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Re: Rich get richer / poor get poorer
Old 09-08-2006, 01:06 PM   #141
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Re: Rich get richer / poor get poorer

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One thing that really bothers me about the new Republicans is the selfishness that I see. *They send our young troops to die in the Middle East and then lower taxes for themselves (and the poor too, I guess), rationalizing the entire process. *This means that when these troops come home someday they will have to pay for the war too, pay off the national debt that building at such a fast rate. *I guess the new Republicans don't see this double duty. *Maybe their all caught up in a rapture of power--without the responsibility that should come with it.
So, let's just cut out all taxes on military personnel, past and present.* I'd go for that!*
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 01:15 PM   #142
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Re: Rich get richer / poor get poorer

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Originally Posted by ash
Furthermore, if licensing requirements were lessened, there would be a higher availability of healthcare providers, decreasing the price. Do we really need someone to attend 7 years of schooling followed by a 3 years residency to be able to prescribe amoxicillin for a sore throat? And why does the government allow the AMA to restrict the number of doctors admitted to med school, essentially limiting the number of doctors? I know there are all sorts of rationalizations to this, such as "safety" and "quality." But under scrutiny, those arguments are show to be nothing more that union-style protections for medical practitioners, and have little to do with ensuring the safety of the general public.
I don't disagree with some of your points. I do disagree with some of your assertions:

The AMA has no power, discretion or any other means for restricting the number of doctors, nor their specialties. I (and probably 50% of doctors) do not even belong to the AMA. It is a shell of its former self of 50 years ago in terms of political clout, etc. It is not a union by any definition.

Where on earth did you get that information? Reminds me of an early thread where the poster was certain that doctors got paid by the prescription. I often wonder where these myths arise.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 01:37 PM   #143
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Re: Rich get richer / poor get poorer

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Originally Posted by Rich_in_Tampa
I don't disagree with some of your points. I do disagree with some of your assertions:

The AMA has no power, discretion or any other means for restricting the number of doctors, nor their specialties. I (and probably 50% of doctors) do not even belong to the AMA. It is a shell of its former self of 50 years ago in terms of political clout, etc. It is not a union by any definition.

Where on earth did you get that information? Reminds me of an early thread where the poster was certain that doctors got paid by the prescription. I often wonder where these myths arise.
Rich,

I was speaking to the fact that licensing laws, by their very nature, restrict the number of doctors that can practice medicine.

To the extent of which trade organizations are actively engaged with the government to define policy (school accreditation, admissions, regulations, etc.), I have commonly heard that the AMA is one of the key players. If there are others or more powerful organizations, I'm simply not familiar with them.

My intent was certainly not to smear the AMA, I'm sure they are doing what they are supposed to be doing, looking out for the interests of physicians.

My point however is that licensing in and of itself has increased costs, by limiting the number of providers, while not providing the increase in quality that was promised. Milton Friedman can say it better than I can: "I am myself persuaded that licensure has reduced both the quantity and quality of medical practice. . . . It has forced the public to pay more for less satisfactory medical service."

http://www.cato.org/pubs/pas/pa-246.html (The Medical Monopoly: Protecting Consumers Or Limiting Competition? by Sue A. Blevins)

So I guess then, I would ask you to help educate me. Who controls the accreditation and admissions processess? Obviously the government enforces them, but surely some trade organization works closely with the colleges and with the government to define restrictions. I have heard repeatedly that the organization is the AMA, but if I'm wrong, please explain it more accurately to me. Thanks.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 01:53 PM   #144
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Re: Rich get richer / poor get poorer

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Originally Posted by ash
So I guess then, I would ask you to help educate me. Who controls the accreditation and admissions processess? Obviously the government enforces them, but surely some trade organization works closely with the colleges and with the government to define restrictions. I have heard repeatedly that the organization is the AMA, but if I'm wrong, please explain it more accurately to me. Thanks.
Accreditation is by a separate private Association of American Medical Colleges, or a similar independent group, IIRC. They review curricula, lab facilities, clinical supervision and other things most would consider reasonable to assure decent training. You must graduate from an accredited medical school to apply for a license.

States are responsible for licensure, and this is basically a vetting process. There are national exams (3 of them at least) that every applicant must pass and they are not trivial.

