The Volokh Conspiracy
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Occupational Licensing Needs a Haircut
A new paper shows how we can trim educational requirements for barbers, manicurists, and cosmetologists.
Are haircuts so complex and dangerous that everybody who cuts hair should undergo mandatory haircut training? Opinions vary.
There are plenty of parents who give their kids the occasional unregulated haircut. But when money is exchanged for a haircut, that's illegal—unless the haircutter has a license. If you want to cut hair professionally—as a barber or cosmetologist does—you'll need to undergo about a year's worth of training and pay around $10,000 or $15,000 of tuition to get a license.
It is hard to see how the nation is made better off by the requirement of such extensive training and licensing requirements to provide haircuts.
To be clear: some training requirements for these services are in the public interest. It's a good idea to make sure barbers and cosmetologists know how to (for example) safely sharpen, sterilize, and wield their tools. But most of the training that these prospective professionals must receive—by law—seems unrelated to health or safety. On the contrary: much of it seems devoted to matters like learning about various hairstyles, so that customers can get more comely coiffures. It's a fine thing for appearance professionals to learn more about makeup, color theory, and the beautification of fingernails, but the health and safety portions of such training are often minor.
The details of some of these licensing requirements are eyebrow-raising. In South Carolina, cosmetologists must take 50 hours of training in "public relations, salesmanship, and psychology"; in Arkansas, cosmetologists must endure 50 hours in "courtesy, neatness, and professional attitude." How Maryland's requirement of 36 hours of barber training in "job search skills" might benefit consumers is mysterious; the same is true for Oklahoma's requirement of 175 hours of barber training in "salesmanship, job search, shop management, history of barbering, and professional image."
The findings of "Regulating Glamour" suggest that—in a nutshell—only about 25% of the required training for barbers and cosmetologists is related to health or safety. That means that, on average, more than 1,000 hours of training that each of these professionals undergo is both required for licensing and unrelated to licensing's public-interest goals.
Such regulatory overreach implies that state-level policymakers could probably trim away the vast majority of their state's hourly training requirements for these professionals without affecting health and safety at all—and it raises an interesting question: what's the point of requiring a license to provide appearance services if the bulk of the license requirements are unrelated to health or safety? The rationale for imposing licensing requirements on appearance professionals that don't lead to health or safety is far from obvious. We don't make shoe-sellers take classes in the history of heels, loafers, and pumps; no law requires eyeglass vendors to study how frames complement facial shapes.
Here are the results from the 38 jurisdictions that specify training in various fields in a manner that permits measurement:
- Barbers on average must undergo 1,348 hours of training; the average percentage of health and safety training in their curriculum is 25.62%.
- Cosmetologists on average must undergo 1,491 hours of training; the average percentage of health and safety training in their curriculum is 25.45%.
- Manicurists on average must undergo 366 hours of training; the average percentage of health and safety training in their curriculum is 39.79%.
Given these figures, the average number of hours of required health and safety training for these 38 jurisdictions can be calculated. On average, barbers must undergo 345 hours of health and safety training in these jurisdictions; the analogous figure is 379 hours for cosmetologists and 146 hours for manicurists.
Notably, a central reason for licensing is that it protects consumers from making bad choices because of their lack of information or expertise. Consumers themselves don't always have the capacity to distinguish between necessary and unnecessary medical services—or between competent and incompetent medical practitioners.
But in the context of services from appearance professionals, the argument that consumers are without the information they need is empty. There is no knowledge barrier that blocks consumers from distinguishing between good and bad haircuts. Someone who receives incompetent medical attention might suffer terrible, life-long difficulties—but the problems of the recipient of an unattractive haircut are usually trivial and brief. The public doesn't need government to protect us from providers of bad haircuts—because of word of mouth and lack of repeat business, that problem solves itself.
These facts do not provide an argument for getting rid of licensing in its entirety; rather, they suggest that streamlining the hourly training requirements for licensees would advance public welfare by eliminating some barriers to entry—or, to put it less technically, by letting more people work. A related (if relatively unaggressive) goal was endorsed by the cosmetologists' Professional Beauty Association, which called for a 1,000-hour ceiling on their own training requirements; achieving that goal would represent a significant improvement on current training requirements, which average more than 1,500 hours nationally. I appreciate the public-spirited nature of the Professional Beauty Association's recommendation, although I doubt that its leaders will return the favor by endorsing the implications of "Regulating Glamour"—which suggest that a 300- or 400-hour ceiling on barber and cosmetology training requirements would be more appropriate.
