Coyote Blog

You Want to Know Why Medical Care Is So Expensive?  Because the government has passed numerous laws to help medical practitioners enforce their monopoly on numerous medical services.

Today I encountered an egregious example.  1-800-Contacts will not ship my contact lens order.  Seeing that my 1-year prescription was about to run out (but still valid for another week, it expires on the 18th), I ordered a bunch of boxes of my daily lenses to see me through some more months.  The retailer called my eye doctor, who confirmed that the prescription was still valid but that the doctor would only allow me to buy one box because he wanted me to return for an exam soon.  They confirmed this by email:

Thank you for choosing 1-800 CONTACTS. While we were verifying your prescription, your eye care provider informed us that your prescription will be expiring soon. Unfortunately, this means that we are unable to ship your order....

But then we get to the real point

Also, if you would like assistance scheduling a new exam, we can help! We have a network of doctors with convenient locations and hours....

Sincerely,

The Doctor Network Team at 1-800 CONTACTS

So the email is not even from the customer service department.  It is from their doctor network.  Its clear the requirement is all about pumping up the eye doctor business.

I remember a Dilbert cartoon (or maybe it was the Far Side) where one copier repairman was pointing into a copier and telling the other that he should "set this dial for when he wanted to return."  We all have suspected something like this exists in copiers, but for all the dark humor, it really exists in the medical profession.

Why should the government force me to pay the doctor for as many visits as the doctor wants just to be able to purchase contact lenses?  One could argue this is for eye health or some happy BS like that, but we don't require everyone to visit the eye doctor at the doctor's pleasure, just people with bad vision who have daily wear contacts.  There is not, to my knowledge, any correlation between glaucoma and contact lens wearing, so why do I face such a government mandate while someone with 20/20 vision does not?

Further, why can't I self medicate on contact lens selection?  I know people who have been raised to be submissive sheep deferring to the almighty medical degree gasp at such a suggestion, but why not?  Because I have problems with both near and far sightedness, my choice of contact lens strength is a tradeoff anyway.  If I can see well long distance, I can't read anything without reading glasses.  Back off a bit on the far vision, allowing a little blurriness in one eye, and I can read in an emergency without my glasses.  I chose my own lens strength, and my doctor then wrote a prescription for it.  Why can't I just do this on my own, say with a trial kit of lenses from the manufacturer.  (for those who think it might be a size issue, there are only about 3 sizes in this type of lens, and they are far enough apart that once a size is selected, they are likely that size forever).  It's fine if people want to do this under a doctor's supervision, and I would certainly get into the doctor every two or three years, but why must the government mandate I go in more frequently, at the doctor's pleasure, not mine?

This kind of thing exists ad infinitum in the medical profession, with government mandates helping to protect over-educated professionals from lower-cost competition.  Why do I have to go to a dentist's office to get my teeth cleaned?  Why do I need someone with 12 years of medical training to put three stitches in my knee?  Why do I need a fully trained doctor to take me through the basics of a routine physical?  Why does Viagra require a prescription -- I mean, doesn't the doctor just take my word there is a problem, or is there actually a doctor out there who sends in hot nurses to prove whether I have an erectile problem?  OK, I might not begrudge that particular doctor visit.

Whatever its stated purposes, in reality most professional licensing efforts are mostly aimed at using the power of government to limit new entrants, and thus new competitors, from a certain business:

In Alabama it is illegal to recommend shades of paint without a
license.  In Nevada it is illegal to move any large piece of furniture
for purposes of design without a license.  In fact, hundreds of people
have been prosecuted in Alabama and Nevada for practicing "interior
design" without a license.  Getting a license is no easy task,
typically requiring at least 4 years of education and 2 years of
apprenticeship. Why do we need licenses laws for interior designers?
According to the American Society of Interior Designers (ASID) because,

Every decision an interior designer makes in one way or another affects the health, safety, and welfare of the public.

