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.

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