The number of places available is up to the medical school. In the case of public supported ones the state legislature decides based on need and budget. Private schools decide based on resources, physical plant, etc.

To my knowledge, the AMA is out of these loops. Zero. Nada.

The health care delivery system is filled with problems, but I don't think this aspect of things is a big one. Hope that helps.

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Re: Rich get richer / poor get poorer
Old 09-08-2006, 02:00 PM   #145
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Re: Rich get richer / poor get poorer

ash, you crack me up..! I guess if you don't like the fact that doctors are licensed you can always go to Mexico for Laetrile, coffee enemas, and $5 liposuction. *

Hairdressers and barbers have to be licensed! Does that mean there's no free market for haircuts?

I guess licensing can increase costs, but lack of licensing would increase them far more.. think of the number of potential malpractice claims.. brrr.. then the highly-limited number of non-free-market licensed lawyers will really be able to write their own ticket! *

(Thanks Rich, for your supremely measured response.. you're a better man than I.)
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 03:47 PM   #146
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Re: Rich get richer / poor get poorer

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Originally Posted by ladelfina
ash, you crack me up..! (Thanks Rich, for your supremely measured response.. you're a better man than I.)
No sh&%! Talk about over the edge, reckless reactionary bull.

There, I feel better.

BTW I really enjoy your posts. Always insightful, great sense of humor, and I like the way you think.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 04:31 PM   #147
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Re: Rich get richer / poor get poorer

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Accreditation is by a separate private Association of American Medical Colleges, or a similar independent group, IIRC. They review curricula, lab facilities, clinical supervision and other things most would consider reasonable to assure decent training. You must graduate from an accredited medical school to apply for a license.

States are responsible for licensure, and this is basically a vetting process. There are national exams (3 of them at least) that every applicant must pass and they are not trivial.

The number of places available is up to the medical school. In the case of public supported ones the state legislature decides based on need and budget. Private schools decide based on resources, physical plant, etc.

To my knowledge, the AMA is out of these loops. Zero. Nada.

I hate to sound like I'm agreeing with ash and I don't want to pick a fight with The Doctor. BUT... Medical schools & state legislatures establishing "body" quotas, states establishing licensing specifics etc. Accreditation by Association of American Medical Colleges, none of these things means that the "Professional Class" isn't pulling the strings or having their input "duly considered" (rubber stamped) just because the AMA by name is officially not on the party list. I think it's Doctors involved in some way at every step doing what Adam Smith told us they'd do.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 05:30 PM   #148
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Re: Rich get richer / poor get poorer

Wow, I didn't think that pointing out that licensure laws restrict supply and therefore increase costs was such a controversial concept, since that is the very thing they are designed to do!

Whether or not that is a good or bad thing by leading to better or worse service can certainly be debated, but it DOES lead to higher costs as long as there are sufficient candidates being turned away from medical school.

I apologize for "recklessly" bringing the AMA into something, that apparently is run by someone called the AMC. Whatever acronym happens to be deciding that, my point was that someone is in fact deciding it and restricting the supply.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 05:38 PM   #149
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Re: Rich get richer / poor get poorer

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Originally Posted by ladelfina
ash, you crack me up..! I guess if you don't like the fact that doctors are licensed you can always go to Mexico for Laetrile, coffee enemas, and $5 liposuction.

Hairdressers and barbers have to be licensed! Does that mean there's no free market for haircuts?

I guess licensing can increase costs, but lack of licensing would increase them far more.. think of the number of potential malpractice claims.. brrr.. then the highly-limited number of non-free-market licensed lawyers will really be able to write their own ticket!

(Thanks Rich, for your supremely measured response.. you're a better man than I.)
Weird. All I said was that if "licesning laws were lessened..." and you jump to $5 liposuctions. My example even was measured in that possibly someone with less than 10 years schooling/residency should be able to prescribe amoxicillin. Why the extreme reply?
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 06:24 PM   #150
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Re: Rich get richer / poor get poorer

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Originally Posted by razztazz

