Thoughts on economics and liberty

Thomas Szasz’s argument against licensing doctors

I mentioned Friedman’s argument against licensing doctors here. And two of Adam Smith’s arguments here and here. Here is Thomas Szasz’s argument:


KURTZ: Your point, then, is that the state should not license doctors.
SzAsz: Certainly not. The licensing of doctors is the symbol of what I am talking about. It’s as if the state would license Catholic priests for the ministry—and would prohibit all other clergymen to practice religion because they are quacks.
KURTZ: But then who should do the licensing?
SZASZ: There should be no licensing.
KURTZ: No licensing? Anyone could practice medicine?
SZASZ: Of course.
KURTZ: But how would you protect the public? What about the quacks?
SZASZ: Professor Kurtz, the idea that licensing doctors protects the public is one of the most uncritically accepted falsehoods of our day.
KURTZ: What do you mean?
SZASZ: Well, suppose a professor of medicine or surgery at the University of London were to come to New York; could he practice medicine? Or suppose a professor of medicine or surgery at Har¬vard—or the State University of New York—were to move to Miami because it’s warmer there; could he practice there?
KURTZ: No, not without first passing the state medical-board examinations.
SZASZ: Exactly. And that is to protect the public? Hardly. I grant, of course, that licensure examinations may, inter alia, also protect the public. But I insist that their first and foremost function is to protect physicians, the medical profession, from too much competi¬tion. In short, medical licensure is a method for preserving a closed union shop for physicians—for maintaining an artificial shortage of doctors. And the whole thing has been successfully palmed off on the American public as something done for its protection.
Kuwrz: So how should the public be protected? Doesn’t it need protection from incompetent medical practitioners?
SZASZ: Oh, I agree that people need protection—but not only from bad, stupid, inept, greedy, evil doctors; they need protection also from bad parents and children, husbands and wives, mothers-in-law, bureaucrats, teachers, politicians—the list is endless. And then of course, they’ll need protection from the protectors! So the question of how people should be protected from incompetent medical prac-titioners is really a part of the larger question of how they should be protected from the countless hazards of life. That is a vastly com-plicated problem for which there are no simple solutions. The first line of protection for the public lies, I would say, in self-protection. People must grow up and learn to protect themselves—or suffer the consequences. There can be no freedom without risk and re-sponsibility. More specifically, the public could look to what school the doctor graduated from and could set up all sorts of unofficial testing mechanisms—sort of consumers’ bureaus. The possibilities of nongovernmental checks on competence are immense. The trouble is no one is interested in even thinking along those lines nowadays.
KURTZ: Many people know very little about medicine. They may go to a man who claims to know what he is doing but doesn’t.
SZASZ: That’s true. But what I am talking about now is a long-range view. It’s a view that couldn’t be implemented overnight. To
make it meaningful, practical, we would have to envision correspond-ing changes in education, in people’s interest in, and knowledge about, their own bodies, about drugs, and so forth.
KuRTz: Why do you think that people don’t know more about medicine?
SzAsz: There are many reasons. One is because they aren’t taught anything about it. You know, most professions thrive on mystification, on keeping the public in the dark—despite all the protestations about popularizing medical knowledge. I have always thought that twelve-year-olds and thirteen-year-olds could be taught a great deal about how the body works—really works; it’s no more difficult either to teach or to learn that than is algebra or French grammar.
KURTZ: You would teach medicine in high school?
SZASZ: Certainly. Not how to take out an appendix, but how the body works, what doctors do—the basic principles and facts of phsysiology, pharmacology, the major diseases that affect man and the treatments for them. Real information—what’s in medical text¬books—not the lies children are now taught in the name of sex education, drug education, health education. None of that is pos¬sible, however, so long as education is a state monopoly.
KURTZ: Why not?
SzAsz: Because the doctor is a priest who teaches only his reli¬gion, and only to a select few. As a priest protected by the state, the doctor becomes the keeper of all kinds of secrets. Remember the Latin prescriptions and the diagnostic mumbo jumbo to keep from patients the knowledge of what ails them. Even today, physicians seriously contemplate when patients should and should not be told they have cancer. The whole thing is really quite absurd once one stands back and looks at it as an anthropologist might at another culture. Magic used to be used as medicine. Now medicine is used as magic.
KURTZ: But that is not all the doctors’ fault?
SzAsz: Certainly not. I wouldn’t want to give the impression that I think it is. It takes two to tango. Freud was quite right in emphasizing that one of the greatest passions men have is the passion not to know—to repress, to mystify—the obvious. Thus, there is a sort of conspiracy between people who do not want to
know, who want to remain stupid, and experts who will lie to them, who will make a profession out of stupefying them. The priests used to do a good job of that. Now the physicians do it. And, above all, the politicians are in there pitching to make sure people hear all the lies they want to hear.

Sanjeev Sabhlok

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