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Medical free trade zones
Why not open up a Medical Free Trade Zone in, say, Detroit? Health care workers in the zone would not be required to get US visas or licenses, and any malpractice claims would be resolved in the courts of the worker's home country.
That is from the comments. Of course in principle we could combine this with a single-payer system or other reforms. That'll cure those rationing blues and those long waits for hip replacement surgery. Or you might favor a single-payer system but be willing to do this in the meantime, for the many millions of uninsured, at least some of whom are waiting in agony. How about it, people?
But let's make it geographically central, I say Memphis not Detroit. Or would you feel better if it were a floating pavilion in the Caribbean? A floating pavilion in the Indian Ocean? Bangalore?
I have Bangalore at 8510 miles from Falls Church, VA. Do I hear medical free trade at 8509 miles? 8508? Can we get the mileage down into triple digits...?
Addendum: Ezra Klein flirts with libertarian anarchism, sort of...
Posted by Tyler Cowen on July 2, 2007 at 05:27 PM in Medicine | Permalink
Comments
The lack of a visa requirement would seem to preclude it from being in a central location. How about putting it inside the internation terminal in Miami?
Posted by: mobile at Jul 2, 2007 5:40:32 PM
It's a good idea to increase the numbers of immigrant doctors, but a bad idea to increase the number of incompetent immigrant doctors.
Instead of reducing malpractice, do whatever you can to improve the current mechanisms so we can more accurately tell which doctors are at fault and which are incompetent. Improve procedures, compensate the victims, and drive out the incompetent. Medical errors are a major reason why more healthcare usually doesn't lead to more health.
Posted by: Mike J. at Jul 2, 2007 5:51:12 PM
Come on, Dr Cowen, don't you read the news? This here is still hot from the FT's site :
POLICE PROBE FOREIGN DOCTOR TERROR THEORY
Police were investigating on Monday whether a network of foreign doctors was responsible for three failed bomb attacks in London and Glasgow.
Two doctors – one who qualified in Jordan and one in Iraq – were identified as being among eight people arrested in the investigation that followed two failed car bomb attacks early on Friday and an attempt to drive a car bomb into Glasgow airport on Saturday. The police confirmed the arrest of two more people on Monday in the Glasgow area. Scotland Yard disclosed Monday night that an eighth person had been arrested at an undisclosed destination, although the BBC reported that the arrest took place overseas.
The developments are likely to trigger reviews of immigration procedures that allow foreign-qualified doctors into the UK to help fill shortages in the National Health Service.
The British Medical Association said it had already become harder since last year for doctors from outside Europe to take up training posts in the UK, following an increase in UK medical school graduates.
The manhunt continued for others connected to the plot. A person briefed on the investigation said that the number eventually arrested could double, and include more medical practitioners.
The driver of the flaming car at Glasgow airport was named as Bilal Abdulla, who qualified in Baghdad as a doctor in 2004. He suffered severe burns in the attack and remained in a critical condition at the Royal Alexandra Hospital in Paisley – where he had been working.
Police said they carried out one controlled detonation of a vehicle in the grounds of the hospital, but said it was a precautionary move and there was no indication it contained explosives.
====
I fear that from now, you can forget the "war on terror", it's the "war on doctors" that is on.
Posted by: Henri Tournyol du Clos at Jul 2, 2007 6:34:04 PM
The broad idea here is to open up the medical system to more competition and new ways of providing service. Sure we need some screening of medical practioners U.S. trained and imported just as we need some screening of food imported or domestic. Many more services could be performed by nurses and nurse practioners (as they are in staff model HMOs). Maybe certified clinics performing hip or knee replacement across the border in Mexico is more feasible than providing these services in India. How about a change of policy toward Cuba? Combine a vacation with a tune up.
Posted by: Sonia at Jul 2, 2007 6:45:56 PM
With today's airline prices, Detroit = Memphis. Maybe a SWA hub would be even better. Las Vegas. Pheonix. Dallas.
In any case, sure, if you're going to do this just create oversight so that someone responsible is writing down the data. We have a free-trade diet system now, but no one knows who's telling the truth any more, and you see how well that works.
