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Dental Licensing: Good Government?

Here is a story for libertarians to chew on. A dentist in Texas has been arrested for practicing dentistry without a license. He served undocumented immigrants, and those without insurance.

On the one hand he is providing a needed service at a market-clearing price. On the other hand the story following his arrest suggests that the quality of his work was uneven …

  1. Severely Ltd.

    Couldn’t consumers rely on private licensing organizations to screen for competence?

    “Dr. so-and-so is certified by the ACME Dental Certifiers Ltd. You can trust the ADCL approved teeth-wranglers.”

  2. Mendel

    The most important factor (which was not mentioned in the story) is whether his customers were aware that he had no license and only had training as a dental technician.

    If his patients were honestly informed and not lied to about his qualifications, I have no problem with this story.  Taking risks to save money is how every market improves itself.  Some people will take risks that turn out to be bad, but that is also part of the collective learning curve.

  3. Bob Laing

    Libertarians have no problem with professionals being licensed, they have a problem with the licensing body being a state run organization.

  4. raycon and lindacon

    Basic conservatism would say that every bit of personal autonomy that you surrender to others will, at some point, be abused and lead you to regret that decision, unless you see that the results of maintaining that power would lead to lesser outcomes.

    Licensing is a means of determining the qualifications of a practitioner in circumstances where the consumer is unable, from lack of personal knowledge, to make the decision intelligently.  Which leads to licensing requirements for braiding hair and manicuring nails.

    Hence, licensing with enforcement is always a can of worms.  The worms, in this case, are politicians and bureaucrats. 

    Severely Limited, above, has the best solution.  Endorsement organizations acting as the recommender of services.  Angie’s List, for instance, serves as a watchdog for service providers.  And, to the extent that we choose to trust that listing, we avoid the power of the state.

    We often need help in evaluating the qualifications of those we hire.  But we behave stupidly when we place that responsibility on the government.  That is the can of worms.

  5. Scott R
    Severely Ltd.: Couldn’t consumers rely on private licensing organizations to screen for competence?

    “Dr. so-and-so is certified by the ACME Dental Certifiers Ltd. You can trust the ADCL approved teeth-wranglers.” · 49 minutes ago

    Yes, that would be best. A Consumer Reports for dentistry, in a sense.

    It could only work, though, in a no-license-needed world. The problem here is the guy had to operate under the radar.

    Any reduction in the need for state-mandated “credentials” would be progress, especially in education. A principal should be free to hire a guy who’s worked for years as an engineer, for instance, to teach math, even if he lacks some silly education certificate. And of course the principal should have freedom to fire him pronto if it doesn’t work out.

    Credentials have become a substitute for judgment. 

  6. DocJay

    Any sexy name could license a quack so it’s not some board that matters. There are a few issues here. One is that dentistry is horrifically expensive and people cut corners one way or the other when their budgets are stretched to the limit. Another obvious issue is that quacks make serious money preying on the vulnerable and ignorant. Yet a person with skills, no degree, and a desire to heal can often have a profound impact in the world for the positive. Somehow the dentists have managed to escape most of the brutality of the insurance scum, however I expect their days of wine and roses are coming to a close. With regards to legality, I think disclosure should be the issue rather than licensing. I could probably remove an appendix with a how to book, but I wouldn’t recommend me to anyone for that.

  7. Severely Ltd.

    DocJay, how would you feel about private licensing for M.D.s? Wouldn’t an Underwriters Laboratory for medicine work? 

  8. DocJay

    All state licensing agencies are effective. I like it that way. Your point has merit though. Since I like telling stories, here’s one for you. I saw a partially paralyzed man nearly two decades ago who had a surgery in some Central American country on what he thought was an emergent basis( severe brutal sciatic pain). The ‘doctor’ was amazed when he found a pile of worms at the base of his spine and removed some of them before I guess an assistant stopped him. The doc had pulled out the cauda equina , which is the continuation of your spinal cord. Oof.

  9. Douglas
    Mendel

    DocJay: All state licensing agencies are effective. I like it that way.

    And if it turned out that unlicensed doctors were all quacks who killed a quarter of their patients, that market would evaporate anyway and bring us back to where we are now. · 2 hours ago

    And this is why I think that Objectivism, and to a lesser extent, Big L libertarianism tends to the direction of airy utopian theory. You say “bad results will drive people away, and market forces will point people to legitimate practicioners”.

    The problem is that humanity would have to be perfect for this to work as you think. Look at the history of medicine and quackery. Look at the history of frauds that sold “elixers” from their wagons that did no good (and sometimes killed people). There’s always that group of people that needed a placebo that will swear Dr. Miracle’s All-Purpose Tonic and Elixer made them feel 19 again. As PT Barnum put it, there’s a sucker born every minute. 

    Licensing of medicine and regulation of the field is a legitimate function of government. A minimal level of state regulation is necessary here.

