The American Medical Association (AMA) was founded in 1847 around two propositions: one, all doctors should have a “suitable education” and two, a “uniform elevated standard of requirements for the degree of M.D. should be adopted by all medical schools in the U.S.” In the days of its founding AMA was much more open–at its conferences and in its publications–about its real goal: building a government-enforced monopoly for the purpose of dramatically increasing physician incomes. It eventually succeeded, becoming the most formidable labor union on the face of the earth. [Full Article]
Source link: http://blog.mises.org/2110/100-years-of-medical-robbery/
100 Years of Medical Robbery
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In the last two decades, demand for more medical schools has been tempered by “offshoring”. That is, making it relatively easy for foreign medical graduates to obtain US licensure. Many of these are US citizens.
This occurred after the number of medical school positions greatly increased in the 1960′s and 70′s. This generated fears of a physician surplus.
The unspoken rationale is that it is easier to control immigration and licensure than it is to shut down “unnecessary” medical schools. It may be time to start opening medical schools again.
Far from being “a union”, we docs are legally prohibited from collective bargaining. More recently, physicians have largely lost control of funding to HMO’s, PPO’s, etc. Not to mention the medicare system. Arguably, these are now the medical monopoly, since they can control the number of physicians they “hire” and their working conditions.
One result is that physicians who are in the HMO PPO “loop” may work very long hours, while physicians outside it may be underemployed. Another result has been rationing by long waits to (e.g) see a specialist.
Mexican medicine: A model for the States?
We had to move to Mexicali, Baja California for a couple of years, and we absolutely loved the attention that we received. Antibiotics are unregulated down there and very reasonably priced, and a regular office visit only costs $10USD–the price of my current co-pay. Doctors there even do house calls at night for a whopping $25.
Doctors there all speak English and are so considerate. Things couldn’t have been better for a young family with routine ear aches and sore throats. Even though we were uninsured, we even made it out of an Emergency Room once for only $106 cash.
Without the interference talked about in this article, competent health care in Mexico is dirt cheap and actually a pleasure.
Since the early 1990s, the FTC and Justice Department has banned groups of physicians from “joint contracting” with managed care payers unless they adhere to government-approved business models. The approved models, however, are all designed to maximize the financial risk to physicians while absolving the third-party payers of responsibility. Any physician group that deviates from the approved models risks civil or criminal prosecution for “price-fixing.” Since the Bush administration took office, more than 20,000 physicians in more than a dozen groups have been prosecuted under this policy. Since most of these case are brought by the FTC, physicians are not entitled to constitutional due process, only an administrative hearing before an FTC-appointed judge (with an appeal to the FTC itself.) All but two of the groups prosecuted to date surrendered without a fight, and they were forced to sign “consent decrees” that prohibit physicians from exchanging any type of price information with each other–the FTC fears free speech will harm consumers, the Constitution’s protections for the former notwithstanding.
Excellent article. Clearly, prohibiting anyone from helping anyone else who wishes that care because they do not hold a license to do so is unethical. This is just what the AMA does by closing down competitive institutions, encouraging the FDA to ban safe and effective alternative medicines such as ephedra (Notice the hypocrisy: The AMA does not call for banning Sudafed and other medicines that contain the same ingredients, but are not “natural”.)
, and legally harassing “alternative” medical providers.
There is nothing wrong with accredidation, but there should not be a government-enforced monopoly by the AMA on it.
If a patient elects to have affordable healthcare from a doctor from a virgin-island acredited institution, they should be entitled. If they elect to take any medicine they should be allowed to do so provided
1. The pharmaceutical manufacturer wishes to sell it to them, which given the risk of liability they may choose not to do so.
2. An agency (XYZ-licensed pharmacist)
elected by the pharmaceutical manufacturer (NOT THE FDA!) decides not to presribe it due to aforementioned risks of lawsuits.
Here is what your AMA membership (Link)gets you:
Medical Liability Reform
Objective: Secure enough votes in U.S. Senate to pass federal medical liability reforms.
Translation: Prevent people from suing incompetent doctors.
Medicare Physician Payment Update
Objective: Pass legislation to stop physician payment cut and implement long-term fix.
Do you think that they might support the free market if the government cuts their payments enough?
Expanding Coverage for the Uninsured/Insurance Market Reforms
Objective: Work with other groups to build public and political support for initiatives that expand health insurance coverage for more Americans through tax credits and insurance market reforms, and move toward a system of individually owned health insurance.
Anytime one has mandatory insurance, the costs go up.
Patient Safety
Objective: Enact legislation to promote voluntary reporting systems for improving patient care with strong confidentiality protections.
Doesn’t the patient own his own medical records?
Antitrust
Objective: Pass legislation to enable physicians to negotiate with large health insurance companies and press Department of Justice and Federal Trade Commission to adopt changes in enforcement policies.
Sure anyone should be able to negotiate with anyone else. What is the FTC doing mucking with employee-employer negotiations?
Funding for Biomedical, Health Services Research and GME
Objective: Advocate increased funding for NIH, AHRQ and graduate medical education.