Some states are making progress. Recently, Texas and Vermont trimmed the training hours required for cosmetologists from 1,500 to 1,000, thus enacting some of the least burdensome license requirements in the nation. Vermont upped the ante by creating the nation's least burdensome training requirements for barbers: a 750-hour requirement. Florida now statutorily confines all required barber education to the topics of sanitation, safety, and state law, although it is unclear to me whether Florida regulators have complied with the constraints of that statute.
Arizona Governor Doug Ducey has also signaled a desire to reduce the requirements that his state imposes on cosmetologists, saying "We want to continue to advance the ball, always protecting public health and public safety, but realizing where these regulatory regimes have been built up to stifle competition." The country will be better off when more states streamline licensing requirements—a practice which will simultaneously protect health and safety, lower prices, and spur job creation.
I can only hope that readers find the above discussion of reform of the regulatory framework for the mandatory training of appearance professionals as fascinating as I do (I suspect that this is not universally the case). In my forthcoming (and final) post here, I will discuss the most methodologically controversial part of "Regulating Glamour": namely, what is the most appropriate way to measure the portion of appearance professional training that is relevant to health and safety?
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In this economy, are you seriously suggesting we should put all those trainers out of work?
Monster.
Next thing you will want to shut down pipelines.
Because all legal procedures are procedures on the body, all should be proven safe and effective. Taking 300 hours of labor is a procedure on the body. Regulators must prove that time of education is required for better outcomes in the regulated task. Prove, 100 hours is not safe in a controlled experiment. Don't make stupid shit up to justify worthless, thievin', fraudulent, rent seeking, make work jobs for Democrat voters.
Criminalize rent seeking with the sentencing guidelines for armed robbery.
Just curious. If the public at large wanted barbers, for instance, to get more training than Greenberg thinks is reasonable, would Greenberg concede what the public wanted was part of the public interest?
More generally, if the public at large sometimes concludes free market economics do not adequately serve their interests, on this point or that one, does Greenberg insist that only free market solutions are in the public interest, with all others out of legislative bounds?
Is the public incapable of looking at the wall in a barber shop, to see if there is a diploma posted? Why does the public at large, in order to give its business to well trained barbers, have to deny the right of those willing to do business with less trained barbers that right?
The public is incapable of making decisions, so the self-important bureaucrats are here to save us from ourselves. Follow the Science!
People don't select doctors, auto mechanics, barbers, or anybody else based on certificates hanging on walls. They do it by word of mouth.
Actually, around here there's enough of a doctor shortage that I've been stuck with a Nurse Practitioner for the last year. "Selecting" a doctor requires that there be enough available that you can actually make a choice.
Sorry Brett, I'm not sure what your complaint is.
Let's assume that we don't require a license to practice medicine, as you seem to think would be desirable. So someone who lives in your area hangs out a shingle, as "Dr. Jones," despite having only minimal training in medicine.
Do you think Dr. Jones is going to provide better treatment than that NP you are complaining about? No. They won't. Stick with the NP.
This seems a strawman argument. I read Brett as asking for the regulators to no longer place ceilings on the capacity of med schools, which is done to reduce competition and create a shortage of doctors.
Not a strawman.
The issue of increasing the supply of medical school graduates is not the same as what Brett seemed to be referring to, which is loosening the requirements to actually practice. That gets you people less qualified than NP's.
It's weird to accuse someone of a strawman argument, and then just completely invent an alternative argument that they should have responded to instead.
I have no idea what Brett is advocating for, but since he never used the word "school" in any of his posts on this topic, it seems weird to suggest he's arguing specifically for a change in the capacity of med schools.
While we're at it, though, my quick Google searching makes me believe it's not true that med school capacity is limited by the government in any meaningful way. Why do you think it is? (There are various other limitations on the supply of health care in this country, notably certificate of need requirements which I agree are a bad idea, but it would be helpful to have a discussion about restrictions that actually exist.)
All of this is only "weird" to those who haven't been paying attention to the storm that has been brewing over this issue for the past couple of decades. Google "residency cap" for a good time.
Ah, so you have been reading about something and despite the fact Brett didn't mention it at all, he must be talking about that very thing!
I Gooogled "residency cap", which does seem like a potential problem. But I learned two things:
1) Seems weird that your argument is actually the government should be intervening *more* in the market by subsidizing more residency positions, and
2) The "cap" is only a limit on the aforemention subsidies and not an actual limit on physicians. For example, from https://www.ucop.edu/federal-governmental-relations/_files/fact-sheets/fgr-health-factsheet-gme-f1.pdf
"In California, there are nearly 11,000 residency slots, with
UCH accounting for more than half of them. Recognizing the
urgency of the situation, UCH began adding unfunded medical
residency slots and absorbing the cost."
