"These laws were passed with a worthy purpose," he explains. "To maintain the high standards of medical care and to protect patients against unscrupulous and inadequately trained practitioners. Back in the heyday of antibiotics this arrangement may have seemed somewhat reasonable. But now that virtually everyone agrees that laypeople do more than doctors to improve the nation's health, these laws are doing more harm than good. Medical licensure laws increase health care costs, stifle competition and innovation and, in many cases, prevent consumers from obtaining the skills, tools, and information they need to take better care of their own health."

Dr. Baron is not alone. A variety of other experts, among them economist Milton Freedman, former Federal Trade Commission Chief Michael Pertschuk, and American Bar Association Foundation Research Fellow Laurie Andrews, have questioned the need for medical licensure laws.

History. Medical licensure is a relatively recent development in the U.S. Up until the early 20th century, Americans took it for granted that people were responsible for their own health. But for the last 50 years, Americans have "let the doctor do it" until, in recent years, we have entrusted virtually all health matters to a system of professional care dominated by physicians.

But the tide has now begun to turn. We are becoming painfully aware of the limits of professional medicine. There is growing interest in the role of alternative therapies, self-care, and social support in treating illness and maintaining health. New medical tools are being created for—and adapted to—consumer use. But the role of the consumer is limited by laws which reserve the right to practice medicine to physicians alone. "A medical license was supposed to protect the consumer," Baron says. "Instead, it has been used to justify the complete domination of health care by the physician."

Our present health care system is created in our doctors' image: highly technological, disease-oriented, hospital-based, expensive, with heavy reliance on diagnostic testing, prescription drugs, and hospital-based surgery. But the present system suffers from physicians' "tragic flaw"—a nearly exclusive focus on high-tech solutions to end-stage problems. The implanting of an artificial heart is dramatic and newsworthy. But where was that surgeon through all the years of smoking, inactivity, stress, social isolation, and high-fat diet it took to destroy the patient's original heart in the first place?

The emerging health care system is being created in the image of the health-active layperson. It emphasizes home testing, self-treatment, preventive health, self-responsibility, shopping-center medicine, chronic and long-term care, and home care.

Hard On Docs. The responsibilities we have heaped upon our doctors have proved a heavy burden. They are charged to cure illness, yet are all too frequently unable to do so.. Little wonder that there is a shockingly high level of suicide, alcoholism, drug dependence, psychiatric disease, and other forms of impairment among physicians.

"Most physicians live in a state of chronic stress," says Dr. John-Henry Pfifferling, director of the Center for the Well-Being of Health Professionals in Chapel Hill, North Carolina. "Very few are truly healthy. Every year this country loses the equivalent of several entire medical school classes to doctors' suicides, drug addiction, and alcoholism. Experts estimate that about 10 percent of all physicians are seriously impaired." '