
America's License Raj - tokenadult
http://www.economist.com/node/18678963?story_id=18678963&fsrc=rss
======
karzeem
> "Some occupations clearly need to be licensed. Nobody wants to unleash
> amateur doctors and dentists on the public."

Actually, Milton Friedman famously (and impressively persuasively) did oppose
mandatory licensure of doctors.

<http://www.fff.org/freedom/0194e.asp>

A lot of the trouble with licensure is that it tends to ratchet upwards. If
I'd been forced to spend $20,000 getting licensed as a barber, I'd be mad if a
competitor opened across the street without having spent all that money.
Repealing licensure requirements benefits everybody except the people who've
already gotten licenses.

~~~
barmstrong
This is true. Part of the reason doctors have high salaries (and healthcare
costs are high) is that the AMA issues licences and creates scarcity. In this
sense, they perform a similar function to a union.

It does seem like an outdated way to see if a doctor is good or not. I'd
personally find a recommendation from a friend or a bunch of positive reviews
on yelp a lot more convincing than the mere fact they have a license to
practice. It's pretty likely hospital administrators and others would be able
to determine which doctors were good without a licensing practice (just like
we find good programmers without licensing), and they have strong incentives
to do so.

~~~
logjam
You're completely wrong.

"The average physician's net income declined 7 percent from 1995 to 2003,
after adjusting for inflation, while incomes of lawyers and other
professionals rose by 7 percent during the period."

<http://www.nytimes.com/2006/06/22/business/22doctors.html>

"...none of this really matters, because doctors' salaries aren't a large
enough chunk of health care spending in the United States to make a
difference. According to Reinhardt, doctors' net take-home pay (that is,
income minus expenses) amounts to only about 10 percent of overall health care
spending. So if you cut that by 10 percent in the name of cost savings, you'd
only save about $26 billion. That's a drop in the ocean compared with overhead
for insurance companies, billing expenses for doctors' offices, and
advertising for drug companies. The real savings in health care will come from
these expenses."

<http://www.slate.com/id/2227965/>

The rest of your comment is incorrect as well. The AMA does not license
physicians, state governments do. Many physicians don't even belong to the
AMA. The AMA lobbies for physicians, but it's not in any way like a union (not
that there's anything wrong with unions).

Resident physicians in particular would probably lead better lives if in fact
there _were_ something like a union to limit hospitals and training programs
that have traditionally worked these young physicians upwards of 100 hours a
week for what amounts to minimum wage. Resident physician hours and primary
care doc hours are _still_ onerous, and most are paying education debut
averaging $150,000.

Physicians can practice without any involvement with a hospital, and many do.
In any event, the idea of using hospital CEOs or CFOs to determine "good"
doctors is about as misguided as asking British Petroleum to determine "safe"
drilling engineers.

There is a reason for (some) licensing. We tried the adolescent libertarian
fantasy of letting the "free market" drive things like medical training and
licensure back in the early days of the 20th century. You could characterize
the vast majority of medical education in that era as training in quackery,
before people like Abraham Flexner got involved:

[http://www.npr.org/templates/story/story.php?storyId=9366625...](http://www.npr.org/templates/story/story.php?storyId=93666259)

~~~
kiba
_You're completely wrong. "The average physician's net income declined 7
percent from 1995 to 2003, after adjusting for inflation, while incomes of
lawyers and other professionals rose by 7 percent during the
period."<http://www.nytimes.com/2006/06/22/business/22doctors.html> "...none
of this really matters, because doctors' salaries aren't a large enough chunk
of health care spending in the United States to make a difference. According
to Reinhardt, doctors' net take-home pay (that is, income minus expenses)
amounts to only about 10 percent of overall health care spending. So if you
cut that by 10 percent in the name of cost savings, you'd only save about $26
billion. That's a drop in the ocean compared with overhead for insurance
companies, billing expenses for doctors' offices, and advertising for drug
companies. The real savings in health care will come from these expenses."
<http://www.slate.com/id/2227965/> _

Interesting data, but the question is if licensing scarcity increase salaries
than without. The salary decrease in 1995 to 2003 doesn't tell us anything
other than.....net income decrease.

 _The rest of your comment is incorrect as well. The AMA does not license
physicians, state governments do. Many physicians don't even belong to the
AMA. The AMA lobbies for physicians, but it's not in any way like a union (not
that there's anything wrong with unions)._

Would it be possible that AMA effectively limits licensing rate through their
lobbying?

 _There is a reason for (some) licensing. We tried the adolescent libertarian
fantasy of letting the "free market" drive things like medical training and
licensure back in the early days of the 20th century. You could characterize
the vast majority of medical education in that era as training in quackery,
before people like Abraham Flexner got involved:_

Interesting data, but not enough details to support your statement. We need
more details on what kind of reforms were made, privately or governmental.