The point is that residency slots ultimately drive the scarcity. Med schools set class sizes with that in mind: it's bad for the stats if too many of your graduates can't get a job.
And a limited amount of slush-funding from organizations like UCH doesn't change that calculus. Your article says a full-length residency costs in the neighborhood of $1M, and that's a cost that generally can't be passed on to consumers since most compensation is either at Medicare rates dictated by CMS or insurance carrier negotiated rates (which are generally scaled to the Medicare rates). So the only other viable option is to take it out of the doctors' hides -- either by lower pay or higher hours. And then if a given hospital/clinic goes ahead and foots the residency bill, they're subject to poaching by others that didn't and thus can offer the doctors a better deal.
See above. The government has already distorted the market, so for better or for worse they now have to fix what they broke.
Is the problem too few doctors, or too many doctors preferring to work in educated, modern, diverse, successful communities? Doctors tend to be educated, reasoning persons, so . . .
Bernard. I go way beyond your complaint. I am saying all meds with a high therapeutic index (low therapeutic dose, high toxic dose) should be over the counter. Everyone is his own doctor. Seek more learned help when you fail. You can diagnose a sleep disorder with an app on a smart watch. Should you require a licensed prescription for a CPAP, which is a fan blowing air? In addition, CPAP's adjust their pressures automatically.
" In addition, CPAP’s adjust their pressures automatically."
Where did you get that idea? Every CPAP I have ever had requires secret procedures to change the pressure setting, except to account for operation at high altitude.
The machine I own has a preset range which requires TPTB to change, but it starts the night at the low end of that range and ramps up through the night as needed by my breathing.
I know of those. But that is different to letting you adjust the range to anything that you'd like.
Mine ramps up in about 10 seconds.
"Let’s assume that we don’t require a license to practice medicine, as you seem to think would be desirable. So someone who lives in your area hangs out a shingle, as “Dr. Jones,” despite having only minimal training in medicine. "
Is a license beyond a medical degree required? I'm not sure how medical doctors are licensed, but is it anything beyond school, residency, etc? What would be lost if licensing were to disappear overnight?
I don't know.
My impression, from the experience one physician friend had when he moved to a different state, is that it's the degree and residency and basically a clean record otherwise.
The harder problem is getting admitting privileges at hospitals, which is a separate process.
And the license is different from board certification which requires a new test after 10 years of certifcation
An interesting question Vinni.
I'll ask my daughter. She works in a hospital environment which adds its own requirements. So that would make for a different situation from someone who just "hangs out a shingle" as a GP.
"Is a license beyond a medical degree required? ..."
I want to clarify this question. What I meant to ask was whether 2 identical persons, one of whom does everything up to and including the licensing, and one who merely does the medical school/residency/whatever. What does the license require that would be a substantial difference between these 2 MDs? What would the unlicensed doctor be missing (in our current system)?
Actually, I *do* believe that a MD will provide better treatment than the NP because *I* know about as much as she does, and it is the additional medical school training that I need.
Of course, I also look at the letters after the "MD" -- the board certifications and those are all private.
No, I don't want an OB/GYN operating on my eyes, even if she did do a surgical rotation in med school. (OB/GYNs ignorance of cardiology is a real issue in women's health today...)
"because *I* know about as much as she does, "
Wow! Dr. Ed is like Dr. Biden– a real doctor
Better treatment? Possibly not. Really depends on the extent to which the NP's legal privileges were abolished, and "Dr. Jones" was permitted to do the same sorts of things, such as providing prescriptions, and letting me get my blood tests done.
More conveniently? Probably, that NP isn't available on short notice.
I'm pointing out that, in the face of a shortage, there's no "selecting" to be done, you take what you can get.
Now, we might address WHY there's a shortage of doctors, a fairly complex topic. But, there is a shortage, and until it's resolved, who's choosing them?
Or maybe you live in Tennessippi: https://www.benzinga.com/general/education/20/04/15836871/states-with-the-most-and-least-doctors-per-capita-in-2020
For primary care, a nurse practitioner is probably better than a doctor would be.
Certainly, my doctor prior to the NP was somewhat elderly, (His retirement is why I'm using the NP now!) but we got along quite well. I have no particular problems with the NP, either, except that she's sufficiently booked up that I can't get a convenient appointment unless I set it up months in advance.
If I had any complaint about either it's that they're somewhat conservative, in a non-political sense, and I'd really like to try replicating Dr. Fahy's experimental thymus regeneration protocol.
