Blog > Breaking Down the Medical Monopoly.
Breaking Down the Medical Monopoly.
Attempts to water down the medical monopoly on the provision of health care have been argued purely on the basis of the effects that this may or may not have on the quality of care.
There are two factors underpinning the medical monopoly on the supply of health care services. The first is the licensing and registration process itself and the second is the rebate on services preferentially provided to registered medical practitioners. Government is currently attempting, through a process of national registration, to gain control of the licensing and registration process and is extending rebates to a wide range of non-medical services providers and threatening to reduce rebates for those medical services that the Minister believes can be equally well performed by alternative providers.
Of course, the justification for monopolies is always couched in terms of benefits to consumers while, as the history of anti-trust laws has shown, it is really all about protecting the positions of less efficient providers. Medical practitioners do not want to have to compete with alternative providers (they do not even want to compete with other medical practitioners); they want consumers to be forced to deal with them. Integral to the profession’s case is the claim that consumers are incapable of making decisions for themselves about the quality of care provided – else they would be capable of identifying and choosing the correct provider and maintenance of the medical monopoly would be unnecessary. The claimed incompetence of consumers to choose is the same philosophy that underlies the operations of the paternalistic Welfare State. In promoting the use of alternative providers, governments have argued, therefore, not that consumers are capable of choosing but that the quality of care will be unaffected by extending the monopoly to a further set of preferred providers.
It is ironic that all the protagonists in this argument must base their arguments on issues of quality and none on the freedom of consumers to choose. On the other hand, a freedom-based philosophy would require the removal of State controlled registration and accreditation and that no rebates be provided to any provider – with the next best alternative being that the same rebates be extended to all providers (thereby rendering the purposes of rebates redundant). Only under these circumstances would consumers have a genuinely free choice. In free markets non-coercive monopolies are achieved by those providers who are most efficient at providing what consumers value – not what governments or medical professions say they ought to value.
If, the Minister carries out her threat to reduce rebates on “bread and butter” items and further open up their performance to non-medical providers, then it seems likely that many GPs will simply raise their fees on other items as they work towards obtaining what is, for many, a predetermined income. On the other hand, those physicians who believe that cost should not be a determinant in the choices that consumers make should be prepared to offer their services at a lower rate. After all, their incomes will only be reduced to a level more commensurate with that of the average worker – and this would be consistent with their egalitarian views.
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