berman@psuvax1.UUCP (Piotr Berman) (09/04/85)
> > In other words, if the state provides such a service, the market need > not. This is news? There's nothing here to suggest that the "national > educational standards" are better than standardized tests, and if you > want diversity in your educational system, I would think that the > standardized test route (public or private) would be the way to go. > > > >The solution here is stricter national standards, not looser ones. > >And personnel departments don't look at ETS results, anyway. > > They don't have to -- the people with poor ETS scores had less of > a chance to attain the credentials that the personnel departments > DO look at, and the ETS info would be old anyhow. On the other hand, > perhaps you have heard of the "Institute for the Certification of > Computer Professionals"? > > >>>Of course, the value of a credentialing system depends on the level > >>>of publicity, the level of enforcement, and the level of agreement > >>>on the value of particular credentials. Hence, since the best > >>>guarantor of publicity, enforcement, and agreement between credentials > >>>is a public regulatory authority, > >> > >>Support please. > >> > > > >I assume you agree with the first sentence. As far as the second goes, > >I think of a credentialing scheme like a security setup. The most > >secure setups are where an outside, central agency takes charge of > >security and makes sure that all sub-central security arrangements > >are consistent, so that the system as a whole is secure against hostile > >entry. And where everyone knows the rules. The same rules which > >maintain secure environments are the rules which maintain consistent > >credentialing systems. > > > > No support here for the notion that the state must administer such > a system -- the "outside, central agency" need not be public at > all (ETS isn't). Indeed, public agencies have the problem of being > under government pressure to pump the scores up. Private agencies > are presumably a little more resistant. This is no a communist country, but a country with checks and balaces. There is a lot of very reliable statistical data which are collected by goverment institutions. > >The only central agency in a state which has coercive powers over > >people within the state is the state. > > AHA! Here's the core of what I believe to be your error. There is > no need for such an agency to be coercive. None. > > >So it has a role if a social > >goal is that educational credentials should be secure and consistent. > > Why? If I tell you that my name is "Nat Howard" and can get you to > agree with me that much, and then we make a joint call to a private > credentialing service that you trust, you will be convinced that I > have a given credential if they say I do. > > Of course, you may elect not to trust the private agency, feeling that > a public one would be more trustworthy. If so, you've fallen into the > bad mistake of believing that public officials are less corrupt > than private ones. > > >>>on the value of particular credentials. Hence, since the best > >>>guarantor of publicity, enforcement, and agreement between credentials > >>>is a public regulatory authority, > >>>and because people outside the > >>>educational system disturb the system of credentials, > >> > >>Support for the implication that the impact that outsiders have > >>is "distortion" and not "adjustment to reality", please. > >> ............. > By "outsiders", I meant the people outside the testing system who > exert pressure to modify testing criteria. Not the beneficiaries > of such modification. Indeed, making a government agency be the > arbiter of such things means that testing criteria MUST be influenced > by politics. A private agency faces ruin if it's credentials are > shown to be fraudulent. Not so a government agency. A private agency > also faces ruin if its credentials are shown to be unattached to > reality. This is also not so true of a federal agency. In short, > the forces that act on a private agency tend to make the credentials > reflect reality more closely. The pressures on a public agency reflect > the degree of power and interest held by pressure groups, some of whom > would benefit from certain changes. > What we see here is a naive belief in the selfregulatory powers. In fact SAT tests are widely criticized for being detached from reality. As somebody put it "since most of the colleges accept practically everybody, they need some fiction to support the claim of mantaining standarts. Thus the need for SAT scores". Yesterday there was an article in NYT about widespread incompetience among doctors. Since no centralized system of credencial exists, it is extremally difficult to prevent incompetient (at time fraudulent) doctors to be in the profession. This illustrates the point that in the absence of universal, imposed standards, private associations and state agencies are not able to assure the desired level of competience. Piotr Berman
gene@batman.UUCP (Gene Mutschler) (09/04/85)
[P. Berman again looks at white and sees black] > What we see here is a naive belief in the selfregulatory powers. > ...Yesterday there was an article in NYT > about widespread incompetience among doctors. Since no centralized > system of credencial exists, it is extremally difficult to prevent > incompetient (at time fraudulent) doctors to be in the profession. Wrong again. These doctors are still in practice precisely because there are credentialling systems. In a free society, where anyone is free to practice medicine and where competitive pressures would cause dissemination of information as to relative competence, the bad doctors would quickly be forced out of business. Under the current system, all one has to do is pass the exam once, and one is a doctor for life. What little state review there is is hesitant to take away a doctor's licence because that would presumably deprive that doctor of his/her livelihood. The free market would not be so sympathetic. -- Gene Mutschler {ihnp4 seismo ctvax}!ut-sally!batman!gene Burroughs Corp. Austin Research Center cmp.barc@utexas-20.ARPA (512) 258-2495
nrh@inmet.UUCP (09/05/85)
>/* Written 5:59 pm Sep 3, 1985 by psuvax1!berman in inmet:net.politics.t */ >/* ---------- "Re: Credentials, State vs. private" ---------- */ >> >I assume you agree with the first sentence. As far as the second goes, >> >I think of a credentialing scheme like a security setup. The most >> >secure setups are where an outside, central agency takes charge of >> >security and makes sure that all sub-central security arrangements >> >are consistent, so that the system as a whole is secure against hostile >> >entry. And where everyone knows the rules. The same rules which >> >maintain secure environments are the rules which maintain consistent >> >credentialing systems. >> > >> >> No support here for the notion that the state must administer such >> a system -- the "outside, central agency" need not be public at >> all (ETS isn't). Indeed, public agencies have the problem of being >> under government pressure to pump the scores up. Private agencies >> are presumably a little more resistant. > >This is no a communist country, but a country with checks and balaces. >There is a lot of very reliable statistical data which are collected >by goverment institutions. Ho-hum. Does this overqualified statement mean anything? I suppose we know how many salmon spawn in Alaska, but the accuracy of certain government figures is widely debated. Indeed, a certain (rather libertarian) book I lent to someone in the social sciences was slammed because it used census data ("Which everyone knows is not worth anything"). Perhaps you didn't notice when Ronnie's administration presided over a change in the way cost-of-living was calculated (around 1981, if I remember right). It was contended at the time that the old method (which showed a higher cost of living) was causing inflation because so many contracts (and a lot of public perception) were pegged to it. No, the government doesn't do this sort of thing lightly, and it cannot prevent (at least not so far) independent statistical studies. But to argue that because our system has checks and balances, the figures our government puts out are actually representative is sort of silly. > >> >The only central agency in a state which has coercive powers over >> >people within the state is the state. >> >> AHA! Here's the core of what I believe to be your error. There is >> no need for such an agency to be coercive. None. >> >> >So it has a role if a social >> >goal is that educational credentials should be secure and consistent. >> >> Why? If I tell you that my name is "Nat Howard" and can get you to >> agree with me