65 Comments
User's avatar
Reid's avatar

"The ADA fights [dental therapists] everywhere. They argue everyone deserves a full dentist. But cost keeps millions of Americans from seeing any dental provider at all. Also, dental therapists work under the supervision of a dentist."

Others have made this point, but it's amazing how much our regulatory environment is just letting the perfect be the enemy of the good. Yes, in theory everyone deserves access to a dentist. In theory, everyone should have an extremely specialist childcare worker looking after their child. But if in practice that means less access to dental care and child care, we're just doing harm.

Abi Olvera's avatar

This one really surprised me. I completely agree. Thanks Reid!

Michael Magoon's avatar

Great list. The Abundance movement needs to get alot more specific on what specific regulations it wants to undo and create model bills for state legislatures to copy.

Abi Olvera's avatar

True Michael thank you!

Quy Ma's avatar

"Three story buildings with only one staircase are illegal in most U.S. jurisdictions."

It’s wild how many cost drivers live in design rules that most people never see. Thank you for the insightful read. Eye-opening.

Abi Olvera's avatar

Thank you! This means a lot :)

Heike Larson's avatar

Lots more to add on childcare:

Some states, like CA, requires huge amounts of outdoor space per child—and that space must be specific for each age group unless the regular provided an exemption. Try having a huge yard in an urban daycare setting!

There are often strict rules on not mixing age groups of kids. If you can’t have 3-year-olds in a group that includes 18- months-olds, even for a month or two, you may need to keep spots open and not generating income in the older age groups. Often, younger kids are ready to move up early and it would be good for them developmentally but is illegal. This is a huge hidden cost—and a rule smaller providers often break anyway

Supervision and ratios often don’t account for flow during the day. While it may make sense to require a staff member for each 6 toddlers when they are awake, why can’t one staff member supervise 12 napping kids so the other staff member can have lunch? No, you need to hire a floater to give breaks while two staff members sit in the darkened nap room (and no, they can’t count that as a break, because of labor laws).

ADA requirements are another big one. When you can have 2nd floor classrooms you often must have elevators and renovate buildings with ramps for wheelchair access. This takes yard space or classroom space and costs hundreds of thousand of dollars. Never mind that you can carry a handicapped 5-year-old upstairs or just place them in a ground floor classroom—and never mind that someone in a wheelchair can’t really work as a toddler caregiver because of the physical demands of the job!

I could go on and on—and I truly believe that removing these restrictions could cut cost by at least 30%, and more in urban settings!

Abi Olvera's avatar

Whoa Heike! Thank you! I can't believe they have to hire a floater. I'll be adding these, thank you! Do the strict rules about ages and naps only apply to daycare centers? Or are they a reason why in-home daycares never register?

Heike Larson's avatar

I also think many providers don’t comply. You can get around some of this if you have a good relationship with your contact at the regulator. They may be kind and alert you when they come to check on you rather than arrive for an unannounced visit—but you are at their mercy as violations can be costly both in fines and in mandated parent communication.

Abi Olvera's avatar

Fascinating. Thank you!! Seems like an area ripe for selective enforcement because everyone agrees the rules are too onerous

Heike Larson's avatar

I don’t know; I only worked in larger daycare settings.

Aaron Bailey's avatar

@Heike - there are a few states that do have separate nap ratios but in practice they’re useless exemptions because the second a child wakes up, you revert to normal. It was less expensive and administratively burdensome for me to hire floaters than to deal with snap ratio changes. 🙃

Angela Richardson's avatar

I remember reading quite a few threads in r/eceproffesionals a while back that were complaining about various nurseries where unsafe, heavily coercive or sometimes downright abusive tactics were used to force infants and toddlers into napping so that they could comply with ratios.

Abi Olvera's avatar

Whoa! Thanks so much for flagging Angela. I love that sub Reddit - I'll dive deeper into this question! This is a really useful flag.

Abi Olvera's avatar

Thanks Aaron! Excuse my ignorance - but if a child wakes up, couldn't the second caregiver be called in from the break room? Also, perhaps the leeway could be "50% staffing OK as long as most kids napping"?

