A Medical Proletariat

Ludwig von Mises Institute ^ | April 5, 2010 | Melchior Palyi

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The doctors are, of course, the key figures of governmentalized medicine. The prime purpose is to procure their services and all that goes with them. Their honoraria alone, disregarding the dentists', constitute anywhere between nearly 50 percent (in Switzerland) and little more than 15 percent (in Britain) of the total cost. But far more is at stake.

Being the focal point of medical procedures, the doctor directs the course. He decides who is sick and for how long, and thereby determines the trend of cash benefits, the quality and quantity of pharmaceutical products, the need for hospitalization, X-ray, laboratory, and hydrotherapeutical services, etc. Even the cost of administration is dependent in part upon the degree of control over the profession. And what is more important than all cost problems — the welfare of the patient is in the doctor's hands.

Governmentalized health services sooner or later run into the iron curtain of mountainous costs. The easiest way out is to curtail honoraria, denouncing the doctors as profiteers. That may or may not be true, but it is both popular and money saving. German Doctors' Miscalculation

There was no serious medical opposition to Bismarck's sickness insurance when it went into operation in 1884. Indeed, the profession was gratified. Legally it still was a Gewerbe like any other, different from barbers in degree of education but subject to police regulations, especially to a tariff with minimum and maximum rates. Governmentalization raised the social level of the profession by bringing it almost to the dizzy height of civil-service status. Also, new vistas of financial and scientific progress seemed to open. The radius of healthcare was to extend a broad front, medical studies to receive a great impetus and encouragement.

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An easier way would be to drastically increase the supply of physicians by breaking the hammerlock of the physician’s guild (union) on medical education. By legal control of credentialing, the physician’s guild has assured a limited supply of service providers. Relax that control, increase admissions to medical schools and, in a few years, problem solved.