Who Protects the Worker?
239
(in the United States licensure is under the jurisdiction of the
state, not the federal government) are typically composed wholly
of physicians or dominated by physicians, who in turn have gen-
erally been members of the AMA.
The boards, or the state legislatures, have specified conditions
for the granting of licenses that in effect
give the AMA the power
to influence the number of persons admitted to practice. They
have required lengthy training, almost always graduation from an
"approved" school, generally internship in an "approved" hos-
pital. By no accident, the list of "approved" schools and hospitals
is generally identical with the list issued by the Council on
Medical Education and Hospitals of the American Medical Asso-
ciation. No school can be established or, if established, long con-
tinue unless it can get the approval of the AMA Council on Medi-
cal Education. That has at times required
limiting the number of
persons admitted in accordance with the council's advice.
Striking evidence of the power of organized medicine to restrict
entry was provided during the depression of the 1930s when the
economic pressure was particularly great. Despite a flood of
highly trained refugees from Germany and Austria—at the time
centers of advanced medicine—the number of foreign-trained
physicians admitted to practice in the United States in the five
years after Hitler came to power was no larger than in the pre-
ceding five years.'
Licensure is widely used to restrict entry, particularly for occu-
pations like medicine that have many individual practitioners
dealing with a large number of individual customers.
As in medi-
cine, the boards that administer the licensure provisions are com-
posed primarily of members of the occupation licensed—whether
they be dentists, lawyers, cosmetologists, airline pilots, plumbers,
or morticians. There is no occupation so remote that an attempt
has not been made to restrict its practice by licensure. According
to the chairman of the Federal Trade Commission: "At a recent
session of one state legislature, occupational groups advanced
bills to license themselves as auctioneers,
well-diggers, home im-
provement contractors, pet groomers, electrologists, sex thera-
pists, data processors, appraisers, and TV repairers. Hawaii
licenses tattoo artists. New Hampshire licenses lightning-rod sales-
240
FREE TO CHOOSE: A Personal Statement
men." ' The
justification
offered is always the same:
to protect
the consumer. However, the
reason is
demonstrated by observing
who lobbies at the state legislature for the imposition or strength-
ening of licensure. The lobbyists are invariably representatives
of the occupation in question rather than of the customers. True
enough, plumbers presumably know better than anyone else what
their customers need to be protected against. However, it is hard
to regard altruistic concern for their customers as the primary
motive behind their determined efforts to get legal power to de-
cide who may be a plumber.
To reinforce the restriction on numbers, organized occupa-
tional groups persistently strive to have the practice of their
occupation legally defined as broadly
as possible in order to in-
crease the demand for the services of licensed practitioners.
One effect of restricting entry into occupations through licen-
sure is to create new disciplines: in medicine, osteopathy and
chiropractic are examples. Each of these, in turn, has resorted to
licensure to try to restrict its numbers. The AMA has engaged in
extensive litigation charging chiropractors and osteopaths with
the unlicensed practice of medicine, in an attempt to restrict them
to as narrow an area as possible. Chiropractors and osteopaths in
turn charge other practitioners with
the unlicensed practice of
chiropractic and osteopathy.
A recent development in health care, arising partly out of new,
sophisticated portable equipment, has been the development of
services in various communities to bring prompt aid in emergen-
cies. These services are sometimes organized by the city or a city
agency, sometimes by a strictly private enterprise, and are
manned primarily by paramedics rather than licensed physicians.
Joe Dolphin, the owner of one such private enterprise organi-
zation attached to a fire department in southern California, de-
scribed its effectiveness as follows:
In one district
of California that we serve, which
is
a county
which
is populated to the extent of five hundred and eighty thousand people,
before the introduction of paramedics, less than one percent of the
patients that suffered a cardiac arrest where their heart stopped lived
through their hospital stay and were released from the hospital. With
the introduction of paramedics, just in the first
six
months
of
opera-
