FTC Drills Alabama Licensing Board for Anti-Competitive Scheme Targeting Teledentistry

“As part of a consent agreement announced Tuesday, the Federal Trade Commission (FTC) said the Board of Dental Examiners of Alabama would stop enforcing rules that limited “consumer choice and excluded new providers” offering braces and other teeth alignment services.

Those rules were crafted in 2017, after startups like SmileDirectClub began operating in Alabama. According to the FTC, the board took steps to stop the expansion of “firms providing clear aligners in Alabama through a teledentistry model” by amending its rules to ban dental hygienists and other medical professionals from performing the scans that are necessary to ensure proper fitting of the alignment devices. Previously, licensed dentists were allowed to supervise the scans from a remote location. Under the new rules, they would have to be on-site when the scans were done.

Over the next two years, the board delivered cease-and-desist letters to providers who offered those services without on-site licensed dentists.

“The actions of the Dental Board have deprived consumers in Alabama of low-price, convenient options for teeth alignment treatment without any legitimate justification or defense,” the FTC argued in a complaint against the board. Those actions, the commission says, “unreasonably restrained competition” and violated federal law.

The case is a sequel to the FTC’s 2015 victory at the U.S. Supreme Court in a case challenging anti-competitive behavior by a similar board in North Carolina. In that instance, the North Carolina Board of Dental Examiners sent cease-and-desist letters to kiosks offering teeth whitening services. The practice of whitening teeth, the board declared, could only be done by licensed dentists.

When that case ended up before the U.S. Supreme Court, the justices ruled that licensing boards controlled by a majority of “active market participants” could not make deliberately anti-competitive rules—unless those boards were “actively supervised” by some other element of state government. As a result of that ruling, licensing boards enforcing anticompetitive rules could be sued for violating federal antitrust laws.

The ruling opened up a new legal avenue for challenging overbearing licensing boards that limit economic opportunities by blocking competition in certain professional fields. It was a resounding defeat for overreaching state regulation and “the culmination of 15 years of effort” Maureen Ohlhausen, then-chair of the FTC, told Reason shortly after the ruling.

That case laid the groundwork for the more recent actions in Alabama, where six of the board’s seven members are required by law to be licensed, actively practicing dentists. And the board’s actions are not “reviewed or approved by any neutral state officials with the power to veto or modify” its decisions, the FTC found.

Under the terms of the consent agreement struck between the FTC and the Alabama dental board, the board does not admit to violating any laws or to engaging in the alleged anti-competitive behavior. But, going forward, the board has agreed to stop requiring on-site supervision by licensed dentists of the alignment scans necessary for teledentistry services.

That should give residents of Alabama—some 1.8 million of whom live in areas deemed to have a shortage of dental professionals and could clearly benefit from a greater supply of teledentistry services—something to smile about.”

It’s time to stop describing lifesaving health care as “elective”

“Data shows that more than 90 percent of US surgeries are considered elective or nonessential. Collectively, they bring the nation’s health care system between $48 billion and $64 billion of revenue per year. This is why so many hospital systems struggled financially in the early days of the pandemic: While beds filled with Covid-19 patients, many profitable services ground to a halt.

Yet the definition of essential care has varied not only by health care provider, insurance company, and hospital system, but also by the state, city, or town that a person happens to live in. Some conditions are clearly emergencies, such as a rupturing appendix. But “nonessential” does not necessarily mean something purely cosmetic like a rhinoplasty or tummy tuck. During the pandemic, Sakran said, he has had to postpone surgeries to repair hernias that impede people from comfortably eating or walking.

The logistical difficulty of defining essential care has been “an ongoing challenge for insurance companies,” said Jesse Ehrenfeld, a physician and LGBTQ health advocate who chairs the American Medical Association board of trustees. It “leads to a lot of individual decision-making happening that is inconsistent.””

Medical debt was cut nearly in half in states that expanded Medicaid

“The Affordable Care Act offered states a huge infusion of federal money to expand Medicaid eligibility to low-income adults, and about 30 states took that deal right away in 2014. Since then, new medical debt in those states has fallen 44 percent, a dramatically bigger drop than was seen in the states that refused to expand the program over the same period. Those states showed only a 10 percent decline.”

