Small government is good medicine

Here's a pretty good interview with Milton Friedman:

Barry Goldwater once said, “I do not want to make government more efficient, I want to make it smaller.”

Republicans have control over the entire Nevada government. Will the state budget be smaller or larger in 2016? You can’t bet on politics in Nevada like you can in England. (Why not?) But if you could, the odds would be against Republicans leaving the state budget even one buck smaller than its current size.

Gov. Brian Sandoval is a thoughtful, accomplished person. He is a former federal judge and Nevada attorney general. It’s just that he thinks government can work well in some cases. I am hard-pressed to find evidence of that. Can you think of anything that government does really well? Certainly not education or health care. The governor did show support for education reform in his State of the State speech. He spoke of strengthening charter schools and private school choice. He proposed breaking up the Clark County consolidated school district, and consolidating rural districts. He stunned us by proposing that local school board members be appointed, not elected.

But then the thoughtful reformer suddenly morphed into a big-government Republican. He pivoted to proposing that the University of Nevada, Las Vegas have its own medical school. Why? Because “every major city has a medical school, and Las Vegas is the greatest city in the country!” (Cue the band and the showgirls with the huge headdresses, please!) For decades, the plan was that Northern Nevada got the medical school and Las Vegas the law school. Does this mean that the University of Nevada, Reno will get a law school in return?

Sandoval was the first Republican governor to build a state Obamacare exchange and expand Medicaid in his state. The Xerox-built Nevada exchange crashed harder than the federal exchange. Medicaid has very little to recommend it. It provides dubious health outcomes and expands government dependency while overworking physicians and cutting their compensation. It’s not a pretty picture, but it’s typical for government programs.

The governor believes that the answer to the problem he helped create—pumping up medical demand while discouraging supply—is to spend more tax money to lure medical students to a shiny new state medical school in Sin City instead of cowboy Reno. Sandoval promises his legion of new doctors will stay in Nevada. Why, exactly?

The current medical service model is top-heavy with doctors. With modern technologies, we don’t need more doctors. Doctors can provide remote consultations via Skype. What we need are more nurses staffing clinics, not more hospitals and doctors. Nevada took a step in that direction in the last legislature by permitting experienced nurse practitioners to work independently of physicians. The market is helping by providing low-cost clinics at CVS and Walmart.

Reno once had a law school. Judge David Humke is a graduate. It didn’t take long for the Nevada Bar and the politicians to shut it down. It violated their occupational licensing codes because it did not have its own law library, despite the fact that there were three accredited law libraries in Reno and Carson City that the students could use.

Nevada needs to abolish its outdated Progressive era occupational licensing boards. The legal and medical professions love occupational licensing, but doctors have been whiplashed because the left has been declaring health care a right while denying that government simply cannot provide it. Milton Friedman once said if you put the government in charge of the Sahara Desert, after a few years you will run out of sand. Doctors are quitting because of government regulations. Nevada doesn’t need a new medical school. It needs less government involvement in health care.