Uwe Reinhardt Defends Free Market Medicine
And quotes Milton Friedman along the way:
An econo
mist can understand that physicians refuse to treat Medicaid patients at low fees when the opportunity cost of doing so is treating patients at higher fees. But what is to be done for the patients whom close to 50 percent of California primary care physicians refuse to treat?
What if independently practicing nurse practitioners were willing to see Medicaid patients at Medicaid’s fees for the range of primary care services for which nurse practitioners are educated and trained? Would the California Medical Association contend that for patients whom physicians refuse to serve, the next best option is no care at all? Or that properly educated and trained nurse practitioners could render such care, as is done in 17 other states (see, for example, evidence from New York). (More)
Then why would someone bother going to med school?
The rewards are still there for doctors, although, you are right that we would require less doctors in the sense that we have them today. That would free up great minds to expand other fields or even focus more on health research as opposed to provision. All-in-all it would be better.
I agree with JD. We want the right number of appropriately trained professionals in the proper field. Right now we have too many, too highly trained doctors.
You’re assuming one equilibrium point across the U.S. Maybe the answer is finding an incentive for doctors to move to less covered areas?
Maybe they like spending lots of money to get a nice title in front of their name?
Not what I’d expect from Uwe.
He definitely wandered into territory he rarely travels.
I’m definitely for relaxing licensing rigidity, particularly in health care where we waste so many resources on “over-provision”. A doctor doesn’t need to be present for all medical issues, less-trained medical professionals can provide quality service at a much lower cost.
“In the end, Friedman concludes:
I myself am persuaded that licensure has reduced both the quantity and quality of medical practice; that it has reduced the opportunities available to people who would like to be physicians, forcing them to pursue occupations they regard as less attractive; that it has forced the public to pay more for less satisfactory medical service, and that it has retarded technological development both in medicine itself and in the organization of medical practice. I conclude that licensure should be eliminated as a requirement for the practice of medicine. “
I support private licensure. Why would we think that government monopoly is efficient for telling us what services/providers to use?
Right. We would certainly see better health outcomes, lower costs, and expanded access.
At the cost of misinformed Americans. It’s hard enough to find out which doctors are good, and you want to add in checking what type of license they hold and whether they got it from a reputable source?
I have no problem with nurse practitioners treating patients. I don’t even mind if an advanced practice nurse becomes proficient in specific procedures (say, liposuction) and practicing if she/he can ensure a certain amount of failsafe procedures. This might be only performing these procedures in an ambulatory surgery center, for example.
Doctors oppose this because they have more advanced training, which cost maybe $100,000 more and years longer to obtain. That’s great. But they should still have to compete for business. I’m not in favor of any bureaucracy protecting an profession (or industry) from competition — or guaranteeing them a particular income.
Good to see these ideas gain traction.