At least in Massachusetts, there is a requirement that they actually have a red/white/blue Barber Pole displayed. I'm told that the Barber Inspectors actually check for it.
How many customers even notice it?
A pole or a sign: https://www.mass.gov/files/documents/2019/05/31/Cosmetology-Barbering-Electrology-Regulations-Effective-PRIOR-6.1.19.pdf
I think the libertarians have the better argument here. If "the public" cares about the training, why can't individuals just check if the professional they want to use is appropriately trained rather than forcing everyone to adopt the same standard? (It would be reasonable for the government to prohibit someone from lying about their credentials, though; and as the post acknowledges, safety-related training so the professionals don't accidentally injure us seems fine as well.)
If I want to pay less for my haircut at the risk of getting a really bad one, why does the rest of society care or get to have an opinion?
If you eliminate all the barriers to entry, it's possible the entire industry will be taken over by people who are bad at it and make little money at it but still manage to undercut anybody who would be good at it and make good money at it.
I know it seems far-fetched, but in fact this is what happened to journalism.
Well, that just seems to be "the public" preferring the cheap but crappy option, no?
I'm sure there are some limited examples of this happening. There's a lot of sadness in the practice of journalism in the past 30 years, but it's mostly a shift in the underlying economic model, not because the crappy options "won".
The underlying model couldn't exist were it not for the presence of the low quality/low pay journalists.
I wouldn't mind an underlying model my own self.
And big-rig truck driving.
There is no shortage of drivers -- there *is* a shortage of drivers willing to work 60+ hours a week and live a nomadic life where they are rarely home -- for $50K a year. Pay has not increased to keep up with inflation, drivers today are paid about what they were when trucking was deregulated 40 years ago.
The annual turnover of drivers in most companies is about 100%.
I see what you did there.
But seriously, this starts to sound a bit too much like the "ruinous competition" antitrust defendants wail about. If people give crappy haircuts for $6, they'll tend to get repeat business from people who care more about money than how they look (and to whom the prior regulatory-driven rate structure just represented deadweight loss). Others will choose to pay more elsewhere.
Yes. It's not like there's a shortage of hair salons at various price points. You can go to SuperCuts or a similar chain and get a haircut for $20, but that hasn't driven out of business the higher end salons that charge $50 or $100 for a better experience. (Or, hell, $500, but in that case you're paying more for the sake of saying you're paying more.)
Personally, I just have my wife go over me once a month with the same buzz cutter we used on the dog. I really don't have enough hair left that there's any point in styling it, as such, just keep it short enough to not be messy, without going for the shaved look. (Which is too much upkeep.)
Spoken like a honest man.
"If you eliminate all the barriers to entry"
If anyone was advocating eliminating all the barriers to entry, your response would make sense.
If medical school and licensing were barriers, med school would be the large concrete blocks, and licensing would be concertina wire.
Well, look at a relatively unregulated profession -- auto repair.
Private entities have largely evolved regulating much of that, from "book time" of how long a certain repair should take -- and hence price regulation with a posted shop hour rate -- to mechanic certifications.
The latter is particularly true with large truck engines and manufacture not only conduct trainings but certify mechanics to work on engines. It becomes relevant with warranty claims (e.g. school buses) because the manufacturer will make the engine, transmission and frame, with someone else making the actual bus and then selling it. Hence if there is a warranty claim for the engine (eg. 12" ratchet extension in the exhaust manifold -- true story) you take it to a factory-approved repair place and they bill the manufacturer.
The private organizations (and UL is one) use copyright/trademark on their logos to regulate. The ASE mechanic's patch, the AAA rating of motels, etc.
Just curious. If the public at large wanted barbers, for instance, to get more training than Greenberg thinks is reasonable, would Greenberg concede what the public wanted was part of the public interest?
I wouldn't.
I WOULD say that if the public really demanded this sort of thing, that would present a legitimate factor to take into account when deciding about the legal status of these regulations. This is a point people don't get but it is true- pragmatism plays a part in legal interpretation.
But the public wants things that aren't in its interest all the time. Democracy is good because it protects basic rights- it is not good because it leads to good decisionmaking. Democratic electorates do tons of idiotic things, and they are generally entitled to what they want, good and hard.
I can't speak for Greenberg, but that question should be locked up for assault and battery for doing extensive violence to the English language.
How bout “educational” requirements for progressive educators, especially at “elite” institutions? The benefits of a “trimming” would far exceed that of any other “profession.”
You're using scare quotes to try to convey a lot of meaning that people not already in your filter bubble are probably going to miss. Care to elaborate? What requirements are you talking about, and if you don't think that elite educational institutions are elite, what explains the demand for their services and the higher pay that their graduates command?
