Gov. Chris Sununu signed a bill this week to make permanent the emergency changes expanding telemedicine services. The restrictions on telemedicine were not primarily to protect patients. They were to protect medical providers from competition. When the state makes it illegal to see a Boston doctor via video, patients have to see their local physicians.
Prohibitions on the practice of telemedicine are an extension of occupational licensing laws. Everyone knows you have to have a state medical license to practice medicine. But licensing laws also have prevented people from consulting online with doctors who are licensed in other states, even though technology makes this easy.
The percentage of occupations that require a state license has exploded, going from about 5% in the early 1950s to about 20% today. Economists have suspected that the growth in state occupational licensing laws has contributed to the decline in American mobility. If you’re licensed in one state, moving to another state can mean starting the licensing process all over again, as many states don’t recognize other state licenses.
A study published this week by the National Bureau of Economic Research supports that theory, concluding that licensing could account for about 8 percent of the decline in mobility.
Researchers Morris Kleiner of the University of Minnesota and Ming Xu of Queens University studied occupational license requirements in U.S. states from the 1980s through 2016. They found that “licensed workers are 24% less likely to switch occupations and 3% less likely to become unemployed in the following year.”
As they wrote, “occupational licensing has a strong and negative effect on worker labor market flows, but is associated with higher wage growth, whether a worker is staying in a licensed occupation or switching into a licensed occupation.”
The connection to higher wages has been well established. When the state erects a large barrier to entry for an occupation, thus restricting the supply of practitioners, compensation for that occupation rises. Who pays for that? Consumers do. And the costs outweigh the benefits.
“Existing studies have yet to find a definitive link between licensing restrictions and their stated purpose of improving service quality,” Utah State University researchers concluded in 2018.
Though improved quality is not evident, the barrier to entry created by licensing laws is significant. Kleiner and Xu find that “occupational licensing represents a barrier to entry for both unemployed workers (1.2% lower entrance rate) and workers who enter from other occupations (24.1% lower entrance rate).”
So not only are occupational licensing laws increasing consumer costs without demonstrating improvements in service quality, they’re also harming the broader economy by reducing economic mobility.
This hurts New Hampshire, which relies on migration for economic and population growth. New Hampshire has the second-lowest fertility rate in the nation (behind only Vermont). A UNH Carsey Institute analysis of Census data earlier this year showed that New Hampshire would have lost population in recent years were it not for people moving here from other states.
Occupational licensing laws, both in New Hampshire and elsewhere, make it harder for people to move here and to find work if they do. That has a negative effect on our economic growth.
We can add this to the long list of reasons why lawmakers should reform the state’s occupational licensing laws.