Tuesday, January 30, 2007

Medical Licensing: Quackery, Financing, and Mixed Market Economics - Part III: More Quality Questions

Of course, the world of healthcare isn't limited to licensed practicioners. Health is such a broad and all encompassing topic, that it is genuinely impossible to put healthcare within specific demarcations that exclude all but the trained practicioner. The obvious, but often overlooked, follow-up question to, "should we have a medical licensing system?" is, "What particular rights should be given to licensed practicioners that unlicensed practicioners shouldn't have?" It's less obvious than it seems.

Everytime a personal trainer gives advice on an exercise program or diet, he is dispensing medical advice. Of course, no one thinks that this sort of advice should be the specific domain of medical doctors. There is no specific licensing requirement for dispensing this sort of advice. However, with the modern focus on preventative medicine, one could argue that good advice in this department can do more long term for a patients health than anything that is routinely done in most medical practices.

Many people are also now spending billions of dollars on all sorts of salves and potions that can be purchased from alternative practicioners. In fact, I can walk into a GNC outlet, and buy vitamins that are supposed to cure everything from arthritis to prostatic hyperplasia from a pimply faced kid named Marco who makes seven bucks an hour. In spite of medical licensing, these industries have flourished, and all attempts to control them only seem to bring a public outcry and more popularity.

What I find the most interesting about this scenario, is that the majority of the unregulated practicioners operate under scientific evidence that is "questionable." Some people swear by these remedies, and others see no tangible benefit. What the current system has done however, is put the most qualified practicioners at a significant disadvantage in the medical market place. I can sell healing pelts from Nakaraka the Beaver god on the internet with minimal intervention. If the government bothers to shut me down, I'll just change my website and sell "new" pelts from Ukbaba the Beaver god's even more healing power endowed brother. I don't have to worry about regulations, license maintenance, or even accuracy in my claims. In fact, the only thing that would likely happen to me is losing my medical license. Someone who didn't actually have training would have almost nothing to lose in the above scenario.

Contrast this to the doctor who cannot operate his practice like a business, cannot operate without a license, has to see patients who won't pay under EMTALA, and always lives under threat of lawsuits. He is SEVERELY disadvantaged. Terms like "usual and customary fees," or "medical malpractice," do not apply to the dissemination of healing beaver pelts. Marco, the GNC employee, doesn't fear malpractice suits if his special vitamin mixture fails to heal my aching joints. The legitimate doctor is the only one who deals with most of the beauracracy. On top of all of this, he is also subject to ever increasing training periods, through which certification is increasingly required to collect from the government, which unthankully frees people from their money in the form of FICA and then sets all sorts of arbitrary guidelines on doling it back out for services utilized by the same people from whom the money was taken in the first place.

Is it really a surprise then, that in the face of the medical crisis, alternative medical practicioners are flourishing? A trained physician might legitimately argue that the quacks have an easier time getting to the people than he does. Marco's company can use the full weight of the market in both distribution and advertising to sell vitamins, while the physician is constantly compromised in his ability to give care and let people know that he has care to give.

So what are the obvious questions? Shouldn't the government regulate these other practicioners more? I don't think that it can be done. Snake oil salesman are always willing to move underground, and they are too numerous to just eliminate. The black market tends to grow by a rate similar to the rate of disappearance from the open market by regulatory decree. Also, this alternative market is the only way to get legitimate therapy out in some cases. With the FDA stranglehold in just about everything in medicine, there has to be some way to get some therapy onto the market that was created by people who angered some beauracrat.

But what about the quality of doctors? Even with the proliferation of practice rights among less trained individuals, the physician's license still implies a certain amount of training. People should have that knowledge when seeking a practicioner, right? Maybe so, but this doesn't necessarily require a license.

Stay tuned for the conclusion.


Blogger Someonetc said...

i just wanted you to see what the mission was for our licensing board

The division provides administrative support to 38 professional licensing boards and commissions responsible for licensing and regulating the activities of approximately 400,000 Missourians representing 240 different trades and professions.

The division exists to serve and protect the public from incompetency, misconduct, gross negligence, fraud, misrepresentation or dishonesty by providing an accessible, responsible and accountable regulatory system that licenses only qualified professionals by examination and evaluation of minimum competency and enforces standards by implementing legislation and administrative rules.

this is who they regulate

Regulated Professions
Accountants, Certified Public
Anesthesiologist Assistants
Appraisers, Real Estate
Athlete Agents
Athletic Trainers
Audiologists, Clinical
Boxers, Professional
Counselors, Professional
Cemeteries, Endowed Care
Dentists, Dental Hygienist
Drug Distributors
Engineer Interns
Engineers, Professional
Funeral Directors
Hearing Instrument Specialists
Interior Designers
Interpreters for the Deaf
Land Surveyors
Land Surveyors-in-Training
Landscape Architects
Marital & Family Therapists
Martial Arts, Professional
Massage Therapists
Nurses, RN, LPN, Advanced Practice
Occupational Therapists
Occupational Therapy Assistants
Pharmacists, Pharmacies
Pharmacy Interns
Pharmacy Technicians
Physical Therapists
Physical Therapist Assistants
Physician Assistants
Physicians & Surgeons
Real Estate Agents, Brokers
Respiratory Care Practitioners
Social Workers
Speech Language Pathologists
Tattooing, Body Piercing & Branding
Veterinary Technicians
Wrestlers, Professional

just a note

7:47 PM  

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