It was actually more expensive. I've stopped asking and feel it's a urban myth.
Large hospital systems totally separate business and care, so it can be difficult to negotiate a discount. Smaller and independent providers are often more accommodating. However, you need to ask for a discount, you can't simply offer to pay cash (i.e. "If I pay cash, can I get 40% off"). The providers can counter your offer, but can't discount you off the bat or else they invite legal action from insurers.
The AMA does not really represent physicians. Less than 1/4 of doctors belong to the AMA. Many of them do not feel the AMA represents them. The AMA also accepts substantial donations from other sources, including corporate donors and foundations.
https://www.physiciansweekly.com/is-the-ama-really-the-voice...
A. Limit medical care to being provided by these people
B. Limit number of residencies
Who else would provide this care? This licensure is similar to other professions, like lawyers, and really doesn't take very much lobbying since the majority of the public want oversight of these sorts of professionals.
Residencies simply haven't kept pace with medical student numbers. They have gone up though. The main question is "where does the funding come from for residency training?". Medicare provides most of that funding, but that is a constrained resource. I find it hard to believe that the AMA lobbied for this provision.
The majority of the public wants whatever they are lobbied to believe they need. The majority also supports the War on Drugs and criminalizing the sex trade, and for the same reason: fear tactics used to convince them that the mere option of doing an ostensibly harmful activity, is to the detriment of themselves and society at large, even though the activity would harm no one but the party engaged in it.
Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public. There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them.
Ok, can you show me the lobbying that swayed their opinion on this topic then? If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?
"Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public."
This is not banned at all. Physician assistants and nurse practitioners exist and can perform some medical procedures/tasks. Even pharmacists. Granted I've personally had some negative experiences with some PAs and try to choose actually physicians for most things.
"There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them."
That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others? Usually things like insurance and bonding are requirements to cover any issues for people in this and other licensed fields.
I only deduce it happens.
I mean the lobbying happens in ordinary conversations like these, where people with a vested interest in gatekeeping argue it's in the public interest. I'm deducing it happens based simply on the incentives that exist for concentrated interests, in the form of insiders, to engage in it.
It also manifests as major political representatives legitimizing said licensure, and rationalizing the principle behind it to the public, in exchange for support from insiders within the regulated industry.
>>If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?
Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life.
>>That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others?
I don't see how the absence of licensure would prevert courts from issuing restrictions on individuals found guilty of criminal misconduct.
The government requiring a conviction in court before restricting someone's right to free association is how it should be. That is what the principles of a free society demand.
That might cover fraud, but that doesn't cover incompetence or other harm.
"The government requiring a conviction in court before restricting someone's right to free association is how it should be."
That is one way to look at it, yet is is not how the legal system works today. The courts have determined that licensure is a lawful restriction on association.
"Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life."
It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice. The important part is "their level of knowledge". Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional. Most people accept it as truth and do not care to do any research on credible sites like PubMed.
If someone acts non-fradulently, and honestly conveys their lack of experience, their lack of competency in carrying out the service is no one's fault than the consumer.
>>The courts have determined that licensure is a lawful restriction on association.
I'm arguing this legal framework, not saying that's how it currently is.
>>It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice.
Only 8% of healthcare spending is on emergency services, which can and should have government involvement to avoid abuse of geography-based monopoly by service providers.
But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options.
>>Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional.
Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market.
You're ignoring the part where it cannot be conveyed, like when people are mentally ill, incapacitated, etc.
"But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options."
Just because it's non-emergency does not mean the person is capable if choosing. You have people who are mentally ill and incapacitated who are treated in settings other than the ER. The highest spending happens at the end of life stage.
"I'm arguing this legal framework, not saying that's how it currently is."
Do you actually have more details for how that framework would work? So far all I'm hearing is that we should nor have licenses for medical professionals. How does that work with medical professionals powers to suspend drivers licenses, commit people, help in emergencies (good samaritan laws), etc. How does this affect malpractice insurance and torts, especially if you're saying that any incompetence can simply be stated by the provider to avoid court intervention? How would this system work in relation to controlled substances and expensive equiptment maintenance/procurement? How are the safety programs legally enforceable or logically possible without training? We already see that VEARS has terrible quality data. There are many adverse events that go unreported, especially by the lower trained PAs/NPs (my experiences).
"Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market."
You keep calling this a monopoly, but it is not a monopoly. There are numerous providers competing with each other. There's simply a training/licensure requirement. How are reputable experts foing to be any different than the current system? My guess is that they will create their own license system and force people through that too. Insurances, which cover the vast majority, will still require licenses to ensure that people aren't getting care that will be ineffective and cost them even more. This includes stuff like Medicare and Medicaid that the government controls.
Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work', how that will affect the numerous aspects of the system as well as it's integration with other systems, and what research there is to support it.
We already have provisions for when someone cannot make decisions for themselves, like guardianship. We do not need to subject the entire population to guardianship-like subordination.
>>You keep calling this a monopoly, but it is not a monopoly.
It is a monopoly: the licensure rules have a monopoly over all providers. Your argument seems to be that people cannot choose for themselves, so it's better we impose this monopoly on them.
But if they can't choose an effective delegate in the marketplace, who says they can choose an effective politician to vote for in an election, who will then appoint the regulator that vets their market options? It's better to go with a decentralized approach, where each individual is free to choose their own delegate, rather than a centralized one where the entire population votes every four years for one delegate that gets the power to vote for every one, whether they consent or not.
>>Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work',
I think the burden of proof is on those who advocate for continuing to limit people's right to freely contract and purchase the goods/services they want.
"For over 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by opposing nurse practitioner (NP) and other nonphysician professional attempts to inappropriately expand their scope of practice."
Here it is again: https://www.ama-assn.org/practice-management/scope-practice/...
So this is a source just saying they oppose inappropriate expansion. That they want PAs and NPs to practice as part of a team that includes a physician. I don't really see this as an issue. I also see PAs, NPs, and nurses as falling into the medical profession and subject to licensing, etc. So I see them as being on the inside of the system, not one of the "other people".
What I was specifically looking for was a source about the second part of this thread - the restriction of residency by the AMA.
If people wanted and needed licensure for health, hair cutting, whatever, you'd expect that they would be at the state house. But they're not.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
This naïveté is typical of HN. You’d read a press release from ISIS and conclude they’ve built a paradise. You need more knowledge than you can Google up. You need to be aware of what they did and do over the last 30 years.
But it’s okay, you can believe falsehoods. No skin off my back.