3 ms·

Let's say there are no state licenses, and you need a doctor, so you go to a hospital. Would you be concerned about the quality of the doctor? Would you be th

by bobbin 17y ago

Let's say there are no state licenses, and you need a doctor, so you go to a hospital. Would you be concerned about the quality of the doctor? Would you be the only one to feel that way? Would a hospital who is capable of addressing those concerns be more successful than one incapable of doing so? Would you as a training doctor be concerned of the public prestige of your license? Would you as a doctor be willing to work in a place who hasn't justified or proved its quality to the public? of course these questions don't answer your main concern, but you post assumes in the absence of a government monopoly in licensing, people would be incapable of creating quality control. There's a tendency to imagine a transition period and think it would be unsolvable because you can't think how it could be solved.

btilly 17y ago
The problem with your reasoning is that we have actually have lots of historical experience with what it is like when we don't license doctors. It was awful. I'm no fan of the AMA. But I like having doctors who know basic anatomy. On all of your reputation issues, people's judgment of the quality of doctors is almost entirely a function of their bedside manner, and not their competence. If you just go off of reputation, and reputation is based on the decisions of lay people, the result is that competent doctors get bad reputations and confident charlatans get excellent ones. And health suffers accordingly. A similar well-documented example are public health measures. My surface impressions of a restaurant are a bad guide for whether the cook washes his hands properly after going to the bathroom. And dysentery comes through infrequently enough that you won't discover this from your neighbor getting sick until far too late. But well-constructed licensing requirements solve this problem and save lives. (In fact there is good data suggesting that public health measures like these save more lives year in and year out than all of the advances of modern medicine.) We also know what happens with public engineering. Before licensing requirements were created, the USA averaged one random bridge collapse per week. That's pretty bad. It gets rapidly worse if you get an earthquake. I live in an earthquake prone zone, and I am a very firm supporter of having the buildings I am around and in be built to standards created by qualified engineers, then inspected by properly licensed inspectors. California is among the few areas where significant earthquakes don't tend to come with massive loss of life, and I appreciate that fact. I could multiply examples, but the flip side of the argument does not hold. The article is correct that there are a lot of stupid licensing requirements out there. The article is correct that the motivation is often restraint of trade. The article is correct that we're often all better off without those rules. But the article is dead wrong in concluding that we're better off removing all licensing requirements.
- bobbin 17y ago
  I'll write a piece of an answer I gave to another person: > Lets say we want quality control in dentistry. You like the government quality control the government gives and would like your dentists to count with their approval. I, on the other hand, think it's requirements are excessive. Most of what my dentist does is find black spots in my teeth, drill them out, and then fill the hole. This does not require 4 years of study. If I ever get to need a root canal I would need someone with more studies but until then I'd me happy with someone with less studies, maybe a certification given by the manufacturer of the equipment, I don't know. If you like the government certification you can limit yourself only to government certificated doctors. No problem. A group of people should be able do give public approval of university courses and degrees. If you like the government that OK. I'm just object locking people in cages when they don't comply with these regulations. The violent monopoly is the problem. > But the article is dead wrong in concluding that we're better off removing all licensing requirements. The key word here is requirements. Not removing all licensing. The distinction is not expressed clearly. If you don't comply with the "required" licensing they lock you in jail, or the demand money from you, and if you don't comply, then you go to jail.
- timwiseman 17y ago
  You make good and interesting points, but remember you can (at least hypothetically) have licensing and accreditation without the government providing it. For instance, there is no legal requirement for IT certifications, and yet there are a plethora of them, some meaningful some not but most in the industry know the difference. Similarly, even if the government did not require a license, insurance companies would likely refuse to provide malpractice insurance for those without proper training. I agree that when it comes to large public engineering and the creation of buildings, then there is a compelling public need to make sure minimimums are met. If a building collapses unexpectedly, likely far more people than the purchaser will be harmed and irrevocably. But that compelling public good is far weaker in other areas that require licenses now. If I have a bad florist, only myself and the person I am bestowing the flowers on is going to be harmed at all, and only minutely then. If I have a bad lawyer, the stakes may be higher, but again only I am harmed.
- gojomo 17y ago

by bobbin 17y ago

btilly 17y ago

The problem with your reasoning is that we have actually have lots of historical experience with what it is like when we don't license doctors. It was awful. I'm no fan of the AMA. But I like having doctors who know basic anatomy. On all of your reputation issues, people's judgment of the quality of doctors is almost entirely a function of their bedside manner, and not their competence. If you just go off of reputation, and reputation is based on the decisions of lay people, the result is that competent doctors get bad reputations and confident charlatans get excellent ones. And health suffers accordingly. A similar well-documented example are public health measures. My surface impressions of a restaurant are a bad guide for whether the cook washes his hands properly after going to the bathroom. And dysentery comes through infrequently enough that you won't discover this from your neighbor getting sick until far too late. But well-constructed licensing requirements solve this problem and save lives. (In fact there is good data suggesting that public health measures like these save more lives year in and year out than all of the advances of modern medicine.) We also know what happens with public engineering. Before licensing requirements were created, the USA averaged one random bridge collapse per week. That's pretty bad. It gets rapidly worse if you get an earthquake. I live in an earthquake prone zone, and I am a very firm supporter of having the buildings I am around and in be built to standards created by qualified engineers, then inspected by properly licensed inspectors. California is among the few areas where significant earthquakes don't tend to come with massive loss of life, and I appreciate that fact. I could multiply examples, but the flip side of the argument does not hold. The article is correct that there are a lot of stupid licensing requirements out there. The article is correct that the motivation is often restraint of trade. The article is correct that we're often all better off without those rules. But the article is dead wrong in concluding that we're better off removing all licensing requirements.

bobbin 17y ago
I'll write a piece of an answer I gave to another person: > Lets say we want quality control in dentistry. You like the government quality control the government gives and would like your dentists to count with their approval. I, on the other hand, think it's requirements are excessive. Most of what my dentist does is find black spots in my teeth, drill them out, and then fill the hole. This does not require 4 years of study. If I ever get to need a root canal I would need someone with more studies but until then I'd me happy with someone with less studies, maybe a certification given by the manufacturer of the equipment, I don't know. If you like the government certification you can limit yourself only to government certificated doctors. No problem. A group of people should be able do give public approval of university courses and degrees. If you like the government that OK. I'm just object locking people in cages when they don't comply with these regulations. The violent monopoly is the problem. > But the article is dead wrong in concluding that we're better off removing all licensing requirements. The key word here is requirements. Not removing all licensing. The distinction is not expressed clearly. If you don't comply with the "required" licensing they lock you in jail, or the demand money from you, and if you don't comply, then you go to jail.
timwiseman 17y ago
You make good and interesting points, but remember you can (at least hypothetically) have licensing and accreditation without the government providing it. For instance, there is no legal requirement for IT certifications, and yet there are a plethora of them, some meaningful some not but most in the industry know the difference. Similarly, even if the government did not require a license, insurance companies would likely refuse to provide malpractice insurance for those without proper training. I agree that when it comes to large public engineering and the creation of buildings, then there is a compelling public need to make sure minimimums are met. If a building collapses unexpectedly, likely far more people than the purchaser will be harmed and irrevocably. But that compelling public good is far weaker in other areas that require licenses now. If I have a bad florist, only myself and the person I am bestowing the flowers on is going to be harmed at all, and only minutely then. If I have a bad lawyer, the stakes may be higher, but again only I am harmed.
gojomo 17y ago