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The Medical Guilds

I have a fairly unusual last name (“Iglesias” is a fairly common last name in Spanish-speaking countries, but the “Yglesias” variant stems from the Galicia region of Spain and is much less common) so I take notice when other Yglesiases pop up in the news:

He worked from a dental clinic in Hialeah. He examined patients. And he dutifully diagnosed all dental complaints.

By all appearances, Eduardo Manuel Yglesias, 57, seemed to be a practicing dentist.

Not so, say Miami-Dade police.

Dude’s in jail now. Interestingly, however, there’s no clear evidence that he’s been doing any bad dental work. The issue is just that though he’s a licensed dental radiographer, he’s not a real licensed dentist.

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Now for all we know, the man in question really was a menace to society. Nevertheless, if you look at it it’s pretty clearly the case that one factor driving costs up in the health care industry is unduly restrictive licensing rules. For example, people need to get their teeth cleaned regularly. This work is not done by dentists, but by lesser-trained lower-compensated dental hygenists. Typically, however, it’s illegal for hygenists to go into business for themselves. It’s also not possible for, say, CVS to just hire some dental hygenists and offer teeth cleaning services. Instead, teeth cleaning typically needs to be done under the supervision of a bona fide dentist. And in a different, but similar, vein even though everyone knows health care is a bigger and bigger share of the economy, we’re not opening up new medical schools.

When naming interest groups who drive up the cost of health services and harm patients, it’s better politics to talk about insurance companies than doctors and dentists, but in reality there’s plenty of blame to go around. One of the biggest sources of opposition to single-payer systems is precisely that health care providers know that a large government program (a “robust public option,” as it were) might have the market power necessary to squeeze their margins.