All Commentary
Tuesday, February 21, 2017

Repealing Obamacare Is Not Enough

And why antebellum healthcare policies are a superior choice.

American health care is not very effective in curing diseases. The National Center for Health Statistics projects over 1.6 million new cancer cases and almost 600,000 cancer deaths for 2016. Among those who suffer heart attacks, fewer than 50% are alive five years later.

Republicans do not want to repeal the regulations that make healthcare expensive and ineffective.

Medical treatment is so expensive that people need insurance to survive financial catastrophe in case they become ill or get hurt. Even middle class folks who need extensive medical care cannot begin to pay the costs. Those facts supported demand for Obamacare, the halfway point on the road to socialized medicine.

Republicans argue that American medicine was the finest in the world, with only minor problems, until it was ruined by Obamacare. But American medicine has been plagued with extraordinarily high costs and ineffective treatments for many years.

According to, in the Commonwealth Fund’s 2014 healthcare survey of the eleven wealthiest countries, the USA came in last.

Republicans campaigned to repeal Obamacare. But they waffle about its replacement, because they sense they have no answers to the problems that predated the disastrous Affordable Care Act. Republicans want medicine to be inexpensive and effective, but they do not want to repeal the morass of regulations that make it expensive and ineffective.

A Brief History of Medical Regulations

After the Civil War, there were virtually no regulations of medicine in the United States. People would choose their doctor and treatment, and doctors would thrive or languish according to the exigencies of the market. Profit-seeking medical schools flourished and graduated many practitioners.

However, the rise of the Progressive Movement soon inspired doctors to lobby legislatures to license physicians, so that only those approved by the state could practice medicine.

The advertised goal of the political doctors was to stamp out what they considered to be bad medical practice and thereby improve the lives of their patients. But their medical journals and meetings revealed other objectives. The crusading doctors emphasized that medical licensing would reduce the numbers of practicing physicians, and thereby increase their incomes and enhance their social standing as members of a restrictive guild.

For example, Dr. Stanford Chaillie, Professor of Physiology and Anatomy at the University of Louisiana, wrote in 1874 that,

The profession has good reason to urge that the number of (medical graduates) is large enough to diminish the profits of its individual members, and that if educational requirements were higher, there would be fewer doctors and larger profits for the diminished number.”

Pushed by persistent physician lobbying, seventeen states enacted medical licensing laws by 1887. The next year, the president of the American Medical Association (AMA), Dr. AYP Garnett, urged national convention delegates to systematically lobby every legislature for the purpose of reducing the number of medical schools, and thereby, the number of doctors.

By the early twentieth century, the AMA had positioned itself as by far the most powerful political force in organized medicine. By elevating political lobbying above all other activities, it succeeded in passing legislation in virtually every state. New laws mandated that licensing applicants attend medical schools “in good standing” with the State Medical Board, and pass a state examination administered by the Board.

Established physicians were exempted from these requirements.

“Regular” Medicine

The Medical Boards among the various states were staffed by doctors who had lobbied for the passage of licensing laws. The boards were empowered to decree which medical schools would be allowed to operate. So, they gradually reduced the number of medical schools, a long standing goal of organized medicine.

The licensing boards required approved medical schools to teach curriculum consistent with the ideas of “regular” medicine. Regular doctors had long sought to outlaw the practice of non-orthodox medicine, consisting mainly of homeopaths and eclectics, who represented about 12% of practicing physicians. From the 1830’s through the 1850’s, these two sects had been instrumental in repealing medical regulations left over from the Colonial Period.

Homeopaths recommended miniscule doses of special curative elements, and eclectics emphasized herbal remedies. In contrast, regular medicine, as late as the 1870’s and 1880’s, looked to “heroic therapy”: Bleeding and blistering, purgation by means of induced vomiting or laxatives, and administering large doses of metallic compounds, including mercury and other poisons.

Regular doctors lacked the political power to outlaw the practice of heterodox medicine. However, by controlling the licensing boards, they were able to suppress teaching of heterodox ideas in medical schools that all aspiring medical practitioners were required to graduate.  

Today’s expensive, often ineffective, therapy is the result of a state-run medical cartel, not free enterprise.

As the twentieth century rolled in, organized medicine continued to complain about a “surplus” of practitioners competing for supposedly inadequate remuneration. Licensing laws in every state but Alaska had failed to turn back the tides of competition. Political doctors responded by demanding ever greater restrictions on medical schooling and practice, and applied pressure to prosecutors reluctant to enforce the unpopular licensing laws.

Eventually, the number of approved medical schools fell so low, and the requirements for admission became so elevated, that many tens of thousands of applicants were turned away every year.

Medical practice became a guarantee of princely income for any who could make it through medical school and residency and pass the medical board examinations. Medical schools indoctrinated aspiring doctors with official orthodoxy; any who challenged these ideas were punished and ostracized. Essentially, most doctors (with outstanding exceptions) became highly paid quasi-officials of medicine, rather than entrepreneurs devoted to medical science.   

Once medical care was established as an extension of the state’s police powers, bureaucratic meddling became the norm. The doctors’ guild forced Americans to pay sky high medical fees, a plight that worsened as restrictions and mandates grew. Today’s expensive, sometimes ineffective therapy is the result of a state-run medical cartel, not free enterprise.

Medical Licensing Laws Ought to be Repealed

Licensing laws, which lie at the base of the medical mess, should be repealed. Let anyone who wants to try to attract customers hang out her shingle as a practitioner, subject only to law prohibiting fraud. Medical costs will plummet. Entrenched medical ideology will be challenged on a thousand fronts, producing a revolution—many revolutions—in medical thinking that will benefit patients.

Progressives and guild doctors say that economic freedom would be disastrous for Americans. They argue that people fall for bad ideas and false promises. They need the authority of the medical guild to guide them in making safe choices.

Scientists and doctors are responsible for brilliant breakthroughs in healing which political authority can only obstruct.

But the authority of the medical guild is false in important ways, despite its pretense to science. Government bureaus and state-privileged medical societies cannot identify truth, or discover cures. They can only defer to political consensus about proper medical thinking. Political consensus is formed with attention to the beliefs of other people, not with respect for facts of science.

Science requires making proper distinctions between truth and falsehood. This requires good thinking. But thinking is an individual exercise, not a collective feeling. Individuals choose to think, or not to think; to identify contradictions or cast them out of mind; to persist, or stop trying; to conform, or question. This is why the merit and character of one’s thinking differs radically from that of another.

Individual scientists and doctors are responsible for brilliant breakthroughs in understanding and healing. Political authority cannot guide or guard thinking, only obstruct or punish it.

Make Informed Choices

But without political authority, who will protect us from bad ideas?

People can protect themselves. The market process enables ordinary people to make informed choices about complicated subjects. Get rid of the medical cartel and its bureaucratic overseers. Then people will seek their own answers, just as they do regarding automobiles, computers and other complexities. People read, they consult experts and they investigate the reputations of providers.  Good ideas work; bad ideas fail. People quickly find out what worked, or did not work, for others.

When Americans are free to think and choose for themselves, our medical mess will evaporate. A flourishing medical market will sweep away regulatory debris and deliver affordable and helpful healing.  

  • Mark Humphrey has published editorials in the Orange County Register,  The Journal of Commerce, the Great Falls (Montana) Tribune, and