Little respect for doctors

Fritz Langley efudd at fas.harvard.edu
Thu Jun 19 16:32:32 EST 1997


Steven B. Harris wrote:
> 
>    We used to have effective oversight-- it was called the "market."
> If you didn't like your doctor, you went to another.   What a concept.
> Works great in the food and auto and other service industries, too (see
> capitalism).
> 
Such a "market" never existed.  An effective market for a commodity
requires some method of grading the quality of the product repeatably,
and that the results of that assessment be freely available to all
potential bidders.  The relative value of individual physicians is
debated in whispers among the staff of every American hospital, and
while what is said isn't entirely gossip, it isn't entirely factual or
verifiable either.  It also isn't available the majority of people who
"consume" medical services.

Furthermore, "shopping" for doctors has real practical limitations. 
Rural areas are natural monopolies; there isn't demand for more than a
very few practitioners.  In many cases it isn't possible at all to
change providers when you're satisfied.  Many procedures are
irreversible or otherwise unrepeatable; you can't try again if you're
dissatisfied with the results.

I agree, the market does an admirable job of providing us inexpensive,
high-quality goods.  Don't believe for minute, though, that this result
is implicit in the concept of a market.  We don't need to return to the
Beef Trust, patent medicines, and the Pure Food and Drug laws for
examples when Archer-Daniels Midland's price fixing schemes are still
fresh in memory.  As for automobiles, I'm with you on a grand,
macroeconomic level but when visiting my local dealerships to shop for a
new car, I can't help thinking that the market is rewarding
misinformation and inefficiency at my expense.  That's why I still drive
my Corvair.  Nothin' like it!



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