I think "teaching" is a great example to bounce ideas off of.
I have advocated since I was in High school during the 70's that lots of courses could be taught by people that haven't been in a classroom as a student for decades.
Advanced math. Accounting, Business, earth sciences.
I just talked to my almost 40 year old Engineering son if he would teach one class for one semester every year in calculus, or Trig, or Stat. Would his international employer give him half a day a week to do that? Yes on both counts.
But no teaching degree, so the teachers unions ban him from donating his time to the community. And the Students are prevented from a real person giving context to the content being taught.
He said yes on both counts
You raise an interesting point -- certification and training is required for high school, but not for college.
It's historical -- when Horace Mann started the Normal Schools, most public education consisted of only grades 1-8. High school was private and paid for (in most cases) by parents, although some communities paid for their children (who wished) to attend one of these "academies."
And what Horace Mann sought to do was to eliminate the practice of town leaders hiring the daughters of influential people to "teach school" until they found someone to marry. He sort to normalize (standardize) teaching and you had the concept of "grades" (i.e. first, second...) coming in around the turn of the 20th Century.
As much as I love to blame the Never Educate Anyone (NEA) for all the woes of education, this wasn't their doing -- they didn't exist yet. And when states expanded into both mandatory kindergarten and high school, the bureaucrats insisted that those teachers be certified as well. (As an aside, the uber-expensive private prep schools do NOT have to have certified teachers, although most prefer to.)
One other thing -- when the Federal Student Aid arrived, once-voluntary accreditation became a mandate to receive Federal $$$.
Even law schools --you aren't just accredited by the ABA but also a regional accreditor -- ask your dean...
"when the Federal Student Aid arrived, once-voluntary accreditation became a mandate to receive Federal $$$."
Hardly surprising. The price for accepting money is also accepting control.
As so-called real person may be an terrible instructor.
"As so-called real person may be an terrible instructor".
You must have had an idyllic educational experience.
I had 5th grade teacher that ruined me for math through college. I always thought I was math stupid until the real world gave context and now I'm very proficient. My Daughter taught for 9 years of elementary and has horror stories about teachers still teaching that are terrible. My own kids had to fight through bad teachers. All with all the required credits and credentials.......which for some reason does not screen for terrible.
That is a foundational assumption supporting licensing. Competence, but it doesn't work that way.
Hence the debate.
"You must have had an idyllic educational experience."
I did and all in public schools
I question whether occupational licensing, strictly speaking, is even constitutional. Quoted from Congressional debate on the meaning of "privileges and immunities":
"The inquiry is, what are the privileges and immunities of citizens in the several States? We feel no hesitation in confining these expressions to those privileges and immunities which are in their nature fundamental, which belong of right to the citizens of all free Governments, and which have at all times been enjoyed by the citizens of the several States which compose this Union from the time of their becoming free, independent, and sovereign. What these fundamental principles are it would, perhaps, be more tedious than difficult to enumerate. They may, however, be all comprehended under the following general heads: protection by the Government, the enjoyment of life and liberty, with the right to acquire and possess property of every kind, and to pursue and obtain happiness and safety, subject nevertheless to such restraints as the Government may justly prescribe for the general good of the whole. The right of a citizen of one State to pass through or to reside in any other State, for purposes of trade, agriculture, professional pursuits, or otherwise; to claim the benefit of the writ of habeas corpus; to institute and maintain actions of any kind in the courts of the State; to take, hold, and dispose of property, either real or personal, and an exemption from higher taxes or impositions than are paid by the other citizens of the State, may be mentioned as some of the particular privileges and immunities of citizens which are clearly embraced by the general description of privileges deemed to be fundamental, to which may be added the elective franchise, as regulated and established by the laws or constitution of the State in which it is to be exercised. These, and many others which might be mentioned, are, strictly speaking, privileges and immunities, and the enjoyment of them by the citizens of each State in every other State was manifestly calculated (to use the expressions of the preamble of the corresponding provision in the old Articles of Confederation) 'the better to secure and perpetuate mutual friendship and intercourse among the peopleof the different States of the Union.'"
Isn't it that a state can't impose MORE restrictions on out-of-staters?
So if they say a barber has to have XXX hours of training, then that goes for all barbers within the state.
If it's a P&I, actually is one, then the state can't deny it to anyone, regardless of whether they do it impartially.
Brett, the problem is that if an incompetent doctor or lawyer messes someone up, a lot of the time the taxpayers will be on the hook for cleaning it up.
