Tuesday, May 28, 2013
Guilds and Health Care
If you think the guild system went out in the middle ages,
you have not noticed how health care and other professionals are organized.
The May 25 issue of the New York Times carried an article
datelined Guntersville , Alabama telling about the problems of one
Joyce Osborn Wilson. It seems that Ms.
Wilson invented a tooth whitener and has been selling it to salons and
spas. Recently, she received a letter from
a lawyer representing the state dental board accusing her of practicing dentistry
without a license and instructing her to cease and desist selling her product
in Alabama . She has filed a lawsuit in protest.
The article points out that our system of professional
licensure now covers some 30% of workers and the issue is whether it is being
abused by preventing competition.
Licensure creates what in effect are guilds that prevent
unlicensed people from engaging in their trade.
The entire professional component of health care is organized that
way. The categories, such as medicine,
nursing, pharmacy, laboratory technology, and physical therapy, were created
when health care was very different than it is now. But each continues to jealously guard its
“turf,” creating formidable barriers to any redistribution of functions that might
reduce cost and improve quality.
There have been a few changes, such as allowing nurse
practitioners to prescribe drugs, but they come slowly and with great
difficulty.