It's been a few months since I took theory of computing, but I seem to recall that one of the "undecidable" problems is determining whether a given Turing machine (which is, in theory, equivalent to any given processor) will be able to successfully operate on a given input string (which is, in theory, equivalent to any set of instructions to that processor). This patent claims, if I read it correctly, that it can somehow examine instructions and determine whether or not the host will be able to execute them without an error. That seems to violate some fairly well-accepted math. You could get around it if the host processor was equivalent to a DFA, I think, but then you'd have a processor that could only do regexps.
Can someone explain to me why I'm wrong? (I'm not very good at abstract math, so I'm quite sure I'm wrong.)
But this is why we need more competition in the field of medical certification. It may be that the standard set of requirements is testing and teaching the wrong things. Perhaps some of the things in the standard medical curriculum are better left to specialists. Perhaps there needs to be an ongoing rating system whereby doctors are rated for their performance every year. Perhaps there's no way to keep doctors from being incompetent, and the regulations are just driving up prices. I don't know, but that's the point: we need competition and freedom of choice so we can see what types of training works best. As soon as the government extablishes a set of standards, that process is short-circuited, and you're stuck with whatever they give you. That's a bad thing.
We do have competition in that regard, actually. Medical school curriculums are constantly changing, and there's a pretty big amount of variance across schools. (I'm leaving "quality" of the school out for now. No accredited med school (and accreditation is given by a board of physician-administrators, not the government) is inadequate in and of itself. Quality of school really comes down, IMHO, to budget of school.) Each school has its own strengths, usually related to what hospital it's affiliated with. There's competition to get into a school that does what you're interested in. There's further competition to land a residency in that field. In general, the process does work --- it tends to produce people who are suited, both by skill and personality, to the field which they end up in.
The standard requirements on the board licensing exams are actually, IMHO, quite appropriate. They try to insure that every doctor knows something about what the others do --- not in-depth, but a sampling. Furthermore, there's a lot more than just the MD out there. One can be a chiropractor, an acupuncturist, an ayurvedist, or one of many other things. Many doctors combine the therapies. There's definitely competition between various styles of medicine, and "alternative" therapies are gaining.
As for the amount of work necessary to become a medical student, that would likely continue to be true in a free market. A doctor who gets his patient killed isn't going to stay in business, and consumers will likely start demanding credentials up front. So you still won't be able to come right out of high school and make money as a physician. But the fact that becoming a competent doctor is difficult does not mean that it needs to be as difficult as the current requirements make it, nor that every doctor should go through the same course. The hardships you've endured to become a med student may not not have all been necessary to make you a good doctor. And if not, it's wrong to force you to go through them.
Every doctor does not go the same course, not by a long shot. The modern curriculum, at least at the schools I visited, has a lot of flexibility once you've got the basic sciences down. (The basic sciences are, I'll admit, invariant. On the other hand, I can't think of a doctor who doesn't need at least a little understanding of anatomy, pathology, pharmacology, and so on.) Once you're into the clinical years, though, you get to choose your study path, with about the same amount of flexibility you would have in planning a college major. There's some base requirements, but beyond that you're free.
I don't think having consumers "require credentials" would really help. Honestly speaking, how well can you tell if the doctor really knows what he's doing? Before I got here, I sure couldn't. (I still can't, but it's only been a few weeks.) The average medical consumer isn't up to judging the competence of his or her care provider.
As for the difficulty of making it all the way to practice --- I don't actually have any objection to that. I don't like having to work like a dog, but I think it really is necessary; otherwise, I wouldn't do it. When you see a doctor today, you know he's willing to go through a lot for his patients; he's already been through a small piece of hell. All that knowledge really does help, too.
And in a free market, doctors would still get paid well, no doubt about that. And in fact, the really good doctors might even get paid more, as patients would be willing to pay a premium for their services.