Say I decide to open up shop as a doctor, even though I've never been to medical school a day in my life. I'm not going to be able to get insurance, but there will be a certain number of people who will see that I'm cheaper than a real doctor and will hire me on that basis. When I then misdiagnose something, and there are 50k in medical bills to fix my mistake, where do you think that money is going to come from? Like it or not, the consequences of bad choices tend to impact other people too.
I agree that someone who wants to give other consenting people haircuts should be allowed to do so, and that's because the stakes are much, much lower. I suppose I could accidentally cut someone with a razor I'm trying to shave, but even so the risk is far lower than for an incompetent doctor.
So I support licensing for the high-stakes professions, but that's not most of them.
"Brett, the problem is that if an incompetent doctor or lawyer messes someone up, a lot of the time the taxpayers will be on the hook for cleaning it up."
It's long been observed by libertarians that, if you collectivize costs, the next step is always collectivizing decisions, since you can't let people make their own decisions if it imposes costs on others. That's why libertarians generally oppose collectivizing costs.
The only way you can expect to make your own choices is if you bear the consequences yourself.
Sure, I understand the desire to license some professions, and maybe we could make the unlicensed practice legal given a waiver being signed?
Lawyers are a special case: They've used their leverage over the legal system to enforce a self-serving guild system for their own benefit. A least 90% of what lawyers do could be handled by paralegals.
So libertarians are against insurance?
Non sequitur, because insurance doesn't collectivize most costs beyond the short term. If I have a car wreck today, my insurance will pay the damages but my rates will go up for long enough that the company will likely get its money back and then some.
They'll go up, but probably not enough to cover the claim.
And health insurance is a substantially different animal than car insurance.
You don't understand insurance. They don't make money controlling claims.
They make money by investing premiums.
Not at all. Those that want insurance, buy insurance. Insurance protections should not be imposed by extortive taxes on the body politic, just because those who were elected decided they would be good.
Do you really need insurance explained to you?
Absent government distortions, such as the ACA, insurance takes a 1 in n chance per year of an event costing $X, and transforms it into a predictable yearly expense of $X/n, plus overhead and profits.
To make this work, the insurance company actively inquires into what your particular "n" and "X" are, and prices the insurance appropriately. So that, on average, and setting aside that overhead and profit, you should neither profit nor lose on the deal.
The insurance company, because they are pricing your risk into the insurance, is basically indifferent to what your risk IS. You want to go sky diving every day? No problemo, just expect to pay a lot for your life insurance.
By contrast, if the government provides your life insurance, and can't be bothered to fix the rate according to actuarial principles, (Because it operates on political principles, instead.) the government very much cares what your risk is, and will coerce you to lower it, and their expenses.
So, insurance is very different indeed from the sort of collectivized risk I'm talking about, that results in you losing your choices.
Voluntary insurance? No, of course not.
The idea that costs are somehow not going to be collectivized is pure fantasy. We are not barbarians. We are not going to allow people to die because they can't afford medical care. Even if they themselves were largely responsible for it. If we did, we could save a lot of money in the health care system by not treating smokers for lung cancer.
". . . if you collectivize costs, the next step is always collectivizing decisions. . . ."
Isn't this the basis of democratic/representative government and society in general?
“You know, we’re living in a society!” - George Costanza.
"There's no such thing as society." — Margaret Thatcher.
"....the problem is that if an incompetent doctor or lawyer messes someone up, a lot of the time the taxpayers will be on the hook for cleaning it up.”
That doesn't routinely happen now?
Medical errors are the third leading cause of death in America....
That includes people getting ill in hospitals. In any case that statistic is grossly misleading. In medicine there are many 40-60 judgement calls. Even within the standard of care by highly competent doctors a significant number of those calls can be judged as "incorrect" in retrospect.
So what is your point Dr. Ed? That you or an untrained, unlicensed person can do better?
"Say I decide to open up shop as a doctor, even though I’ve never been to medical school a day in my life. I’m not going to be able to get insurance, but there will be a certain number of people who will see that I’m cheaper than a real doctor and will hire me on that basis. When I then misdiagnose something, and there are 50k in medical bills to fix my mistake, where do you think that money is going to come from? Like it or not, the consequences of bad choices tend to impact other people too."
Is it licensing that ensures you're a "real" doctor, or the many years of medical school? I think your doomsday hypothesis of everybody claiming to be doctors just because licensing is changed, or even removed, is overly dramatic.