You mean the 40K per year tuition is not enough? Well just raise it. It should not be much of a burden for those earning $150k +. Of course, there are those malpratice bills…
Disease Prevention/Health Promotion
Objective: Improve public health through initiatives to promote health and prevent premature deaths.
I am so happy that this is one of their objectives.
Well, this is quite interesting indeed. Would love to read a little more of this. Excellent post. Thanks for the heads-up.
The ironic thing about all this is that this attempt by the AMA to put up entry barriers to the medical profession has backfired in a way.
In my observation of waiting rooms in doctors’ offices, hospitals and doctors themselves I have observed doctors being overworked.
I used to work at a casual dining restaurant in a mall that was across the street from a hosipital. Some MDs would come in there every once in awhile and they would talk to me a little bit.
One of them came in one day and said that it was his first day off in years of practicing medicine and he told me: “I am a slave to my profession.”
Therefore, by putting up entry barriers to the labor market of medicine the AMA has exacerbated the problem of doctors being overworked. This is in no way a good thing. This is not to say that government intervention has nothing to do with it, just that what the AMA is doing certainly can’t be helping the situation.
Unless a Doc is also an excellent business manager, he is bound to be barely breaking even UNLESS he exploits the system.
This is less of a ‘problem’ outside medicine because everyone knows it getting into other professions. Docs are seen by just
about everyone as a “cash cow”, to be heavily milked for a long time and then slaughtered. This is an opinion formed from years
as a medical/business consultant and son of an ‘old-style’ FP. Said FP is perhaps a decade away from retirement and gets to
work at 8AM and leaves home at 2AM… and that’s just M-F in the office. Add to this CME’s, hospital rounds, meetings, etc.
and 6 hours sleep is 365/year norm. He’s growing old every time I see him.
On a more positive note, I, personally, long for the days of medical saving accounts and having a $6K deductible. If that doesn’t
improve the doc’s lot, I don’t know what will…
Thoughts?
Isn’t it odd that the government dispenses Iodine to protect against radioactive Iodine resulting from a nuclear disaster when the medical quacks are dumping the same type of radioactive Iodine into patients with thyroid problems in a stupid attempt to “cure” thyroid “disease” caused by a lack of this same Iodine?
Natural Iodine protects our thyroid glands from taking up biologically destructive, radioactive, Iodine, yet the medical quacks use similar radioactive Iodine to destroy our thyroid glands??!! [mainly in women].
Why did doctors quit using Lugol’s solution, the sure cure for most thyroid disease? Why did the medical quacks bring in antithyroid drugs to kill the thyroid gland when Iodine was being used so successfully for so long? Since Thyroid disease is caused by malnutrition or poisoning [as are most diseases – if you believe otherwise you need to read elsewhere on this site to relieve yourself of the "infectious" disease ideas you carry around in your head.], why is this malnourishment NOT addressed? How many doctors even know what the [fictitious] RDA for Iodine is, much less that it has never been established by proper studies? And how many doctors busily destroying female thyroids with quack antithyroid remedies know that the Japanese mainlander consumes a hundred times the amount of Iodine as American citizens and enjoys the lowest cancer rate of all cancers except stomach. The very term, antithyroid, gives one pause?? Why would we want to be “anti” any body gland???
to read the rest see http://www.duffyslaw.com article 2 under CURRENT TOPICS.
There are at least 6 areas with which I take issue regarding this article.
1. Some schools closed down by the Flexner report were diploma making factories. In return for a year of service, a student could receive a medical degree. Other students took classes, demonstrated skills seeing patients, and showed themselves ethical in the treatment of patients. Both students got the same degree. After Flexner, medical education became more standardized. Now all of students must pass three levels of licensure exams in order to able to practice.
2. Medical education is funded primarily by state and federal govenments. The AMA doesn’t control how many medical school there are the US. States fund medical school in an effort to lure students to stay and practice medicine. The federal government funds graduate medical education through Medicare (residency) with few exceptions.
3. Race is used by admissions committees at many schools. The US Supreme Court recently ruled that the University of Michigan could use race as a part of their admissions criteria. Other schools use state of residence, rural background, and speaking foreign language when deciding who they will admit.
4. By whatever means one measures a medical school, the University of Alabama School of Medicine (UASOM, University of Alabama at Birmingham, or UAB) is an excellent school. The faculty generate important research in all fields, write textbooks, and serve on editorial boards of major medical journals. UAB residencies have good reputations (see US News and World Reports annual rankings of graduate programs) and are very competitive. The undergraduate program (med school) innovates in how students are taught and assessed. The authors offhanded derision of the school shows either poor taste or bad research.
5. Footnote 23 cites a chemistry professor at the university saying that older white males cannot be admitted. By following the link earlier in the article, one can see that older people are admitted. In 1997, five older white males were admitted to the class of 2001. I am one of them. This information is readily available via the school’s webpage (www.uab.edu/uasom, see applicant section). The author did not research this point well.
