...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
I actually was involved in a fight in the Capitol a few years ago between the dentists and the dental hygienists. The hygienists wanted to be allowed to do teeth cleanings in under-served (read rural) areas of the state. There is an obvious need for this type of care as the economies of scale don't lend themselves to having licensed dentists in every county in the state. The dentists essentially predicted that the world would end as we know it if hygienists were allowed to do teeth cleanings for rural residents of Colorado.
The whole thing was quite a spectacle and rather eye-opening, these types of turf battles don't get the attention of say doctors v trial lawyers but in they have a real world impact on our healthcare system.
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This is true, but probably not a driving factor in health care costs. Dentistry is an example of an area with fairly low cost levels, high levels of market price competition, and low levels of insurance and government benefits, relatively to regular health care.
There are lots of health care professionals who can operate independently (even if their services are sometimes prescribed). Pharmacists, physical therapists, optomitrists, nurse practioners, and more operate with considerable autonomy. Osteopathic doctors operate as a competing parallel profession with M.D.'s. Veterinarians have far more dominance in their profession than M.D.'s.
Also notably, dental hygenists and dental technicians make up two of the top ten most female dominated professions, and unlike most of the rest (e.g. child care, kindergarten and pre-school teaching), do not involve caring for young children. The pay isn't that horrible (about 60% more than retail clerks, the most common job in the state, and it would probably pay more if a larger percentage of men were in the profession), the professional training isn't particularly long or onerous (no more so than welding or truck driving), and there are many traditionally male jobs that require fine motor dexterity (e.g. electricians, barbers).
Unlike the case of nurse practioners v. primary care physicians, e.g., this also isn't a case where there is gender based substitution in kindred professions. Only a tiny percentage of dental hygenists would have been eligible to go to dental school, and there are a fair number of female dentists.
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