that much, and then we make a joint call to a private >> credentialing service that you trust, you will be convinced that I >> have a given credential if they say I do. >> >> Of course, you may elect not to trust the private agency, feeling that >> a public one would be more trustworthy. If so, you've fallen into the >> bad mistake of believing that public officials are less corrupt >> than private ones. >> >> >>>on the value of particular credentials. Hence, since the best >> >>>guarantor of publicity, enforcement, and agreement between credentials >> >>>is a public regulatory authority, >> >>>and because people outside the >> >>>educational system disturb the system of credentials, >> >> >> >>Support for the implication that the impact that outsiders have >> >>is "distortion" and not "adjustment to reality", please. >> >> >............. >> By "outsiders", I meant the people outside the testing system who >> exert pressure to modify testing criteria. Not the beneficiaries >> of such modification. Indeed, making a government agency be the >> arbiter of such things means that testing criteria MUST be influenced >> by politics. A private agency faces ruin if it's credentials are >> shown to be fraudulent. Not so a government agency. A private agency >> also faces ruin if its credentials are shown to be unattached to >> reality. This is also not so true of a federal agency. In short, >> the forces that act on a private agency tend to make the credentials >> reflect reality more closely. The pressures on a public agency reflect >> the degree of power and interest held by pressure groups, some of whom >> would benefit from certain changes. >> >What we see here is a naive belief in the selfregulatory powers. In fact >SAT tests are widely criticized for being detached from reality. As >somebody put it "since most of the colleges accept practically everybody, >they need some fiction to support the claim of mantaining standarts. >Thus the need for SAT scores". SAT tests are indeed widely criticized. So, for example, is this or that football team. The solution? Use SAT scores to evaluate certain things and not others. I do not argue for a moment that SAT scores are perfect for any use whatsoever. In fact, I suggest you dig up some of their literature and see if you can find precisely what they promise to do. All colleges that I'm familiar with use SAT or other standardized tests to evaluate certain aspects of a prospect, but they would be fools to reject or accept a student on that basis alone, just as you would be a fool to hire someone on the basis of having a "CCP" after his name. I see here no evidence that government testing would be any better -- certainly we would see "self-regulatory" behavior there too. >Yesterday there was an article in NYT >about widespread incompetience among doctors. Since no centralized >system of credencial exists, it is extremally difficult to prevent >incompetient (at time fraudulent) doctors to be in the profession. Excuse me, but I believe you can call the AMA to verify such things, can you not? If not, perhaps you could call the school name that appears on the Doctor's MD? I've noticed that real doctors tend to post their diplomas prominently. >This illustrates the point that in the absence of universal, imposed >standards, private associations and state agencies are not able to >assure the desired level of competience. Excuse me, but there's no evidence in your note to suggest that federal agencies would do any better. Against someone who SEEMS legit, and who can bribe the right people, federally-controlled systems are probably even weaker. I'm also curious who you think would sit on the board of a hypothetical federal testing agency. Do you suppose we'd find.... doctors? Perhaps the same ones who make up the AMA? Why not? By the way, how did these bogus doctors fare in the face of malpractice suits? What were their insurance premiums like? If they were merely incompetent (as opposed to fraudulent) how is the government to test them for this.
berman@psuvax1.UUCP (Piotr Berman) (09/05/85)
> [P. Berman again looks at white and sees black] > > > What we see here is a naive belief in the selfregulatory powers. > > ...Yesterday there was an article in NYT > > about widespread incompetience among doctors. Since no centralized > > system of credencial exists, it is extremally difficult to prevent > > incompetient (at time fraudulent) doctors to be in the profession. > > Wrong again. These doctors are still in practice precisely because > there are credentialling systems. In a free society, where anyone > is free to practice medicine and where competitive pressures would > cause dissemination of information as to relative competence, the bad > doctors would quickly be forced out of business. > Gene Mutschler {ihnp4 seismo ctvax}!ut-sally!batman!gene Wrong again. How a competitive pressure would cause dissemination of information as to relative competence? The only result of "competitive pressure" could be an advertising war between providers of health services. As a consumer, I would receive a barrage of conflicting claims. Another possibility as that the group with the best credencials (like AMA) would curtail this as well as it happens today. When I am ill the first time in a given city, I take Yellow Pages and look for a needed specialist. I do not want to get a competient one after many trials and errors. One does not to be psychic to forsee the consequences of the system proposed by Gene. After many trials and errors, I am yet to find a decent auto mechanic in my small city. Yet, I havenot noticed any dissemination of information as to relative competence in this area. It s clear why. Who could make money on this? Perhaps you, Gene, but I do know how to do it. Unfortunately, I cannot afford as many bad experiences in my health care. Piotr Berman
tan@ihlpg.UUCP (Bill Tanenbaum) (09/10/85)
> > [P. Berman] > > What we see here is a naive belief in the selfregulatory powers. > > ...Yesterday there was an article in NYT > > about widespread incompetience among doctors. Since no centralized > > system of credencial exists, it is extremally difficult to prevent > > incompetient (at time fraudulent) doctors to be in the profession. ----- > [Gene Mutschler] > Wrong again. These doctors are still in practice precisely because > there are credentialling systems. In a free society, where anyone > is free to practice medicine and where competitive pressures would > cause dissemination of information as to relative competence, the bad > doctors would quickly be forced out of business. Under the current > system, all one has to do is pass the exam once, and one is a doctor > for life. What little state review there is is hesitant to take away > a doctor's licence because that would presumably deprive that doctor > of his/her livelihood. The free market would not be so sympathetic. -- Oh, come on, Gene. There is already an oversupply of doctors in most metropolitan areas of the U. S. Only rural areas, many small towns, and some inner city areas have shortages. The free market, as you call it, already operates among credentialled physicians. The competitive pressures you talk about already exist. Doctors and hospitals are already advertising for patients. It may be true that the medical profession keeps medical school admissions down to control the supply of doctors. But when I go to a doctor, I want to know that he/she has gone to medical school, had some experience as an intern, and passed that exam. So does virtually everybody else, except Libertarian utopians. You are right about the condition of state review. Abolishing it would make matters still worse, not better. At least now, a small handful of the most blatantly incompetent lose their liscences. -- Bill Tanenbaum - AT&T Bell Labs - Naperville IL ihnp4!ihlpg!tan
ark@alice.UucP (Andrew Koenig) (09/10/85)
Bill Tanenbaum says: > But when I go to a doctor, I want to know that he/she has gone to medical > school, had some experience as an intern, and passed that exam. So > does virtually everybody else, except Libertarian utopians. That, of course, is not in dispute. What is in dispute is whether or not the government should be in the certification business. Medical schools have reputations, and reputations are not easily gained or kept. Do you really think that Harvard is going to start letting incompetents graduate just because the government stops looking over their shoulders? In a free society, if you wanted to know whether your doctor had gone to medical school, you would ask. If you didn't get a satisfactory answer, you could go elsewhere. The only role the government would play is that if the answer you got were a lie, you could press fraud charges.
