Documentary on a Fix for the Healthcare System

[PaulinVA]

You follow the Jon Gruber school of thought that people are not smart enough to manage their own affairs and need the heavy hand of government to micromanage their lives. I follow the Milton Friedman school of thought that people know their own interests much better than the government which allegedly “protects” them.

Your logic works for shampooing, not for brain surgery.

 

[stinkcat_14]

Your logic works for shampooing, not for brain surgery.

You have not established that the government has any competence in determining who is qualified to perform brain surgery. After all, the government has proven its incompetence in everything else, what makes you think that the government that is so incompetent suddenly becomes competent when it comes to deciding who can perform brain surgery?

Did your beloved government regulation keep this guy from performing surgery?

skepticalscalpel.blogspot.com/2013/09/on-horrific-story-of-texas-neurosurgeon.html

 

[PaulinVA]

You have not established that the government has any competence in determining who is qualified to perform brain surgery. After all, the government has proven its incompetence in everything else, what makes you think that the government that is so incompetent suddenly becomes competent when it comes to deciding who can perform brain surgery?

Did your beloved government regulation keep this guy from performing surgery?

skepticalscalpel.blogspot.com/2013/09/on-horrific-story-of-texas-neurosurgeon.html

One or two (or a dozen) incompetent licensed physicians does not mean that the government can not determine, through testing and education requirements, who is likely to be competent.

Professional organizations like the AMA or ABA can not be counted on to regulate their own industries.

The thing that you fail to understand is that no ideology survives intact in the real world. No pure ideology can take into account all variables. A blend of philosophies usually works best.

As an example, what we have seen is that business executives can be counted on to do the expedient - to pollute, to lie, to cheat on testing, etc. Without some basic government regulation, the consumer is at the mercy of the corporations. Quite frankly, the consumer is never sovereign.

 

[stinkcat_14]

One or two (or a dozen) incompetent licensed physicians does not mean that the government can not determine, through testing and education requirements, who is likely to be competent.

Of course, you have not established that the government can competently determine who is competent to practice. You claim that it can, but you offer no evidence that backs up your claim. We have more evidence that the government is not competent than evidence proving the government is competent.

Professional organizations like the AMA or ABA can not be counted on to regulate their own industries.

The AMA and ABA only have power because of the government. Take away government occupational licensing and you take away all the power of both.

The thing that you fail to understand is that no ideology survives intact in the real world. No pure ideology can take into account all variables. A blend of philosophies usually works best.

As an example, what we have seen is that business executives can be counted on to do the expedient - to pollute, to lie, to cheat on testing, etc. Without some basic government regulation, the consumer is at the mercy of the corporations. Quite frankly, the consumer is never sovereign.

Competition itself is a form of regulation and one of the most effective forms of regulation.

 

[PaulinVA]

Of course, you have not established that the government can competently determine who is competent to practice. You claim that it can, but you offer no evidence that backs up your claim. We have more evidence that the government is not competent than evidence proving the government is competent.

The fact that most physicians are competent must mean the government can determine who to license, right?

Competition itself is a form of regulation and one of the most effective forms of regulation.

Yeah, sure.

 

[stinkcat_14]

The fact that most physicians are competent must mean the government can determine who to license, right?

No. For example, what is the difference between a nurse practitioner and a physician? Some states are very restrictive on what nurse practitioners can do, others are more liberal. Does this mean that the government is competently regulating the medical profession when it cannot even agree on what the standards should be?

Yeah, sure.

I would suggest you learn a little more about how markets work.

 

[PaulinVA]

No. For example, what is the difference between a nurse practitioner and a physician? Some states are very restrictive on what nurse practitioners can do, others are more liberal. Does this mean that the government is competently regulating the medical profession when it cannot even agree on what the standards should be?

So, if one state is more restrictive than another, you view this as a problem? If they all meet a certain floor level, then a more restrictive state simply has additional restrictions.

However, if you let “the market” determine who practices, then there will be differences in the minimum education and experience all across the country, perhaps city by city. So, if that is acceptable, why aren’t state-by-state differences allowable?

I would suggest you learn a little more about how markets work.

And I would suggest that you not assume what I know or what I don’t know. This is a rude comment that does not advance your position.

