Dennis Packard and Dr. Jared Inouye, Philosophy

I proposed to articulate the art of healing by examining the relationship between morality and practical knowledge. I proposed to examine this relationship by extensively interviewing and working with a local neurosurgeon. I hypothesized that his reputation as an excellent surgeon—a healer—was grounded in his moral way of being. One of the practical applications of my project was to show that if doctors are to be healers, then a doctor’s formal education usually isn’t sufficient and that measures to morally educate doctors ought to be taken. Another one of the practical applications was to show that the education doctors receive have much to do with the current healthcare crisis.

Unfortunately, I was not able to work as closely as I would have liked with the neurosurgeon and I found it a near impossible task to articulate what a person is doing when he or she is being moral. Furthermore, while I still firmly believe that the way doctors are educated is insufficient to make them healers, I realized the system (obviously this is a very vague expression, but at the time, that’s what it was) was such that simply advocating a standard of morality wouldn’t be a practical solution to the shortage of healers problem.

After having discovered all of this, I turned my research efforts to understanding the current healthcare crisis in hopes that it would afford me some insight into what the system was and how it worked. I soon found out that the current healthcare crisis is extremely complex and what it is usually depends on who you talk to. Employers and public officials say the crisis is having to spend $3,200 per person per year for healthcare. However, employees and citizens demand that more be spent on healthcare—more than 34 million Americans lack health insurance, and many more lack proper care. The crisis for doctors is that administrators and bureaucrats interfere too much thus raising costs and lessening the quality of healthcare. However, insurance companies and hospitals complain that doctors have too much freedom to increase prices. Moreover, everyone except doctors think that doctors overcharge, while doctors and hospitals feel that they are grossly under-compensated.

While no one of the above mentioned parties can be relied on to define the healthcare crisis, together they constitute one general problem: dissatisfaction over the cost of healthcare. While it can be argued that we live in a progressive age where increasing costs are inherent, it has been well established by economists that we could get more and better care for a substantially lower cost. Economists call this a market failure. Economists are divided when it comes to explaining the healthcare market failure.

Naturally, their solutions are divided as well. One side argues that the market is failing because the healthcare market is so complex that it can never function as a normal market, and therefore, more regulation is requisite. The other side argues that the market is failing because it has never been allowed to function as a regular market, and therefore, ought not to be so strictly regulated.

Through research, I became partial to the latter side, and began another leg of research focusing on why and how the healthcare market has never been allowed to function as a regular market. I was eventually directed to several publications by an economist named John Goodman. Following Reuben Kessel and Ronald Hamowy, Goodman argues that since the American Medical Association (AMA) was formed in 1847, its policies have been inconsistent with its stated objectives—to protect consumers from unqualified healthcare providers and to raise the quality of healthcare. Goodman, Kessel, and Hamowy argue that the AMA’s policies serve one objective: to maximize the status and income of physicians (1).

Goodman goes to great lengths to explain how the objectives of the AMA and their policies are largely responsible for the healthcare crisis as employers, employees, public officials, hospital administrators, third party payers, and physicians see it (2).

In all of this, what interested me most was the effect of the AMA’s control of the physician. In 1847, when the AMA was first formed, a report by the AMA states, “the profession of medicine has ceased to occupy the elevated position which once it did; no wonder that the merest pittance in the way of remuneration is scantily doled out even to the most industrious in our ranks” (3). Hamowy explains that the way the AMA set out to restore medical practitioner’s “elevated position” and make their income’s less scanty was threefold: 1) establish medical licensing laws which would restrict entry, 2) destroy for profit schools and replace them with nonprofit schools that would be more selective and provide a more extensive course of study, and 3) eliminate competitive heterodox medical sects. With the help of the state, the AMA was able to accomplish these goals (4).

In his article, “Medical Licensure,” Milton Friedman argues that the AMA restricts the number of people who can become physicians by restricting admission to medical school (5). The obvious way is by denying admission, and the less obvious way is simply by setting a discouraging standard for those who wish to apply. He argues that this reduces both the quantity and quality of medical practice. In addition, it makes the medical profession quite homogenous. To me, this is interesting because there is something about the nature of the medical education system, its administrators, teachers, and students that make talk of morality nearly comical. Perhaps it’s viewed as such since most of those who are in the system were admitted according to, and once in it are required to abide by similar standards.

With regards to the type of education doctors receive, I found that what is orthodox medicine is what the AMA considers to be orthodox medicine. The AMA has been commissioned by the state to accredit schools which amounts to prescribing how doctors ought to be educated and how they will eventually practice. Andrew Hunt, the first dean of the recently accredited Michigan State Medical School has written his “reflections” on the many encounters he and his staff had with the AMA in trying to develop a more innovative and proactive curriculum. Eventually, in order to get accredited, much of his innovation was compromised (6). However, there is nothing that suggests that the AMA’s way of educating doctors is necessarily the most efficient or effective way. In fact, in 1972, 46 percent of those who obtained licenses to practice in the United States had gone out of the country to receive schooling (7). Moreover, although osteopaths, chiropractors, and the more radical acupuncturists, and faith healers are labeled “alternative” at best, they are becoming increasingly popular.

References

1. Goodman, John. The Regulation of Medical Care: Is the Price too High?. San Francisco: Cato Institute, 1980.
2. Goodman, John, and Gerald Musgrave. Patient Power: Solving America’s Healthcare Crisis. Washington D.C.: Cato Institute, 1992.
3. The Regulation of Medical Care p. 5.
4. Hamowy, Ronald. “The Early Development of Medical Licensing Laws in the United States, 1875-1900.” Journal of Libertarian Studies 3, no. 1 1979: 73-119.
5. Friedman, Milton. “Medical Licensure.” Capitalism and Freedom. Chicago: University of Chicago Press, 1962.
6. Hunt, Andrew. Medical Education, Accreditation and the Nation’s Health: Reflections of an Atypical Dean. East Lansing: Michigan State University Press, 1990.
7. The Regulation of Medical Care p. 33.