When you trust someone to wield a scalpel on the most sensitive parts of your anatomy – and such, dear reader, was my painful lot some 18 months ago – you cross your fingers and hope they are a properly trained surgeon.
But according to the free market right, regressive attitudes like that hold back the development of a free market in health services. The requirement for licensure both prevents all and sundry who wish to practice medicine from doing so, and deprives the rest of us of the opportunity to purchase their services, and so should be scrapped.
In case you suspect that I am making this stuff up, it is all there in black and white in the work of Milton Friedman, a thinker whose impact on the policies of recent Conservative and Labour governments since the 1970s has been incalculable.
On a range of issues from monetarism and exchange controls to the clear ideological animus against public housing, the emasculation of trade unionism and explicit tolerance of tax avoidance, Friedman’s Capitalism and Freedom has been the de facto blueprint for successive administrations.
His stipulations often have had to be watered down, simply because they are too extreme for public taste. But Friedman’s work is nonetheless crucial to understand neoliberal thinking, largely because it provides the intellectual underpinnings for what Thatcherism, the Third Way and now the coalition have tried to do.
Much the same can be said of the present government’s decision to hand over the National Health Service to the private sector, which will effectively result in the transformation of hospitals into what Friedman called ‘department stores of health’, acting as intermediaries between patients and service providers.
Such a change is necessary, the late economist maintained, because bodies such as the British Medical Association, which licences doctors to practice, are monopolists who purposely restrict entry to the profession in order to boost members’ wages.
Instead, Friedman suggested an alternative based on untrained practice, including practice by ‘people who have no professional qualifications at all’. And of course, when it comes to routine matters such as scans, it would be foolish to argue that doctors should undertake tasks that technicians can carry out perfectly well. But Friedman wouldn’t stop there.
‘I conclude that licensure should be eliminated as a requirement for the practice of medicine,’ he writes, and anyone should be ‘free to practice medicine without restriction except for legal and financial responsibility for any harm done to others through fraud and negligence’.
Individual GPs and hospitals should be replaced by the medical equivalents of John Lewis and Selfridges, with consumers able to judge between them on the basis of reputation. That having surgery is an act in no way akin to purchasing a pop-up toaster is not considered to be any obstacle to such a vision.
Here we have the inspiration for the Clinical Commissioning Groups and the ‘any willing provider’ clauses contained in the Health and Social Care Act, which is the strongest medicine the Tory and Lib Dem right feels it can get away with forcing down the electorate’s throat right now.
Naturally, it would be hyperbolic to maintain that the legislation is the full Friedmanite Monty. But it takes us more than half way there, and its impact on the standards of practitioners is all too predictable.
Never mind doctors without borders; the next stop is doctors without qualifications.