The Problem with Federalized Nursing

Representative Lois Capps (D-California) seems to be a nice person. If she weren't so busy trying to erase the Tenth Amendment, I would have more respect for her legislative record. But the freedom train makes very few stops here in whine country, where natural-born anti-federalists are more elusive than grizzly bears.

On a recent trip to the foothills of the Santa Lucia Mountains at the northern end of her congressional district, the Democrat from Ladysmith, Wisconsin via Santa Barbara, California, spoke urgently about the shortage of skilled nurses.

Capps used to be a nurse. Having worked in hospitals and schools before ascending to the congressional seat previously held by her late husband, Capps knows that her former profession has an image problem. Men still associate nursing with women, even while women gravitate toward less stressful jobs as rodeo clowns, air traffic controllers, and real estate brokers.

Unmotivated by low pay and high stress, fewer people are applying to nursing programs. In a speech earlier this year, Capps estimated that California already lacks 30,000 registered nurses. Additionally, the Bureau of Health Professions reports that the average age of registered nurses working in healthcare nationwide has climbed to 43. These trends are worrisome because Baby Boomers are going to need more nurses as they get older, and the rest of us are either in the same boat or within hailing distance of it.

Capps tackled the nursing shortage by calling it a crisis. (Politicians think in terms of "crisis" rather than "problem" or "challenge" because crisis management of any kind wins funding.) She then sponsored House Bill 1436, also known as the Nurse Reinvestment Act of 2001.

This legislation was popular enough to arrive in the subcommittee where it now sits with bipartisan support from 141 co-sponsors, all of whom are from the government and here to help. Because Congress has a socialist fondness for central planning and chases causes faster than some dogs chase tennis balls, lawmakers hope to ease the nurse shortage by giving nurse recruitment and training efforts a $116-million-dollar shot in the arm over the next three years. Similar legislation is crawling through the Senate.

Many health care professionals applaud these efforts. By federal standards $116 million is chump change, but the Capps bill is not a sure thing, because there is no word yet on plans for addressing similar shortages of engineers and pharmacists. More importantly, congresscritters have already tampered with the budget surplus and the so-called "lockbox" on Social Security. Columnist Stephen Moore observes that, "It used to be that Congress spent $20 or $30 billion a year on parochial projects like parking garages, dams, and hometown university grants on honeybee mating behavior. This year the total cost of requested pork projects has reached $280 billion."

The national nurse service corps that Capps envisions cannot be dismissed as pork, but her bill does have to compete with other funding requests. Accordingly, a motor home left San Luis Obispo, CA on July 2, hoping to build a groundswell of public support for the Capps bill. This vehicle is now embarked on an eleven-week trip across the United States, with stops planned for sixty cities en route.

I love the irony. Unfamiliar with the yeoman work of writers for this site who debunk junk science as soon as it makes news, Capps fans mean to drum up support for her Nurse Reinvestment Act by contributing reluctantly to their own nightmares of global warming and fossil fuel depletion. If they could wow the populace without propagandizing from a big white 1999 Fleetwood Tioga motor home, they would.

There is, however, a real problem: federal subsidies for nursing are unconstitutional. In an age when policymakers arguing about the Patients' Bill of Rights can't remember more than two of the ten amendments in the original Bill of Rights, few people question federal spending anymore, but I'm one of them.

With regard to the Bill of Rights, lawmakers typically pervert the First Amendment, invoke the Fifth, and ignore the other eight. As denizens of LewRockwell.com well know, the Tenth Amendment says plainly, "The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people." Among other things, the Constitution says nothing about federal subsidies for nursing.

Never mind that bovine (or, more commonly, taurine) excrement about the Constitution being a living document subject to the evolving experience of the American people. George Washington warned us about con artists who use that argument, not least among them federal judges and former presidential candidates. In his Farewell Address, Washington emphasized that the Constitution applies to all citizens, and that "change by usurpation" (that is, without passing an amendment) is "the customary weapon by which free governments are destroyed."

James Madison wrote most of the Constitution and was even more blunt about its limits. "I cannot undertake to lay my finger on the article of the Constitution which grants a right to Congress of expending, on the objects of benevolence, the money of their constituents," he said. In other words, Congress is not authorized to spend taxpayer money on everything it thinks is a good idea.

Some people say that congressional spending fulfills the constitutional purpose of "promoting the general welfare," but Madison had an answer for that, too. "With respect to the words general welfare," he wrote, "I have always regarded them as qualified by the details of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character.not contemplated by its creators."

If more legislators heeded Madison's advice, many of the 107 informal committees that seek to influence House policy on a wide range of issues would be dissolved. The Lois Capps web site cites her membership in 27 different committees, among them the fishy-sounding "Fairness " and "Cut Flowers" caucuses.

(When Congress talks about "fairness," think affirmative action; when it talks about cut flowers, be grateful that gladiolas are not as starry-eyed by political power as interns seem to be).

Bottom line: the Nurse Reinvestment Act trashes the Constitution. Better to leave nurse recruitment and retention in the hands of cities and states where it belongs. Classical liberals whom we now call conservatives might remind their state-worshipping friends that the Constitution is a blueprint, not a blanket.

Naturally, neither this argument nor the people who make it are popular with those who have no qualms about expanding state power. On reading some years ago that the usual suspects did not want Rush Limbaugh to be a spokesman for Florida orange juice, humorist Tony Kornheiser wondered whether leftists think conservatives should get scurvy. Of course they do. Tolerance for diversity only goes so far with this crowd.

In lieu of federal subsidies, communities and clinics hoping to attract nurses and nurses' aides can provide low-interest home loans like the ones some banks now reserve for teachers. They can encourage flexible shifts, increase staffing, pay higher wages, and publicize the rewarding aspects of nursing in particular environments.

Local solutions help to ensure that congressional problem solving remains within Constitutional bounds. In the immortal words of Thomas Jefferson, "The two enemies of the people are criminals and government, so let us tie the second down with the chains of the Constitution so the second will not become the legalized version of the first."

Nurses are wonderful, but if government growth continues unchecked, American freedoms will be at "Code Blue" in emergency rooms before Americans themselves are, and no amount of nursing will help then.

July 14, 2001

Patrick O'Hannigan is a technical writer in California.