Sycophantry Masquerading as Bargains

This argument seems a little, I dunno if I have the right word for it - pointless?

Picking on doctors seems popular when it comes to professional regulation, but in reality we do this every day for everything that is non-trivial that we can't fully understand ourselves.

So we bring doctors under state regulation (rather than self-regulation via the AMA) - who will run this regulatory agency?

I hope your answer is "doctors" because any other answer is nuts, and would remind me of the Cultural Revolution where the distrusted intelligentsia were systematically ousted from positions of authority and replaced with proletariats. And then millions of people died from insane agricultural, industrial, and medical policy...

All professions that are non-trivial are always going to be largely self-regulating, because its members are the only people qualified to regulate it. Which isn't to say that this doesn't pose risk for corruption and conflicts of interest, or that self-regulation shouldn't answer to the population at large, but the idea that this delegation is somehow sycophantly or somehow inherently bad is... silly.

The regulatory systems we establish - whether self-regulating or regulated via state policy - are a bargain. They're imperfect but there is no other way about it, unless you want to go down the path of having architects dictate medical policy or doctors dictate building codes. (though I do detect the sentiment of "software engineers should dictate everything" a lot on HN)

This whole blog post has shades of anti-intellectualism that creeps me out a bit - that assume that the intelligentsia must be malicious, and that they have somehow subjugated the rest of society to their whims. We've heard this rhetoric before, and it didn't lead anywhere good.

Predicting that everything will be done by "machines" is just kicking the can down the road. Who built the machine? How do you know that they programmed it with the correct knowledge to make accurate diagnoses (in the case of medicine)? Some authority is likely going to have to certify that the machine is built and programmed correctly. So, whatever authority we confer on doctors know is just going to shift to whoever has to certify that the machines are correct, which, again we consumers will not be able to accurately judge ourselves.

In the case of a machine that tests for a rare disease, it could just automatically say "no" every time and have a pretty high success rate. Someone will have to verify that the machine is actually performing some kind of test.

His premises are not very sound.

> We make similar bad “bargains” with a few kinds of workers, to whom we grant extraordinary privileges of “self-regulation.” That is, we let certain “professionals” run their own organizations which tell us how their job (...) is to be done, and who can do it.

The author speaks of "privileges" and "prestiges", but for doctors, his go-to example, it always was a prestigious (and privileged) profession, way before any modern diplomas/regulations were introduced. (Self-)regulations and certifications did not result in privileges, since they were already there. In fact they attached quite a few strings where before there were none.

> (...) that they will only admit appropriately qualified individuals into their ranks, and that they will always act honestly (...)

Regulations/certifications are here to provide a minimum evidence of competence in a given field. Are they a weak evidence? Absolutely. But it also always beats the alternative, which is "just trust me". The point is that in advanced societies anything critical, profession or otherwise, cannot be built on trust, it has to be built on some kind of proof and accountability, however imperfect. And the author here is not demanding or proposing different, better proofs to the current system, he is just saying that enforcing such proof via regulation is a privilege built on prestige.

> Notice how in this supposed bargain, what we give the professionals is concrete and clearly valuable, while what they give us (...) is vague and very hard for us to check.

This is the laziest part of the argument, and to be honest it feels as if it's from someone who has never set foot abroad. Of course we can check it. We just have to compare with countries where these regulations ("privileges") are not enforced. You want to know how it looks like when pilots, architects, or surgeons can practice without a licence (or fake it)? Just go to Congo or Sierra Leone, and observe the number of accidents, failures, or outright fraud. Notice also how all societies, when they modernize, move to the same type of regulations, regardless of their cultural/religious/political specificities.

> and yet we have mostly not chosen those substitutes due to our eagerness to affiliate with prestigious professionals

And of course there are countries that are (comparatively) considered "low prestige", like Poland or Thailand, that attract a large number of medical tourists because despite being lower profile the professionals there abide by the same vetting mechanisms, and their doctors are on par with ours... So the "it's just prestige" thing doesn't hold up.

> Cheaper yet outcome-effective substitutes to expensive professionals have long been physically available

The point of "exclusive" regulations is not to say that someone un-certified couldn't do it, but that someone certified can, and that in critical domains only them should. A surgeon is not certified because they're privileged, but because they're the closest thing you can get to "guaranteed not to accidentally stab you in the neck while operating". There is no free ride, where there is a cheaper alternative, there is a cheaper guarantee, and in some domains "cheaper" is not acceptable. The only example given is of nurses Vs physicians, an unconvincing argument since both are a self-regulated profession.

(I have to admit the name of their blog cracks me up every time.)

>"You give them something tangible and clearly valuable, and they give you a vague promise on something you can’t see, and can’t even check if anyone has ever received."

Nice analogy and all, but I find the condescending and disdainful tone towards a widely practiced religious act inappropriate.