tan@ihlpg.UUCP (Bill Tanenbaum) (09/11/85)
> > [Me] > > But when I go to a doctor, I want to know that he/she has gone to medical > > school, had some experience as an intern, and passed that exam. So > > does virtually everybody else, except Libertarian utopians. ------ > [Andrew Koenig] > That, of course, is not in dispute. What is in dispute is whether > or not the government should be in the certification business. > > Medical schools have reputations, and reputations are not easily > gained or kept. Do you really think that Harvard is going to start > letting incompetents graduate just because the government stops > looking over their shoulders? > > In a free society, if you wanted to know whether your doctor had > gone to medical school, you would ask. If you didn't get a > satisfactory answer, you could go elsewhere. The only role the > government would play is that if the answer you got were a lie, > you could press fraud charges. ------ Personally, I would rather know ahead of time that whomever I choose to be my doctor has the basic qualifications. I don't want the burden on me to determine my doctor's credentials. Anyone who would practice without having gone to medical school would have no hesitation in lying about it. Of course, I could press fraud charges, but by that time I might be dead, or at least impoverished from the quack's bills. 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 not want to have to become an authority on WHICH private groups to trust. So I might want the government to approve the private credentialling groups. But that is another issue. -- Bill Tanenbaum - AT&T Bell Labs - Naperville IL ihnp4!ihlpg!tan
laura@l5.uucp (Laura Creighton) (09/12/85)
There is nothing in Libertaria which says that you shouldn't get the doctor that you want who went ot the medical school of your choice. All you have to do is hire *that* doctor rather than some other doctor. What it will do is to get rid of the fiction that all doctors are created equal, and make it clear to people that they are going to have to do the same level of research in selecting a doctor that they already do to select a car or a television. I consider that a good thing. -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
mangoe@umcp-cs.UUCP (Charley Wingate) (09/13/85)
In article <4297@alice.UUCP> ark@alice.UucP (Andrew Koenig) writes: >Bill Tanenbaum says: >> But when I go to a doctor, I want to know that he/she has gone to medical >> school, had some experience as an intern, and passed that exam. So >> does virtually everybody else, except Libertarian utopians. >That, of course, is not in dispute. What is in dispute is whether >or not the government should be in the certification business. >Medical schools have reputations, and reputations are not easily >gained or kept. Do you really think that Harvard is going to start >letting incompetents graduate just because the government stops >looking over their shoulders? >In a free society, if you wanted to know whether your doctor had >gone to medical school, you would ask. If you didn't get a >satisfactory answer, you could go elsewhere. The only role the >government would play is that if the answer you got were a lie, >you could press fraud charges. The problem with this is that in fact people aren't well enough informed to judge in general, and that changes in reputation generally lag changes in actuality considerably, often being completely unrelated to reality. A person living in rural Tennessee often does not have the resources available to find out whether the slick young man is really from Harvard, as he claims to be. Charley Wingate
laura@l5.uucp (Laura Creighton) (09/13/85)
Bill Tannenbaum 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. 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? -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
mrh@cybvax0.UUCP (Mike Huybensz) (09/13/85)
In article <4297@alice.UUCP> ark@alice.UucP (Andrew Koenig) writes: > In a free society, if you wanted to know whether your doctor had > gone to medical school, you would ask. If you didn't get a > satisfactory answer, you could go elsewhere. The only role the > government would play is that if the answer you got were a lie, > you could press fraud charges. When you are struck by a car, I will be happy to bring you to the nearest medical practicioner I can find. If he specializes in acupuncture or voodoo, well, you should have asked. The fact is, that people frequently need immediate medical attention, in situations where we are coerced by circumstances, where we cannot practically choose. For those circumstances, I want regulation. Either specific certification for emergencies, or a more general regulation. -- Mike Huybensz ...decvax!genrad!mit-eddie!cybvax0!mrh
tan@ihlpg.UUCP (Bill Tanenbaum) (09/13/85)
> [Laura Creighton] > There is nothing in Libertaria which says that you shouldn't get the doctor > that you want who went ot the medical school of your choice. All you have to > do is hire *that* doctor rather than some other doctor. What it will do is > to get rid of the fiction that all doctors are created equal, and make it > clear to people that they are going to have to do the same level of research > in selecting a doctor that they already do to select a car or a television. > > I consider that a good thing. ----- OK, I can research my personal physician's credentials. What happens, however, when I need emergency medical care, or if I get sick when away from home. I want to know that all practicing doctors, not just mine, have met some minimal competency standards. State liscensing is not perfect in this regard, but it is better than nothing. -- Bill Tanenbaum - AT&T Bell Labs - Naperville IL ihnp4!ihlpg!tan
berman@psuvax1.UUCP (Piotr Berman) (09/13/85)
> > There is nothing in Libertaria which says that you shouldn't get the doctor > that you want who went ot the medical school of your choice. All you have to > do is hire *that* doctor rather than some other doctor. What it will do is > to get rid of the fiction that all doctors are created equal, and make it > clear to people that they are going to have to do the same level of research > in selecting a doctor that they already do to select a car or a television. > > I consider that a good thing. > > -- > Laura Creighton (note new address!) > sun!l5!laura (that is ell-five, not fifteen) > l5!laura@lll-crg.arpa I do not consider that a good thing. When I am ill, I do not have the time to look for a doctor, certainly not as much of time as in the case of a car. Also, the potential damage of a wrong choice is much larger. You assume that a citizen of Libertaria has a lot of information and sophistication. He/she decides without help of the state whether doctors are good, whether banks/insurance companies have good financial standing, whether a given ingredient of some food you are want to eat may be harmful, etc. Before the age of state regulations, citizens were never sure of those things, and frequently they were paying dearly for this. Piotr Berman
wjr@x.UUCP (Bill Richard) (09/16/85)
<coercion> Note: This is STella Calvert, not frog or wjr. I'm a guest here. In article <750@cybvax0.UUCP> mrh@cybvax0.UUCP (Mike Huybensz) writes: > >When you are struck by a car, I will be happy to bring you to the nearest >medical practicioner I can find. If he specializes in acupuncture or >voodoo, well, you should have asked. > >The fact is, that people frequently need immediate medical attention, in >situations where we are coerced by circumstances, where we cannot practically >choose. For those circumstances, I want regulation. Either specific >certification for emergencies, or a more general regulation. >-- No, no, no! I will be carrying (probably on the back of my medicalert necklace) a toll-free number to notify my medicare plan that I am in need of service. That plan will have some qualified (by my standards) personnel on the scene as soon after I call (or you as my agent) as I am willing to pay for. Response time is important. So is quality of care. I'll pay for both, and make it easy (dial 1 100 MED HELP) for you to carry out my wishes. But I will have chosen the flavor of medical care I want before I need it. If you find me without my tag, I will possibly suffer for my error as you take me to the brand of doctor you think best, so be assured, I will be wearing that tag. I will also be paying, in my premiums, for the right to call my plan if I encounter a John Doe who does not appear to have medical coverage. STella Calvert (guest on ...!decvax!frog!wjr) Every man and every woman is a star.
