[net.politics] The medical industry is not regulated?

ark@alice.UUCP (Andrew Koenig) (02/08/85)

Marcel Simon claims the medical industry is not regulated.
That claim is simply false.  If you doubt me, try setting
yourself up a medical practice without government permission.
Or try to buy a drug that the government doesn't like,
such as Laetrile.  Or even one that they do, such as
penicillin.

Or consider that the government will permit only one surgeon
to implant artificial hearts.  Or consider the government's
increasingly active role in mandating hospital accounting systems.

mfs@mhuxr.UUCP (SIMON) (02/12/85)

> Marcel Simon claims the medical industry is not regulated.
> That claim is simply false.  If you doubt me, try setting
> yourself up a medical practice without government permission.
> Or try to buy a drug that the government doesn't like,
> such as Laetrile.  Or even one that they do, such as
> penicillin.
> 
> Or consider that the government will permit only one surgeon
> to implant artificial hearts.  Or consider the government's
> increasingly active role in mandating hospital accounting systems.

What I meant, and did not make sufficiently clear, is that the medical
industry's FEES are not regulated. This contrasts with, say, Canada
Britain and other countries. Note the howls of protests from the
medical industry against the government's efforts to impose
some regulations on medical costs, in an effort to reduce the cost
of medical insurance for all and for the government in particular
(medicare)

ark@alice.UUCP (Andrew Koenig) (02/13/85)

>> = me
> = Marcel Simon

>> Marcel Simon claims the medical industry is not regulated.
>> That claim is simply false.  If you doubt me, try setting
>> yourself up a medical practice without government permission.
>> Or try to buy a drug that the government doesn't like,
>> such as Laetrile.  Or even one that they do, such as
>> penicillin.
>> 
>> Or consider that the government will permit only one surgeon
>> to implant artificial hearts.  Or consider the government's
>> increasingly active role in mandating hospital accounting systems.

> What I meant, and did not make sufficiently clear, is that the medical
> industry's FEES are not regulated. This contrasts with, say, Canada
> Britain and other countries. Note the howls of protests from the
> medical industry against the government's efforts to impose
> some regulations on medical costs, in an effort to reduce the cost
> of medical insurance for all and for the government in particular
> (medicare)

The claim that medical fees are not regulated is also false.  While
the government does not set doctors' fees directly (yet), those fees
are kept artificially high by government regulations that make it
artificially difficult for people to become physicians.  Specifically,
one needs a license to practice medicine.  In order to qualify for that
license, you must go through a government-approved course of study.
Since the people who determine the nature of that course of study
are all license-holders themselves, they have a vested interest
in making it as difficult as possible for others to obtain their
licenses, so as to minimize competition.

Restrict supply, and up goes the price.

This restriction would not be possible without government collaboration.

mfs@mhuxr.UUCP (SIMON) (02/13/85)

> 
> The claim that medical fees are not regulated is also false.  While
> the government does not set doctors' fees directly (yet), those fees
> are kept artificially high by government regulations that make it
> artificially difficult for people to become physicians. 
> 
> Restrict supply, and up goes the price.
> 

Are you really suggesting that the way to lower health care costs is
to loosen the standards required to practice medicine?? Considering
the increase in the rate of malpractice suits, at least some of which
are actually due to the doctor's incompetence, I find that proposal
incredible, if not dangerous.

Marcel Simon

abeles@mhuxm.UUCP (abeles) (02/13/85)

> The claim that medical fees are not regulated is also false.  While
> the government does not set doctors' fees directly (yet), those fees
> are kept artificially high by government regulations that make it
> artificially difficult for people to become physicians.  Specifically,
> one needs a license to practice medicine.  In order to qualify for that
> license, you must go through a government-approved course of study.
> Since the people who determine the nature of that course of study
> are all license-holders themselves, they have a vested interest
> in making it as difficult as possible for others to obtain their
> licenses, so as to minimize competition.
> 
See the Sunday NY Times, 10 Feb 85, for an article concerning the drop
in professional school, including med school, enrollments.  There are
now about 70,000 students in med schools in the US.  A number of med
schools have reduced their enrollments not because of lack of applicants
per se, but because of a lack of applicants able to pass the muster on
their high standards.  Dental school enrollments are down by approaching
50% from their peak, I believe (it is not too difficult to get in to
dental school today at all).  All professional schools, according to the
article, face problems of oversupply of their graduates, including
medical schools, law schools, and dental schools in particular.  The kind
of people who formerly went into many of these fields today are programming
computers, just like the majority of the readers here.  Leave me out,
though, of the latter classification.