I think it's important to realize that most people don't directly pay for their medical care. They do it via insurance, or Medicaid, or some other program. Such a program is generally not willing to pay anything more than it has to. Thus, premium care will be (as it is now) reserved for those who pay out-of-pocket. A free-market system will heavily favor the wealthy. I'm not saying that there's anything wrong with that, I'm just pointing out the implications of your model.
Also, how exactly, then, is the current system unfree? The only real regulation on it (aside from the FDA, which is necessary --- doctors do not have time to evaluate drugs themselves) is the licensing standards, plus laws which prevent physicians from doing evil things. If I understand your argument, you're saying that licensing keeps the supply of doctors low by setting standards very high, and that this keeps prices artificially high. On the other hand, you also think that doctors would still be paid well in the free market. So what's the difference?
So don't confuse government requirements with medical requirements. The fact that the government says that all doctors must do X, Y, and Z does not mean that that's what it requires to become a competent doctor. It may be that med school could be shortened and simplified without hurting the quality of care. If so, the medical profession should have the freedom to try it and find out.
Personally, I feel that the profession does have that option. The requirements for licensure mainly revolve around the standardized USMLE tests. The tests are designed by committees which consist almost exclusively of doctors. The licensing boards tend to also be composed almost exclusively of doctors. So, it's physicians who say what makes a good physician. Also, consider health-care laws. In general, the AMA tends to get what it wants when it lobbies, because even Congresspeople tend to trust physicians.
I don't perceive a problem with the medical profession's current autonomy. The doctors still call most of the shots, which is how it ought to be --- they're the ones who've trained for years to learn the art of medicine. The only real threat is the insurance provider, and even that force seems to be crumbling a bit in the face of unionizing physicians, independent physician associations, and other politicking which goes on far above my level.
The standards are at their current level because a whole bunch of doctors believe they ought to be there. I've never heard a physician argue that they should be lowered. Admittedly, they might just want to make me suffer the same way they did, but if your goal is to let the medical profession experiment with educational techniques, you're already there.
binarybits burbles: There are ways for the free market to handle these problems, however. One example would be that hospitals would have brand names and each brand would set certain standards for all their doctors. You could then specify that you want your medical care coming from XYZ hospital chain, and you'd be guarunteed a certain level of care.
Interesting idea in theory. There's a major problem in practice, which is that doctors would probably not want to be branded. It's sort of like saying that you can guarantee the quality of software by buying from the big-name companies, because they have standards concerning who they hire. This is certainly true. However, a lot of the best stuff comes from teeny little firms who most users have never even heard of. As one example, BBEdit is probably the best text editor for the Mac. I know maybe five people who use it, and they're all in CS. The rest of the Mac community which I've met uses either SimpleText or Microsoft Word --- inferior products from big companies.
There are other methods as well. One would be that groups like the AMA would doubtless still provide ceritification, and you could refuse to go to any doctor who wasn't AMA certified.
The AMA can't handle that, at least not effectively. The laws governing medical practice are different in each state, which is why each state has a regulatory board and licensing procedure for physicians. There's no reason for a national organization to try and take on the challenge of doing licensing in each state; the AMA would much rather work at the federal level.
But how is this different from any other profession? All industries want to chage as umuch as possible, yet most products' prices stay relatively flat. Why are doctors different? The major reason that medical costs have spiraled out of control is precisely that we *don'(* have a free market in health care. let me elaborate:
Doctors certification. As you said, doctors like to charge monopoly prices. This helps them do it. By setting very high standards, they exclude as many doctors as possible and thereby put themselves in demand.
You're right; it's hard to become a practicing physician, and this probably does raise the cost of care. On the other hand, would you really want it another way? As it is, there's some damn incompetent docs out there. If they got through, imagine what the ones who got screened out were like.
