From: starr@genie.slhs.udel.edu (Tim Starr)
Subject: Re: health care industry woes
Organization: UDel, School of Life & Health Sciences
Distribution: usa
Date: Sun, 13 Dec 1992 12:42:27 GMT

In article <1992Dec11.051931.14101@sci.ccny.cuny.edu> dac@sci.ccny.cuny.edu (David A Cooke) writes:
}In article <1992Dec6.112048.2815@genie.slhs.udel.edu> starr@genie.slhs.udel.edu (Tim Starr) writes:
}>In article <1992Dec5.004844.21362@sci.ccny.cuny.edu> dac@sci.ccny.cuny.edu (David A Cooke) writes:
}>}	Foreign doctors are expected to meet the standards of training
}>}and knowledge that American doctors are.
}>
}>And pass tests in english.
}
}	Considering that they will have to consult with other physicians in
}English, give directions to nurses in English, write out prescriptions in
}English, review literature written in English, and treat mostly English-
}speaking patients, I don't think it's such an unrealistic expectation
}that they should have sufficient mastery of the language to pass a 
}licensing exam.

What if they're going to cater exclusively to Chinese-american clients in
San Francisco's Chinatown?  Then they wouldn't meet these conditions.  You're
still supporting an arbitrary standard for dehumanizing medical practitioners
as deviants and persecuting them in denial of their rights.

}	I really hadn't meant this to be an argument over language           
}requirements--that's really a whole other kettle of fish.  The point
}I was getting in was the variance in levels of training of doctors from
}country to country--and it's quite a range.  As for "society,"  I don't
}think it is hard to see that there are things which the large majority
}of the people of the nation agree on.

Aren't you being concretistic?  The essential principle at issue here is
whether medical consumers and service providers should be free to contract
by mutual consent to mutual benefit, without coercive intervention.

For example, to ask for any sort of justification from you once again, why
shouldn't we be free to choose doctors trained at different levels?  Why
do you oppose this diversity in favor of the monoculture of the State?

As for your construal of "society" to mean large majority, a large majority
elected Hitler.  Did that justify the Holocaust?  The USA was founded upon
the idea that minorities have rights which are to be defended against the
claims of any, whether Monarch or Majority.  The Judiciary was designed
with the express idea of protecting minority rights from majoritarianism.
On what grounds do you oppose this?

}	So where exactly is this "Incompetent Doctor Desirees of America"
}lobby headquartered?

Gentle readers, please take note of the level of argument with which I
have been presented.  Is this what you think proper and correct for the
defense of such a noble profession as medicine?

Also note that I've pointed out that licensure operates as a transfer
payment subsidy of the information searches of the rich, with the source
of the transfer being the poor, who are also less capable of forming their
own lobbies (unlike doctors, who have the AMA and other organizations) and
thus less likely to be able to articulate their case to those who might
ameliorate their situation.

}>}	You seem to be of the belief that opening a medical practice is
}>}like opening a corner pizza restaurant.
}>
}>Wrong.  My mother's in the medical business - a medical technologist.  I
}>know a bit about it.  I'm no expert, but at least I know something.
}
}	That's well and good, but your arguments suggest that you do
}indeed see it as a pizza shop venture, regardless of where your mother
}works.

Selectively quoting out of context?  This is a new fallacy to add to your
arsenal.  You seem to require such shoddy ammo with which to attack me -
you don't seem to have bothered with my ideas, and gone straight to the
abusive ad hominem.

For those who might be just starting to read this thread, the claim which
I responded to was that I was entirely ignorant of the field of medicine,
not how I viewed the business.  I've also offered to provide my attacker
with the names of doctors who oppose licensure to provide expert authority
I may lack on the subject.  He's ignored these efforts, possibly because
he's unable to defend his position any othe way.

}>}But if you do want to,
}>}anybody can apply to medical school.
}>
}>I have a friend who has applied, and can't get in - not because she
}>lacks merit, but because they consider her too old.  She would be more
}>likely to be admitted to a medical school if we had a free market in
}>education and training for physicians.
}
}	That's funny.  I know a 40-year old with 4 kids in my class,
}and there are a fair number in their 30's.

Where?  I'll ask her if she's tried applying there.

