If I had to pick one book that has shaped my political philosophy, it would have to be Milton Friedman’s Capitalism and Freedom. It was a wakeup call, of sorts. All of his ideas made sense to me and were written from a radical perspective that I had never even thought of.
Many of the things he recommended seemed radical at the time but have now become accepted or at least respectable ideas: school vouchers, flexible exchange rates for currency, negative income tax instead of traditional welfare state measures, and a flat tax. However, I found it most difficult to grasp his recommendation to end the mandatory licensing of doctors. I still feel fairly uneasy about such a proposition and more importantly I think it is the least politically feasible of all his views.
If you want to think about the benefits of doctor licensure in consequentialist terms, consider these points:
- Do the licenses really completely protect consumers against medical malpractice (not really).
- Do the licenses potentially raise overall medical costs (yes, because there is a much smaller supply of doctors, they charge more)
- Are the requirements necessary to be certified set at the right level (potentially, but look how many years one has to go to medical school to get a license).
- Does the fact that a doctor has a license make you more trustworthy of that doctor (yes, I am going to assume).
- If there are no licenses, will people acting as doctors do a worse job because they can (maybe, but probably not. Think of other professions that don’t have licenses).
I remember reading a story a while ago that said the Florida attorney general tried taking the Florida Bar Exam and failed. The attorney general wouldn’t have been able to be a lawyer in Florida. This example shows that while occupational licensing may have the (supposed) intention of protecting the consumer, it can really just act as an effective cartel for those already in the profession. The cartel will limit the supply of those in the industry and effectively raise their wages. I think we can see this in the fact that some places require babysitters to have a license.
I am definitely not convinced completely that we don’t need licenses for doctors. If anything, I think we should have an “optional” licensing system. For example, doctors can be given a gold star if they have certain qualifications (which would make people more confident going to them) but doctors without those qualifications cannot be legally excluded from working. For instance, I could treat you with “alternative” medicines if you really trust me to do so. This seems more plausible. I know Carson supports the ending of licensing for doctors so maybe he’ll have something to say about it.
The following is a short video of Friedman speaking to the Mayo Clinic about the idea:
Video courtesy of Will Wilkinson.
September 29, 2009 at 6:08 pm
We should stop requiring that people get drivers licenses to be able to drive. The government costs in running DMV’s and driver education programs are completely unnecessary. Driving accidents continue to occur even though so called “licenses” are issued every day.
I’m kidding. I’m just pointing out that you are completely neglecting the concept of safety standards in the name of capitalism and competition. The point is that standards and licensing procedures must be constantly reformed and changed as new problems arise, but never completely done away with. It seems that system you propose would result in a class based system of doctors where the rich get “gold star” doctors and the poor get doctors that by today’s standards would be completely illegitimate.
I realize you probably have a good point to make here, but you must understand the ridiculousness of the idea of a medical free for all.
November 8, 2009 at 10:16 am
I think a good middle ground would be to allow doctors to practice given a certain amount of training — say, the equivalent of a masters degree — but can opt to receive (and pay for) more training, which would then be rewarded. That way, people with more money can pay more for premium care, but people without are still guaranteed some level of quality.