let the market decide. Not too much expertise. So if you're an expert retailing ideas and policy that say politicians or court or judges can understand. That's not a good strategy so that when economists are professionalizing and trying to sell their services as experts to the state they're making both an epistemic move. On the one hand worse there saying to politicians into judges and to parties we know something that you don't. They're also making a vocational move which is that it's probably going to be good for business. I belabor this slightly because I wanted to understand how audacious this move was in retrospect right if you're going to establish an administrative government sort of staffed and directed by scientific experts. You have to first transform economics. Second, you have to transform higher education and third you have to transform government because none of these things exist. As I said in 1880 early professional economists had no love for laissez-faire liberalism.

The progressives take their newfound authority as social scientists with expert knowledge.

They turn them into rhetorical weapons and they use that to convince Americans and their political leaders. Laissez-faire is not only economically out mode is also ethically wanting right.

They say that industrial capitalism creates conflict it creates on dislocation. It operates wastefully. This is a hugely important idea that capitalism is inefficient as well as in humane and it distributes its copious fruits unjustly. Not only that industrial capitalism has given us new organizational entities, things that simply really didn't exist before, like saying natural monopolies like say industrial corporations like say industrial labor unions so the idea here is that free markets if they ever could. Can no longer self regulate what we need if we want progress is the visible hand of a powerful administrative state, guided by expert social scientists. That's the voice of Thomas Leonard of Princeton all through the book liberal reformers recent speaker at Duke University. Leonard says these liberal progressives pursued various goals. What united them most in the ways we should think about them collectively is an abiding faith in the visible hand of the administrative state is the best means for realizing their decidedly pleural ants, their labor reformers or immigration reformers. Their political reformers. There are prohibitionists there are scientific charity workers there. There are many motley and diverse programs but they all agree that they can get what they want with an administrative state. Leonard says progressives placed experts ahead of business and government leaders in the progressives conception. The capitalist is grubbing profit. The politician is pursuing power with the expert uniquely is selflessly pursuing the good of society, which she also uniquely can be trusted to identify and to serve, I would claim further, that the establishment of the fourth branch of government also marks an epochmaking change in the relationship of government to American economic life. It also importantly shifts power within the stated moves powers for American courts and American parties to the new independent agencies of the executive doesn't lose power from judges and for politicians to bureaucratic experts. These so-called experts got some issues very wrong. Aggressive sets of really admirable ideals, along with some reprehensible ideas. And the thing to recognize is they advocated both kinds of ideas in the name of progress in the late 19th century in the United States.

Liberal was someone who was committed to individual freedom market economy and strong protection of individual rights against state. If you want a bumper sticker version. It would be free soil free labor and free trade was a short interval. Progressives saw this as laissez-faire, which was a pejorative term they judged to be unjust, inefficient and outmoded and they led the successful crusade to dismantle and when they remade American economic life. With this new instrument of reform. They also simultaneously made liberalism. That's why when you go to the Oxford English dictionary, and you look up the term liberal you'll find one term that says liberal in the 19th century sense supporting or advocating individual rights, civil liberties and political and social reform tending towards individual freedom with little state intervention liberalism in the 20th century sense they bring social reform, and a lot of state intervention in matters of economic different definitions for the very same progressives live up to their name Leonard address that question. The original progressives were not progressive. Many of them. The intellectual leaders among them certainly promoted scientific racism.

They promoted eugenics.

Eugenics is the social control of human heredity. Why was it the progressives in particular were attracted to eugenics for reasons that I think matter.

The first is that eugenics is deeply anti-individualist and so too was progressivism. Second, eugenics promised efficiency. Third, it required expertise excellent. After all, you have to identify the fit and the unfit X empty and, for it was scientific, the raison d'être of eugenics. Certainly, the progressive Arab version of his racial health is just too important to be left unregulated Leonard suggests, today's experts should learn lessons from what early progressives got wrong actually thought they had it right and they didn't and they were the best and the brightest. You have to remember that people like Woodrow Wilson and Richard T.

Ely and John are Commons and Edward a Ross are the most prominent public intellectuals of their day. We still have buildings and institutes. I sit in one Enterprises named for these men and they were mostly all men still today right.

They were racist. They were eugenicist.

They were sexist they were elitist and they used and abused their political and intellectual authority to promote these ideals that we can say in retrospect that, by golly they're wrong and we won't make those same mistakes. I suggest we will hundred years from now will be making similar sorts of mistakes. I hope not so egregious, so be humble in your work that's Thomas Leonard, research fellow at Princeton University and author of the book liberal reformers. He's urging caution to an audience of experts and future experts at Duke University overture with more Carolina journal radio in a moment a commitment to truth and transparency in government.

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Call 1866 JL FINF0 for your free subscription, welcome back to Carolina journal radio I'm Donna Martinez. All she wanted to do was to open a makeup artistry school but Charlotte resident Yas notebook Fitch by Arnie didn't realize that she would have to battle the state of North Carolina to have the right to open her business.

It is a battle that she has finally won a battle that shines the light on a group of cumbersome regulations known as occupational licensing requirements.

John Sanders is with the John Locke foundation. He follows the fight to free North Carolinians from these outdated rules joins us now John, welcome back to the program. Thanks, why couldn't this Charlotte resident open up a makeup artistry school.

