Free To Choose: a personal Statement

part of the graduation ceremony of most medical schools in the
United States.
Like most professional codes, business trade agreements, and
labor union contracts, the Hippocratic Oath was full of fine ideals
for protecting the patient: "I will use my power to help the sick
to the best of my ability and judgment. . . . Whenever I go into
a house, I will go to help the sick and never with the intention of
doing harm or injury. . . ." and so on.
But it also contains a few sleepers. Consider this one: "I will
hand on precepts, lectures and all other learning to my sons, to
those of my teachers and to those pupils duly apprenticed and
sworn, and to none others." Today we would call that the prelude
to a closed shop.

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Who Protects the Worker?
231
Or listen to this one referring to patients suffering from the
agonizing disease of kidney or bladder stones: "I will not cut,
even for the stone, but I will leave such procedures to the practi-
tioners of that craft,"
1
a nice market-sharing agreement between
physicians and surgeons.
Hippocrates, we conjecture, must turn in his grave when a new
class of medical men takes that oath. He is supposed to have
taught everyone who demonstrated the interest and paid his tui-
tion. He would presumably have objected strongly to the kind of
restrictive practices that physicians all over the world have
adopted from that time to this in order to protect themselves
against competition.
The American Medical Association is seldom regarded as a
labor union. And it is much more than the ordinary labor union.
It renders important services to its members and to the medical
profession as a whole. However, it is also a labor union, and in
our judgment has been one of the most successful unions in the
country. For decades it kept down the number of physicians, kept
up the costs of medical care, and prevented competition with
"duly apprenticed and sworn" physicians by people from outside
the profession—all, of course, in the name of helping the patient.
At this point in this book, it hardly needs repeating that the
leaders of medicine have been sincere in their belief that restrict-
ing entry into medicine would help the patient. By this time we
are familiar with the capacity that all of us have to believe that
what is in our interest is in the social interest.
As government has come to play a larger role in medicine, and
to finance a larger share of medical costs, the power of the Ameri-
can Medical Association has declined. Another monopolistic
group, government bureaucrats, has been replacing it. We believe
that this result has been brought on partly by the actions of
organized medicine itself.
These developments in medicine are important and may have
far-reaching implications for the kind and cost of health care that
will be available to us in the future. However, this chapter is
about labor, not medicine, so we shall refer only to those aspects
of medical economics that illustrate principles applicable to all
labor union activity. We shall put to one side other important,

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FREE TO CHOOSE: A Personal Statement
and fascinating, questions about current developments in the
organization of health care.
Who Benefits?
Physicians are among the most highly paid workers in the
United States. That status is not exceptional for persons who have
benefited from labor unions. Despite the image often conveyed
that labor unions protect low-paid workers against exploitation
by employers, the reality is very different. The unions that have
been most successful invariably cover workers who are in occupa-
tions that require skill and would be relatively highly paid with
or without unions. These unions simply make high pay still
higher.
For example, airline pilots in the United States received an
annual salary, for a three-day week, that averaged $50,000 a year
in 1976 and has risen considerably since. In a study entitled The