This hardly passes the laugh test.  Moreover as Carpenter and Ross point out in an excellent article in Regulation from which I have drawn:

In
more than 30 years of advocating for regulation, the ASID and its ilk
have yet to identify a single documented incident resulting in harm to
anyone from the unlicensed practice of interior design...These laws
simply have nothing to do with protecting the public.

As always on this topic, I end with a quote from Milton Friedman on licensing:

The justification offered is always the same: to protect the consumer. However, the reason
is demonstrated by observing who lobbies at the state legislature for
the imposition or strengthening of licensure. The lobbyists are
invariably representatives of the occupation in question rather than of
the customers. True enough, plumbers presumably know better than anyone
else what their customers need to be protected against. However, it is
hard to regard altruistic concern for their customers as the primary
motive behind their determined efforts to get legal power to decide who
may be a plumber.

Update:  This is timely, as 1-800-CONTACTS has informed me that due to various state and federal laws, they may not sell me the contact lenses any more that I have been purchasing from them for a year.  I must go into an office and pay a government-licensed eye doctor to get an updated prescription.  This is despite the fact that, once sized, contact lens strengths are easy to understand.  Every year or so my eyes go up by about 0.5.  I could easily get by still with my old contacts, or I could, if I wanted, self-medicate by adding 0.5 (the minimum step at my level of vision) to each eye and testing to see if this new setting was any better.  This is exactly how people buy reading glasses (or pants, or shoes), by simple trial and error in the store.  But I can't do this with my contact lenses -- or actually I do exactly this, but can only do it in a doctor's office, paying the government mandated annual toll to get my prescription updated.

Yes, I know, there are all kinds of fabulous reasons to go to the eye doctor each year, to test for glaucoma and other stuff.  But why shouldn't that be my choice?  The government doesn't force people with good vision to go to the eye doctor for such tests each year, only those of us with bad vision.  The only analogy I can come up with would be having to go to your physician each year to get your shoe size validated before you could buy shoes for the coming year.  After all, I am sure there are substantial health and safety issues with wearing poorly-fitted shoes.

I drive into my local Shell station to fill up, and stick my card in the pump, but the pump refuses to dispense.  I walk into the office and ask the store manager why I can't get gasoline.  She checks my account, and says "Mr. Meyer, your Volvo fuel prescription has expired."  I say, "Oh, well its OK, I am sure I am using the right gas."  She replies, "I'm sorry, but the law requires that you have to have a valid prescription from your dealership to refill your gas.  You can't make that determination yourself, and most car dealerships have their prescriptions expire each year to make sure you bring the car in for a checkup.  Regular checkups are important to the health of your car.  You will need to pay for a service visit to your dealership before we can sell you gas."  I reply, "RRRRRRR."

OK, so if this really happened we would all scream SCAM!  While we all recognize that it may be important to get our car checked out every once in a while, most of us would see this for what it was:  A government regulation intended mainly to increase the business of my Volvo dealership's service department by forcing me to pay for regular visits.

So why don't we cry foul when the exact same situation occurs every day with glasses and contact lenses?  The parable above is nearly exactly the conversation I had the other day with the operator at 1-800-CONTACTS, except with "gas" substituted for "contacts".  I know that my contact lens prescription is a bit out of date, but I really needed them for a trip, and in terms of safety, a slightly out-of-date contact lens in my eye is much better than none (My contacts are about -6.5, which means I am pretty blind without them).  No joy, though.  I did not have time to get to the doctor, so I wore -5.0 contacts I found in a drawer just to have something.  The operator told me that doctors have the prescriptions expire each year so that I am forced to come see them.  Why with eye doctors do we consider this "for my own good" when in any other profession it would be called a scam? 

In fact, each year I know my eyes get about 0.25 worse on each lens.  I would really like to just self-medicate and order myself the next level up, but of course that is way out of bounds.  Can't trust people to figure out their own lens correction (though we do allow this for reading glasses, go figure).