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PaperclipPerfector  1yr ago (text post)   25228 thread views

Culture War Roundup for the week of October 30, 2023

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Was the idea of raising wages discussed?

Yeah, this was the crux of the side debate, where Democrats pointed out in the past they've tried to pass greater funding to allow for raises, but Republicans have been opposed. The rule that 80% of federal funds must go to direct workforce is also an atetmpt to ensure that wages are prioritized, if not having raises literally mandated.

If there truly are not enough workers who meet the legal requirements, then maybe the law should be changed to stop limiting supply. The federal government could make a "shall issue" style law for getting qualified as a caregiver.

I think this would be ideal, but both Democrats and Republicans are less likely to pass laws that are seen as targeting state level regulations in absence of a very compelling reason. It happens of course, but getting a serious majority on board with removing a masters degree requirements for specific industries for twenty seven states or whatever is a harder legislative sell than just passing funding laws or regulations that aren't directly challenging state govs. Significantly, this wasn't even discussed by either party in the hearing, I've just happened to hear Senator Cassidy say it in another context.

Or leave it up to facilities and customers to negotiate the level of training they require.

Training and cert requirements are also mostly handled by state law so unfortunately there isn't a ton of room to directly negotiate for providers.

The rule that 80% of federal funds must go to direct workforce is also an attempt to ensure that wages are prioritized, if not having raises literally mandated.

But the side effect is that technology that reduces the workload of nurses is discouraged, since you run into problems if you spend money on technology, rather than nurses. Thus making the nurse shortage worse.

Fair point

I think this would be ideal, but both Democrats and Republicans are less likely to pass laws that are seen as targeting state level regulations in absence of a very compelling reason. It happens of course, but getting a serious majority on board with removing a masters degree requirements for specific industries for twenty seven states or whatever is a harder legislative sell than just passing funding laws or regulations that aren't directly challenging state govs. Significantly, this wasn't even discussed by either party in the hearing, I've just happened to hear Senator Cassidy say it in another context.

They should just go all the way and remove the ability of states to create licensing requirements for jobs. It was a nice little experiment while it lasted, giving every last petty tyrant in every industry the right to restrict their own competition. But it has two inevitable outcomes, worker shortages and price increases for consumers. Allow states to set up certification systems, but do not allow them to restrict what work can be done by whom.

Of course it takes a crisis in geriatric care to get the geriatrics in congress to notice this massive blunder.

I'm in favor. It would be a pretty massive move away from federalism and towards centralization, so I imagine it would be hard to pass though.

Of course it takes a crisis in geriatric care to get the geriatrics in congress to notice this massive blunder.

You seem optimistic and assume they notice actual problem

They are noticing a worker shortage in geriatric care. There has been a shortage of medical personnel for a while.

I suspect they may be noticing evilness and bizarre uncooperativeness of nursing homes operators, utterly without connecting it to worker shortage or guild system causing it.

everyone in both parties agrees that we have a critical lack of workers in nursing homes

are they agreeing that it is caused by shortage of such workers?

Yeah, the hearing the OP was from focused on a shortage of workers in nursing homes. There were a few people who ran nursing home systems as witnesses, no one suggested they or anyone else were evil or uncooperative.

Is it a blunder if such policy would be unconstitutional?

“Interstate commerce” may be pretty tortured, but license to practice within state borders is certainly not a central example. I’m not sure you could destroy the state ability to regulate work without also destroying its ability to regulate…anything.

Forbidding protectionist licensing schemes seems squarely within the Dormant Commerce Clause powers of the federal government:

The Dormant Commerce Clause, or Negative Commerce Clause, in American constitutional law, is a legal doctrine that courts in the United States have inferred from the Commerce Clause in Article I of the US Constitution.[1] The primary focus of the doctrine is barring state protectionism. The Dormant Commerce Clause is used to prohibit state legislation that discriminates against, or unduly burdens, interstate or international commerce. Courts first determine whether a state regulation discriminates on its face against interstate commerce or whether it has the purpose or effect of discriminating against interstate commerce. If the statute is discriminatory, the state has the burden to justify both the local benefits flowing from the statute and to show the state has no other means of advancing the legitimate local purpose.

For example, it is lawful for Michigan to require food labels that specifically identify certain animal parts, if they are present in the product, because the state law applies to food produced in Michigan as well as food imported from other states and foreign countries; the state law would violate the Commerce Clause if it applied only to imported food or if it was otherwise found to favor domestic over imported products. Likewise, California law requires milk sold to contain a certain percentage of milk solids that federal law does not require, which is allowed under the Dormant Commerce Clause doctrine because California's stricter requirements apply equally to California-produced milk and imported milk and so does not discriminate against or inappropriately burden interstate commerce.[2]

The question becomes whether states have a legitimate compelling interest in having separate regulatory regimes, even if they have fundamentally the same actual standards. I would think not. States could probably carve themselves out some exemption in cases where they demonstrate materially different working requirements though.

Thanks for linking this, that was useful to know the exact way the law could apply to state licensing regimes.

Congress has multiple levers for encouraging state compliance. But no, none of this is really constitutional.

The political solution should be at the state level, but if congress is going to keep insisting on messing with medical care at the national level I don't see how this is much different.

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