From: rkaplan@netcom.com (Richard Kaplan)
Subject: Re: Repealing medical licensure laws
Organization: Netcom - Online Communication Services  (408 241-9760 guest) 
Distribution: usa
Date: Sat, 21 Nov 1992 19:34:25 GMT

In article <1992Nov21.123250.29506@genie.slhs.udel.edu>
 starr@genie.slhs.udel.edu (Tim Starr) writes:

>This is also true for bonds.  Yet we have the private sector providing the
>service of bond ratings through agencies which supply the demand for this
>information.  This could also be done for rating doctors.

Yes, but who regulates the bond rating agencies?  No one does.
And thus there are good ones and bad ones.  And some
give good advice, while some give bad advice.  You can figure
out which one is good over the long run by seeing which
one recommends the best bonds, i.e. which one would have
made you the most money.  But evaluating a doctor-rating
agency is very different; there is no clear-cut bottom
line which shows which agency is better (or even
competent) at rating doctors.

Furthermore, while you have lots of time to evaluate bonds
and bond rating agencies before you buy one, such is
not the case for medical emergencies.  If you get sick away
from home, you need to be sure that you can find a 
competent doctor rather quickly and there is not sufficient
time for comparative shopping.  If you are in a motor
vehicle accident and are brought to an emergency room
unconscious, you deserve to know that the doctor treating
you is competent; your free market system does not address this.   

>}You might say that  
>}we should publish information on doctors' effectiveness
>}in treating patients, but this data would be horribly
>}distorted by confounding variables, such as discrepancies
>}in the acuity of various doctors' practices.
>
>I don't understand this.  Will you please elaborate?

Rating doctors is not like rating stocks or bonds.  You
can't just publish how many lives a doctor saves or how
many of his patients die during surgery because often
the best doctors at the best hopsitals treat the sickest,
highest risk patients.  


>}2.  Acutely ill patients may not be able to rationally
>}make decisions, further exacerbating # 1 above.  If you
>}drive into a tiny town in Idaho with an acute appendicitis,
>}how will you know if your "surgeon" has appropriate training? 
>
>How will knowing that he's state-sanctioned provide this knowledge any
>better than a private rating agency?

As I mentioned above, (1) we have no way of knowing the quality
of the private rating agency; (2) in an emergency situation
there is no time to check a rating agency.  If you wish to 
argue that our current medical licensing authorities are
not regulating doctors sufficiently, that's another 
issue I will be glad to discuss in a separate thread.  But
we clearly must have a publicly accepted method for
determining a physician's competency; complete free
market economics do not apply to seriously ill or unconscious
patients.
    

>}3.  If we repeal medical licensing laws, who will regulate
>}narcotics and other controlled substances?  Or should
>}all medications be legal for over the counter sale?
>
>The latter.

See my posting earlier today.  Very few, if any, non-physicians
can properly diagnose their illnesses and thus most people
do not know what medications to take.  Many illnesses and
medications will impair one's thought process and thus
will require an impartial person to assess the drug's
effect.  

>This goes on now, only on the black market.  Laetril ring a bell?  How does
>relegating this to the black market improve things over having such phonies
>operating where they'd be subject to fraud liability and the rating of
>health services consumers' agencies?

Yes, Laetril is a perfect example of what would happen if we
deregulated medicine.  How does relegating this to the black
market improve things?  Because if this were legal then 
many more people would consider this to be a valid treatment and
thus would either waste their money or defer more valid treatment.

I am NOT saying that MDs know all the answers and that homeopathy
and other non-traditional techniques do not have something to
offer.  But those who wish to introduce newer techniques must
back them up with some data to show their efficacy and all
medical treatment should be subject to licensure of some sort. 


>Competency isn't the issue I raised, competition is.  MDs are a legally
>privileged labor cartel or oligopoly because of licensure.  This raises
>prices, decreases quality, and stratifies practices against demand-driven
>changes.


Raise Prices?  Unfortunately yes, I agree

Stratify against demand-driven changes?  In the short run, yes.
In the long run, no.  This is the way it must be.  Medicine
cannot react to fads as the music and fashion industries do;
too many times this was attempted in medicine with tragic
consequences, e.g. thalidomide.  

Decrease quality?  Absolutely not.  We are dealing with people's
lives here, not the latest in automobiles or food.  A 
conservative approach is in order to be sure we do not 
harm people with fads.


-- 
Richard Kaplan M.D.           Medical Software Exchange BBS
806 2nd St. SW # 104          (507) 281-1989 14,400 HST
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