--J. Abeles

ark@alice.UUCP (Andrew Koenig) (02/13/85)

> = Marcel Simon, >> = me

>> The claim that medical fees are not regulated is also false.  While
>> the government does not set doctors' fees directly (yet), those fees
>> are kept artificially high by government regulations that make it
>> artificially difficult for people to become physicians. 
>> 
>> Restrict supply, and up goes the price.
>> 

> Are you really suggesting that the way to lower health care costs is
> to loosen the standards required to practice medicine?? Considering
> the increase in the rate of malpractice suits, at least some of which
> are actually due to the doctor's incompetence, I find that proposal
> incredible, if not dangerous.

I am not suggesting that the way to lower health care costs is to
deregulate the medical industry -- I am stating it outright.

The number of malpractice suits is clear evidence that the licensing
system does not prevent incompetents from practicing medicine.
In fact, I claim it makes it somewhat easier, because it provides
the gullible with a substitute for reputation.

mfs@mhuxr.UUCP (SIMON) (02/14/85)

> : Andrew Koenig
> 
> I am not suggesting that the way to lower health care costs is to
> deregulate the medical industry -- I am stating it outright.
> 
> The number of malpractice suits is clear evidence that the licensing
> system does not prevent incompetents from practicing medicine.
> In fact, I claim it makes it somewhat easier, because it provides
> the gullible with a substitute for reputation.

So you would solve that problem by making it easier still for
incompetents to practice medicine? Do you expect that incompetent
doctors will somehow vanish or be forced into line by the AMA?
Curiouser and curiouser.

Marcel Simon

ark@alice.UUCP (Andrew Koenig) (02/14/85)

>> I am not suggesting that the way to lower health care costs is to
>> deregulate the medical industry -- I am stating it outright.
>> 
>> The number of malpractice suits is clear evidence that the licensing
>> system does not prevent incompetents from practicing medicine.
>> In fact, I claim it makes it somewhat easier, because it provides
>> the gullible with a substitute for reputation.

> So you would solve that problem by making it easier still for
> incompetents to practice medicine? Do you expect that incompetent
> doctors will somehow vanish or be forced into line by the AMA?
> Curiouser and curiouser.

I can think of two good reasons why abolishing government regulation
of the medical industry would make it harder, not easier, for
incompetents to practice.

	1. If physicians were permitted to advertise, it might
	   be possible for prospective patients to compare their
	   qualifications.

	2. I understand that most of the malpractice claims
	   come from a small number of physicians, but the
	   insurance companies are generally required by law
	   to charge the same rate for everyone.  In a free
	   market, incompetents would not be able to afford
	   to stay in business very long.

Although it is nice that deregulating medicine would improve
the customers' log, I think it is almost irrelevant because I
don't think that government has the moral right to do it in the first place.

mfs@mhuxr.UUCP (SIMON) (02/14/85)

> => Andrew Koenig
> 
> I can think of two good reasons why abolishing government regulation
> of the medical industry would make it harder, not easier, for
> incompetents to practice.
> 
> 	1. If physicians were permitted to advertise, it might
> 	   be possible for prospective patients to compare their
> 	   qualifications.

How so? Are you able to really tell the differences between, say, cars
*strictly* by their advertising? To take an example closer to the
subject matter, lawyers are now permitted to advertise. How does this
fact (advertisement), to the exclusion of others, make for better
lawyers?

If you meant that advertisement might make a given doctor better known,
thereby increasing his/her word of mouth reputation, the present system
is only marginally less efficient, since physician advertisement by
nature would be local and thereby not widely recognized.

> 
> 	2. I understand that most of the malpractice claims
> 	   come from a small number of physicians....

Not quite. Most of the *successful* malpractice suits are against a
relatively small number of doctors. In my opinion, the increase on
malpractice suits is a direct result of the increased litigiousness
of US society. "If the doctor did not heal me totally and immediately,
the doctor must have done something wrong". The cost of malpractice
insurance would go up even if all suits were dismissed, just because
of the legal costs involved.

> 	   In a free
> 	   market, incompetents would not be able to afford
> 	   to stay in business very long.
> 

As I said above, a deregulated (by your definition) medical industry
would only marginally improve public knowledge of a doctor's competence
and not at all reduce the trend toward more malpractice suits.

Marcel Simon

mmt@dciem.UUCP (Martin Taylor) (02/15/85)

>The claim that medical fees are not regulated is also false.  While
>the government does not set doctors' fees directly (yet), those fees
>are kept artificially high by government regulations that make it
>artificially difficult for people to become physicians.  Specifically,
>one needs a license to practice medicine.  In order to qualify for that
>license, you must go through a government-approved course of study.
>Since the people who determine the nature of that course of study
>are all license-holders themselves, they have a vested interest
>in making it as difficult as possible for others to obtain their
>licenses, so as to minimize competition.