Posted by: Chi at Jul 2, 2007 8:29:11 PM
Bangalore was a nice city until 15 years back, that is, before the IT industry's invasion and before the advent of liberalisation, globalisation and privatisation.Now it has lost its charm as the "garden city" of India.All locals(the real Bangalorians) were marginalised in the consequent process of great migration and mobility.
Posted by: GVV at Jul 2, 2007 9:40:17 PM
Bangalore was a nice city until 15 years back, that is, before the IT industry's invasion and before the advent of liberalisation, globalisation and privatisation.Now it has lost its charm as the "garden city" of India.All locals(the real Bangalorians) were marginalised in the consequent process of great migration and mobility.
Posted by: GVV at Jul 2, 2007 9:41:54 PM
"a floating pavilion in the Caribbean?"
Not as silly as it sounds. What would stop someone from turning a cruise liner into a hospital ship moored just outside US waters?
Posted by: Dan Hill at Jul 3, 2007 12:28:50 AM
"Medical free trade zones" are a great idea, maybe you could buy insurance there that doesn't have all the regulatory requirements like birth control, x day minimum stays in hospitals, limits on deductibles, etc.
Posted by: Mr. Econotarian at Jul 3, 2007 9:09:43 AM
Why not open a medically free trade zone in say, every place except NY and Mass.
Posted by: Joe Stummer at Jul 3, 2007 9:53:26 AM
A medical free trade zone, with no licensure or visa requirements for health care personnel and no FDA oversight of drugs and devices? Sounds great - a safe haven for every bogus practitioner and snake oil merchant! Just the place to have Dr. Quack treat your brain tumor!
Posted by: Ned at Jul 3, 2007 10:50:53 AM
Ned,
Then nobody will go there and the snake-oil people will have to live in Detroit and get no business. The mainstream healthcare market will be unchanged.
Also, presumably the people who don't need visas to get in will have to prove they're doctors.
Posted by: jb at Jul 3, 2007 2:22:55 PM
Isn't Detroit already a "medical free" trade zone?
Posted by: fustercluck at Jul 3, 2007 3:47:11 PM
Hijacking an idea from Patri Friedman, how about a for-profit medical barge registered in a lawsuit-free country? Step 1: Staff it with a globally sourced, low cost, high quality English speaking doctors, nurses, and assorted personnel. Fill it up with drugs from countries that are bought from countries with substantial discounts to USA list price. Anchor it off the coast of the US (in territorial waters of Mexico in Baja California if need be) and charge prices at a discount to prevailing prices in the US. Run, or charter, a ferry service from shore to the barge.
Step 2: Profit! Scale up supply when you start getting lines for low everyday prices for high quality services.
Downsides?
1) Perhaps your barge is too expensive of an overhead?
2) That, and storms. You may have to move the barge seasonally (or due to political forcings). I wouldn't want surgery on a boat that was rocked by waves.
3) Some clever (i.e. evil) lawyer might decide that even though your barge is foreign territory, it is in US or Mexico waters and subject to US or Mexico laws.
Posted by: happyjuggler0 at Jul 3, 2007 4:44:38 PM
Hmmmm. Reading more closely I see that TC already came up with the "floating pavillion in the Caribbean" idea first. Sorry Tyler, I'm slipping. Still, I filled out the thought a bit more anyway. Also, Patri Friedman's idea of whole "countries" is worth reading, from this libertarian's perspective anyway.
Posted by: happyjuggler0 at Jul 3, 2007 4:50:15 PM
How about increasing the number of American doctors and the competition between them so as to lower their fees?
1. Increase the number of medical schools and the size of medical school classes.
2. Make medical school a low-cost, two-year clinical experience, with the current first two years of textbook medicine offered as an undergraduate major at colleges and universities.
3. Don't require medical school attendance to take a national examination for license to practice.
4. Allow adults over age 30 to write their own prescriptions and to visit unlicensed practitioners.
Posted by: SY at Jul 3, 2007 6:43:05 PM
Posted by: 鑽石 at Apr 2, 2008 8:57:17 PM