laura@l5.uucp (Laura Creighton) (09/16/85)
In article <1565@umcp-cs.UUCP> mangoe@umcp-cs.UUCP (Charley Wingate) writes: > >The problem with this is that in fact people aren't well enough informed to >judge in general, and that changes in reputation generally lag changes in >actuality considerably, often being completely unrelated to reality. A >person living in rural Tennessee often does not have the resources available >to find out whether the slick young man is really from Harvard, as he claims >to be. Okay, it sounds to me like there is a market for doctor-verification here. The prospective patients will want this and the doctors will want this a great deal. So someone will set up a doctor-verification agency. (Actually, it will probably be more general than just doctor verification -- in Libertaria this problem is going to crop up again and again.) It will be constrained to be honest by the same constraints that make the AMA (or Consumer Reports, or a high-minded public official) honest -- because it will be staffed by people who are genuinely concerned with the problem, because it will be staffed by people who are honoroable, because it will loose all its customers if it prints lies and because people will sue it for fantastic sums of money if it doesn't. -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
mrh@cybvax0.UUCP (Mike Huybensz) (09/16/85)
In article <568@x.UUCP> wjr@x.UUCP (STella Calvert) writes: > No, no, no! I will be carrying (probably on the back of my medicalert > necklace) a toll-free number to notify my medicare plan that I am in need of > service. That plan will have some qualified (by my standards) personnel on > the scene as soon after I call (or you as my agent) as I am willing to pay > for. Response time is important. So is quality of care. I'll pay for both, > and make it easy (dial 1 100 MED HELP) for you to carry out my wishes. But I > will have chosen the flavor of medical care I want before I need it. If you > find me without my tag, I will possibly suffer for my error as you take me to > the brand of doctor you think best, so be assured, I will be wearing that tag. If you are rich enough to afford that sort of medical service, you can buy it right now. The only thing that might make it slightly more expensive is that you still need real doctors. People who can't afford high medical premiums (many plans cost about $2000 a year) will still have difficulty. Assuming a real libertaria, then your flavor of medicine is quite likely to be Dr. Smith's Astrological Aura Manipulation. Once you remove medicine and medical practice from regulation, you end up with the full spectrum of snake oil and other fraud, only now with better advertising. Look at all the people who use fraudulent (unregulated and sometimes lethal) diet plans. Advertising dollars generate much better profits than research or training dollars, and advertising reaches a much larger audience than product comparisons. If you were brought up within a libertaria, bombarded with propaganda and counterpropaganda, with no statistics you could trust, you would probably pick a popular, well advertised quackery. After all, it would probably be cheaper than the best medicine. Kidney machines too expensive? Oh, then they're bad for the aura. Pills cheap? They brighten the aura. And let's not forget the addictive "health" prescriptions, whose ingredients need not be divulged. But wait, you need psychic surgery for your muffler bearing (oops, that was the "doctor"'s previous employment.) > I will also be paying, in my premiums, for the right to call my plan if I > encounter a John Doe who does not appear to have medical coverage. Very generous of you. I'm sure that your provider will provide enough disincentives to reign your generosity in, and thus prevent your distribution of medical services to everyone in libertaria. -- Mike Huybensz ...decvax!genrad!mit-eddie!cybvax0!mrh
tan@ihlpg.UUCP (Bill Tanenbaum) (09/17/85)
> [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. 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.) Then the consumer's problem of judgeing physicians would be replaced by an equally difficult one of judgeing credentialling organizations, and credentialling would become useless. In such a case, I would want the government to step in and either do the credentialling itself, or do the equivalent and credential the credentiallers. 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. I suspect, however, that it is a possibility. -- Bill Tanenbaum - AT&T Bell Labs - Naperville IL ihnp4!ihlpg!tan
mangoe@umcp-cs.UUCP (Charley Wingate) (09/17/85)
In article <126@l5.uucp> laura@l5.UUCP (Laura Creighton) writes: >In article <1565@umcp-cs.UUCP> mangoe@umcp-cs.UUCP (Charley Wingate) writes: >>The problem with this is that in fact people aren't well enough informed to >>judge in general, and that changes in reputation generally lag changes in >>actuality considerably, often being completely unrelated to reality. A >>person living in rural Tennessee often does not have the resources available >>to find out whether the slick young man is really from Harvard, as he claims >>to be. >Okay, it sounds to me like there is a market for doctor-verification here. >The prospective patients will want this and the doctors will want this a >great deal. So someone will set up a doctor-verification agency. (Actually, >it will probably be more general than just doctor verification -- in >Libertaria this problem is going to crop up again and again.) It will >be constrained to be honest by the same constraints that make the AMA >(or Consumer Reports, or a high-minded public official) honest -- because >it will be staffed by people who are genuinely concerned with the problem, >because it will be staffed by people who are honoroable, because it will >loose all its customers if it prints lies and because people will sue it >for fantastic sums of money if it doesn't. Will it? If corruption is everywhere, then why not here as well? And what's going to prevent the appearance of phony certification companies? What bothers me more is that this governmental function has simply moved to a new location where it is even less accessible to pressure from ordinary folk. The power that was wielded by the government through this function still remains; only now it is in the hands of a board of trustees, who aren't necessarily going to be responsible but to a few people (and certainly for different ends). Charley Wingate
ark@alice.UucP (Andrew Koenig) (09/17/85)
> I do not consider that a good thing. When I am ill, I do not have the time > to look for a doctor, certainly not as much of time as in the case of a car. > Also, the potential damage of a wrong choice is much larger. > You assume that a citizen of Libertaria has a lot of information and > sophistication. He/she decides without help of the state whether > doctors are good, whether banks/insurance companies have good financial > standing, whether a given ingredient of some food you are want to eat > may be harmful, etc. Before the age of state regulations, citizens > were never sure of those things, and frequently they were paying > dearly for this. They still are. Regulations or not, half of all doctors are below the median! There is NOTHING you can ever do to change this! And regulations that allow physicians to avoid competing with each other make it easier, not harder, for an incompetent to stay in business.
