Suck It Up: Medical License = Government Franchise + Obligations

A license to practice medicine, or function as a health care professional in any of the allied fields which require government certification, is a franchise.  It gives the holder the unique ability - in the furtherance of public interest - to provide personal and technical health services in exchange for payment - to people within its jurisdiction. Non-licensed persons cannot hold themselves out as able to provide and charge for those services.  A franchise protects its holder from competetition.

The report that a nationally recognized medical organization has refused to provide further or future care to Medicare beneficiaries is disturbing. It is inconsistent with the essential caring spirit of physicians, nurses and other health care professionals and institutions and and contrary to the public service requirement that the franchise invokes.  Systematic exclusion from receipt of services because one is a Medicare beneficiary is un-American and wrong.

The United States needs a reformed national health care system, not parochial local or state operations. The essential requirement for critical health care services, such as obstetrics, cancer treatment, fracture care, treatment of devastating infections and the skills, equipment and facilities necessary to deliver these services doesn't change from rural Georgia to Arizona or Ohio.  State licensure of health care personnel is an anachronism: if a physician has the requisite evidence of competence and personal conduct qualifications to provide care in New York, why should that person be forbidden to practice medicine in Utah without going through an entirely new, expensive, time consuming and resource wasting evaluation. If a physician in Florida has practiced competently for fifteen years and moves to Minnesota, why impede that change by measures which are formulated specifically to reduce competition in the guise of "licensure quality"? Why not have federal licensing in full recognition that the federal government is the major funder of health care services and facilities? Why not have federal standards which will protect every patient and every provider in the United States rather than the wasteful duplication of political-administrative functions in every jurisdiction in our nation?

Physicians and other providers know that dealing with health care insurers is more disruptive to their practices, in terms of inadequate compensation, bureaucratic bottlenecks and denial of essential services to patients, than dealing with the federal government.  The federal government, hamstrung by political contributions and lobbying, has not engaged with insurers to set matters right except for patients covered by Medicare. There is no fair uniform protection of patients and health care providers from financial ruin in the event of medical malpractice or the determination that malpractice has occurred  (the public is not aware of the extraordinary cost of medical malpractice insurance to many practitioners, including those who have never lost a malpractice lawsuit). Our government has failed to deal with inflation in pharmaceutical costs and its impact on health care providers, patients and their families.  The federal government has cost-shifted its drug war by imposing $500 fees on providers  for a 3-year Drug Enforcement Administration license, using health care providers as cash-cows rather than as a vital part of our system of health care.

The government grants a franchise.  Providers have to provide necessary health services to all of the public that the franchise envisions. And government has to reasonably protect health care providers, and all Americans, from being financially gouged by parasitic uncontrolled interests including those masquerading as government agencies or licensees or contractors. If not, as is the case today, we all lose.