His premises are not very sound.

> We make similar bad “bargains” with a few kinds of workers, to whom we grant extraordinary privileges of “self-regulation.” That is, we let certain “professionals” run their own organizations which tell us how their job (...) is to be done, and who can do it.

The author speaks of "privileges" and "prestiges", but for doctors, his go-to example, it always was a prestigious (and privileged) profession, way before any modern diplomas/regulations were introduced. (Self-)regulations and certifications did not result in privileges, since they were already there. In fact they attached quite a few strings where before there were none.

> (...) that they will only admit appropriately qualified individuals into their ranks, and that they will always act honestly (...)

Regulations/certifications are here to provide a minimum evidence of competence in a given field. Are they a weak evidence? Absolutely. But it also always beats the alternative, which is "just trust me". The point is that in advanced societies anything critical, profession or otherwise, cannot be built on trust, it has to be built on some kind of proof and accountability, however imperfect. And the author here is not demanding or proposing different, better proofs to the current system, he is just saying that enforcing such proof via regulation is a privilege built on prestige.

> Notice how in this supposed bargain, what we give the professionals is concrete and clearly valuable, while what they give us (...) is vague and very hard for us to check.

This is the laziest part of the argument, and to be honest it feels as if it's from someone who has never set foot abroad. Of course we can check it. We just have to compare with countries where these regulations ("privileges") are not enforced. You want to know how it looks like when pilots, architects, or surgeons can practice without a licence (or fake it)? Just go to Congo or Sierra Leone, and observe the number of accidents, failures, or outright fraud. Notice also how all societies, when they modernize, move to the same type of regulations, regardless of their cultural/religious/political specificities.

> and yet we have mostly not chosen those substitutes due to our eagerness to affiliate with prestigious professionals

And of course there are countries that are (comparatively) considered "low prestige", like Poland or Thailand, that attract a large number of medical tourists because despite being lower profile the professionals there abide by the same vetting mechanisms, and their doctors are on par with ours... So the "it's just prestige" thing doesn't hold up.

> Cheaper yet outcome-effective substitutes to expensive professionals have long been physically available

The point of "exclusive" regulations is not to say that someone un-certified couldn't do it, but that someone certified can, and that in critical domains only them should. A surgeon is not certified because they're privileged, but because they're the closest thing you can get to "guaranteed not to accidentally stab you in the neck while operating". There is no free ride, where there is a cheaper alternative, there is a cheaper guarantee, and in some domains "cheaper" is not acceptable. The only example given is of nurses Vs physicians, an unconvincing argument since both are a self-regulated profession.

(I have to admit the name of their blog cracks me up every time.)