You wouldn't make a claim like this if you had any connection with
an institution that trains physicians. And I don't mean that the
connection would automatically turn you into a liar, either.

For an eye-opening view of what it takes to train a physician, or
what it takes to be trained, find the issue of the Johns Hopkins
Magazine that featured the topic, about a year ago.
-- 

Martin Taylor
{allegra,linus,ihnp4,floyd,ubc-vision}!utzoo!dciem!mmt
{uw-beaver,qucis,watmath}!utcsrgv!dciem!mmt

act@pur-phy.UUCP (Tselis) (02/17/85)

In article <250@mhuxr.UUCP> mfs@mhuxr.UUCP (SIMON) writes:
>> : Andrew Koenig
>> 
>> I am not suggesting that the way to lower health care costs is to
>> deregulate the medical industry -- I am stating it outright.
>> 
>> The number of malpractice suits is clear evidence that the licensing
>> system does not prevent incompetents from practicing medicine.

I suspect that the author of this statement was being distracted while making
it, because it is nonsense as it stands.  One can just as easily say that
the very large number of people who believed that the earth was flat provided
strong evidence that this was so.  It is certainly true that there are   
incompetents who practice medicine.  The further suggestion that the author
makes concerning how letting anyone who wants to practice medicine to do so
without any special qualifications is somewhat beyond belief.  Why not let
a witchdoctor do brain surgery?  Of course, no hospital will provide a
witchdoctor with privileges, so the WD will have to remove glioblastoma
multiformes in his hut.  But this does provide more choice, and hence
better medical care.  Right?
-- 
A.C.Tselis 
...ihnp4!pur-ee!pur-phy!act

cliff@unmvax.UUCP (02/18/85)

> Are you really suggesting that the way to lower health care costs is
> to loosen the standards required to practice medicine?? Considering
> the increase in the rate of malpractice suits, at least some of which
> are actually due to the doctor's incompetence, I find that proposal
> incredible, if not dangerous.
> 
> 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

mfs@mhuxr.UUCP (SIMON) (02/22/85)

> > 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). 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.
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.

Marcel Simon

orb@whuxl.UUCP (SEVENER) (02/22/85)

> 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

It just so happens that, yes indeed, there is a certification process known
as a driver's license required to operate a motor vehicle.  Whether that
certification process is very rigorous or not, it *is* a requirement before
driving a potentially lethal automobile 55 miles per hour. And if a person
*should* be proven to have killed somebody by negligence in driving, they
are not allowed to drive for a certain period.
 
There are also regulations to insure that electrical wiring is safe.

I am glad of it.            tim sevener  whuxl!orb

cliff@unmvax.UUCP (02/24/85)

> > Were the designers
> > of the car government certified?

> It just so happens that, yes indeed, there is a certification process known
> as a driver's license required to operate a motor vehicle.  Whether that
> certification process is very rigorous or not, it *is* a requirement before
> driving a potentially lethal automobile 55 miles per hour. And if a person
> *should* be proven to have killed somebody by negligence in driving, they
> are not allowed to drive for a certain period.

Can you say: designers?
Chalk up another straw man.
 
> > 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?

> There are also regulations to insure that electrical wiring is safe.
 
Can you say: because a computer program failed?
Chalk up another.

What is it with you, Tim?

Do you just not care what you say as long as you say something?

The point is there are many professionals in industry that are not government
certified and many of them are responsible for decisions that could cost
lives if mistakes are made.  If a company may be liable for faulty products
then it is in everyones best interest to see that key people know what they
are doing.
 
> I am glad of it.            tim sevener  whuxl!orb

--Cliff

mmt@dciem.UUCP (Martin Taylor) (03/01/85)

>The point is there are many professionals in industry that are not government
>certified and many of them are responsible for decisions that could cost
>lives if mistakes are made.  If a company may be liable for faulty products
>then it is in everyones best interest to see that key people know what they
>are doing.
>
>--Cliff

One might hope that people holding publicly sensitive jobs would in due
course come under certification regulations.  The fact that technology
is now changing very rapidly should not be used as an indication that
these professions shouldn't be certified.

You know what the company's response is to a faulty product: hire
PR people and fancy lawyers to prove to the public and to the courts
that they didn't do it, they didn't know it was dangerous, it wasn't
their fault anyway, and the victim should have been more careful, so
it's the fault of the dead for being there.

I prefer not to have the fatal (so-called) accidents happen. Training,
certification, and regulation should be properly applied, not eliminated
because there now exist significant areas where fools are allowed to
kill people and get away with claiming ignorance.
-- 

Martin Taylor
{allegra,linus,ihnp4,floyd,ubc-vision}!utzoo!dciem!mmt
{uw-beaver,qucis,watmath}!utcsri!dciem!mmt