mrh@cybvax0.UUCP (Mike Huybensz) (09/17/85)
In article <126@l5.uucp> laura@l5.UUCP (Laura Creighton) writes: > In article <1565@umcp-cs.UUCP> mangoe@umcp-cs.UUCP (Charley Wingate) writes: > >The problem with this is that in fact people aren't well enough informed to > >judge in general, and that changes in reputation generally lag changes in > >actuality considerably, often being completely unrelated to reality. A > >person living in rural Tennessee often does not have the resources available > >to find out whether the slick young man is really from Harvard, as he claims > >to be. > > Okay, it sounds to me like there is a market for doctor-verification here. > The prospective patients will want this and the doctors will want this a > great deal. So someone will set up a doctor-verification agency. (Actually, > it will probably be more general than just doctor verification -- in > Libertaria this problem is going to crop up again and again.) It will > be constrained to be honest by the same constraints that make the AMA > (or Consumer Reports, or a high-minded public official) honest -- because > it will be staffed by people who are genuinely concerned with the problem, > because it will be staffed by people who are honoroable, because it will > loose all its customers if it prints lies and because people will sue it > for fantastic sums of money if it doesn't. I don't think this would work for the majority of people, and I think Charley is right, popular judgement about medicine is unrealistic. Consider diet plans for example. They are unregulated. Is there a diet-plan verification agency (public or private)? Well, there's no shortage of sound medical advice about the dangers of diet plans, and what works. Do people heed it? No. They need only ask their doctors, but instead they prefer to dream, and make the diet industry one of the largest food- related industries in America. Why are people so foolish? Got me. However, they are bombarded with outrageous advertising claims continually. And it doesn't pay anyone to advertise that something doesn't work. Remove the restrictions on medical practice, and you open up a huge can of worms of this sort. People will choose the quack who makes them feel best about their medical service; because he tells them "yes, take that drug", because he makes outrageous claims for their health if they follow his advice, because he tells them their aura gets better and better every time they visit. And how could anyone sue for malpractice, without some implicit standard of medical practice? "You didn't diagnose that cancer!" "That wasn't a cancer, it was an evil spirit, and the patients will wasn't strong enough. I can't cure everybody." -- Mike Huybensz ...decvax!genrad!mit-eddie!cybvax0!mrh
mcgeer@ucbvax.ARPA (Rick McGeer) (09/19/85)
In article <760@cybvax0.UUCP> mrh@cybvax0.UUCP (Mike Huybensz) writes: >In article <126@l5.uucp> laura@l5.UUCP (Laura Creighton) writes: >> In article <1565@umcp-cs.UUCP> mangoe@umcp-cs.UUCP (Charley Wingate) writes: >> >The problem with this is that in fact people aren't well enough informed to >> >judge in general, and that changes in reputation generally lag changes in >> >actuality considerably, often being completely unrelated to reality. A >> >person living in rural Tennessee often does not have the resources available >> >to find out whether the slick young man is really from Harvard, as he claims >> >to be. >> >> Okay, it sounds to me like there is a market for doctor-verification here. >> The prospective patients will want this and the doctors will want this a >> great deal. So someone will set up a doctor-verification agency. (Actually, >> it will probably be more general than just doctor verification -- in >> Libertaria this problem is going to crop up again and again.) It will >> be constrained to be honest by the same constraints that make the AMA >> (or Consumer Reports, or a high-minded public official) honest -- because >> it will be staffed by people who are genuinely concerned with the problem, >> because it will be staffed by people who are honoroable, because it will >> loose all its customers if it prints lies and because people will sue it >> for fantastic sums of money if it doesn't. > >I don't think this would work for the majority of people, and I think >Charley is right, popular judgement about medicine is unrealistic. >Consider diet plans for example. They are unregulated. Is there a diet-plan >verification agency (public or private)? Well, there's no shortage of >sound medical advice about the dangers of diet plans, and what works. >Do people heed it? No. They need only ask their doctors, but instead >they prefer to dream, and make the diet industry one of the largest food- >related industries in America. The point is, it's their bodies and their dream. Not your business. The other point is that there are therapies and drugs currently banned in the USA, but permitted elsewhere, which might or might not be succesful. Regulation discourages experiment and innovation, and hence progress. See "Free To Choose" for a full discussion of the full costs of health industry regulation. And, I might add, the size of the diet industry is an effective stimulant to researchers to develop therapies that do work (as some on the market do). If you REALLY BELIEVE that the government should certify doctors for the patients' good, why not permit uncertified doctors to practice? That way, patients can decide for themselves if they want to be treated by an uncertified doctor -- and hospitals can decide if they want uncertified doctors on their payroll. Why this decision should be made in Washington is beyond me. > >Why are people so foolish? Got me. However, they are bombarded with >outrageous advertising claims continually. And it doesn't pay anyone to >advertise that something doesn't work. Sure it does! You haven't seen many computer or cleanser adds recently. > >Remove the restrictions on medical practice, and you open up a huge can >of worms of this sort. People will choose the quack who makes them feel >best about their medical service; because he tells them "yes, take that >drug", because he makes outrageous claims for their health if they follow >his advice, because he tells them their aura gets better and better every >time they visit. And how could anyone sue for malpractice, without some >implicit standard of medical practice? "You didn't diagnose that cancer!" >"That wasn't a cancer, it was an evil spirit, and the patients will wasn't >strong enough. I can't cure everybody." Good point. But it is their business. And, as for malpractice suits, I don't see the problem. Welders aren't certified, but you can certainly sue for a faulty weld. Mike, why don't you get over this nasty itch you have to run other people's lives? -- Rick.
