Wednesday, April 8, 2009
The Capitalist Cure: Physician, Deregulate Thyself
By: Adina Cappell
I’m a medical student in Southern California, and am honored to write my first post for the SFL blog. Through my series, "The Capitalist Cure," I hope to address the intersection between liberty and health care, regarding issues such as medical marijuana, physician-assisted suicide, and the fight against socialized medicine. Today, I’d like to discuss government licensure of health professionals.
The Nevada State Senate is currently considering a bill that would “tighten” standards for a doctor to practice medicine. New Mexico is now the first state to require official licensure of medical sonographers, due to a new law signed by Governor Bill Richardson. Meanwhile, the Minnesota Dental Association is vigorously fighting against a bill that would allow “Oral Health Practitioners” to perform cleanings and fill cavities, without dentist oversight. Even as health care becomes increasingly expensive, patient advocacy groups, professional organizations, and government bureaucrats push for less freedom to perform medical procedures. It sounds reasonable to protect people from unqualified, or even dangerous health care providers. But, overall, do all of these restrictions and regulations help patients?
Milton Friedman didn’t think so. In his 1962 book, Capitalism and Freedom, Friedman wrote, “I am myself persuaded that licensure has reduced both the quantity and quality of medical practice; that is has reduced the opportunities available to people who would like to be physicians, forcing them to pursue occupations they regard as less attractive; that it has forced the public to pay more for less satisfactory medical service, and that it has retarded technological development both in medicine itself and in the organization of medical practice.”
Many medical protectionists lobby against Wal-Mart clinics, where kids can get vaccinations from nurse practitioners, at a fraction of the cost of a visit to the doctor's office. While physicians are certainly most qualified to perform particular health-related tasks, such expertise provides little comfort to uninsured Americans who are ineligible for Medicare, and who would benefit most from visiting a health care provider who is “somewhat less qualified.” Additionally, the medical tasks that nurse practitioners perform are often relatively routine and basic; It is most efficient for physicians to direct their time and expertise to the most complex cases and procedures, rather than to health-related needs that others could address competently. Indeed, in the absence of medical licensing, there would still be many ways for a layperson to ensure that a health practitioner is skilled and knowledgeable, whether by heeding the recommendations of private licensing institutions, poring over respected consumer review agencies, or finding out by simple word of mouth.
We’ve all heard of the pre-med sabotage stories- some real, some apocryphal. Tearing out pages from the library’s organic chemistry book. Messing up the roommate’s drosophila experiment. Students take desperate and immoral measures to ensure admission into one of the precious few spots available in U.S. medical schools. But why must things be this way? Why can’t any old ambitious and dedicated creature become a successful pre-med? Like many situations involving the heavy hand of government, the artificial cap on medical students leads to the yearly disappointment of almost 60% of applicants to allopathic schools, as well as the corrosive pre-medical cultural norm. The tragic thing is, however, that none of the barricades that we place before aspiring physicians does anything to help the many Americans who half-heartedly consume their vitamins, hoping to stave off a potentially unaffordable visit to the hospital.
Adina Cappell blogs at http://healspiel.blogspot.com