  10. iWc
    Douglas

     A minimal level of state regulation is necessaryhere. · 2 hours ago

    No. Medicine is no different from any other good or service.  Either you think consumers have the right and freedom to make informed decisions for themselves, or you think they must be nannied for all decisions.

    I think the government function is to require that everyone offering any service puts all endorsements (or lack thereof) front and center.

    So an alternative medicine quack would have to say “I am an endorsed by the Quack Institute, but I never passed Medical Boards.”  Information is all we need to make our own decisions.

  11. iWc

    Consider experimental drugs for a terminal illness. In that situation, I would be interested in considering all potential treatments. But the government, in its infinite wisdom, makes that illegal.

    There are, of course “clinical trials” on experimental solutions that are open to those with connections/money. It is just another way to deny options to those less fortunate.

  12. iWc
    Foxfier

    They don’t do very well.

    Quite so. Why does anyone think the federal government is any better at licensing medicine than it is, at, say, the TSA function?

  13. Douglas
    iWc

    Douglas

     A minimal level of state regulation is necessaryhere. · 2 hours ago

    No. Medicine isno differentfrom any other good or service.  

    I couldn’t disagree with you more on that. Medicine is one of those few areas where I’m quite happy that there are government agencies watching things like licensing and retraining and a malpractice history. Because those are life and death questions. How good your, say, house painter is are not.

  14. iWc
    Douglas

    iWc

    Douglas

     A minimal level of state regulation is necessaryhere. · 2 hours ago

    No. Medicine isno differentfrom any other good or service.  

    I couldn’t disagree with you more on that. Medicine is one of those few areas where I’m quite happy that there are government agencies watching things like licensing and retraining and a malpractice history. Because those are life and death questions. How good your, say, house painter is are not. · 33 minutes ago

    Then you are not paying attention.

    Consider: the state of Florida has an influx of doctors, retiring. Because the government built a guild, those doctors have to pass a range of tests to practise in Florida – so medicine costs much more than it would otherwise, and very high quality doctors are being told they cannot practise medicine.

    Because there are finite resources, anything that makes something more expensive, also makes it less accessible. In other words, government “quality” requirements restrict the available breadth and depth of medical treatment. 

    A single new drug costs upward of $>1 billion  to get approved. Because of government. So more people die, waiting for drugs that are delayed, or never get underway.

  15. iWc
    Douglas

    I couldn’t disagree with you more on that. Medicine is one of those few areas where I’m quite happy that there are government agencies watching things like licensing and retraining and a malpractice history. Because those are life and death questions. How good your, say, house painter is are not. · 40 minutes ago

    Thanks to the guilds, the lawyers, and all the government regulations, health insurance is ridiculously expensive. My daughter hit her head last year, requiring a single stitch at the local hospital.

    The total bill: $1,000.

  16. raycon and lindacon
    Frozen Chosen: Dentistry is tough enough when the pros do it – good luck getting treatment from an unlicensed quack! · 11 hours ago

    Unlike the licensed quack who gave dozens of patients aids in the late 1980s.

  17. Frozen Chosen

    Dentistry is tough enough when the pros do it – good luck getting treatment from an unlicensed quack!

  18. Foxfier
    Douglas

    Medicine is one of those few areas where I’m quite happy that there are government agencies watching things like licensing and retraining and a malpractice history.

    They don’t do very well.

    My grandfather was killed by an anesthesiology who had maimed many others previously, while committing fraud– he would leave medication on unrefrigerated trays over night and over the weekend, when they were to be used within 12 hours of being opened, then charge full price to all the patients.  Two in a coma, several lost limbs; Papa was the first death.

    The gov’t agency did not take his license to practice, in spite of him being found at fault several times prior, nor did they tell the hospital that hired him.

    When he was found guilty of killing my grandfather, his license was suspended.  For six months.  And he had to pay blood money.

    The agencies are supposed to catch this stuff, make sure there aren’t kooks practicing, etc; usually, it’s just one more hurdle.  Like the fees my sister is supposed to pay to do massages. (She got the degree, but needs to pay the same state for training every few years.)

  19. Mendel
    DocJay: All state licensing agencies are effective. I like it that way.

    Even in my libertarian fantasies I recognize that state licensing of doctors is not going away anytime soon.

    But why does it have to be illegal to practice without a license, if the “doctor” is open about it?  If you had licensed doctors commanding higher fees, and unlicensed “doctors” charging much less, each patient could choose what option provided him with the most suitable risk:benefit ratio given his current cash flow.

    And if it turned out that unlicensed doctors were all quacks who killed a quarter of their patients, that market would evaporate anyway and bring us back to where we are now.

  20. Douglas

    “Who are YOU to get between me and my customers? Licensing agency? Cartel! Free markets! Willing sellers! Willing buyers!”

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