I hate to sound like I'm agreeing with ash and I don't want to pick a fight with The Doctor. BUT...* Medical schools &* state legislatures establishing "body" quotas, states establishing licensing specifics etc. Accreditation by* Association of American Medical Colleges, none of these things means that the "Professional Class" isn't pulling the strings or having their input "duly considered" (rubber stamped) just because the AMA by name is* officially not on the party list. I think it's Doctors involved in some* way at every step doing what Adam Smith told us they'd do.
I had the same thoughts. The "medical establishment" by whatever formal or informal organizational structure does a lot of harm related to supply of medical doctors and regulation of who can administer medicine. Many doctors tend to become very defensive about these issues when you bring them up. I'm pretty sure this all Hillary's fault.
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Re: Rich get richer / poor get poorer
Old 09-08-2006, 06:52 PM   #151
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Re: Rich get richer / poor get poorer

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had the same thoughts. The "medical establishment" by whatever formal or informal organizational structure does a lot of harm related to supply of medical doctors and regulation of who can administer medicine. Many doctors tend to become very defensive about these issues when you bring them up. I'm pretty sure this all Hillary's fault.
Well it ain't just Dr's. It's anybody with aproprietary interest. Most of the anti union jibba-jabba is correct at least in principle. But the "Business Class" is as much in colusion as anybody else. It's one of those things that is a given in nearly every situation. The problem is how we choose to manage things for best results. I have no more confidence in some mystical magical unfettered free-market thingy than I have in The Big Government Store, or Divine intervention.

And I have no respect for anyone, or at least their reasoning abilities and knowledge base, who insists that this way or that is always the best way or that any way can be the only way to deal with things.
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Re: Rich get richer / poor get poorer
Old 09-09-2006, 07:17 AM   #152
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Re: Rich get richer / poor get poorer

I guess I don't see this happening. I see a LOT of care, including prescriptions (amoxicillin included), being given out by Physician's Assistants and Nurse Practitioners.. roles that didn't even exist a few decades ago. Also, there are a lot more over-the-counter meds that used to be prescription only.

Yes, every group has an incentive to protect its interests.. but as for the licensing.. isn't there another thread going about "unemployed" lawyers?

I don't think doctors are sacrosanct but I do see that there is probably 10x more information that a doctor has to be familiar with today, compared to a generation or two ago. Back then, the doctor really was "God", whereas today the system is far more 'democratic', if you will.

Licensing laws are not "designed" to restrict supply. Under (I assume) the same regime.. a few years back there was supposedly a "glut" of physicians!!

If there is a shortage of MDs today there are probably a lot of other factors at work.. And anyway.. what's wrong with a shortage creating a situtation in which higher compensation could attract more talent? Sounds like that would be right up the Cato Institute's alley!

Am I the only one confused here..
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Re: Rich get richer / poor get poorer
Old 09-09-2006, 08:14 AM   #153
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Re: Rich get richer / poor get poorer

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Originally Posted by ladelfina

Licensing laws are not "designed" to restrict supply.
Sadly, that's not always true.* Some are "designed" to do so.* And even if they aren't restrictive in the beginning, some become so over time and need modification.

I think we should look at the MD supply from another point of view.* What can we do as an society to aggressively promote a larger supply of medical services suppliers such as MD's, nurses, technicians, etc.?

Finances and classroom availability should not be a restriction on supply.* Everyone with the brains, integrity and ambition to served in this area should be able to do so.

When MD pay levels drive a MD supply that is at equilibrium with demand, we'll have the correct number of MD's.

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Re: Rich get richer / poor get poorer
Old 09-09-2006, 11:25 AM   #154
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Re: Rich get richer / poor get poorer

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Sadly, that's not always true. Some are "designed" to do so. And even if they aren't restrictive in the beginning, some become so over time and need modification.
Exactly.

At the risk of doing the unmentionable and comparing doctors to cab drivers ... take NY taxicab licenses. Anyone who wanted one in the 40's went down, paid a fee and got one. Then the city stopped issuing them (because of the war IIRC) and didn't start up again because there wasn't a demand. By the time there was a shortage, the people that already had them had an interest in making sure that no one else got one. Today, a NYC taxicab license is worth tens of thousands of dollars. Want to start a taxicab service in NYC? You have to break the law or get rich first.

A license is a barrier to entry; as a barrier to entry it naturally keeps some people out. Again, we can debate whether that's good or bad, but that's what they do.