}>}>}	I'm not sure what you mean by "deviant" medical practicioners, 
}>}>}nor why the state and the medical profession would be interested in
}>}>}"persecuting" them for reasons unrelated to public health and safety.  
}>}>
}>}>There's gold in them thar hills!  That's why.
}>}
}>}	You still haven't answered my question.
}>
}>I thought a sophisticate would be able to draw the conclusion: the state
}>and medical profession are interested because they have economic incentives
}>to be, as the public choice school of economics has taught us.
}
}	Which are?  Please be more explicit than that just "eliminating
}competition."  You've spoken frequently of this "competition" that is
}being kept out of the field, but you have yet to clearly say who comprises
}it.  All you've come up with so far are the incompetent and foreign doctors
}unable to speak English well enough to pass licensing exams.

Those are apparently the only examples which have either appeared since you
intruded into a previously civil debate, or the only ones you selectively
care to present.

How about practitioners that charge less?  That believe in unorthodox
treatments?  Both of these have been subjected to persecution in the past.
I've maintained all along that the only purpose of licensure can be to
persecute the deviant; perpetrators of fraud and malpractice can be handled
by tort law.

}>}	I'm not going to play silly logic games with you.
}>
}>No, instead you're going to insult me.  What an excellent doctor you
}>will be!  So, "first, do no harm" doesn't extend to etiquette?
}
}	No, I don't think it does apply to political arguments, unless you
}are planning to argue that you might be so hurt by my comments that you
}would go throw yourself off a bridge after reading them.

So you admit that you dispose of etiquette when your sacred cows are subjected
to scrutiny?  You belie your earlier claim; you are indeed trying to play
silly logic games with me, but the silly games are all of your own intro-
duction.

}>>You have no 
}>}conception of what the hell you are talking about in real terms.  All you
}>}can look at is dry economic theory selectively chosen to support your
}>}political agenda.  But you haven't looked at medicine, and you don't know
}>}what it's about.
}>
}>Shall I find the names of the libertarian doctors who agree with me to
}>provide the authority you think I lack?
}
}	Big deal.  I can turn up ten non-libertarian doctors for every
}libertarian doctor you produce.

If what an opponent of licensure then has no bearing on its rectitude, then
your bringing the subject up was merely a cheap rhetorical trick, a silly
game pretense at logic.

}	If you had any real experience with what you are arguing the 
}economics of, you would know that emotion is inextricably involved in  
}medicine.  It has a lot to do with what goes on and why things are done.
}It can't just be dismissed as a logical impediment, because even if the
}physician completely removes his/her own emotions from decision-making,
}he/she is going to have to deal with the patients' emotions.  These
}are things which are directly impacted by your proposals, but they are 
}not taken into account because they are not easily quantifiable.
}Unquantifiable does not necessarily mean non-existent, especially in
}the context of medicine.

If you had any honesty, you'd refrain from pretending to know what my
experience is and from misrepresenting me as dismissing emotion as a
mere logical impediment.  You accuse me falsely of arguing from
authority, but have the audacity to argue from your own - that of a
mere medical student, rather than an experienced practitioner.  Nor have
I ever made the patently absurd claim that the uneasily quantifiable
doesn't exist!

}	As for what I am being taught in medical school, I am being
}taught to give some attention to emotional considerations when I am
}making difficult decisions.  It might not fit nicely into an economic
}model, but patients happen to be rather concerned about it.

Just so long as you're taught some better logical skills to complement
this "sensitivity training," then your patients will be less at risk in
your hands.

}	My professional judgement demands that I reject solutions which
}leave out such critical aspects of the system they propose to fix.  It
}also requires that I be skeptical of your claims that application of a
}simple axiom will fix such a complex subject, especially given the spottiness
}of the track-records of free-markets and the pronouncements of economists
}in general.  If it will make you feel any better, I wouldn't take it from
}a weather reporter or a chaos researcher, either.

If all you were guilty of were mere skepticism, you'd be innocent.  However,
that isn't the case.  You've shown very poor judgement, and I wouldn't advise
anyone to be your patient so long as there remains any alternative that
were capable of intellectual honesty.

Tim Starr - Renaissance Now! - Think Universally, Act Selfishly
starr@genie.slhs.udel.edu

"True greatness consists in the use of a powerful understanding to enlighten
oneself and others." - Voltaire