I'm not hypothesizing that "everybody" will claim to be a doctor. But it doesn't take that many to do a lot of damage. If you have 100 non-degreed "doctors" practicing, and over the course of their careers they do a half million dollars in damage each, that's a lot of money. And, depending on what they miss, potentially a lot of shortened lives of their patients as well.
And yet your catastrophizing scenarios didn't happen
a) in the many years before medical licensing became rampant or
b) in the countries that still don't have medical licensing.
Medical school is useful and, depending on the discipline, important for good patient care. Medical licensing is not the same thing at all.
Tell me,
Your kid has a life threatening illness as your are traveling across country. You can choose between two physicians one licensed and the other unlicensed and proud of it.
Which do you choose and why?
I choose the one with the degree, certifications and experience in the relevant field for that illness, not the one with a piece of government-issued paper.
Anyone proud of not being license is highly unlikely to be competent and also even more unlikely to pass the board certification test.
Rossami, I very much doubt that those are apples to apples comparisons. But if you have any citations I'll take a look at them.
Not to mention how many quacks – let's call 'em as they are – will declare bankruptcy after losing a suit that hey have delivered services below the standard of care.
How about the fully-licensed Black MD who got Bakke's seat in med school?
See: https://www.jeffjacoby.com/10931/affirmative-action-can-be-fatal
How about it Ed?
Why not discuss the many white doctor's who have grievously injured their patients.
You just can't resist the usual racist complaint, can you.
Is it actually racist to notice that the guy who got the slot contrary to merit turned out to be... not meritorious?
Actually, yes it is, as Ed just cherry picked that fellow with the implication that the case is typical.
It's hard for me to see how a loss of merit isn't inevitable in any field where meritocracy is displaced by some other basis for promotion.
But that's not the way affirmative action works, at least in theory.
Suppose that competence can be measured on a scale from 1 to 10. Suppose further that basic competence is an 8, but most good schools won't take you unless you're a 9 or higher.
Under affirmative action, you should not be admitted to any school unless you are at least an 8. But some of the better schools might admit some minorities who are an 8.5, thus dropping what had been their standard, but still within the bounds of competence. Yeah, someone who was more competent didn't get admitted, but neither did anybody who meets threshhold competence.
Sorry, "but neither did anyone who DOES NOT meet threshhold competence."
So, we agree the average competence dropped?
With the average competency dropping, the total costs of errors ought to rise? Upthread you seemed pretty concerned about those costs rising as a result of less competent people giving medical advice. What changed?
No, because it’s still within the bounds of competence.
You seem to be positing that a doctor's competence is a binary value - they are competent or they aren't. I think that it's much more likely that their competency is a continuous variable, from not competent to marginally competent to mediocre to pretty good to outstanding.
Brett,
As an engineer, you should know that any of the "meritocracy" measures have an associated error that is at least ±5% to 10%. Within that range placing one's "thumb on the scales" is not choosing "loss of merit." Indeed it may be choosing greater potential.
Any form of slavish adherence to scores is NOT choosing based solely on merit.
I certainly would never make a hire based only on so-called objective scores.
As someone who is statistically literate, you should know that deliberately sampling in a biased direction will result in the expected value of the mean of the sample moving in the direction of the bias, even if your measurement has errors.
Why do you assume that I commit systematic sampling errors that are as large as the error in the measurement? Why do you assume that the measurement does not have systematic errors that stem from the sub-populations. Moreover why do you assume that in small samples that the distribution is not asymmetric?
In my experience with 1 to N ranking of 100 to 400 persons, the uncertainty associated with a score can easily be ±10%. A few % weighting by a thumb on the scale is not going to change the statistical measures of the selection by an amount commensurate with the initial error.
It doesn't matter that the accuracy of your scale is plus/minus 10 pounds, and the systematic bias you are introducing is only one ounce - you are still moving the expected mean of the sample by an ounce.
What a non-race-obsessed individual might take from Jacoby's article is that doctors who don't know how to do liposuction shouldn't be allowed to do it.
It's case for some regulation, maybe. or should we let anone who wants to do liposuction, and the market will sort it out?
"the market will sort it out?"
That seems to be MrEd's preference
"It’s case for some regulation, maybe. or should we let anone who wants to do liposuction, and the market will sort it out?"
Why do you insist on continuing to make it sound like people who are in favor of revising, or eliminating, licensing are suggesting that any random person with no medical training can, will, or should be able to play doctor? Why do you insist on ignoring that doctors spend a decade in school?
Maybe the market will decide that the amount of schooling required to perform liposuction is less than the amount required to perform brain surgery, but that still doesn't infer that "no licensing" equals "no training/education". Or that Joe Mama should be allowed to open up shop and perform liposuction just because.