Others have commented that licensing laws have been loosened in some areas recently (citing PAs and RNPs) which is all I initially suggested!
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Re: Rich get richer / poor get poorer
Old 09-09-2006, 12:21 PM   #155
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Re: Rich get richer / poor get poorer

There is a difference in licensing for professionals and to mearly restrict...

I do not want to got to a doctor that does not have training... or use a lawyer that does not have training.. or CPA, or....

But, a cab driver that is only to restrict the number... hairstylist well, for the women who have a lot done to their hair, maybe it is needed, but for my haircut with a number "4".. most anybody can do it.. but I do not see a problem with making them take a test to show that they at least KNOW what they are doing.. and hence a license..

Using your cab as an example.. there is NO test involved for the tag number... they sell on the open market!!! I could go and buy one if I had about $100K.. now, I would have to take a driving test to get a correct drivers license.. but I could get one and not be able to drive a cab without the tag.. big difference than doctors..
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Re: Rich get richer / poor get poorer
Old 09-09-2006, 03:20 PM   #156
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Re: Rich get richer / poor get poorer

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Originally Posted by Texas Proud
There is a difference in licensing for professionals and to mearly restrict...

I do not want to got to a doctor that does not have training... or use a lawyer that does not have training.. or CPA, or....

But, a cab driver that is only to restrict the number... hairstylist well, for the women who have a lot done to their hair, maybe it is needed, but for my haircut with a number "4".. most anybody can do it.. but I do not see a problem with making them take a test to show that they at least KNOW what they are doing.. and hence a license..

Using your cab as an example.. there is NO test involved for the tag number... they sell on the open market!!! I could go and buy one if I had about $100K.. now, I would have to take a driving test to get a correct drivers license.. but I could get one and not be able to drive a cab without the tag.. big difference than doctors..
I agree with you in that the only people who would make the quality/safety argument about restricting taxicab licenses are members of the taxicab industry!

And I understand that there is an accepted, and not unreasonable, argument that physician licensure increases both safety and quality. This can be debated, but I accept that the argument exists and is held by reasonable and intelligent people, who put forth good logic in support of it.

Nonetheless, merely because licensure might increase safety and quality is no reason to believe that it isn't also used to protect the interests of those who are already licensed. Consider this logic:

1) Licenses restrict the number of people providing a service (for better or worse).

2) If the number of persons supplying a good or service is decreased (shift of the supply curve caused by say, a license requirement), the price will go up (all things being equal).

3) Those providing the good or service now have an inherent personal and financial interest in restricting others from obtaining the license, and may use political and social forces to protect that interest, whether they be doctors, taxicab drivers, teachers or department store Saint Nicks.

Believing that doctors are somehow fundamentally immune to self-interest or economic laws doesn't make any more sense than believing that gold somehow has a gravitational advantage over lead.

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Re: Rich get richer / poor get poorer
Old 09-09-2006, 06:47 PM   #157
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Re: Rich get richer / poor get poorer

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doesn't make any more sense than believing that gold somehow has a gravitational advantage over lead
you mean it doesn't? but we do get french benefits with that, right?
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Re: Rich get richer / poor get poorer
Old 09-10-2006, 08:59 AM   #158
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Re: Rich get richer / poor get poorer

Ash..

You have a lot to say, but it does not pan out for most of what I see (except maybe doctors)..

There are a glut of lawyers... and you can go to MANY schools to get a degree...

There is nothing 'limiting' the number of CPAs... go to any college, get the required knowledge, take and PASS the exam.. you got it.. and in Texas at least... a glut...

Now, the taxi drivers in NY is to prevent new entrants... but except for a little bit on the side, NY has not increased in size much...you do have a limit on the number of cars that can fit on the streets..

But.. you seem to indicate that the license requirements are more for restrictiion instead of 'safety'.. I don't believe that.. now I wish they would remove the licensees from more people who 'do bad'.. but that is another discussion...
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Re: Rich get richer / poor get poorer
Old 09-10-2006, 12:03 PM   #159
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Re: Rich get richer / poor get poorer

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There are a glut of lawyers... and you can go to MANY schools to get a degree...

There is nothing 'limiting' the number of CPAs... go to any college, get the required knowledge, take and PASS the exam.. you got it.. and in Texas at least... a glut...
(emphasis added)

Your statements support my conclusions. You assert that the licensing requirements are easier for lawyers and CPAs, and that we have a glut of those professions.
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