An interviewer once asked H.L. Mencken, “If you find so much that is unworthy of reverence in the United States, then why do you live here?” Mencken quickly responded, “Why do men go to zoos?”
It is for the same reason that I find myself continually watching political debates.
Many questions seem so incredibly simple to answer, yet politicians divert from yes-or-no answers to complex, unrelated explanations about how patriotic the candidate really is. I frequently try to place myself onstage and wonder how I’d answer questions if given 30 or 60 seconds.
The topic of healthcare especially bugs me, and questions about how to fix it can certainly be answered in 60 seconds, although not explained so quickly.
To improve medicine in the United States, we’ll first need to explain that we are far from a free market in healthcare.
Of all government interferences in healthcare, one of the most insidious is the state’s granted privilege to the American Medical Association.
Through various attempts to portray homeopaths as uneducated witch doctors, the AMA has managed to get its preferred, allopathic form of medicine enforced by a legal monopoly. And as recently as the 1980s, the AMA attempted to prohibit voluntary associations between its member physicians and chiropractors, who were deemed participants in an “unscientific cult” (PDF).
The AMA’s main interest isn’t the safety of the American population; its main interest, like any union, is to increase the salaries and conditions of its members — medical practitioners.
Warning for decades of a surplus of physicians, the AMA is basically letting consumers know that their healthcare bills would be much lower if there were a greater supply doctors to address patient demand. Yet the organization has been successful in avoiding this hazard, with the average doctor now maintaining a patient list of at least 2,000 people.
The AMA’s Council on Medical Education has limited and shut down medical schools, increasing the barriers to entry in the field. Dale Steinreich writes,
Since AMA’s creation of the Council a century ago, the U.S. population (75 million in 1900, 288 million in 2002) has increased in size by 284%, yet the number of medical schools has declined by 26% to 123. In terms of admissions limits, the peak year for applicants at U.S. schools was 1996 at 47,000 applications with a limit of 16,500 accepted. This works out to roughly 64% of applications rejected. On a micro level, for the last six years the University of Alabama (hardly a beacon of prestige in the medical discipline) has averaged about 1,498 applicants per year with an average of about 194 accepted. This is about an 87% rejection rate. The sizes of the entering classes have been of course even smaller, averaging about 161.
It is almost impossible to imagine that every single student rejected from these medical schools was so incompetent that his mere existence in the medical market would have wreaked havoc on American healthcare. When a fiercely limited supply is coupled with third-party payments, it is no wonder that the healthcare system in the United States is absolutely disastrous.
The common opinion is that our country needs the AMA to protect us from unskilled physicians and surgeons. But this fails to consider the possibility that the AMA’s licensing process might not be the best option. If it were, patients would voluntarily ensure that their physicians were licensed by the association; after all, who cares more about an individual’s body than the individual himself?
For one reason or another, I am quite prone to strep throat; and, this being a phenomenon I’ve experienced since childhood, I can easily self-diagnose. I can recognize the symptoms, and I know exactly which dose of medicine my body requires, yet the government insists that its bureaucrats understand my health better than I do.
Instead of just walking to the nearest convenient store to purchase the 875mg tablets of amoxicillin, I’m forced to take a visit to my state-licensed physician for a 10-minute appointment (usually 1 minute spent diagnosing my strep throat and 9 minutes spent diagnosing my bill), drive to the nearest convenience store to deliver my prescription to a state-licensed pharmacist, and take the antibiotic, while my now-mandated insurance skyrockets.
Getting rid of the state privileges of the AMA is the first battle we need to fight in reaching a freer and more prosperous market in healthcare. The AMA will still exist for those who wish to employ its members, but stripping down licensure legislation will guarantee other options for those of us who are weary of current medical education and its subsequent practice.