The New Ideas Blog

I recently wrote a page about one of the ways to make a government health care plan work better. That doesn’t mean that I am in favor of such a system, but if we are going to have one I hope that we can at least do it in a way that doesn’t result in either bankrupting the country or rationing medical care. My idea was that you have to make people pay for the first thousand dollars of their care annually and pay an ongoing portion thereafter in order to discourage unlimited demand and to keep the medical industry competitive, as well as to make the whole thing affordable for taxpayers. That page is here:

Health Insurance Reform - New Solutions

But in this post I want to suggest some more radical ideas for making the system more affordable for everyone. Specifically, I want to start with this: Stop licensing doctors and other health care professionals. Stop regulating who can offer what services.

This sounds a lot more extreme than it actually is. After all, would you go to a surgeon who could only say, “Well, I read about this procedure so I think I can do it?” No, you would want one with training. And if he had a medical degree on the wall but didn;t actually earn it he would rightfully go to jail for fraud.

On the other hand, if a legal license was not necessary, a training facility could certainly turn out nurse practitioners in six months of intensive training, and these would be qualified to treat minor injuries and illnesses in clinics that they could easily open. Lower barriers to entry would get a lot more people involved in providing health care in new ways like this, and so costs would go down.

For a good example that is easy to understand, look at having your teeth cleaned. If you have had this done in recent years you know that dental hygienists do the cleaning most of the time now. But they cannot do it in their own office. A licensed dentist must be there. This is why it costs $60 for that thirty minute cleaning, even though the hygienist is making only $12 per hour.

Now if the law did not prohibit it, a smart hygienist could open a service just for cleaning teeth. He or she might do a dozen cleanings or more daily at $30 and even after overhead and payments for the necessary tools make a net profit of $160 daily. I’ll do the math for you: The costs of dental cleaning is cut in half for the consumer while the hygienists wage/profit goes up to $20 hourly.

We don’t here about any solutions like these that allow for true innovation in the area of medical care. If we do mention them people bring up safety issues, apparently unaware of two facts:

1. Medical care is already far more dangerous than people know.

2. Licensing is not primarily about safety, but about providing the control necessary to keep wages and profits up in an industry.

I mentioned the idea of eliminating licensing requirements to a friend, and he brought up the fact that there would be fake doctors out there. I said this is serious fraud and they would go to jail when caught. He mentioned that some are practicing without a license now and don’t get caught for years. He made my point perfectly: the current system does not in any way guarantee safety. However, because it provides the politically necessary illusion of greater safety we spend more time researching which large screen television to buy than checking into the track records of the doctors who we hire - despite the obvious logic that out of any 100 heart surgeons one has to have the worst record of success (and fifty have to be in the bottom 50%).

Now, once you understand that people would still demand actual training as a doctor before hiring one, and that many hospitals would probably require the same credentials as they do now (minus the piece of paper that the law currently requires), it isn’t so scary is it? If you have the money you already have the ability to go yet another step and search out the best doctor in his field - and that has nothing to do with legal requirements. But think of the possibilities this opens up!

A man trained intensively for six months specifically in treating sprains and minor injuries could open a clinic and charge half of what clinics charge now for treatment. With such specialization he might even do a better job than doctors who were trained for eight years in all areas of medical care. If a case was beyond his abilities he would just refer you on to someone else - as is done now anyhow. If it was a true emergency he would sent you to the hospital emergency - as is done now.

I won’t go on too much further with this. If you are intelligent and creative you can easily imagine a hundred ways to provide better and cheaper medical care if there were no laws to prevent people from doing so.

But there is one last issue that is worth bringing up. It has to do with the concepts of crime and law. True crime is a concept that certainly goes beyond illegality. Many crimes have been committed that were legal at the time, and many perfectly innocent actions have been illegal at times. So if we want to do what is right we cannot be constrained by the concept of legality. Now, with that in mind, let’s suppose the following scenario:

A woman who didn’t have the money to finish nursing school nonetheless has a real talent for caring for people and their injuries. She charges a modest fee for treating the cuts and scrapes of children of poor neighbors who can’t afford a regular doctor. She never presents herself as having attended medical school nor as having a medical license, so her customers are not deceived or taken advantage of - they know what they are getting. She refers serious cases to the local hospital.

Is she committing a crime? If the customers know what they’re getting and want it, do we have the right to get between the two parties and say it isn’t allowed? Furthermore, for helping to heal their children at a lower cost, but without government permission, do we have the right to take away her freedom and put her in a cage for years?

It’s an important question because all licensing assumes  that no matter what consenting people want to agree to between themselves, the rest of us through our governments have a right to not only prevent such freely entered agreements but to imprison people for daring to assume such freedoms. I’ll have more to say about this in future posts.

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Tags: government health care, health, health care

This entry was posted on Friday, August 14th, 2009 at 2:15 pm and is filed under Political Ideas. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.