In 2010, the small town of Collegedale, Tennessee had the dubious distinction of having the highest prevalence of Type II Diabetes in the world. Without a single endocrinologist in the small town, those suffering from this preventable and treatable form of the disease were unable to gain access to the treatment they needed.
The country is experiencing a shortage of doctors in virtually every state.
Dealing with this issue firsthand, a local employer who operates a donut manufacturing plant decided to dedicate a portion of his warehouse to be used as a health clinic. By hiring an endocrinologist from Chattanooga to travel to his warehouse a few days a week, his employees were finally able to receive the help they so desperately needed.
The employer reasoned that the prices associated with the hiring of an endocrinologist were actually less costly for the company than the insurance expenses related to the disease.
The donut maker’s free market solution solved the problem of constrained supply of medical professionals for his employees. But this disconnect between supply and demand exists far beyond Collegedale. In fact, the country is experiencing a shortage of doctors in virtually all specialties and every state, which begs the question, where are all the doctors? (For more on this topic, see "Government Makes Healthcare Worse and More Expensive.")
A Choreographed Shortage of Care
Though few Americans realize it, health care is a monopoly. In the early 20th century, the American Medical Association (AMA) lobbied the Federal government to close all schools not approved by its own Council on Medical Education. They unfortunately succeeded and 30 percent of medical schools were closed within 30 years. The number of doctors has been artificially capped ever since.
The AMA also controls state boards of licensing, limiting the number of physicians in each state and preventing competitors from treating patients. The United States has 50 percent fewer practicing physicians per capita than Sweden or Germany. Unsurprisingly, US doctors also work fewer hours while earning much higher salaries.
Even as the US population and its demand for medical services continue to expand dramatically, the number of new doctors educated by “approved” schools and licensed by state boards hasn’t improved. In fact, two-thirds of highly qualified medical school applicants are turned away each year.
Licensing quotas and arbitrary caps set by state boards literally make it illegal to train a single additional candidate in the medical field. Inevitably, where there is a shortage, prices rise for everyone. This results in smaller and poorer markets being shut out altogether. Even if the additional physicians were “B list” doctors from sub par medical schools, smaller towns like Collegedale would still be better off with a “B-” doctor than no doctor at all.
Though few Americans realize it, health care is a monopoly.
Cartels Protecting Doctors
Both directly or indirectly, the AMA also controls the prices paid to physicians, the licensing of physicians, the accreditation of medical schools, admittance into medical schools, and the payment policies of insurance companies. The AMA runs on membership fees, and its mission is protecting the interests of current doctors, not the American public.
Fewer doctors mean higher salaries, less competition, and more negotiating power for physicians. This is allowed to happen because physicians, like any other group of citizens, are free to associate and express their interests through donations.
What should outrage all US patients is the collusion of our government under the guise of protecting the public interest by requiring licenses and letting a cartel of campaign donors say who can have one.
Not only can the cartel set prices but the taxpayer is also forced to fund the muscle to shut down and jail those caught trying to circumvent the government-protected monopoly.
Americans need the freedom to access more health care choices.
Similar federal regulatory monopolies prevent generic drugs from competing with big brands, block the building of new health care facilities, and limit health insurers to two or three per state. Our health care options shrink as special interests’ regulatory control grows resulting in fewer drugs, fewer doctors, fewer plans, and fewer choices.
Less Government, More Choices
Like US consumers in all markets, the residents of Collegedale need the freedom to access more health care choices. Allowing lobbyists to block out competition limits everyone’s choices and forces them to pay higher prices for less access to care.
If Americans want real choice, they need to demand that Congress end the AMA’s control of medical school enrollments and licensing. If more Americans could become doctors without first asking the government’s permission, more Americans could receive medical care without the state’s help.