6. The AMA does not determine who is offered surgerical procedures. That role is left to individual surgeons, many of whom are not AMA members. In the same way, I do not consult the AMA when I decide who to refer for any procedure. Rather, I evaluate each patient and make recommendations based upon the best medical literature I have.
American medicine has many problems. Sick people delay medical evaluation and treatment because of lack of ability to pay. Physicians flee states with prohibitively high malpractice insurance, further limiting access to care. The number and severity of medical errors is unacceptable. Blaming the AMA for all of them is wrong and hinders fixing the medical system.
Point of information on Steven M’s argument that the the FTC should not interfere with “employer-employee” negotiations: Most physicians are not “employees” of managed care organizations, but independent contractors who often deal with several HMOs or PPOs. This is what gives the FTC its opening; if physicians are “employees,” they generally can take advantage of the monopoly union privileges afforded under federal law. Even the FTC and DOJ have not argued, to my knowledge, that physician-employees cannot organize.
Hi Dale,
I posted a link to your article, and an excerpt, to the Usenet newsgroups sci.med and sci.life-extension.
Not only did the messenger (me) get shot, but you are being torn to shreds and called a moron there. If you are up for a fight to defend yourself (which certainly I cannot do) then please join in.
–Paul Wakfer
MoreLife for the rational – http://morelife.org
Reality based tools for more life in quantity and quality
The Self-Sovereign Individual Project – http://selfsip.org
Rational freedom by self-sovereignty & social contracting
The AMA has been extremely active in suppressing alternative treatment modalities and even whole professions such as homeopaths and chiropractors for some decades. This overt suppression has now been moved to a “quackbusters” operation, which is working with licensing boards to come after anyone supplying alternative services. Tim Bolen has lots of information on that particular operation, collected in a series of “comments”.
Given the extremely close co-operation between medical system and pharmaceutical industry, and the tendency of both to suppress any alternatives, one could argue that there is a medical/pharmaceutical monopoly on health that would merit an investigation by the anti-trust authorities. So far, the authorities’ eyes seem tightly closed to any such possibility.
The pharma/medical monopoly has become one of the major causes of unnecessary death and injury in the US (see: Death by Medicine), yet we keep feeding the monster instead of taking it apart to force some real competition between medical systems and between toxic pharmaceuticals and natural alternatives.
I say an investigation by anti-trust authorities would be in order.
Sepp, what do you think an antitrust investigation would accomplish? I have yet to find any problem where a bunch of third-rate government lawyers have provided the solution. The real solution, as your own comments indicate, is to dismantle the state-run licensing machinery that allows the AMA and other industry participants to suppress competition.
Skip, certainly the anti trust laws were made with a purpose in mind – that of impeding the formation of monopolistic cartels. Even though they are clearly not being applied in this case, an investigation would put the attention where it belongs.
The solution, as you say, would not necessarily be coming directly out of such an investigation, but with public (and legislator) awareness of the problem, it would be comparatively easy to propose a solution such as yours: dismantle the state-run licensing machinery and let people get on with what they do best.
Without a big splash and controversy however that puts the eye of transparency on the problem, I doubt if you’d have an easy time with your proposal.
As I stated before, this article is receiving a resounding condemnation on many grounds (some of which may be warranted) on the newsgroup sci.med. However, in spite of being informed of this both here and by direct email, the author of this article has not so far appeared to defend his work. Although I have been a libertarian free market advocate for many decades, I find myself somewhat ashamed to see so many market advocates who only wish to preach to the mostly converted.
–Paul Wakfer
MoreLife for the rational – http://morelife.org
Reality based tools for more life in quantity and quality
The Self-Sovereign Individual Project – http://selfsip.org
Rational freedom by self-sovereignty & social contracting
I would also like to see an author response to the above comments.
Skip, certainly the anti trust laws were made with a purpose in mind – that of impeding the formation of monopolistic cartels. Even though they are clearly not being applied in this case, an investigation would put the attention where it belongs.
The solution, as you say, would not necessarily be coming directly out of such an investigation, but with public (and legislator) awareness of the problem, it would be comparatively easy to propose a solution such as yours: dismantle the state-run licensing machinery and let people get on with what they do best.
If that were true, Sepp, then the 20,000 physicians prosecuted by the Bush administration for “price fixing” would have generated public and political awareness of the unlevel playing field created by government sponsorship of HMOs. Yet that has not been the case.
Just as two wrongs don’t make a right, you cannot correct the problems created by the government’s initiation of force through another government initiation of force. You just expand the State’s power without correcting the underlying problems.
Skip,
I believe you may be right. It’s really ourselves who have to wake up and insist on what we believe is right.
It’s just … a very long shot, if I may say so.
Here is an interesting link discussing the Flexner Report and the selection process of the American medical schools that remained after other schools were closed down.
He Who Pays the Piper – Creation of the Modern Medical (Drug) Establishment, by G. Edward Griffin.
I think it adds to the discussion and shows the direction Medicine took at that crucial time at the beginning of the 20th century.
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