Aaron Bailey's avatar

That helps if someone’s literally 2 doors down the hall eating lunch or running to the bathroom. It doesn’t help overall staffing because I still need to have that many staff available. I can’t use the exemption to let people go to lunch (many states’ employment law says if I force you to stay on-site and on-call, it isn’t actually a meal break). I can’t use the exemption to cover other classrooms.

So it only helps for the extremely narrow cases of bathroom breaks, and even those are difficult-to-impossible to plan or rely on. I can’t exactly forbid you from peeing unless or until Timmy falls asleep.

Abi Olvera's avatar

Ah thank you! I know you've developed the chart of states. Do you know which states it would make a difference in by chance? I'd love to flag those.

KP's avatar

Having two staff members sit in on nap time is a child safeguarding measure. That is absolutely worth paying for.

In Australia, we've just jailed the worst pedophile we've ever seen who was a daycare worker. 60+ kids affected and he wasn't the only one that's come to light.

Abi Olvera's avatar

This sounds like the premise is that children should never be left alone with one person. Does this mean you would also want to make illegal a solo person running a five-person daycare in their home? This would probably make illegal a large chunk of Americas current affordable daycare slots.

Or could also install cameras.

KP's avatar

A key principle in child safeguarding is that children should not be left alone in a space with poor external visibility with only one unrelated adult. A lot of homes who have been set up for family daycare are mindful of this rule, and use sensible workarounds. Most family homes have a lot of windows for example. I've used Family daycare for my children and loved it. It was the right fit for my eldest especially who is autistic and completely overwhelmed by Center care facilities as a little one. I'm extremely pro-family daycare and starting one should be a lot simpler on all other metrics. Our government is also attempting to regulate it out of existence (it's max four kids in addition to the carer's own children).

Centre-based care NEEDS serious consideration of child safeguarding. You've got preverbal children who are extremely vulnerable, and a lot more of them. Cameras carry their own risks. We're currently weighing up surveillance cameras in daycare centres again because of the privacy risks to said children, and the fact that they are exposed to the internet which imposes an additional burden on Childcare providers to ensure their footage is secure.

Centre-based care is heavily government subsided and not means tested here In Australia. Yet we've had a series of major scandals with regulatory bodies failing to penalise or enforce improvements to Centers that were not meeting standards or outright abusive to children, not to mention their failure to report criminal sexual crimes against children until our Public Broadcaster exposed it. It's almost as bad as the Catholic Clergy Sexual Abuse Crisis. They took our tax money, gave it to private equity firms who charge parents 20k a year on top of those subsidies whilst failing to do basic safeguarding of kids. All while crying 'poor' and leaving parents and children hurt, and trying to find alternatives (whilst still funding said daycares with their taxes).

Heike Larson's avatar

Oh, I’m not arguing for lack of supervision; of course it is critical to avoid child abuse. You can solve for that problem though without requiring low adult/student nap time ratios: consolidate 20 or 25 kids into one room with two adults for naps, and/or install cameras. The issue with these very specific regulations is that they mandate extremely costly solutions when better alternatives are clearly possible.

Stephanie Nakhleh's avatar

I love this, Abi! Maybe an addition: New Mexico has the second-highest medical malpractice insurance rates in the nation—it's been driving away physicians at an alarming rate. We have no abundance of doctors, that's for sure. This was the source of the biggest legislative battle of this past session. That's a direct cost driver—not just for physicians, but ultimately for patients. And it's a rule-based problem, not a subsidy problem, which fits your framing perfectly. It's also the issue where NM has the most documented evidence, as it was the focus of this last session. And, reform won!

Abi Olvera's avatar

Oh amazing!! Thank you for flagging!! This week I’ll try to get a sense of what other states are impacted - that fits in yes!

ConnGator's avatar

Would the Jones Act and the Dredge Act be in scope of this?

