Healthcare and Status
Tuesday, April 26, 2011 at 09:00AM Arnold Kling is developing an interesting classification of industries, based on how status is obtained, retained, and enforced:
|
How Status is: |
System A |
System B |
|
Obtained |
market acceptance |
credentials |
|
Retained |
competition |
tenure |
|
Enforced |
choice |
authority |
Read the whole post.
The question in health care is this: Is it closer to system A or B? Specialties like Ophthalmology are closer than others to system A, and general medicine in hospitals is closer than others to system B, but overall the industry seems to have moved away from A and closer to B over the course of the last century.
Licensing laws have privileged credentials over market acceptance. The restriction in the supply of physicians has limited the amount of competition for customers, and ensured that almost every licensed physician can retain his status (i.e., tenure). The trend in the last element, enforcement, is more mixed. Medicare, Medicaid, and now the individual mandate severely limit the choice that people have to refuse to pay for medical care. However, autonomy has become a major principle of medical ethics, and certain physician authorities have been curtailed (e.g., giving a patient a drug against his will, involuntarily hospitalizing a patient).
This general trend toward system B may help explain why physicians have become more accepting of government regulation of healthcare. Contrast AMA’s opposition in the 1950s and 60s to the enactment of Medicare, to its support of Obamacare.
I don't know if the data is available to prove this, but I'm willing to bet that physicians in specialties or practices that are closer to system A are, on average, less supportive of government regulation of medicine than those in specialties that are closer to system B.
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