gadfly@ihuxn.UUCP (Gadfly) (09/19/85)
-- > ... Welders aren't certified, but you can certainly sue for a > faulty weld. Mike, why don't you get over this nasty itch you > have to run other people's lives? > > -- Rick. Welders *are* certified (in Wisconsin, anyway). You can't get a job with a shipbuilder unless you've got that certificate. On the larger issue of government vs. self regulation, I will admit to some ambivalence. If you are for the latter, as I assume most libertarians are, then you must wax ecstatic every time you hear about silly lawsuits, for without govt. intervention civil court must be one's first and last resort, and there can be, therefore, no prejudgement as to the seriousness of a suit. On the other hand, it's perfectly obvious that government regulation (in practice) introduces as much, if not more corruption than it alleviates. -- *** *** JE MAINTIENDRAI ***** ***** ****** ****** 19 Sep 85 [3ieme Jour Sans-culottide An CXCIII] ken perlow ***** ***** (312)979-7753 ** ** ** ** ..ihnp4!iwsl8!ken *** ***
friesen@psivax.UUCP (Stanley Friesen) (09/21/85)
In article <4333@alice.UUCP> ark@alice.UucP (Andrew Koenig) writes: > >They still are. Regulations or not, half of all doctors are below >the median! There is NOTHING you can ever do to change this! >And regulations that allow physicians to avoid competing with >each other make it easier, not harder, for an incompetent to stay >in business. Of *course* half the doctors are below the median! That is the *definition* of median! What is important is how high the median is, that is how good the worst doctors are. I maintain that the current median is *much* higher than it was before credentially was established. What we call an "incompetent" doctor today would likely half been an above average doctor a century ago. Except in small rural areas where everyone knows everyone else, it is simply too difficult for the individual to evaluate the relative competence of doctors at all adequately. Remember, the current system was established because there was a major problem with *completely* unqualified doctors, not merely underqualified doctors as we have today. -- Sarima (Stanley Friesen) UUCP: {ttidca|ihnp4|sdcrdcf|quad1|nrcvax|bellcore|logico}!psivax!friesen ARPA: ttidca!psivax!friesen@rand-unix.arpa
laura@l5.uucp (Laura Creighton) (09/21/85)
In article <1789@psuvax1.UUCP> berman@psuvax1.UUCP (Piotr Berman) writes: >> >> There is nothing in Libertaria which says that you shouldn't get the doctor >> that you want who went ot the medical school of your choice. All you have to >> do is hire *that* doctor rather than some other doctor. What it will do is >> to get rid of the fiction that all doctors are created equal, and make it >> clear to people that they are going to have to do the same level of research >> in selecting a doctor that they already do to select a car or a television. >> >> I consider that a good thing. >> >> -- >> Laura Creighton (note new address!) >> sun!l5!laura (that is ell-five, not fifteen) >> l5!laura@lll-crg.arpa > >I do not consider that a good thing. When I am ill, I do not have the time >to look for a doctor, certainly not as much of time as in the case of a car. >Also, the potential damage of a wrong choice is much larger. > Sorry, Piotr, that I haven't gotten back to you, but the fact of the matter was that I was very sick. Since the only good doctor I know in this town (I just moved here) was away, I was in this precise situation. Do you want to know what happened? *Nobody* was able to diagnose what I had despite having a complete physical/medical history of me. I kept getting perscribed things which did not work. I got sick to the point of being semi-delerious with pain and poor John Gilmore had to keep checking up on more doctors, adn the results of more tests and so on... eventually Dr. Flash Gordon got back. He looked over the charts of what I had been doing the last 2 weeks and found that one doctor had (correctly) diagnosed one of the three things that were wrong with me and had done *nothing* for it. The medicines that I had been given had already been determined to be marginal at best with my particular makeup (also documented). And one of them had no relation to any of my symptoms. The upshot is that with a new perscription I felt well enough to go to work one day (about 12 hours) after first taking the perscription. While I was lying sick i would dearly have liked to know that i was getting diagnosed by a lousy/inexperienced internist. I would really have appreciated knowing who the AMA considered the best internist. But could I find out? No. All doctors are certified therefore all are competant, right? >You assume that a citizen of Libertaria has a lot of information and >sophistication. He/she decides without help of the state whether >doctors are good, whether banks/insurance companies have good financial >standing, whether a given ingredient of some food you are want to eat >may be harmful, etc. right now a citizen has to trust that the state only certifies good doctors, does not cause banks and insurance companies to fail, and won't allow harmful things to be put into foods. Right now a citizen is paying in taxes for this. ARE THE CITIZENS GETTING VALUE FOR THEIR MONEY? Right now there are lousy doctors, and inflation and too damn much sugar (not to mention dyes and preservatives) in food. I'd like my money back. what? i can't get it back because the state is necessarily providing good doctors and keeping the banks from failing (actually it is the banks which are collectively supporting each other right now) and keeping those nasty businesses from putting harmful substances ont he supermarket shelves? But there *are* lousy doctors, and it looks like all the banks are going to fail if nothing is done about inflation and I have to work damn hard to get granola for breakfast which doesnt have any sugar to rot my teeth and make me fat! I'd like my money back... Faith that the government will do what you want it to do isn't enough. >Before the age of state regulations, citizens >were never sure of those things, and frequently they were paying >dearly for this. I'm paying dearly for this *now*. -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
laura@l5.uucp (Laura Creighton) (09/21/85)
In article <1237@ihlpg.UUCP> tan@ihlpg.UUCP (Bill Tanenbaum) writes: >OK, I can research my personal physician's credentials. What happens, however, >when I need emergency medical care, or if I get sick when away from home. >I want to know that all practicing doctors, not just mine, have met some >minimal competency standards. State liscensing is not perfect in this >regard, but it is better than nothing. >-- The question is, what makes it better than the Rich Rosen certification of only objective and materialist physicians? Or the Stanford Medical School certificate of graduation? Or the Consumer's Report on Physicians in the State of (say) California? Right now I have no way of knowing whether any given doctor graduated first or last in his class, or whether he is a brilliant theoretician who can do splendid medical research but who has difficulty in coming up with an accurate diagnosis. The tendancy to rely on state certification leads to apathy on the part of the public. The number of people, who, when faced with a serious medical decision (say to either have a mastectomy or to have chemotherapy instead) do not get a second, thrid and forth opinion is astonishing. Clearly they believe that either the first opinion they got was the only one (based on a belief that all doctors are minimally competant and couldn't be wrong on such an issue) or that their first doctor was in some way better than other doctors. This is frightening. -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
laura@l5.uucp (Laura Creighton) (09/21/85)
