Occupational Licensing

Medical Licensing vs. Basic Health Care


Kevin Carson makes some points about medicine that can't be made too often:

doctorscoutThe professional licensing cartels outlaw one of the most potent weapons against monopoly: product substitution. Right-wing libertarians are fond of using "food insurance" to illustrate the effect of third-party payment: if there were such a thing as grocery insurance, with low deductibles and a flat premium, people would be buying a lot more filet mignon and a lot less hamburger. The problem is that we've got a medical licensing system that criminalizes the sale of hamburger and mandates the sale of filet mignon. While healthcare consumers fall into many tiers of income, the state mandates only one tier of service regardless of ability to pay.

Much of what an MD does doesn't actually require an MD's level of training. Unfortunately, no matter how simple or straightforward the specific procedure you need done, you have to pay for an MD's level of training. The medical, dental and other lobbies make sure that legislation is in place prohibiting advance practice nurses or dental hygienists from performing even the most basic services without the "supervision" of an MD or DD.

In an open-source healthcare system, someone might go to vocational school for accreditation as the equivalent of a Chinese "barefoot doctor." He could set fractures and deal with other basic traumas, and diagnose the more obvious infectious diseases. He might listen to your cough, do a sputum culture and maybe a chest x-ray, and give you a round of zithro for your pneumonia. But you can't purchase such services by themselves without paying the full cost of a college and med school education plus residency.

I'm not sure what would be "open source" about such a service, but I agree that it ought to exist. I also appreciate Carson's call for something like the old lodge practice system that existed before the AMA destroyed it, in which a fraternal society would pool its resources to hire a doctor who handles its members' medical care. Put those ideas together, and you'll have neighborhood clinics

staffed mainly with nurse-practitioners or the sort of "barefoot doctors" mentioned above. They could treat most traumas and ordinary infectious diseases themselves, with several neighborhood clinics together having an MD on retainer (under the old "lodge practice" which the medical associations stamped out in the early 20th century) for more serious referrals. They could rely entirely on generic drugs, at least when they were virtually as good as the patented "me too" stuff; possibly with the option to buy more expensive, non-covered stuff with your own money….No doubt many upper middle class people might prefer a healthcare plan with more frills, catastrophic care, etc. But for the 40 million or so who are presently uninsured, it'd be a pretty damned good deal.