I will admit that I've got a biased perspective on this: I'm a medical student. On the other hand, let me present my perspective. I sacrificed essentially everything except my studies in college so I could get into med school. I will spend the next two years doing the same, only more so. I will then spend two years being a gofer for doctors and nurses, followed by another two to five as a resident, where I will get even less sleep and basically do the work for an entire department. By the time I'm actually allowed to practice on my own, I'll be between 30 and 35. I will have zero savings, and if I were a typical student, I'd have about $300,000 in debt. (I'm lucky --- my folks financed college, and I have a scholarship to pay for med school.) Meanwhile, all my fellow CS majors have gone off to Silicon Valley or other industry. Their options will have vested about five years ago. Some of them will have been at companies which went public and shot to the top. At least half of them will be millionares.
This is what it takes in order to have the minimal knowledge to practice good medicine. Maybe it's just the start of an overinflated ego, but I think I deserve to make some serious money after having put up with fifteen years of hard work for a piece of paper and a warm fuzzy feeling.
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Can someone explain to me why I'm wrong? (I'm not very good at abstract math, so I'm quite sure I'm wrong.)
We do have competition in that regard, actually. Medical school curriculums are constantly changing, and there's a pretty big amount of variance across schools. (I'm leaving "quality" of the school out for now. No accredited med school (and accreditation is given by a board of physician-administrators, not the government) is inadequate in and of itself. Quality of school really comes down, IMHO, to budget of school.) Each school has its own strengths, usually related to what hospital it's affiliated with. There's competition to get into a school that does what you're interested in. There's further competition to land a residency in that field. In general, the process does work --- it tends to produce people who are suited, both by skill and personality, to the field which they end up in.
The standard requirements on the board licensing exams are actually, IMHO, quite appropriate. They try to insure that every doctor knows something about what the others do --- not in-depth, but a sampling. Furthermore, there's a lot more than just the MD out there. One can be a chiropractor, an acupuncturist, an ayurvedist, or one of many other things. Many doctors combine the therapies. There's definitely competition between various styles of medicine, and "alternative" therapies are gaining.
As for the amount of work necessary to become a medical student, that would likely continue to be true in a free market. A doctor who gets his patient killed isn't going to stay in business, and consumers will likely start demanding credentials up front. So you still won't be able to come right out of high school and make money as a physician. But the fact that becoming a competent doctor is difficult does not mean that it needs to be as difficult as the current requirements make it, nor that every doctor should go through the same course. The hardships you've endured to become a med student may not not have all been necessary to make you a good doctor. And if not, it's wrong to force you to go through them.
Every doctor does not go the same course, not by a long shot. The modern curriculum, at least at the schools I visited, has a lot of flexibility once you've got the basic sciences down. (The basic sciences are, I'll admit, invariant. On the other hand, I can't think of a doctor who doesn't need at least a little understanding of anatomy, pathology, pharmacology, and so on.) Once you're into the clinical years, though, you get to choose your study path, with about the same amount of flexibility you would have in planning a college major. There's some base requirements, but beyond that you're free.
I don't think having consumers "require credentials" would really help. Honestly speaking, how well can you tell if the doctor really knows what he's doing? Before I got here, I sure couldn't. (I still can't, but it's only been a few weeks.) The average medical consumer isn't up to judging the competence of his or her care provider.
As for the difficulty of making it all the way to practice --- I don't actually have any objection to that. I don't like having to work like a dog, but I think it really is necessary; otherwise, I wouldn't do it. When you see a doctor today, you know he's willing to go through a lot for his patients; he's already been through a small piece of hell. All that knowledge really does help, too.
And in a free market, doctors would still get paid well, no doubt about that. And in fact, the really good doctors might even get paid more, as patients would be willing to pay a premium for their services.
I think it's important to realize that most people don't directly pay for their medical care. They do it via insurance, or Medicaid, or some other program. Such a program is generally not willing to pay anything more than it has to. Thus, premium care will be (as it is now) reserved for those who pay out-of-pocket. A free-market system will heavily favor the wealthy. I'm not saying that there's anything wrong with that, I'm just pointing out the implications of your model.
