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From: laura@l5.uucp (Laura Creighton)
Newsgroups: net.politics.theory
Subject: Re: Credentials, State vs. private
Message-ID: <142@l5.uucp>
Date: Sat, 21-Sep-85 20:02:32 EDT
Article-I.D.: l5.142
Posted: Sat Sep 21 20:02:32 1985
Date-Received: Wed, 25-Sep-85 07:30:34 EDT
References: <1208@ihlpg.UUCP> <4297@alice.UUCP> <1224@ihlpg.UUCP> <112@l5.uucp> <1258@ihlpg.UUCP>
Reply-To: laura@l5.UUCP (Laura Creighton)
Organization: Ell-Five [Consultants], San Francisco
Lines: 78

In article <1258@ihlpg.UUCP> tan@ihlpg.UUCP (Bill Tanenbaum) writes:
>>	[Me] 
>> 	I don't really care in principle whether the government or a
>> 	private group does the credentialling itself.  But I want the
>> 	government to enforce it ahead of time, not ex post facto when
>> 	it may be too late.  Of course, if multiple private groups do
>> 	the credentialling, I might notwant to have to become an
>> 	authority on WHICH private groups to trust.  So I might want
>> 	the government to approve the private credentialling groups.
>> [Laura Creighton]
>> There are frauds passing themselves off as doctors right now. That there
>> are governments does not prevent this. If you like the current doctors,
>> all you have to do is only accept AMA accredited doctors. Why do you believe
>> that having the government approve the private credentialling groups is
>> going to do anything above and beyond only going to AMA registered doctors?
>---
>1)Granted that governmental policing does not guarantee the absence of frauds.
>Governmental policing does not guarantee the absence of murder either, but
>we all think government should try.

First of all, you didn't answer my question. Second of all, the comparison is
specious. The government is not certifying people as non-murderers.  Currently
the government is involved in handing out stiff penalties for being a murderer.
Okay, we can have stiff penalties for fraudulently claiming to be an AMA
registered doctor as well. Does this solve the problem?

>2)In the absence of governmental credentialling of physicians, a situation
>might arise where there were lots of small credentialling organizations, and
>no generally recognized large ones.  (The extreme, albeit unlikely, example
>of this would be each doctor having his own organization to credential himself.)
Sorry, but this is not likely to happen at all.  If all the physicians
thought that they were rotten, then this might happen but there *are* large
bodies of good physicians out there. 25 years ago the physicians and surgeons
in the Commonwealth believed that they had this problem.  In the colonies
(well, former colonies by this time) people were graduating from medical
school who were not up to the exacting standards of the best British hospitals.
The solution was to have a standard exam in either Medicine or Surgery which
individual doctors could take if they wanted.  It was hard -- so hard that
most candidates had to take it two or more times to pass it. Those who passed
were entilted to put some extra initials (RSPS for Royal Society of
Physicians and Surgeons? I forget the exact title) after their name. Those
who didn't pass were still doctors but couldn't use those initials.

In recent times (ie withing the last 25 years) in Canada it was decided to do
away with this and to allow all doctors who had practiced for I forget how
many years to use those initials. This, of course, made the initials useless
for separating doctors in Canada. I don't know what it is like in the US
now but I am checking this.

There are such vetinary exams right now which means that I am better
equipped to find out how good my vet is than my doctor.

The thing to remember is that the good doctors wanted some way of letting
people know that they were good doctors because they are the ones who have
the most to lose. (Hmm. it is hard to phrase this. the patient who has
lost his life by going to a quack has not lost less than the doctor who
looses a bit of business -- it is just that the good doctors, as a class
are supporting the bad ones and will clearly see this and do something about
it.)

>Unlike libertarians, who can always predict the exact consequences of every
>libertarian experiment with unerring accuracy, I don't know whether such
>a situation would occur in practice in the absence of government credentialling.

Get serious. I don't know any libertarian who can predict the exact
consequences of any political experiment, and I don't think that you do either.
However, it is reasonable to predict that in the absense of govenrment
credentialling credentialling organisations will arise. I don't know how
many. I don't know what they will use to test physicians. But I do know that
this exact problem has been delt with by the physicians of the past and so
it is reasonable to assume that the physicians of the future would be equal
to the challenge.


-- 
Laura Creighton		(note new address!)
sun!l5!laura		(that is ell-five, not fifteen)
l5!laura@lll-crg.arpa