What was the problem. The problem was that the cosmetology board decided that they really wanted her to be able they really want her to teach cosmetology nest aesthetics instead of just makeup that she just wanted to talk about makeup okay so forgive my ignorance but what's the difference between makeup and aesthetics aesthetics. As I understand it involves such things is hair plucking and facials and and it gets into a whole greater array than just applying makeup so we had this licensing board that essentially told this woman know you have to do all these different things and you have to meet all the rules and requirements to do all these different things, but she wanted to do. John no and it would've been a significant expense on as it turned out, it would've been a prohibitive expense against her meet her school had to spend more time 5 to 1 in terms of hours. If I understand correctly teaching aesthetics over teaching makeup and required her to buy a lot of equipment over $10,000 worth, and of course walk the line with the licensing for what when she discovered this, of course, that she was dismayed by this and didn't think that this was right that it was impeding her right to earn a living decided to really make this a battle and went to court over this.

This ended up in mediation tell us about about this what occurred and who were the parties involved here will she contract contacted the Institute for Justice, which represents people like her around the country and fighting government and they soon went to court in the state of North Carolina that they sue this particular board. Yes, anyway, as you said it went into mediation and the right outcome was was reached. I believe that essentially they said look, the First Amendment should not prohibit you from being able speak about makeup and so the state of North Carolina should not either. So John people may not realize that this is just one example of a much larger picture that there are many of these types of boards and one the great things about the work that you do here at the John Locke foundation is you are monitor a lot of these cases pretty regularly and you write about them@johnlocke.org.

In fact, you've been taking a look at what other states are doing to try to combat this, because North Carolina is not the only state that engages in this kind of a prohibitive licensing requirements tell us about what other states are doing right. North Carolina is one of the more prohibitive states in terms of occupational licensing, but in the last few years. Really, I think it stems from another North Carolina case, one that went all way to the Supreme Court, the Board of dental examiners on versus. Anyway, they got was a case where dental board wanted to pay.

Prevent people from opening teeth whitening kiosks and in from Dace Basel allowing teeth whitening services they were selling for under hundred dollars to less than $400, whereas Dennis were able to charge $1300 or so and the the dental board lost and the follow-up from the case is several states nine that I've counted so far have started deregulating some of their licensing. Three of them Arizona, Tennessee and Mississippi have passed a right to earn a living act or something very similar Mississippi which lays out a process whereby states check their licenses see if it's the most freeing way of of regulating the occupation without so basically they're trying to make sure that the occupational concerns are taken care of without some going too far in regulating and John, that seems to be really that kind of thing not of the debate here because when you have professions say in the medical field.

For example, one might think that seems to make sense that someone should have to be licensed and have to meet strict on knowledge requirements. Training requirements because the consequence of something going wrong. If they aren't trained properly could be very, very serious or in some cases even fatal. How do you determine then what industries really do legitimately need to have some sort of a a state licensing role how you even know go about looking at that is the open question in recently it's been studied by the Council state governments is over several thousand licenses over like 1100 different licenses, occupations or licenses in different states, but it's how you realize if there that many fields that might be licensed within only about 60 that are licensed in all states, which means that the vast majority of them almost 95% of them are not licensed in all the states, which means it states are in significant disagreement over whether this occupation or that deserves rises to the level of licensing it almost sounds like states are making arbitrary decisions as to a whole list of things that they're gonna require to be licensed, it can seem like that and on.

I think that's a fair criticism and sometimes it seems like if this particular occupations, strong enough lobby in that state. John based on the fact that we now have two pretty high profile legal cases here in North Carolina and we talked about them.

Both the you mentioned the US Supreme Court decision related to the states dental board and teeth whitening and then also at the makeup artistry question that we were talking about. One would think in that North Carolina policymakers would be looking at these decisions and saying you know what this is going against us. We need to reform our regime for how we license our occupations will I know in the last couple of years has been a lot of discussion at the Gen. assembly about what to do regarding licensing in North Carolina. Nothing is come out the them and then not passed anything yet, but there's been a lot of discussion and that's one of the things I want to do is provide as much information that I can that can hopefully inform these discussions in these debates, what kind of guidelines would you suggest the policymakers to follow when they're assessing these mean that the top guideline is to leave the occupation free unless and until they can be decided that there is actually a significant reason for the state to get involved. Even so, the state doesn't have to go all the way into licensing.

That's the most extreme way because licensing is an entry regulations a barrier to entry. So for example if you're worried about me for civil courts of the first and foremost role in government. If you have a bad experience with with the service professional you can take him to court. If you worried about fly-by-night provider someone is showing up me and allow registration with the Secretary of State's office. If you worried about insurance reimbursement than you can have certification if you worried about cleanliness. For example, require inspections, none of those say you have to perform all of these things and jump through all these hoops for you can even start your line of work. John, it sounds like your your recommending that licensing occupational licensing really be the last resort, not the first that's all the time we have for the program this week. Thank you for listening.

I'm Donna Martinez hope you'll join us again next week for another edition of Carolina Journal radio Carolina Journal radio is a program of the John Locke to learn more about the John Locke foundation donations support programs Carolina Journal radio send email to development John Locke.66 GLS info 166-553-4636 Carolina Journal radio protection of the timeline foundation airline is maintaining Carolina and run system. All opinions expressed on this program nearly formation about Michelle or other programs and services in the John foundation is John not very many like to thank our wonderful radial cross North Carolina and are sponsored Carolina Journal radio listening again