When people are left free, they tend to work out effective solutions. In a free society, there would likely be a multiple authorities to judge physician competency. The consumer would get to pick.
A big problem with doctor certification today is that doctors are graded on a boolean scale, pass/fail. So two physicians can both be certified, but one can be vastly better than the other, and you, as a uninformed patient, have little way of judging. A close relative of mine has had an opportunity to assist in many open-heart surgeries performed by several doctors. He tells me that there is a huge difference between surgeons. One surgeon regularly completes operations in 20 minutes with no mistakes and complications, another surgeon, at the same medical center, takes two or three times as long, is much "messier" (cutting things he shouldn't), and his patients have many more complications. It's obvious to everyone in the operating room who is the better doctor, but no one will tell patients. For patients, both doctors are "competent." In free market, presumably there would be at least one rating agency that would provide a more nuanced report on doctors.
Also, to get an MD, there is not a "uniformly high bar," at least there hasn't been in the past. Medical schools discriminate in their entry requirements based on at least race, but possibly other non-competency factors like sexual orientation and parental alumni status. So entering medical students are not held to a uniformly high bar. Once in medical school, student performance diverges. Some students are at the top of their class, others are at the bottom. Some pass the certification exams with high scores, others barely pass after two or three attempts. Most of this information is not readily accessible to the average healthcare consumer.
The primary aim of doctor certification seems to be to restrict the supply so as to keep wages high, not to help consumers choose. The best solution really is freedom, not mere "detailed technocratic tweaks" to a system designed from the bottom-up to protect the interests of the medical profession against competition.
Why can't we have both? There's no regulation on rating doctors at the present and it seems to me like the fact that there aren't a dearth of patient/consumer ratings of doctors already precludes your assertion that if we stop requiring certification that many will suddenly spring up.
There's also the problem that medical care is an inherently non-free market. If I'm bleeding to death, I don't have time to search the BBB's ratings on a hospital and decide which emergency room I'd prefer. The same is true for pricing: If I'm dying my demand for service is going to be irrespective of it's price.
Regulation is a critical component in the medical industry, in my opinion.
Look, empty platitudes like "more freedom" are never the answer, unless the question is, "how do we sell people on something so crazy that they'd never agree with it otherwise, like for example, 'giving jbooth and dpatru the ability to sell a MD degree for 5 bucks on the street corner'"?
You may as well say the solution to the medical credentialiing problem is pancakes.
There was a point in time where you didn't require a government certified authority to give you the title of doctor. People decided to start certifying. For obvious reasons.
There was also a time you did not need a government issued ID to get on a plane. That also changed, for obvious reasons, but not necessarily good ones. Fear of the unknown is not equivalent to rationality.
The worst government policies are those where "concerned mother" (= Democrat) and "stern dad" (= Republican) stand shoulder to shoulder to protect you from yourself. Millions of people are in regular contact with that sort of "stern + concerned" thing in the form of the TSA, but other agencies are no less Kafkaesque (more so in fact given that they are operating in comparative darkness).
You can stand on a street corner and call yourself a programmer willing to work for $5. Or for zero. That doesn't mean that GE will hire you to write the code for their next X-ray machine. Distributed intelligence is much smarter, and centralized evaluation much dumber, than many believe.
A big problem with doctor certification today is that doctors are graded on a boolean scale, pass/fail. So two physicians can both be certified, but one can be vastly better than the other, and you, as a uninformed patient, have little way of judging. A close relative of mine has had an opportunity to assist in many open-heart surgeries performed by several doctors. He tells me that there is a huge difference between surgeons. One surgeon regularly completes operations in 20 minutes with no mistakes and complications, another surgeon, at the same medical center, takes two or three times as long, is much "messier" (cutting things he shouldn't), and his patients have many more complications. It's obvious to everyone in the operating room who is the better doctor, but no one will tell patients. For patients, both doctors are "competent." In free market, presumably there would be at least one rating agency that would provide a more nuanced report on doctors.
Also, to get an MD, there is not a "uniformly high bar," at least there hasn't been in the past. Medical schools discriminate in their entry requirements based on at least race, but possibly other non-competency factors like sexual orientation and parental alumni status. So entering medical students are not held to a uniformly high bar. Once in medical school, student performance diverges. Some students are at the top of their class, others are at the bottom. Some pass the certification exams with high scores, others barely pass after two or three attempts. Most of this information is not readily accessible to the average healthcare consumer.
The primary aim of doctor certification seems to be to restrict the supply so as to keep wages high, not to help consumers choose. The best solution really is freedom, not mere "detailed technocratic tweaks" to a system designed from the bottom-up to protect the interests of the medical profession against competition.