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PaperclipPerfector  2mo ago (text post)   25732 thread views

Culture War Roundup for the week of November 10, 2025

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What would you change?

The government outsources quality control by letting each guild collect its rent. There’s deadweight loss, but that’s the price you pay for hedging out some of the worst outcomes.

Maybe we have the capacity to do a more laissez-faire model based on reputation? It’s more plausible now than in the Yellow Pages era.

Maybe we have the capacity to do a more laissez-faire model based on reputation? It’s more plausible now than in the Yellow Pages era.

I don't think it is, even within the field with expert level knowledge it's hard for me to know if a doctor I'm seeing is good before I go, and depending on my knowledge of the speciality it's also hard afterwards.

Patient surveying and other mechanisms of assessing doctor quality tend to zero in on customer service which is important but is often the opposite of what you need for an actual quality doctor.

In smaller tighter knit communities you were more likely to get to "he was gruff but I think he caught things others wouldn't."

I have a friend in primary care who picked up most of the local population of a specific ethnic group. He's a good doctor but they don't know that, he was just nice to them and understood their culture so they all came.

They don't know that he's not making mistakes other PCPs would make.

The government outsources quality control

I think this is the thing that is being challenged. That they're basically not even doing quality control. It's license control, not quality control.

I'd note from my previous comments regarding the book, they had examples from other industries, too. One that stood out was doctor malpractice that the boards would just kick the can on. "Better to have a bad doctor than no doctor." (But definitely not a foreign doctor!) IIRC, they talked about a case where the board just kept kicking the can and stringing it along, and nothing happened to "control this guy's quality" until he was arrested on criminal charges by the county prosecutor for the utterly obscene stuff he was doing (completely separately from the board's proceedings).

Different industries probably need different changes, because sure, there should be some sort of standards/quality control, and what that looks like can vary. But as it is, it seems to be pretty clear that they're not really doing that.

"Better to have a bad doctor than no doctor."

Unironically yes, which is precisely why occupational licensing is evil.

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