 

[stinkcat_14]

So, if one state is more restrictive than another, you view this as a problem? If they all meet a certain floor level, then a more restrictive state simply has additional restrictions.

Here we have you claiming that the government is competent in determining who is qualified to practice and yet the government cannot even agree on a standard. So the question is, what is the minimum standard to practice medicine? If you want to demand that it is an MD, that is fine for you. But if someone wants to hire some with different qualifications, why should the government stand in that person’s way? You have provided zero evidence that government has any competence in this area, so there is no reason the government should be the arbitrator.

However, if you let “the market” determine who practices, then there will be differences in the minimum education and experience all across the country, perhaps city by city. So, if that is acceptable, why aren’t state-by-state differences allowable?

Because with the market, the consumer is the ultimate decider. If you want an NP, you can choose that, if you want an MD, that is also a choice. But the government intervention here raises costs and provides no benefit to anyone in return.

 

[PaulinVA]

Because with the market, the consumer is the ultimate decider. If you want an NP, you can choose that, if you want an MD, that is also a choice. But the government intervention here raises costs and provides no benefit to anyone in return.

No, No, No! You can’t say Nurse Practitioner or Medical Doctor. In your world they don’t exist, remember? MD and NP are just government designations, awarded after government-designated testing and education.

So, in your world, without an MD or NP or PA, how can you determine qualifications?

 

[Viki63]

I’m a nurse licensed in 17 states. Each state requires slightly different qualifications, such as the number of Continuing Education Units, but all basically go by the national exam. It’s created by the nursing profession, and without that basic standard, you’d be back in the middle ages, when nurses were the equivalent of actresses or prostitutes. We need professional standards, period. They are set by professionals in each state, not by “the government.”
I’m pretty sure physicians’ standards are even more exacting, for good reason.

.

 

[stinkcat_14]

No, No, No! You can’t say Nurse Practitioner or Medical Doctor. In your world they don’t exist, remember? MD and NP are just government designations, awarded after government-designated testing and education.

So, in your world, without an MD or NP or PA, how can you determine qualifications?

MDs and the like are not awarded by the government. After all, Harvard awards MDs.

 

[PaulinVA]

MDs and the like are not awarded by the government. After all, Harvard awards MDs.

Okay, but take your argument to it’s conclusion. Do you think a medical degree is required, in your world, to call oneself a doctor? Do Nurse Practitioners exist? Is a degree in nursing required to be a nurse?

Please, you are saying that the licensing boards in each state should be abolished and the consumer should decide who will treat him/her. How does that work in the real world?

 

[stinkcat_14]

Okay, but take your argument to it’s conclusion. Do you think a medical degree is required, in your world, to call oneself a doctor? Do Nurse Practitioners exist? Is a degree in nursing required to be a nurse?

I think what people are called is irrelevant. What is relevant is the skills that they possess. The rise of credentialism came along with occupational licensing and the whole process is an exercise in keeping out competition. At one time, you didn’t need a nursing degree to be a nurse, now it is more and more required, partly because providers have captured the regulatory process to keep out competition.

Please, you are saying that the licensing boards in each state should be abolished and the consumer should decide who will treat him/her. How does that work in the real world?

People choose who will treat them. A provider puts out their credentials and the consumer decides whether they are acceptable. In some countries, when a child gets malaria, they don’t go to a doctor. The mother calls the pharmacist and orders the required drugs. It is much cheaper that way and nobody is harmed because everyone knows what the proper treatment is. Regulation would just make things more expensive and harm people.

 

[PaulinVA]

In some countries, when a child gets malaria, they don’t go to a doctor. The mother calls the pharmacist and orders the required drugs. It is much cheaper that way and nobody is harmed because everyone knows what the proper treatment is. Regulation would just make things more expensive and harm people.

Okay, thank you for the discussion. I find your argument in favor of adopting third-world medicine to be without merit and not persuasive. Let’s call it a day.

 

[stinkcat_14]

Okay, thank you for the discussion. I find your argument in favor of adopting third-world medicine to be without merit and not persuasive. Let’s call it a day.

Who is in favor of adopting third world medicine? The issue is not one of standards but one of choice. Are individuals harmed in places where you don’t need a prescription for drugs? There is no evidence to support such a claim. We are the country which forces people to pay $100 for something worth $2, and you claim its the other countries that are backwards!

