I’ve been thinking a lot about how to improve the house of medicine.
I have several ideas that are going to get put into several posts over the next week or so.
Here’s idea #1.
People’s perception of medicine as a “free” service has to change.
I won’t go into the discussion about whether health care is a right. It’s like a gun control argument or an abortion debate. Everyone just digs in their heels and shouts at the other side. Strange how the ones who would be forced to provide this “right” to others have different views than the ones who demand the “right,” though, isn’t it?
See also this post about, even if healthcare is a “right,” why – just like every other right afforded to Americans – it shouldn’t be an absolute right.
Whether or not healthcare is a right doesn’t really matter for this idea, though.
What would happen if we did away with licensing of medical professionals and certification of medical facilities? When you think about it, licensing only serves two purposes: it allows the state to extract money from a class of people trained in a given art and it allows for regulation of those classes of people. Ditto for certification. You can argue all day that certification and licensing improve “safety”. I can give you just as many examples of how that argument doesn’t work.
What if we let anyone hang out a shingle and practice medicine out of their garage or their living room? With all the physician extenders performing the tasks that used to be performed solely by physicians, we’re heading down that road already. Get rid of the incremental steps. Jump in head first.
Let my 11 year old forget her paper route and practice medicine – just like Lucy on the Peanuts. She may only make 5 cents per patient, but she would still get paid for her services.
What effect would opening the practice of medicine to everyone have?
Anyone could receive health care from anyone.
Access would improve immediately.
Any patient could choose to go to their kid, the neighborhood witchdoctor, Reverend Bubba, the local Rolfer, or their good ol’ family physician.
But … with no regulation of the medical industry, consumers would then be forced to make a value judgment about the care they receive. It may be a bargain to get psychiatric help from Lucy for 5 cents, but how reliable is what she tells you? Would you rather pay a little more to speak to a psychiatric nurse? Or would you rather pay the “big bucks” to talk to a psychiartist?
We can pay high school kids minimum wage to work in a medical clinic and treat patients for “free.” Patients have access. Patients have timely care. Everything is great. If you want to pay some money, you can see the nurse practitioner and if you want to pay more money, you can see the physician. Maybe there’s a new physician that wants to build a practice and is only charging the going rate for a college grad. That doctor will probably get more patients. Free market at work. Want to sell more product – lower the cost.
To make extra money, someone could set up a couple of beds out in the garage with IV poles and a TV set. That would cost you very little. Would you pay more to be taken care of in a hospital? How about having a nurse tend to your needs? Is it worth more to you if the hospital is deemed “better” at the government’s “Hospital Compare” site? Would you pay more to go to a hospital that is certified by JCAHO? Maybe, maybe not. But the consumer is the one who has to do the research and decide.
If we give patients unlimited availability to health care, then everyone can have “free” or nearly free care. That’s when market forces kick in. If you want a specialist, you have to pay for it. All that training doesn’t come cheap. Maybe the college grad can do a colonoscopy on you for $25, but if you want someone with experience, you have to pay more. Some people will only go to the “best of the best” and those practitioners will be able to charge premium prices.
Once people had access to health care, there wouldn’t be a need for a lot of health care insurance. Then we could get back to what insurance was intended for – catastrophes. Major heart attack? Open heart surgery? Neurosurgery? You could get less experienced practitioners providing your health care “right” to you for free at a county hospital or you could pay a healthcare insurance premium for the more experienced ones to perform surgery at that cushy suburban hospital. Everything is up to the consumer.
Just like everything else in this world, if you can’t afford the premium prices, you’ll still get care – it just won’t be the “best” care.
People on welfare don’t get to live in five star hotels. You can’t use food stamps to eat out at expensive restaurants. Not every accused criminal has a right to representation by Johnnie Cochran or his progeny.
Access to health care shouldn’t be any different, but right now it is the only industry in which, for the most part, the best practitioners get paid the same amount as the worst practitioners. Aside from climbing the academic ladder, there is little financial incentive for most health care professionals to be better in the field. The emphasis is on how quick you can do your job. That has to change.
Removing licensing requirements for the practice of medicine may sound extreme, but extreme changes are what we need before the system collapses.
You can now commence your flaming in the comment section.