New School Politics

Closed Shops and Rotting Teeth

Ryan | 2 05 2008

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An article in today’s NY Times chronicles a dental clinic operating in rural Alaska, without any certified dentists and without the sanction of the dental unions.

The dental clinic in this village on the edge of the Bering Sea looks like any other, with four chairs, a well-scrubbed floor and a waiting area filled with magazines.

But to the Alaska Dental Society and the American Dental Association, the clinic is a place where the rules of dentistry are flouted daily. The dental groups object not because of any evidence that the clinic provides substandard care, but because it is run by Aurora Johnson, who is not a dentist. After two years of training in a program unique to Alaska, Ms. Johnson performs basic dental work like drilling and filling cavities.

Some dentists who specialize in public health, noting that 100 million Americans cannot afford adequate dental care, say such training programs should be offered nationwide. But professional dental groups disagree, saying that only dentists, with four years of postcollegiate education, should do work like Ms. Johnson’s. And while such arrangements are common outside the United States, only one American dental school, in Anchorage, offers such a program.

The number of dentists in the United States has been roughly flat since 1990 and is forecast to decline over the next decade. A study last year from the Centers for Disease Control showed that Americans’ dental health was worsening for the first time since statistics began to be kept …

…[T]he A.D.A. continues to oppose allowing therapists to operate anywhere in the lower 49 states. Currently, therapists are allowed to practice only in Alaska, and only on Alaska Natives.

Unions are historically ruthless and effective in pursuit of their political interests, even when they consist of dentists. Its no surprise, of course, that dentists want a closed industry especially when non PHDed dental workers earn a third to a half as much.
The obvious effect of regulations that mandate certain standards for dental servants is to limit the supply of labor in a sector where training and education is already expensive and time consuming. The consequences are manifest in the number of dentists remaining stagnant for almost two decades as well as the fact that “100 million Americans” can’t afford coverage (100 million seems to be an absurdly high amount, but upon further research it does appear that around 150 million don’t have insurance at all, so the number may be realistic).
The case-study may also tell us something about the problems in the healthcare industry, where the American Medical Association uses its weight to limit the supply of medical workers–as well as the amount that certain non-PHDed workers are allowed to do.
A review of the book Profession and Monopoly gives examples:

“…in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals, it points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA’s influence on hospital regulation was also criticized in the book.”

While I assume that some regulations may have arisen in recent years, most have been in place for years and do not explain the overall climb in healthcare prices of late. However their rollback would still be a positive step toward making healthcare a more a affordable and more competitive industry, allowing low-priced medical practices, such as the dental practice in Alaska, to do business.

What I propose is neither dangerous nor radical really–all it is is an opportunity for the price system to operate. When prices rise, demand falls, which is impetus for supply to surge and bring prices back toward equilibrium. But because supply of health service is relatively inelastic (especially because of how expensive and capital intensive it is in both the human-educational sense, and the physical-technological sense), and various policies disable lower priced service to compete, a price floor is essentially created.