Thank you for the discussion. So far, you have claimed the following:

1. The government can competently determine who can perform medical tasks. However, you have provided no evidence to back up your claim.
2. That extensive government regulation is necessary, but you provide no logical reasoning for why we need the intrusive hand of government micromanaging our lives.

 

[Biggin]

A big problem is that occupational licensing restricts entry into the medical profession. The government should not be deciding who is qualified to practice medicine, only the consumer should have the right to decide who is qualified to treat them.

I may have misunderstood your response, but licensing is is not really that big of a deal. If they can pass the tests, Great. If not, well, more than likely they need more “study time.”
The consumer already has the decision of who can treat them, at least here in the USA.

 

[LeafByNiggle]

I think what people are called is irrelevant. What is relevant is the skills that they possess. The rise of credentialism came along with occupational licensing and the whole process is an exercise in keeping out competition.

Without credentials the average consumer cannot determine if a doctor possesses the relevant skills. Choice is great if you have the information on which to make a choice.

 

[stinkcat_14]

Without credentials the average consumer cannot determine if a doctor possesses the relevant skills. Choice is great if you have the information on which to make a choice.

Credentials by themselves are not bad. The problem is where the government decides that you need an MD to prescribe antibiotics. The government has no competence in this domain. The result is higher costs with no corresponding benefits.

 

[LeafByNiggle]

Credentials by themselves are not bad…

That’s not the conclusion I see you reaching in your previous postings. You said:

The AMA and ABA only have power because of the government. Take away government occupational licensing and you take away all the power of both.

So it appears you do not trust the AMA or the ABA to issue credentials. And you certainly don’t trust the government to do it. But yet you say now that credentials have their proper place and are not bad by themselves. I think you need to separate your view of government’s role in establishing credentials with government’s role in saying when those various credentials can be used. If you would just disavow your condemnation of professional organizations or government to set standards for credentials, you would have a more consistent and supportable position by just arguing that patients should be allowed to choose which credentialed professional they choose to go to.

Even though that position is more supportable, it is not without its difficulties. What if the patient chooses, for reasons of economy or ignorance, to use the services of a snake oil salesman instead of an MD neurologist to treat a brain tumor? You may want to say “Caveat emptor”. But that would leave many less-educated people open to predation by these unscrupulous practitioners. Most people believe that restrictions on businesses that operate in this manner to be a valid function of government. I suspect you believe otherwise, so I would be interested to hear your defense of such people.

 

[stinkcat_14]

That’s not the conclusion I see you reaching in your previous postings. You said:

The AMA and ABA only have power because of the government. Take away government occupational licensing and you take away all the power of both.

So it appears you do not trust the AMA or the ABA to issue credentials. And you certainly don’t trust the government to do it. But yet you say now that credentials have their proper place and are not bad by themselves. I think you need to separate your view of government’s role in establishing credentials with government’s role in saying when those various credentials can be used. If you would just disavow your condemnation of professional organizations or government to set standards for credentials, you would have a more consistent and supportable position by just arguing that patients should be allowed to choose which credentialed professional they choose to go to.

Even though that position is more supportable, it is not without its difficulties. What if the patient chooses, for reasons of economy or ignorance, to use the services of a snake oil salesman instead of an MD neurologist to treat a brain tumor? You may want to say “Caveat emptor”. But that would leave many less-educated people open to predation by these unscrupulous practitioners. Most people believe that restrictions on businesses that operate in this manner to be a valid function of government. I suspect you believe otherwise, so I would be interested to hear your defense of such people.

I don’t have a problem with professional organizations themselves, they actually have an important role, the problem is when professional organizations get hooked up with government that they become problematic. The AMA is more concerned with physician outcomes than what is right for patients. Now, if we didn’t have government occupational licensing would it be the wild west for medicine? My answer is no, because there are private organizations that do essentially the same thing without the entry barriers of government regulation. For example, malpractice insurers rate practitioners and base their premiums on their abilities and outcomes. A bad practitioner won’t be able to get malpractice insurance, nor would they be able to get hospital privileges, or get into managed care networks. All of these provide gatekeeping functions and arguably do a much better job than the government. The government does a horrible job of disciplining bad doctors.