5 ms·

> (1) and (2) have the usual "who watches the watchers?" problems, Since we already deal with “who watches the watchers” problems in our current system, I see

> (1) and (2) have the usual "who watches the watchers?" problems, Since we already deal with “who watches the watchers” problems in our current system, I see no problem here. > And even without those issues, who wants to have do this level of research? Yeah, I know, libertarian nerds (meant with all possible respect). But almost nobody else. Anyone who wants a good physician. > Part of the point (not all of it, to be sure) of things like the AMA, the FDA and other governmental regulation is to make people's lives simpler. Stop worrying about whether the doctor you're going to see has even met a basic level of medical qualification, and focus on whether you like their personality and approach, for example. If those things worked, this would be a point. Currently people can’t even afford to go to medical school, or afford to see a doctor, and when they get past the gatekeepers they are so desparate to get treatment that they can’t really even fathom rejecting a doctor because of a poor bedside manner.

PaulDavisThe1st 6y ago
> If those things worked, this would be a point. Currently people can’t even afford to go to medical school, or afford to see a doctor, and when they get past the gatekeepers they are so desparate to get treatment that they can’t really even fathom rejecting a doctor because of a poor bedside manner. Other countries with socialized health care systems (i.e. doctor credential gatekeeping) do not have these issues (certainly not to anything like the extent that we do). I suspect therefore that changing the credentialling process is unlikely to have much impact on these issues and/or is not the most effective way to impact these issues. > Anyone who wants a good physician. I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended. If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great"). > Since we already deal with “who watches the watchers” problems in our current system, I see no problem here. Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways.
- chordalkeyboard 6y ago
  > I suspect therefore that changing the credentialling process is unlikely to have much impact on these issues and/or is not the most effective way to impact these issues. The easiest way to expand medicine access would probably just be to remove government restrictions on the number of medical schools, the number of hospitals, and the number of physicians. I don’t think we need to dismantle the credential system. > I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended. This why we have to be careful about generalizing from our own experience conclusively :) > If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great"). There’s how things are, and how things should be. People ought to take more responsibility for their healthcare and that includes who provides it. > Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways. Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”.
  - PaulDavisThe1st 6y ago
    > The easiest way to expand medicine access ... This seems to suppose one (or both) of two things: 1) access to medicine is limited because of the supply of health care providers, so more providers would help 2) access to medicine is limited due to cost, and more providers would force the cost down, as per "supply and demand", "the market" etc. I'm not aware of much evidence for (1), though I don't deny that it is possible. For (2) to be true, it would have to be the case there can actually be a competitive marketplace for all kinds of health care, and we know that this is not true for (at least) emergency care. Many volumes have been written by people much smarter than me that explain the many reasons why health care is not really susceptible to what are supposedly "normal market" behaviors and benefits. Just increasing the number of doctors will (a) not necessarily drive down the cost of health care nor (b) expand access to health care. > This why we have to be careful about generalizing from our own experience conclusively :) Certainly in general, this is true. But when the claim is that "anyone who wants a good physician" would do this, not so much. Falsifiability, and all that. > People ought to take more responsibility ... This is a moral statement, not some sort of fundamental statement about the nature of reality. Not only is the level of personal responsibility up for the debate, but so is the form such responsibility should take. Citizens in many other countries have chosen to "take more responsibility" for their healthcare in different ways than you are proposing (by taking aggregate action to create socialized health care systems that delegate many things to the system, intentionally). > Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”. Speaking of over-generalizing ... also, "There’s how things are, and how things should be." I do not believe that regulatory capture is an inevitable outcome of a democratic-ish governmental structure.

PaulDavisThe1st 6y ago

> If those things worked, this would be a point. Currently people can’t even afford to go to medical school, or afford to see a doctor, and when they get past the gatekeepers they are so desparate to get treatment that they can’t really even fathom rejecting a doctor because of a poor bedside manner. Other countries with socialized health care systems (i.e. doctor credential gatekeeping) do not have these issues (certainly not to anything like the extent that we do). I suspect therefore that changing the credentialling process is unlikely to have much impact on these issues and/or is not the most effective way to impact these issues. > Anyone who wants a good physician. I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended. If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great"). > Since we already deal with “who watches the watchers” problems in our current system, I see no problem here. Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways.

chordalkeyboard 6y ago
> I suspect therefore that changing the credentialling process is unlikely to have much impact on these issues and/or is not the most effective way to impact these issues. The easiest way to expand medicine access would probably just be to remove government restrictions on the number of medical schools, the number of hospitals, and the number of physicians. I don’t think we need to dismantle the credential system. > I'm 57 years old. I've never, ever met anyone who isn't a libertarian nerd (I have friends ...) that checks to see what medical school a physician attended. This why we have to be careful about generalizing from our own experience conclusively :) > If they are "checking" at something approximating that level, they do so via clinical affiliation (e.g. "anyone at the Mayo has to be great"). There’s how things are, and how things should be. People ought to take more responsibility for their healthcare and that includes who provides it. > Not really. The "watchers" in our current system are government agencies, not private (potentially for-profit, or at least for-big-salary) corporations. The incentives align in significantly different ways. Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”.
- PaulDavisThe1st 6y ago
  > The easiest way to expand medicine access ... This seems to suppose one (or both) of two things: 1) access to medicine is limited because of the supply of health care providers, so more providers would help 2) access to medicine is limited due to cost, and more providers would force the cost down, as per "supply and demand", "the market" etc. I'm not aware of much evidence for (1), though I don't deny that it is possible. For (2) to be true, it would have to be the case there can actually be a competitive marketplace for all kinds of health care, and we know that this is not true for (at least) emergency care. Many volumes have been written by people much smarter than me that explain the many reasons why health care is not really susceptible to what are supposedly "normal market" behaviors and benefits. Just increasing the number of doctors will (a) not necessarily drive down the cost of health care nor (b) expand access to health care. > This why we have to be careful about generalizing from our own experience conclusively :) Certainly in general, this is true. But when the claim is that "anyone who wants a good physician" would do this, not so much. Falsifiability, and all that. > People ought to take more responsibility ... This is a moral statement, not some sort of fundamental statement about the nature of reality. Not only is the level of personal responsibility up for the debate, but so is the form such responsibility should take. Citizens in many other countries have chosen to "take more responsibility" for their healthcare in different ways than you are proposing (by taking aggregate action to create socialized health care systems that delegate many things to the system, intentionally). > Perhaps you haven’t noticed but the watchers in government agencies and the for-profit, big salary corporations they are supposed to be watching are the same people. its called “regulatory capture” and “revolving door”. Speaking of over-generalizing ... also, "There’s how things are, and how things should be." I do not believe that regulatory capture is an inevitable outcome of a democratic-ish governmental structure.