|
I would disagree about professional licensure, and think the same arguments apply there as in other areas, although maybe in different ways. In fact, I think the problem in licensed professions is even worse, because assumptions are never questioned, to avoid being called reckless, and have the weight of law. In fact, I think this is a prime problem with healthcare in the US in the moment. The problem James outlines is the same with professional fields: we assume that license X, which often requires degree A, is necessary for competence in an area, and that competence cannot be achieved in an area in any other way. As a result, we stop actually paying attention to competency per se, and focus on licensure, which is not the same. As a result of that, we lose choice: any other way of meeting a demand is assumed to be illegitimate and unsafe, which is untrue. Competition is lost, and monopoly is gained. In your example, for instance, you suggest a hypothetical case where someone doesn't have a dental degree. But in reality, it's almost certainly not that that person would have no degree at all, and no experience, it's that they would have a different sort of degree, with a different sort of experience. Dentists are maybe a poor example, because if anything, their profession is an example of one that is being stifled by current practice. I suspect that they are in a position to learn to do a lot more than they are, and are held back by professional licensing laws relative to MDs. The appropriate example isn't "would you hire someone without a dental degree to treat your cavity?" It's "would you hire a dentist with appropriate surgical training to do jaw surgery?" Would you hire an optometrist with years of opthomological surgery training to do LASIK surgery? Would you hire a psychologist with pharmacology training to prescribe you lithium, or a psychologist with appropriate training to do TMS treatment of your depression? Would you trust your pharmacist to pick the right antibiotic for your infection, that has been precisely characterized by a lab already? What about a neuroscientist with clinical training to interpret your MRI scan? Licenses, although well-intended, have become hindrances to lower cost and better choice. The tail is wagging the dog in professional fields exactly the way James suggested over a century ago. |