“nonmedical debt had fallen by similar amounts in expansion and non-expansion states over the time period they studied, 2009 to 2020, strengthening the case that Medicaid expansion was the difference with medical debt.”

“In states that expanded Medicaid, both the lowest- and highest-income groups saw their medical debt drop after expansion, but the amount of medical debt added annually decreased much more for the former (by $180, from $458 to $278) than the latter (by $35, from $95 to $60).
In non-expansion states, on the other hand, the lowest-income group averaged a $206 average increase in new medical debt, from $630 to $836. But the highest-income bracket still saw a small decline in new debt for medical care.”

“Those states are concentrated in the South. Eight of the 12 non-expansion states are in the region. Nearly one in four Southerners have some medical debt in collections listed on their credit report, compared to 10.8 percent of people in the Northeast and 12.7 percent in the West.”

Alabama’s Dumb Health Care Regulations Helped Create a Shortage of ICU Beds

“An insufficient supply of ICU beds is one of the acute crisis points of the pandemic. When hospitals run out of room to treat patients who need the most help, doctors and hospital administrators must make difficult triage decisions. This affects not just COVID patients but anyone else who might be in urgent need of medical care—car crash victims or those who’ve had heart attacks—and it almost certainly means that some people will die who otherwise may have survived.

It’s a crisis that has been made worse by outdated and ineffective government regulations—known as “Certificate of Need” (CON) laws—that actually reduce the number of available hospital beds by requiring that hospitals get permission from the state before adding capacity.

In Alabama, which is one of 27 states that subjects the supply of hospital beds to CON oversight by the state, we’re now seeing some of the consequences of these rarely thought-of policies. While the surging number of serious COVID cases there and elsewhere across the country is largely the result of unvaccinated Americans being hit by the highly contagious delta variant, a restricted supply of hospital beds is not helping.

Since March 2020, states that use CON laws to regulate the supply of hospital beds have seen an average of 14.99 days per month where ICU capacity has exceeded 70 percent, according to Matthew Mitchell, a senior research fellow at the Mercatus Center who crunched Department of Health and Human Services (HHS) data and shared his findings with Reason. Meanwhile, states that do not have CON laws governing the supply of hospital beds have seen an average of just 8.65 days per month with ICU capacity exceeding 70 percent, according to Mitchell.”

Covid-19 isn’t the reason that US life expectancy is stagnating

“The stagnation in life expectancy isn’t due to some natural limit of human lifespans. In 2019, life expectancy was 84.4 in Japan, 83 in France, and 81 in the United Kingdom and Germany. The US, with its life expectancy of 78.8 years, was already lagging before the pandemic.”

“The relatively poor health of the US is rooted in “fundamental causes,” according to epidemiologists Bruce Link and Jo Phelan. These are the social conditions like economic inequality and racial segregation that worsen some illnesses and reduce access to health care. In the US, solutions could also include policies that replace jobs in towns and cities that have been hollowed out by globalization and deindustrialization. The dignity of meaningful work can improve health.
Of course, we should not ignore the gains that can be made within medicine. I don’t mean high-profile technological advances that will make headlines or boost the bottom line of new biotech startups. I mean routine and preventive care that can detect disease early, help get patients into treatment, and provide a trusted source of medical advice.

Rather than wringing our hands about the Covid-19 life-expectancy dip, the US should be passing laws and expanding programs that draw medical workers into primary and preventive care, not least by paying them more. This is especially true in rural areas with aging populations and a shortage of doctors. Training more Black doctors, especially in obstetrics and gynecology, may lead to dramatic improvements in the shamefully bad maternal health outcomes among Black women in the US.

By focusing on one historical measure of years lost to the pandemic, we run the risk of dwelling on what we can’t change and ignoring what we can improve. If you want the next generation to live longer and healthier lives, one of the best things you can do is push for economic and health care policies that reduce economic and racial inequality, and help ensure that every person has access to the kind of world-class, routine health care that saves lives. Let’s give the demographers of 2110 something to celebrate.”

Will the Taliban roll back two decades of public health progress in Afghanistan?

“relatively little attention has been paid to what the Taliban victory will mean for one of the nation’s biggest accomplishments: the sharp decline in child and maternal mortality over the past two decades.

A study in The Lancet Global Health found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, one data set found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.

This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.”

“The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.

The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country”