Freedom means freedom from fraud. So if the guy with a mail-ordered degree lies to someone and says he got a degree from Harvard, causing that person to get "treated" when they would otherwise have gone elsewhere, that's when the government should intervene.
Saving people from themselves is foolhardy, and such efforts are invariably used as tools of repression.
Is this tongue in cheek? The solution is "freedom"? Like get ahold of a whole bunch of powdered freedom and just sprinkle it over the medical industry?
The solution is likely a series of detailed, technocratic tweaks to the accreditation process to allow more schools offer an MD while not allowing Clown College to offer one. I'm an educated guy and I have zero ability to rate a doctor aside from the fact that in order to get the MD there's a uniformly high bar. You're suggesting I should bring a copy of US News and World Report Med School rankings to the doctors' office with me to make sure they don't operate on the wrong knee or something? And if I'm not diligent enough to do that, I deserve whatever happens to me?
When people are left free, they tend to work out effective solutions. In a free society, there would likely be a multiple authorities to judge physician competency. The consumer would get to pick.
A big problem with doctor certification today is that doctors are graded on a boolean scale, pass/fail. So two physicians can both be certified, but one can be vastly better than the other, and you, as a uninformed patient, have little way of judging. A close relative of mine has had an opportunity to assist in many open-heart surgeries performed by several doctors. He tells me that there is a huge difference between surgeons. One surgeon regularly completes operations in 20 minutes with no mistakes and complications, another surgeon, at the same medical center, takes two or three times as long, is much "messier" (cutting things he shouldn't), and his patients have many more complications. It's obvious to everyone in the operating room who is the better doctor, but no one will tell patients. For patients, both doctors are "competent." In free market, presumably there would be at least one rating agency that would provide a more nuanced report on doctors.
Also, to get an MD, there is not a "uniformly high bar," at least there hasn't been in the past. Medical schools discriminate in their entry requirements based on at least race, but possibly other non-competency factors like sexual orientation and parental alumni status. So entering medical students are not held to a uniformly high bar. Once in medical school, student performance diverges. Some students are at the top of their class, others are at the bottom. Some pass the certification exams with high scores, others barely pass after two or three attempts. Most of this information is not readily accessible to the average healthcare consumer.
The primary aim of doctor certification seems to be to restrict the supply so as to keep wages high, not to help consumers choose. The best solution really is freedom, not mere "detailed technocratic tweaks" to a system designed from the bottom-up to protect the interests of the medical profession against competition.
Why can't we have both? There's no regulation on rating doctors at the present and it seems to me like the fact that there aren't a dearth of patient/consumer ratings of doctors already precludes your assertion that if we stop requiring certification that many will suddenly spring up.
There's also the problem that medical care is an inherently non-free market. If I'm bleeding to death, I don't have time to search the BBB's ratings on a hospital and decide which emergency room I'd prefer. The same is true for pricing: If I'm dying my demand for service is going to be irrespective of it's price.
Regulation is a critical component in the medical industry, in my opinion.
Look, empty platitudes like "more freedom" are never the answer, unless the question is, "how do we sell people on something so crazy that they'd never agree with it otherwise, like for example, 'giving jbooth and dpatru the ability to sell a MD degree for 5 bucks on the street corner'"?
You may as well say the solution to the medical credentialiing problem is pancakes.
There was a point in time where you didn't require a government certified authority to give you the title of doctor. People decided to start certifying. For obvious reasons.
There was also a time you did not need a government issued ID to get on a plane. That also changed, for obvious reasons, but not necessarily good ones. Fear of the unknown is not equivalent to rationality.
The worst government policies are those where "concerned mother" (= Democrat) and "stern dad" (= Republican) stand shoulder to shoulder to protect you from yourself. Millions of people are in regular contact with that sort of "stern + concerned" thing in the form of the TSA, but other agencies are no less Kafkaesque (more so in fact given that they are operating in comparative darkness).
You can stand on a street corner and call yourself a programmer willing to work for $5. Or for zero. That doesn't mean that GE will hire you to write the code for their next X-ray machine. Distributed intelligence is much smarter, and centralized evaluation much dumber, than many believe.
It comes down to a basic philosophical difference: centralized or decentralized?
Every single other product we use -- including things like cars/motorbikes, with a direct impact on your health -- we read reviews, ratings, and reports before purchasing. We allow people to set their own risk dial, whether that be a motorbike or a Volvo.
Indeed, the whole point of sites like Metacritic or Amazon's review section is that any particular review could be in error, but the sum total provides signal. Not perfect, but provably better than selecting a few people at random and keeping the product from the market unless they all agree.
And this extends to medical procedures too. Of course I will research hospitals before having that kidney transplant. Cedars Sinai has a good reputation; I don't need 13 years of medicine to know that it's good, anymore than I need to know how to direct a film to appreciate a movie. Because there are many other sources of reputation checks other than government: search engines, your friends, books, newspapers, etc. Good word of mouth about a device or doctor usually reflects technical merit, and when it does not, it is unlikely that a single bureaucrat will uncover that which has fooled the world. Bureaucrats go with public opinion, they do not buck it.
Moreover, every other area of life, we accept that products will suit some and not others. There is no accounting for taste, as the saying goes.
Medicines and treatments show just as much interpersonal variation as nutrients; indeed, many of them are simply refined nutrients. Yet we expect a centralized system to account for something inherently individualized. Little known fact: many arthritics wept when Vioxx was taken off the market, because it worked for them.
Why not let these people have their choice? Cancer patients cannot opt out of the FDA to take experimental drugs (the FDA actually sued to keep it this way!). And sometimes the crazies are actually right and the government is way wrong, like low fat vs. low carb.
The bottom line is that centralization of assessment in a fast-moving, technical area is going to be provably worse than peer review. Make the FDA opt-in rather than mandqtory and let the decentralized network of doctors be the ultimate judge. That's how Europe does it.
Freedom means freedom from fraud. So if the guy with a mail-ordered degree lies to someone and says he got a degree from Harvard, causing that person to get "treated" when they would otherwise have gone elsewhere, that's when the government should intervene.
Saving people from themselves is foolhardy, and such efforts are invariably used as tools of repression.