Also, how exactly, then, is the current system unfree? The only real regulation on it (aside from the FDA, which is necessary --- doctors do not have time to evaluate drugs themselves) is the licensing standards, plus laws which prevent physicians from doing evil things. If I understand your argument, you're saying that licensing keeps the supply of doctors low by setting standards very high, and that this keeps prices artificially high. On the other hand, you also think that doctors would still be paid well in the free market. So what's the difference?
So don't confuse government requirements with medical requirements. The fact that the government says that all doctors must do X, Y, and Z does not mean that that's what it requires to become a competent doctor. It may be that med school could be shortened and simplified without hurting the quality of care. If so, the medical profession should have the freedom to try it and find out.
Personally, I feel that the profession does have that option. The requirements for licensure mainly revolve around the standardized USMLE tests. The tests are designed by committees which consist almost exclusively of doctors. The licensing boards tend to also be composed almost exclusively of doctors. So, it's physicians who say what makes a good physician. Also, consider health-care laws. In general, the AMA tends to get what it wants when it lobbies, because even Congresspeople tend to trust physicians.
I don't perceive a problem with the medical profession's current autonomy. The doctors still call most of the shots, which is how it ought to be --- they're the ones who've trained for years to learn the art of medicine. The only real threat is the insurance provider, and even that force seems to be crumbling a bit in the face of unionizing physicians, independent physician associations, and other politicking which goes on far above my level.
The standards are at their current level because a whole bunch of doctors believe they ought to be there. I've never heard a physician argue that they should be lowered. Admittedly, they might just want to make me suffer the same way they did, but if your goal is to let the medical profession experiment with educational techniques, you're already there.
Interesting idea in theory. There's a major problem in practice, which is that doctors would probably not want to be branded. It's sort of like saying that you can guarantee the quality of software by buying from the big-name companies, because they have standards concerning who they hire. This is certainly true. However, a lot of the best stuff comes from teeny little firms who most users have never even heard of. As one example, BBEdit is probably the best text editor for the Mac. I know maybe five people who use it, and they're all in CS. The rest of the Mac community which I've met uses either SimpleText or Microsoft Word --- inferior products from big companies.
There are other methods as well. One would be that groups like the AMA would doubtless still provide ceritification, and you could refuse to go to any doctor who wasn't AMA certified.
The AMA can't handle that, at least not effectively. The laws governing medical practice are different in each state, which is why each state has a regulatory board and licensing procedure for physicians. There's no reason for a national organization to try and take on the challenge of doing licensing in each state; the AMA would much rather work at the federal level.
But how is this different from any other profession? All industries want to chage as umuch as possible, yet most products' prices stay relatively flat. Why are doctors different? The major reason that medical costs have spiraled out of control is precisely that we *don'(* have a free market in health care. let me elaborate:
Doctors certification. As you said, doctors like to charge monopoly prices. This helps them do it. By setting very high standards, they exclude as many doctors as possible and thereby put themselves in demand.
You're right; it's hard to become a practicing physician, and this probably does raise the cost of care. On the other hand, would you really want it another way? As it is, there's some damn incompetent docs out there. If they got through, imagine what the ones who got screened out were like.
I will admit that I've got a biased perspective on this: I'm a medical student. On the other hand, let me present my perspective. I sacrificed essentially everything except my studies in college so I could get into med school. I will spend the next two years doing the same, only more so. I will then spend two years being a gofer for doctors and nurses, followed by another two to five as a resident, where I will get even less sleep and basically do the work for an entire department. By the time I'm actually allowed to practice on my own, I'll be between 30 and 35. I will have zero savings, and if I were a typical student, I'd have about $300,000 in debt. (I'm lucky --- my folks financed college, and I have a scholarship to pay for med school.) Meanwhile, all my fellow CS majors have gone off to Silicon Valley or other industry. Their options will have vested about five years ago. Some of them will have been at companies which went public and shot to the top. At least half of them will be millionares.
This is what it takes in order to have the minimal knowledge to practice good medicine. Maybe it's just the start of an overinflated ego, but I think I deserve to make some serious money after having put up with fifteen years of hard work for a piece of paper and a warm fuzzy feeling.