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From: nrh@inmet.UUCP
Newsgroups: net.politics
Subject: Re: Orphaned Response
Message-ID: <2005@inmet.UUCP>
Date: Wed, 27-Feb-85 02:18:29 EST
Article-I.D.: inmet.2005
Posted: Wed Feb 27 02:18:29 1985
Date-Received: Sun, 3-Mar-85 02:58:15 EST
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Nf-ID: #R:mhuxr:-25600:inmet:7800315:177600:4397
Nf-From: inmet!nrh    Feb 26 02:04:00 1985

>***** inmet:net.politics / mhuxr!mfs /  4:13 am  Feb 23, 1985
>> > Are you really suggesting that the way to lower health care costs is
>> > to loosen the standards required to practice medicine??
>> > Marcel Simon
>> 
>> Think about all the activities that you take part in each and every day
>> that, were someone important to have made foolish decisions, could leave
>> you dead.  Ever drive a car above 30 miles per hour?  Were the designers
>> of the car government certified?  Do you know how many people could die
>> if electricity were to be cut off to large sections of a city because a
>> computer program failed?  Should all those programmers be government
>> certified?
>> 
>> 	--Cliff
>
>A car does have to pass certain safety standards (seat belts, 5 MPH bumpers
>etc) and I have to be certified (driver's license) and the car has to
>be recertified each year (inspection). 

Just a few side-notes:

Some states have vehicle inspections and some do not.  It was
found a few years ago that the ones WITH inspection were no safer
statistically than the ones without.  "60 Minutes" sent a crew to 
the office of the governer of one of the states with inspection 
to ask him why the inspection program was going to continue anyhow.....

On another front, one little European country had no drivers licenses
until quite recently (sorry, can't remember which).

>If the kind of blackout you
>describe did have the effects you cite (not at all obvious. did anything
>of the sort happen after the two big New York blackouts of 1965 and 1977)
>the utility would for sure not get any kind of rate increase, and have
>to pay some heavy fines, a powerful incentive not to screw up.
>
>But all this is besides the point. I drive the car myself, so as long
>as the car maker provides regulated safety standards, if I use them
>improperly or not at all, I only have myself to blame. I have no
>such recourse when I am prescribed some drugs by a physician, or
>if I am being operated on. I HAVE to trust that doctor. The only
>basis for that confidence is that thge doctor has undergone
>some training before being able to practice medicine.

There's still no need to require that the doctor be certified
by the STATE -- a simple call to the AMA (which would certainly
prosecute vigorously anyone using their name falsely) would
suffice to make sure you had a doctor trained "the good old way"
rather than a Doctor Feelgood they've never heard of.

>The original posting (by Koenig) proposed the loosening of
>these requirements to insure better medical practice and lower costs.
>I argue that would be folly, and would invite quacks to provide
>inferior medical service, supposedly at lower cost.

I'm quite willing to believe that the "average" medical competence would
go down -- but think of how high "average" medical competence would be
if we forbid anyone except the people who were in the top 10 of their
medical schools to practice medicine!  On the other hand, we'd wind up
with only a couple of thousand doctors, tops (and of course, the rich
would get the overwhelming majority of their time).  In a sense, this is
what we've got now -- an artificially savage competition for medical
school because of the immense rewards reaped by an artificially small
number of (admittedly very qualified) doctors.

Clearly, the public interest would not be served (and is not served) by
artificially restricting the practice of medicine to the
ultra-competent.  The question is, what happens if you don't restrict it
at all?

The answer is that you get a spread of degrees of competence, but so
long as one enforces liability laws, one finds that the incompetent
quickly drop out, and so long as professional associations may form and
certify professionals, one has the option of paying more for a
"guaranteed-competent-by-the-AMA" doctor.  How much more?  Well, less
than we pay now (you see, they have to compete with the people who
didn't quite have the sterling academic record, but who could get into
medical school anyhow (as such medical schools would be able to turn out
"doctors" even without the AMA and the State Licensing Board's
approvals), and with the acupuncturists, and with the herb doctors, and
with the rest.

The doctors at the top would be no less competent --  they'd just
have to compete with everyone else, as opposed to letting the
State winnow the competition in advance.