~~~
carbocation
Logjam's comments on the Flexner repor are widely accepted to be true. If
you're not familiar with it, it's worth reading the wikipedia article on the
subject. Pre-Flexner, it was a dangerous, anything-goes world.

~~~
kiba
I am not disputing Flexner's report at all. I am asking Logjams to provide me
with a list of reforms, private and governmental.

------
tzs

       But, as the Wall Street Journal has doggedly pointed out,
       America’s Licence Raj has extended its tentacles into
       occupations that pose no plausible threat to health or
       safety—occupations, moreover, that are governed by
       considerations of taste rather than anything that can be
       objectively measured by licensing authorities. The list
       of jobs that require licences in some states already
       sounds like something from Monty Python—florists, handymen,
       wrestlers, tour guides, frozen-dessert sellers, firework
       operatives, second-hand booksellers and, of course, interior
       designers—but it will become sillier still if ambitious
       cat-groomers and dog-walkers get their way
    

Handymen, frozen-dessert sellers, and firework operatives all plausibly
involve health or safety concerns.

Where in the US do second-hand booksellers need a license?

I suspect that they may be counting for some of these requirements to have a
business license, rather than any license tied specifically to the occupation.
They may also be mixing up requirements to be licensed with requirements to be
bonded.

~~~
solutionyogi
Do you know that you need a license to be a barber? Or that in Texas, you need
a license to be a florist? [
[http://www.agr.state.tx.us/agr/program_render/0,1987,1848_56...](http://www.agr.state.tx.us/agr/program_render/0,1987,1848_5649_0_0,00.html?channelId=5649)
]

I can learn programming on my own (through books or Internet) and get a
employment as a programmer working on business critical systems and I do not
need to get any license from anyone. But hey, if I want to cut someone's hair,
I need to pay my dues to the state?

I think for non medical businesses, the licensing requirements should be
removed. We save tax payer's money and there could be more competition in the
market place which will benefit the consumer. [And don't worry about
protecting the consumer, once you get a bad hair cut from a salon, you will
announce it to the world (thanks to the Internet) that the hair salon is bad
and you will never visit that place again. Market forces will take care of the
crappy businesses.]

~~~
_delirium
Barbers are actually one of the traditional license-requiring occupations
going back centuries, because one of their main jobs used to be shaving men
with straight razors, which carried a risk of injury or disease if the barber
was poorly trained, or if the equipment was poorly disinfected. It might
admittedly be a bit obsolete now.

~~~
lukeschlather
While modern clippers are less likely to draw blood, that only means they're
less likely to transmit bloodborne illnesses. But there are plenty of other
diseases that they can transmit.

~~~
Symmetry
Wait, what diseases? And are the risks worse than those involved with food
preparation or janitorial work (both unlicensed)? EDIT: Lice, obviously, but
that's both treatable and not particularly dangerous.

~~~
lukeschlather
>Wait, what diseases?

[http://www.tpub.com/content/armymedical/MD0164/MD01640044.ht...](http://www.tpub.com/content/armymedical/MD0164/MD01640044.htm)

[http://www.sanitarian.com/14_American_Jails___Barbering_and_...](http://www.sanitarian.com/14_American_Jails___Barbering_and_Infection_Control.htm)

Here in Washington state you do need a food handlers license just to wash
dishes in a restaurant. It's not especially onerous, something like $15 to
take a fairly simple test. (And even for the lowest-wage employees I imagine
most Restaurants will eat the cost of licensing without complaint.)

And I think it's the general assumption that you don't need to worry about
disease in a salon that merits the higher barrier of entry to getting a
license than a Janitor, where everyone knows that if there's a bunch of human-
sourced fluid on the ground, you need to be careful.

------
forensic
People who gained power and money in America's free market closing the door
behind them.

It's really sad.

~~~
lukifer
This is a frequent pattern in many contexts. A wave of immigrants gets
demonized, they integrate over the course of a few generations, and then they
turn around and demonize the next wave of immigrants. A school of art or
literature survives the scoffing of the old guard, only to become the old
guard themselves, et cetera.

~~~
karamazov
Descendents of immigrants are not immigrants.

------
jrwoodruff
I'm not sure why wrestlers, tour guides and handymen need to be licensed, but
many of the professions the author highlights genuinely should be licensed.

The main profession the article picks on - interior designers - seems to be
misunderstood by the author. He incorrectly insinuates interior designers only
choose fabrics and colors. In fact, interior designers are professionals who
have completed training in space management, ergonomics and architecture. They
are able to recommend structural changes that could, if designed incorrectly,
cause structural damage. Interior Decorators, who in fact are NOT licensed,
are limited to choosing fabrics and colors (so to speak). More info:
[http://www.schools-of-interior-design.com/Interior-Design-
vs...](http://www.schools-of-interior-design.com/Interior-Design-vs.-Interior-
Decorating.htm)

Some of his other examples:

Frozen desert sellers - I hate to bring out the '...but think of the children
argument,' but seriously, do you know if the grungy dude in the van selling
ice-cream to your kids knows how to handle food safely? Has a criminal record?
Has 12 DUIs?

Firework Operators - their job is to set off large explosions close to large
crowds, occasionally indoors. I, for one, don't have a problem making sure
they know what they're doing.

