Tuesday, September 15, 2009

Dr. Milton Friedman Argues for No Licensure of MDs to a Group of MDs at the Mayo Clinic in 1978



Speaking to a group of medical professionals at the Mayo Clinic in 1978, economist Milton Friedman argues for "no licensure of physicians," because that would help to "reduce and elmininate the monopoloy power of the Amercian Medical Association. That monopoly power is derived almost entirely from the fact that the practice of medicine is an activity which can be engaged in by only those who have licenses from government. And the control over that licensure procedure is what has enabled the AMA to exercise its monopoly power for these many decades."

In addition to being an excellent economist, Milton Friedman was a brave and fearless man.


10 Comments:

At 9/15/2009 9:53 PM, Blogger Greg said...

Friedman wrote his dissertation on this topic, and worked with another Nobel winner on the empirics.

 
At 9/16/2009 10:55 AM, Anonymous CompEng said...

In essence, I agree. I would not go to a doctor that lacked credentials. Those credentials do not have to be government-supplied.

 
At 9/16/2009 12:33 PM, Anonymous Ian Random said...

How about just getting rid of Medicare funding of residencies?

http://www.aamc.org/advocacy/library/gme/gme0001.htm

 
At 9/16/2009 1:01 PM, Anonymous Benny The Real Truthseeker said...

A dicey one. I cannot be a smart medical consumer. I don't know enough.
Charlatans had a field day before licensing.
Also, if someone has a transmittable disease, and they go to a charlatan, and then they pass the disease on--there are costs.
Using torts?
Most likely, ineffective. Remember, in America we have the "corporate shield."
Anybody can incorporate. Your "doctor" treats you and your dick falls off. You sue. His corporation declares bankruptcy.
This is a dicey issue.

 
At 9/16/2009 2:13 PM, Anonymous Shill said...

"
dick falls off. You sue
"

The Adventures of Dick and Sue, the movie


Of course the consumer hopefully subscribes to the idea of the clumsy surgeon being shut out by licensure regulations, but is such a barrier to entry merely a heavily guarded yacht club perimeter? Is today's gate guard dog less medical diploma requirement, less licensure requirement, but more a requirement of professional liability, malpractice insurance? Do the club members tend to blackball the newcomer from access to malpractice insurance in hopes of retaining more *market share* for self? Should medical degree and criminal records be the only determinants for practice?

U B Judge
!

 
At 9/16/2009 5:39 PM, Anonymous Benny The Bill Payer said...

Annual premiums for employer-sponsored health insurance rose to $13,375 for family coverage this year — with employees paying $3,515 and employers paying $9,860, on average, according to a new survey.

The benchmark 2009 Employer Health Benefits Survey, released Sept. 15 by the Kaiser Family Foundation and the Health Research & Educational Trust, found that family premiums rose about 5 percent in 2009. That’s more than general inflation, which fell 0.7 percent, and workers’ wages, which rose 3.1 percent, during the same period.

Since 1999, premiums have gone up 131 percent. That’s far more than than workers’ wages, up 38 percent, or inflation, up 28 percent, over the same time period.

The above from the South Florida Business Journal.

$13k to cover a family.

Ouch.

Let Milton Friedman pay it.

 
At 9/16/2009 10:48 PM, Blogger QT said...

It is an interesting idea. The same thing applies to many other professions like architecture & engineering.

If a professional has a degree from an outstanding university, i.e. a M.Arch from Harvard, why does she/he need to go through the registration process (ie. professional experience & additional exams). If one is merely talking about liability insurance, that can be provided by any insurance company and a certificate of insurance can be provided to the customer. What value does the architects' assoc. bring?

There are other models for assuring liability. British naval engineers used to be required to be on the maiden voyage of the ships they designed. If the boat sinks, that would be your problem/responsibility. That is why the designer of the Titanic was on board. Of course, he had to be separated from the passengers after the disaster & whisked away.

 
At 9/17/2009 12:25 AM, Blogger DaveinHackensack said...

"If a professional has a degree from an outstanding university, i.e. a M.Arch from Harvard, why does she/he need to go through the registration process (ie. professional experience & additional exams)."

I'm not sure I see how this would lower medical costs though. The point of licenses, presumably, is that not all medical schools have the reputation of Harvard, Johns Hopkins, Stanford, etc. So if there were no medical licenses, presumably, the universe of physicians most people would feel comfortable seeing would shrink to those who had gone to well-respected medical schools. As the supply of putatively qualified physicians shrank, wouldn't their rates rise?

Friedman's argument here is an example of why libertarians get laughed at sometimes. You could make a legitimate argument that licensing standards for foreign MDs are too strict today, e.g., there's no reason the equivalent of a board-certified, attending physician from France who is fluent in English should be required to re-do his entire residency in the U.S. before practicing here. That's simply anti-competitive. But to scrap licensing entirely is daft. It would lead to a surge in quackery and medical malpractice.

It's possible to be a genius and to still be deficient in common sense occasionally. Friedman provides us an example of that here.

 
At 9/17/2009 4:08 AM, Blogger 1 said...

"Let Milton Friedman pay it"...

Let benny the pseudo everything pay for it...

The real question is why is the employer paying for 'family coverage' in the first place...

Is it contractual? Is the whole family working for the employer?

Therein lies the problem, almost every case is different...

"That monopoly power is derived almost entirely from the fact that the practice of medicine is an activity which can be engaged in by only those who have licenses from government"...

Again another problem since people want some sort assurance that the supposed professional they are paying for services received is nominally competent to provide those services...

Can there the medical equivalent of the Underwriters Laboratories that people can place their trust in?

Something needs to be done instead of leaving in the hands of the federal government...

From Investor Business Daily:

Grim Prognosis From Doctors Opposed To Health Care Plan

Doctor opposition to health care overhaul proposals is broad and deep, revealing concerns not just about soaring costs, declining care, possible rationing and a lack of limits on malpractice suits, but also about government competence and motives, detailed responses to a new IBD/TIPP Poll show...

As reported Wednesday, 65% of the 1,376 practicing physicians who responded to a mailed questionnaire over the last two weeks said they opposed health care plans that have emerged from the administration and Congress. Just 33% supported them.

 
At 9/17/2009 6:31 AM, Blogger randian said...

Since 1999, premiums have gone up 131 percent. That’s far more than than workers’ wages, up 38 percent, or inflation, up 28 percent, over the same time period.

Medicare and Medicare reimbursements have been dropping, and millions more illegal immigrants have been showing up for "free" health care. That deficit has to be made up somewhere.

 

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