I would also be willing to bet that even most people who are against licensing in general think that doctors are one of the classes of profession that have the most need for some form of proof of competency.
The right to go into business (which I actually somewhat agree with you has been underprotected) does not mean the right to go into business free of regulation.
At any rate, what some framer said about the P/I clause is irrelevant to what it means now. Supreme Court caselaw is what counts, and under Williamson v. Lee Optical, almost all regulations are constitutional.
Google “list beauticians Phoenix” and witness all the stifled competition.
Mr. Greenberg advances a number of worthwhile points.
It is a shame he squandered his credibility (among reasoning, educated, modern Americans) by volunteering to become part of the Trump administration.
Just imagine Artie shuffling down the hall on a walker in a nursing home __ years from now muttering, "not enough marshmallows in the Lucky Charms this morning... that dad-blasted TRUMP!"
Years from now?
Arthur, you already made this point five times or so when commenting on my previous post, so I'm not going to take the bait again. But look at it this way -- I served four terms as a county and state legislator long before I took a position in the federal executive branch in 2017 -- so my credibility was squandered beyond repair long before the period you are concerned about!
I know you work here, but you should really use the mute function. Its hard to explain how good I feel when a comment is greyed out and muted and who is muted.
I wonder if Artie is the #1 most muted?
This is why. Just ignore him Dan, he's a shitty spam troll.
We really should start licensing those "fact checkers" and see no real reason why not to do it.
Other than that pesky Constitution.
Doesn't seem to get in the way of any "progressive" these days so don't see a hurdle there...
Isn't some state legislature actually working on a law to do just that?
Pennsylvania requires training and licensing for barbers and cosmetologists. Over 25% of that training is health related. Yet some of the first places closed and the last to reopen were barber shops and beauty parlors. That's right. They closed one of the few industries that were trained and equipped to deal with the virus. It was mentioned that the politicians didn't want images of "rich people in barber shops and beauty salons" on television during the "15 day shutdown".
Um, nobody trained barbers in dealing with respiratory illnesses.
Hopefully we can all agree that the only medical procedure barbers should be doing is bloodletting.
How about price gouging?
The training and licensing requirements for 'appearance' occupations have to be BS...A barber requires 2000 hours of training, but a paramedic only requires 1100 or so? A paramedic that can just as easily stop your heart, as start it?
I will discuss the most methodologically controversial part of "Regulating Glamour": namely, what is the most appropriate way to measure the portion of appearance professional training that is relevant to health and safety?
I don't get why this percentage matters. The main thing, ISTM, is to make sure that this part of the training is adequate, in terms of hours, to cover relevant health and safety issues. To say, for example, that 50% of the training must cover these matters is silly, since you can achieve that by just reducing the rest.
Just specify an hours and content requirement. If the schools want to offer additional coursework, or not, leave it up to them.
I don't think the author would disagree--highlighting that the majority of hours are NOT related to health and safety just demonstrates that the current requirements are significantly more burdensome than necessary.
" Florida now statutorily confines all required barber education to the topics of sanitation, safety, and state law"
That sounds sensible
The first step is to eliminate all the non-safety-related training. The second step is to make sure the safety-related requirements are reasonable. It does not take hundreds of hours to learn to sanitize equipment or to read the safety instructions on the product label.
"Ah, chi mi dice mai
quel barbaro dov'è?
Che per mio scorno amai,
che mi mancò di fè?"
"Ah, who can tell me
where that unlicensed barber is
whom I chose, unfortunately,
and whose professional ethics turned out to be sub-standard?"
https://www.youtube.com/watch?v=vMXU5pjhPTM&t=1362s
another myopic post. the author does not think its important for stylists to be required to keep up with current hair styles? Maybe he gets crew cuts or does not have any hair remaining but I can think of lots of people who would disagree with him on its importance..
I can't tell if this is a Poe's Law thing. Which is actually what makes Poe's Law, Poe's Law, so…
It's pretty funny either way.
I think a lot of girls will like a dirty light hairstyle. Such hairstyles give a new sexual image and look just great. My roommate told the site https://lovehairstyles.com/feathered-hair-cuts/, where everything is written, about such hairstyles. And indeed, my neighbor's appearance has changed surprisingly. What's for the best.
I think that the hairdresser is obliged to have a license, since many of them do not even monitor the state of their instrument. My girlfriend found the article "45 On-Trend Ideas Of Featured Hair Cuts For Every Length And Taste." If interesting, then on the https://lovehairstyles.com/feathered-hair-cuts/, more detailed information about such hairstyles. She's very suitable for my girlfriend.