Abi Olvera's avatar

YEEES. Though I'm planning a food/groceries/cost of living post. Jones and Dredge seem to impact prices of *everything*, rather than scarcity in the sectors above. Do you have favorite deep dives on these? :)

ConnGator's avatar

Balsa Research (which I support) has been doing good work on this.

https://www.balsaresearch.com/

Abi Olvera's avatar

I have a feeling I’m about to get radicalized. 😆

“Today, less than 4% of domestic freight moves by water despite our 95,000 miles of shoreline and 25,000 miles of navigable rivers”

Aaron Bailey's avatar

Minor tweak - home daycare is heavily split by numerical caps. So for instance CA actually has very strong preemption of local restrictions and allows it by right in all residential neighborhoods without allowing onerous extra fire or code requirements…for 1-8 children (including any of your own children younger than 10). If you want 9 children…well now you’re screwed because it’s up to your city.

There are a lot of numerical “cliffs” like this. I’m dealing with one now in the form of IBC requirements for schools of 50+ students to build extensive storm shelters in any part of the US rated for 250mph+ winds. Are tornado shelters evil? Of course not! But I can put 49 children in a building without a shelter (or weirdly enough, I can put unlimited children in a mobile building?!). And then as soon as #50 walks through the door, I have to build the same structurally-reinforced, fully-plumbed, fully-wired storm shelter that a 2000 student public school does. Which costs in the low to mid six figures. Suddenly, that viable school project is financially impossible.

(note that the square footage requirements scale with students, so my 50 student shelter is notably smaller than the 2000 student one. But the costs of running water, sewage, and electrical tend to be front heavy so they don’t neatly scale)

Abi Olvera's avatar

Thanks Aaron! Great point. I’m so glad you flagged! What would help? - for these rules would it be better to 2x them? Or switch to something more flexible? Or make the implementation required be more gradual?

Aaron Bailey's avatar

Better natural scaling would be helpful. Ditto better grandfathering of existing uses. Like the bike lane we chatted about, you often see that an existing (school, whatever) is perfectly fine without, but the second a new owner moves in they have to bring up to modern code. The same happens a lot with “use” (not occupancy) changes; sure, this is E occupancy and a school is allowed by right, but the building’s previous “use” was a preschool, so you need a change of use to do a K-12, and a CoU triggers new building code.

ICC does have International Existing Building Code that’s supposed to set more reasonable standards for existing buildings, but it’s so limited it often doesn’t apply.

I actually found a really good solution in Chicago of all places. They classify uses by hazard level. So if you want to change from Use A (which is level 5 or whatever) to any other use at the same or a lower risk level, no changes are needed. If you want to escalate +1 risk level higher, there’s a partial upgrade requirement (some updates, but you don’t bring the whole building up to new construction code). Anything +2 or greater, new construction code. It preserves the intent of grandfathering but gets rid of a lot of those “gotcha! K-6 is a different use than K-8!” traps.

Abi Olvera's avatar

Whoa, excellent flag. Aaron, thank you!!!!

Jeremy Levine's avatar

Great article Abi! And thanks for the link 🫡

Daycare NIMBYism can be truly the worst, but it’s changing. California has allowed in-home family daycares by-right in all neighborhoods, and it exempted mixed-use commercial daycares from local zoning and environmental review. But it’s insane daycares ever had to undergo environmental review in the first place, as if children are pollution! https://jeremyl.substack.com/p/how-i-became-a-radical-dimby-daycares?r=74nn5&utm_medium=ios

Abi Olvera's avatar

Thank you so much for writing that piece. It radicalized me! Lives in my head rent free o.o

John Quiggin's avatar

It would be good to talk about the general issue of local control versus harmonised regulation. Apart from the NIMBY/YIMBY context, I haven't seen much of this in the abundance literature. Australia has moved fairly strongly to harmonization, which was necessary. When I was growing up, each state had its own rail gauge, not to mention professionall qualifications.

Sam Harsimony's avatar

Wonderful. And looking forward to the ideas you add.

For healthcare, you might consider FDA using "peer approval" where it lists other countries with strict drug authorities and if one of those countries approves of a drug, it is automatically approved in the US:

https://marginalrevolution.com/marginalrevolution/2024/09/peer-approval-to-address-drug-shortages.html

Also on the FDA, this post has a lot more ideas, but I haven't read it fully:

https://blog.joelonsdale.com/p/make-the-fda-great-again

Abi Olvera's avatar

Thank you!! Added to my reading list! Thats an excellent flag about peer approval! That would probably decrease drug prices because of competition and because of newer cheaper drugs - is that correct?