In article <1611@umcp-cs.UUCP> mangoe@umcp-cs.UUCP (Charley Wingate) writes: >Will it? If corruption is everywhere, then why not here as well? And >what's going to prevent the appearance of phony certification companies? > Nothing will. But if they are fraudulent then they will get sued and sued and sued. Fraud is a big offense in Libertaria. Also, remember, that there is a limit to how many certification companies there can be, simply because people will only be buying certification reports from a given number of places. The lousiest ones are doomed to go out of business...either because they cannot withstand the continuing cost of lawsuits or because nobody is willing to pay for their services, or both. >What bothers me more is that this governmental function has simply moved to >a new location where it is even less accessible to pressure from ordinary >folk. The power that was wielded by the government through this function >still remains; only now it is in the hands of a board of trustees, who >aren't necessarily going to be responsible but to a few people (and >certainly for different ends). Wrong. wrong. wrong. If you duplicate the government function then you are more accesssible to the pressure of common folk. First of all, they can vote with their wallets and not support lousy certification agencies and second of all, they can sue fraudulent certification agencies for fraud. (Have you ever tried to sue the AMA because it allows the existence or a whole host of drugs that simply do not work as described? Have you ever tried to sue the FDA because you have run laboratory experiments and have been unable to duplicate the results they have used to declare a drug unsafe?) Moreover, at a very simple level, the existence of other agencies will keep any one honest. You cannot get away with calling Joe Quack (the brother of the eldest trustee) a great brain surgeon if 10 other agencies are calling him a butcher and a hazard -- even if you wanted to. Finally, it is wrong to assume that the trustees will have different ends than government agencies. Where do you get this? -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
laura@l5.uucp (Laura Creighton) (09/21/85)
In article <760@cybvax0.UUCP> mrh@cybvax0.UUCP (Mike Huybensz) writes: > >I don't think this would work for the majority of people, and I think >Charley is right, popular judgement about medicine is unrealistic. >Consider diet plans for example. They are unregulated. Is there a diet-plan >verification agency (public or private)? Well, there's no shortage of >sound medical advice about the dangers of diet plans, and what works. >Do people heed it? No. Actually, a lot of people do heed it. But others do not. >They need only ask their doctors, but instead >they prefer to dream, and make the diet industry one of the largest food- >related industries in America. > Remember, fraud is a big crime in Libertaria. I would like to take a hatchet to North American advertising because I think that it is mostly fraud. The problem is that this level of fraud is tolerated in advertising today. Suppose it were impossible to make outrageous claims - wouldn't this problem go away? Are certification programs now fronts so that the level of lies in advertising need not decrease? Wow, this one will please those who see conspiracies everywhere.... >Why are people so foolish? Got me. However, they are bombarded with >outrageous advertising claims continually. And it doesn't pay anyone to >advertise that something doesn't work. > Wrong! It sure paid Pepsi to advertise that Coke didn't work as well as Pepsi. I don't own a tv, but I got the distinct impression that spot removers, diapers, detergents and paper towels were advertised this way. (of course, why anyone would want to buy a paper towel because it held 4 full coffee cups while the competetor's did not is beyong me.) >Remove the restrictions on medical practice, and you open up a huge can >of worms of this sort. People will choose the quack who makes them feel >best about their medical service; because he tells them "yes, take that >drug", I got news for you. Take a look at the figures on valium consumption. A lot of people choose their doctor *now* for precisely this reason! >because he makes outrageous claims for their health if they follow >his advice, because he tells them their aura gets better and better every >time they visit. And how could anyone sue for malpractice, without some >implicit standard of medical practice? "You didn't diagnose that cancer!" >"That wasn't a cancer, it was an evil spirit, and the patients will wasn't >strong enough. I can't cure everybody." If you take out the bit about ``evil spirits'' and talk about ``diseases which are not responsive to medication'' and ``spontaneous remissions'' you are describing what we have *now*. People really do live and die for no discernable reason. However, if I sell you a car that doesn't have a carburator you are free to sue me. If I don't diagnose your cancer you are free to sue me for precisely the same reason -- fraud. Of course, if I make no claims to diagnose cancer and claim to be a spirit healer, I may not be guilty of fraud -- but then you got what you asked for. -- Laura Creighton (note new address!) sun!l5!laura (that is ell-five, not fifteen) l5!laura@lll-crg.arpa
laura@l5.uucp (Laura Creighton) (09/22/85)
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
berman@psuvax1.UUCP (Piotr Berman) (09/24/85)
> >Remove the restrictions on medical practice, and you open up a huge can > >of worms of this sort. People will choose the quack who makes them feel > >best about their medical service; because he tells them "yes, take that > >drug", because he makes outrageous claims for their health if they follow > >his advice, because he tells them their aura gets better and better every > >time they visit. And how could anyone sue for malpractice, without some > >implicit standard of medical practice? "You didn't diagnose that cancer!" > >"That wasn't a cancer, it was an evil spirit, and the patients will wasn't > >strong enough. I can't cure everybody." > > Good point. But it is their business. And, as for malpractice suits, I don't > see the problem. Welders aren't certified, but you can certainly sue for a > faulty weld. Mike, why don't you get over this nasty itch you have to run > other people's lives? > > -- Rick. It not as simle as it sounds. First, I doubt that you may sue a welder. It makes sence to sue a construction company. If you hire a construction company, then you are a developer with suficient recources to perform checks on financial standing, performance history and bussiness insurance of the construction companies available. An individual customer does not have the recources to do it. The truth is that the medical credencials ARE can of worms even now, but most of the existing worms would be alive and well under "free market" system, plus many new would appear. If the free-market of medical services would work as the market for car repair is doing it now, I say "No, thanks". If it would work as it is doing now, all the abuses would remain in place, with less possibility for recourse. Do not think that you would be let free to run your life as you see it fit. Insurance companies, professional associations and legislators would do it for you anyway. Insurence companies need credential for service providers anyway. The abuses here are of the following nature: dominant professional organizations try to eliminate minor providers, like midwifes and chiropractors. The lobbying and politics occur in the "free market" as frequently as in the legislatures. In the free-market the dominant regulatory role would be placed in the legal system, the tort law regulations. You would not change that. In fact, the American health care system is one of the least regulated and most expensive in the world. Complete deregulation would: a. create even more expensive "legimitate medicine"; b. create a variety of less expensive substandard providers for the poor, with great possibilities for quacks; c. create a dangerous jungle in the market of medicines. Piotr
bob@pedsgd.UUCP (Robert A. Weiler) (09/25/85)
Organization : Perkin-Elmer DSG, Tinton Falls NJ Keywords: In article <139@l5.uucp> laura@l5.UUCP (Laura Creighton) writes: > >State of (say) California? Right now I have no way of knowing whether any >given doctor graduated first or last in his class, or whether he is a >brilliant theoretician who can do splendid medical research but who has >difficulty in coming up with an accurate diagnosis. Is there any resaon at all to suppose it would easier to find this out in Libertaria? In fact, you *can* currently check some of these things out if you are so inclined. > >The tendancy to rely on state certification leads to apathy on the part of >the public. The number of people, who, when faced with a serious medical >decision (say to either have a mastectomy or to have chemotherapy instead) >do not get a second, thrid and forth opinion is astonishing. Clearly they >believe that either the first opinion they got was the only one (based on >a belief that all doctors are minimally competant and couldn't be wrong on >such an issue) or that their first doctor was in some way better than other >doctors. This is frightening. >-- >Laura Creighton (note new address!) This seems a little illogical. We are assumed to be so stupid that we cannot see the limitations of the current system. However, we are so brilliant that left to our own devices we could verify the technical competence of our physician apriori. Bob Weiler.