So the author may have a valid point, but his poor choice of examples does not
support his case well in my opinion.

~~~
Muzza
> Frozen desert sellers - I hate to bring out the '...but think of the
> children argument,' but seriously, do you know if the grungy dude in the van
> selling ice-cream to your kids knows how to handle food safely? Has a
> criminal record? Has 12 DUIs?

I fail to see the relevance of criminal records and DUIs to handling ice
cream.

~~~
lurker19
Criminal background checks are a common concern when licensing adults who work
with children.

DUI history is a common concern when licensing occupations that involve
driving niche equipment under challenging circumstances, such as a truck in a
throng of tiny jaywalking pedestrians.

~~~
Muzza
I see. Your definition of "working with children" is miles wider than mine. I
take it you're also in favor of licensure and criminal background checks for
people working in children's clothing stores?

If the law allows you to have a driver's license even though you have 12 DUIs,
I can't see any reason why you shouldn't be allowed to drive a van.

------
mef
As a counterpoint, here's the pro-licensing argument for interior designers
from a friend's mother who is an interior designer in Florida: interior
designers are distinct from interior decorators in that they often propose
structural changes to buildings that, if done improperly, could compromise the
integrity of the structure. Licensing interior designers is another layer of
safety akin to a building permit for someone renovating their home.

~~~
lukesandberg
but presumably you would still need to actually hire carpenters/architects and
get a building permit to implement the structural changes. I don't think you
should need to be licensed to make a recommendation.

~~~
pyre
I think that the implication is that the designer is acting as the architect,
and just directly hiring the carpenters/etc. I don't know if this is true or
not though.

------
ianb
Though not professional licensing, we had an example of the unintended
consequences of licensing here (Minneapolis) when there was a proposal to
license community gardens. Though the licensing would not be particularly
expensive it would also mean gardens would require insurance, because the city
would have liability if something happened at a licensed location (but as long
as the city simply wasn't involved no one could sue the city). The result of
course would simply halt these otherwise entirely non-commercial efforts, as
much out of bureaucratic overhead as financial.

------
sskates
Thank goodness any form of licensing or certification never caught on in the
tech community. Way too libertarian to let any of that sort of stuff stand.

On the flip side the worst that can happen in the vast majority of cases is
that programs won't work (or maybe they'll even lose your data or leak it to
the world). It's pretty rare that a programming error can kill someone.

------
tokenadult
There have been some interesting comments here since I posted this article
just before I took my son to his soccer tournament. Now that I'm back, I see
some commenters have suggested that some of the occupations identified in the
submitted article as probably not needing state licenses (as indeed they don't
need in many states) do need licenses. Those suggestions by my fellow HN
participants are often made on the basis of hypothetical examples or imagined
worst cases.

My own sister has formal training in interior design from a baccalaureate
program at a state university, and she has pursued that occupation since
graduation for more than two decades. I am aware from my sister's work in
commercial interior design in a big city with skyscraper office buildings that
some interior designers have somewhat of an influence on the safety of public
spaces. But it's ludicrous to think that Florida's pattern of regulation of
interior designers is in any sense motivated by public safety concerns. If
there are such huge public safety concerns from interior designers not being
state licensed, why do we not hear news stories from other states with
different patterns of regulation about all the people who die from entering
buildings that are owned by owners who hired unlicensed interior designers?

The experiment in federalism that has been going on in the United States
offers a wonderful comparative laboratory of policies. Unfortunately, for
reasons well explored by public choice theory,

<http://www.econlib.org/library/Enc/PublicChoice.html>

state legislatures often ignore the real-world experience of other states in
setting policy, preferring instead to listen to rent-seeking

<http://www.econlib.org/library/Enc/RentSeeking.html>

lobbyists who divert attention from real-world experience to focus on
hypothetical harms that could (maybe) happen if they don't obtain their
favorite kind of special treatment. So I would respectfully suggest to my
fellow HN participants that if someone wants to make a case that some
occupation (e.g., hacking to build web-based SaaS businesses?) should be
regulated by state-issued licenses, the persuasive way to make that case is to
refer to detailed statistics about actual benefits or harms to the general
population, rather than referring to imagination or common fears.

P.S. The one time I had to shop for a surgeon, for my wife, I asked my mom, an
operating room nurse who has worked with some world-famous surgeons, to help
me find the best doctors in town. That she was readily able to do. People
always work the best network they can for the other people they care about
most, and life will always be this way, regulation or no regulation. My wife
had a completely uneventful and full recovery from her surgery.

------
jasonjei
What the British author of the article should point out is that the US states
determine how and what professions are licensed. Some US federal laws and
regulations require licensure in a profession in federal domain, but those
requirements are determined by the state (e.g, Arizona CPA licensure has
greater school credit requirements than a Georgian CPA).

------
fleitz
It's laughable the professions that require licensing. Up here in Vancouver
you need a license just to be a waitress.

~~~
pyre
IIRC in Ontario (Canada), you need a license to serve alcohol, though I
believe it's basically just a series of classes to make sure that people all
have a baseline level of competency in things like "determining if someone is
too drunk" or stuff like that.