Sam Harsimony's avatar

I guess with peer approval, I think of it as increasing the speed of approval more than increasing competition.

For example, say Ozempic gets approved in France for obesity 1 year before the US. With peer approval, Ozempic gets approved in the US at the same time as France rather than having to wait a year for the FDA to also approve it. The US market doesn't enjoy more products/competition (it was already going to approve Ozempic 1 year in the future); those products just arrive sooner and the FDA doesn't need to review as much stuff.

But to your point, if lots of new drugs are coming in from other countries, then presumably you'd see more competition in each drug category.

Tim's avatar

Here's another to add around housing costs: manufactured houses in the US are required by the federal government to have wheels on them. This highly constraints the form factors and usefulness for manufactured housing. The housing legislation moving through congress would eliminate this rule if it passes.

In places without these rules such as Scandinavia have much, much higher rates of manufactured housing and it's much cheaper to build.

Abi Olvera's avatar

I'll add this sometime this week. That's such a useful flag that Scandinavia has allowed manufactured homes. Thanks so much Tim! I love this!

K. Nikolas Renik's avatar

I like the idea of a living document. There's always room for improvement.

Here's a hundred ideas from another guy in a related vein, some of them might be of interest: https://danlewis8.substack.com/p/century-another-25-fresh-policy-ideas

Abi Olvera's avatar

I love it! Thank you! The kei trucks, apprentice-style nursing training, Swedish medical malpractice, research and commercialization of R&D, and gov agency to focus on seeking outdated regulations are perfect for this! I’ll check out the other 75 he wrote later - this is gold. Thank you!

James Brobin's avatar

I feel like the most important fact when it comes to this conversation, is, as the The New York Times states, "Rich countries contribute an average of $14,000 per year for a toddler’s care, compared with $500 in the U.S."

No matter how many supply-side deregulations are put in place, the US will never come close to matching similar countries in terms of supporting parents.

Abi Olvera's avatar

Yes, absolutely. Especially since toddler years, parents are earlier in their career too and likely making less money than later!

Valentina's avatar

This is great, I tend to think housing is simply broken but don’t really think about policy (because I don’t know enough about it). Easy blindspot for economists to forget about policy as an invalidator of many economic principles

Abi Olvera's avatar

That’s a good way to put it! :) There’s probably some way these dysfunctions are translated into econ speak - I think Econ does try to model rent seeking incentives too FWIW. :)

Jordan Young's avatar

Great list! The almighty HOA and its hatred of children is so infuriating.

I’d love to see one for small businesses. Where I live, permitting, signs, regulations are extremely strict and discourage small restaurants, shops, and businesses.

Abi Olvera's avatar

That would be great! How to make entrepreneurship easier and more accessible. Can you tell me about the signs?

Jordan Young's avatar

The code for getting “signage” for your restaurant or small business requires an entitlements expert and an attorney to decipher…..

White Squirrel's Nest's avatar

Wow this is all so ridiculous. I'm so sick of "safety concerns" that just result in more things being unregulated and potentially less safe. The childcare stuff reminds me of rules for foster care, so much red tape and it barely protects kids anyway & turns away quality foster parents.

Abi Olvera's avatar

Whoa - thanks for flagging!! Nest, do you happen to have any recommended readings? I’d really love to take this on as a research direction too!!

White Squirrel's Nest's avatar

I don't really have academic sources as such...I've been informally learning about it...I first became aware of many of the problems in CPS & foster care from a podcast episode, they used the term "Jane Crow" to refer to the systemic racism- here's a NYT article about it. I'll see if I can find the podcast episode. (I listen to many different podcasts!) https://longreads.com/2017/07/28/the-new-reality-of-jane-crow/ This Youtuber, Laura is a foster parent that makes educational shorts. Good accessible way to share info. https://www.youtube.com/@foster.parenting/videos. In general, African American & American Indian child welfare advocacy groups are great sources. https://www.nabsw.org/ Nat'l Association of Black Social Workers. I just found this org, National Indian Child Care Association. https://www.nicca.us/about

Abi Olvera's avatar

This is gold - thank you!