Comment by supertrope | Hacker News Reader

Comment by supertrope | Hacker News Reader

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"It is difficult to get a man to understand something, when his salary depends on his not understanding it." - Upton Sinclair

There's no single institution or person holding us back. Real life isn't a movie with a villain who can be defeated and then we live happily ever after. There's no magic HealthBot 3000 technology that will deliver a breakthrough in curing disease and injury, and/or disrupt current business models.

Hospitals don't want to lose revenue. Physicians who don't want to lose revenue and turf. Drugmakers don't want to lose revenue. Health insurance. Patients refuse to opt into* any limits on care, demand nearly perfectly safe drugs, and say they only want the best care. We want to see our doctor over a cold and demand a pharmaceutical solution. We get annoyed when doc tells us to lose weight or quit smoking/drinking. We cannot accept death or taxes. "We have met the enemy and he is us." - Walt Kelly. The only deflationary force in the industry is have nots avoiding care at significant cost to life and limb.

*Even relatively comfortable employer plans and Medicare have significant gatekeeping: "out of network," deductibles, what procedures and drugs are not covered.

Quick background on the great Walt Kelly quote, with images of the comic strip in which it was used.

https://library.osu.edu/site/40stories/2020/01/05/we-have-me...

A good start would be to end the need for medical licensing. It creates an artificially low supply of doctors thus increased costs. Before medical licensing there were more breakthroughs and competition.

How would you know if your doctor wasn’t a fraud?

Milton Friedman covers this in detail in “Capitalism and Freedom” if you want the full Libertarin justification, but the short answer is

1) voluntary certification, or

2) market reputation, or

3) threat of enforcement of anti-fraud laws that are less specific than licensure requirements.

The general idea being that it is seldom a good thing to remove cheap options (eg forcing poor people to go bankrupt instead of letting them choose worse care), and licensure both sets a quality floor, and also artificially restricts supply.

I think for life-and-death things like medicine this idea breaks down a bit, but that’s the end of the spectrum and how it’s argued as far as I’ve seen.

I wouldn't trust Milton Friedman's opinion when it comes to life and death. He loves busting supporting pillars without first considering how to migrate off of them. His economic "misadventures" in China resulted in protests at the Tiananmen Square and everyone knows how that ended.

I think trying to blame Friedman for the Tiananmen Square massacre is a bit of a stretch.

You would use the various methods for determining competence used in other less-regulated fields, such as degrees, certification, and word-of-mouth. The major difference would be that individuals could choose how they wished to determine which doctors they wished to use[1].

To give an example, many people who wish to become doctors are required to go through a residency program that features elements such as required 24 hours shifts. Personally, I would be quite fine seeing a doctor who wasn't required to do such shenanigans. As it stands right now, I can't make that choice, because various special interest groups have gained a government-granted monopoly on the certification of physicians.

[1] One objection would be that, if we didn't have the force of law (which is the force of violence) keeping "quacks" from practising medicine, then many people, particularly the poor, would actually have /less/ choice. This is a utilitarian argument, but even if the premise of utilitarianism is granted, this still seems incorrect due to two factors. First, regulatory capture has led to a system that already can prevent poor people from accessing care. No care is probably worse that mediocre care. Second, the U.S. (as a nation) spend more money than other developed nations on healthcare and gets similar outcomes. This seems to indicate that a lower cost of care wouldn't necessarily cause a sudden influx of quacks onto the market.

Why not just license more doctors?

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