mrh@cybvax0.UUCP (Mike Huybensz) (09/25/85)
In article <141@l5.uucp> laura@l5.UUCP (Laura Creighton) writes: > Remember, fraud is a big crime in Libertaria. I would like to take a > hatchet to North American advertising because I think that it is > mostly fraud. The problem is that this level of fraud is tolerated > in advertising today. Suppose it were impossible to make outrageous > claims - wouldn't this problem go away? Are certification programs now > fronts so that the level of lies in advertising need not decrease? Wow, > this one will please those who see conspiracies everywhere.... North American advertising is FAR less fraudulent than it used to be. But libertarianism would not solve the problem of fraud except where both parties have explicitly listed results desired. How can you do that sort of thing for something that statistically cures? "Oh, you were one of the 1% that this treatment doesn't work on. Go ahead, disprove that." What expert will you rely upon to determine fraud? You call a medical doctor to say the treatment was fraudualent, and I call a voodoo doctor to say the treatment was sound, though it didn't work. > >Remove the restrictions on medical practice, and you open up a huge can > >of worms of this sort. People will choose the quack who makes them feel > >best about their medical service; because he tells them "yes, take that > >drug", > > I got news for you. Take a look at the figures on valium consumption. A lot > of people choose their doctor *now* for precisely this reason! Correct. However because the doctor is limited to legal drugs and subject to malpractice liability, the problem is probably less than it would be were everybody to take the latest miracle cancer preventative described in the National Enquirer ("America's Largest Weekly Circulation"). > >because he makes outrageous claims for their health if they follow > >his advice, because he tells them their aura gets better and better every > >time they visit. And how could anyone sue for malpractice, without some > >implicit standard of medical practice? "You didn't diagnose that cancer!" > >"That wasn't a cancer, it was an evil spirit, and the patients will wasn't > >strong enough. I can't cure everybody." > > If you take out the bit about ``evil spirits'' and talk about ``diseases > which are not responsive to medication'' and ``spontaneous remissions'' > you are describing what we have *now*. Believe it or not, there are tests which can provide scientific evidence for the presence of diseases. (The course of a disease is a different matter.) What is your evidence of the evil spirit? How are you to resolve whether it was a Satanic spirit or a spirit from some other mythos? > People really do live and die for > no discernable reason. However, if I sell you a car that doesn't have > a carburator you are free to sue me. If I don't diagnose your cancer you are > free to sue me for precisely the same reason -- fraud. A car without a carburator does have a discernable reason. That's not analogous. Non-diagnosis of cancer would only be fraud if my diagnostic procedure is not up to standards. In the absence of standards, there can be no fraud. > Of course, if > I make no claims to diagnose cancer and claim to be a spirit healer, I may > not be guilty of fraud -- but then you got what you asked for. If I am asking for healing, and doctors, spirit healers, etc. all stand up and say "we heal, choose us", then what I get will be considerably better if I happen to get the doctor to treat (say) cholera. -- Mike Huybensz ...decvax!genrad!mit-eddie!cybvax0!mrh
doc@cxsea.UUCP (Documentation ) (09/29/85)
Mike said: > > >Remove the restrictions on medical practice, and you open up a huge can > > >of worms of this sort. People will choose the quack who makes them feel > > >best about their medical service; because he tells them "yes, take that > > >drug", because he makes outrageous claims for their health if they follow > > >his advice, because he tells them their aura gets better and better every > > >time they visit. And how could anyone sue for malpractice, without some > > >implicit standard of medical practice? "You didn't diagnose that cancer!" > > >"That wasn't a cancer, it was an evil spirit, and the patients will wasn't > > >strong enough. I can't cure everybody." And then Rick said: > > Good point. But it is their business. And, as for malpractice suits, > > I don't see the problem. Welders aren't certified, but you can certainly > > sue for a faulty weld. Mike, why don't you get over this nasty itch you > > have to run other people's lives? (well, actually, yes. Welders ARE certified, but that's beside the point) And then Piotr said: > It not as simle as it sounds. First, I doubt that you may sue a welder. > It makes sence to sue a construction company. If you hire a construction > company, then you are a developer with suficient recources to perform > checks on financial standing, performance history and bussiness insurance > of the construction companies available. An individual customer does > not have the recources to do it. > The truth is that the medical credencials ARE can of worms even now, > but most of the existing worms would be alive and well under "free market" > system, plus many new would appear. ... > In the free-market the dominant regulatory role would be placed in > the legal system, the tort law regulations. You would not change that. > In fact, the American health care system is one of the least regulated > and most expensive in the world. You don't have to study too much legal history in the US to discover that most forms of government regulation were created to deal with the fact that lawsuits are an incredibly cumbersome, expensive and inefficient (that's an important word to libertarians) way to resolve injuries to people and property. I see someone else on the net, in another posting to this group, notes that fraud would be a VERY serious offense in Libertaria. Well, so what? Common-law fraud is a pretty serious matter right now, but it won't solve all problems of professional misconduct. For one thing, fraud is damn hard to prove. In order to succeed in a lawsuit for fraud you have to show that 1) whomever defrauded you knew they were defrauding you 2) in a material way 3) and intended to do so, 4) that you relied on their misrepresentation, 5) it was reasonable of you to rely on their misrepresentation, 6) you suffered real damages 7) as a direct result of your reliance. I think most states require proof on a few other elements, too. And all that just gets you to the jury! If you think proving all the elements is easy or inexpensive, think again. We have a whole bunch of securities laws and regs on the books precicesly because suits for fraud aren't a very effective means of keeping bogus stock off the market. If you feel the SEC and the Securities Acts are an un-holy burden on your sacred right to free enterprise, or whatever, read William O. Douglas's writings on what Wall Street was like in the decade before the market crashed. Rather than do away with regulating the medical industry, I think we should regulate it a great deal more. Those megabuck malpractice awards you hear so much whining about from the medical industry don't happen because all lawyers are slime, juries are mindless idiots, etc. They happen because the medical profession refuses to regulate itself in any meaningful way, and a lot of quacks are on the loose. Actually, health care in Libertaria probably wouldn't be that much worse than it is right now, because the profession is so poorly regulated right now. The problem is that all of us end up paying for the malpractice insurance they carry, simply because they won't weed out the hacks and charlatans from their ranks. Joel Gilman