The License

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The
state does not license cats. Why is that? They license dogs, why
not cats? Could it be that cats refuse to be licensed? Are they
too independent, stubborn, stuck-up, wily, and disobedient to be
licensed?

According
to my dictionary, the main meanings of the word, license, are:
a. Official or legal permission to do or own a specified thing.
b. Proof of permission granted, usually in the form of a document,
card, plate, or tag. I never knew a cat who ever asked anybody
for permission to do anything, so maybe that's the answer.

But
let's look at other categories of licensing. We have to license
cars and trucks, but we do not have to license backhoes or lawn
mowers. Does that make sense? Evidently the demand to license a
thing is not inherent to the thing. I mean, these things all have
engines and wheels and they move around, but we only license some
of them. Why license cars? The individual car is already identified
by the manufacturers' number, why do we need another one? The fee,
of course, goes to support a state bureaucracy consisting of bored
and indifferent individuals who are only working there for the wages
and benefits and who couldn't care less about their career, if you
can call it that. So why bother?

Yes,
I know, the real reason we must license cars is so that the state
can keep track of us. It's the same reason we must file a personal
income tax return. Americans, unlike Europeans, have never been
required to register with the police whenever they move from one
place to another and we probably would not do it. This works.

What
does a business license accomplish? Well, I guess it proves that
you're seriously in business, although in most cities you can't
be in business without one. So it's outright extortion, like property
taxes, going to fund city government services that you didn't want
anyway. Police? Well, maybe you do want police protection of your
property, but police won't go near a riot and they're always too
busy elsewhere, so you'll have to pay extra to hire your own.

How
about a marriage license? That's something everybody really needs.
How many times has a business asked you to show them your marriage
license? What is this? Of course, in legal disputes it serves as
a record of marriage, an implied contract, but what's to keep couples
from making explicit contracts that could be used in private arbitration
of disputes? It wouldn't be romantic, I suppose, but then waiting
in line at the county clerk's desk isn't terribly romantic either.
Neither is divorce court.

But
we all know that doctors and dentists and nurses and such need to
be licensed. Don't we? Their license is the state's guarantee that
they are fully educated and competent at their business and that
they won't cheat you or cause you bodily harm. Right? Okay, take
away that guarantee, the state doesn't guarantee anything. But the
license proves they're educated and competent, doesn't it? College
degrees also prove they're educated and the validation of supervisors
also proves they're competent. In fact, these are the very things
that states use to issue the license. So what does the license prove?
Why is it necessary? Why do we believe in it?

When
I started working in hospitals back in the sixties, my particular
niche in that world was not licensed. We had our own private organization
that issued a certificate after a person voluntarily submitted to
testing and that certificate was accepted in hospitals all over
the country. Specific institutional education was not required to
qualify for that test, but a person had to have two years of supervised
experience and the endorsement of two of those supervisors to apply
for it. That could get real sticky.

People
who knew the business had to be convinced that you knew the business
before they would commit themselves to endorsing you and it was
up to you to convince them. There were no textbooks on this subject
in those days, but there were textbooks on anatomy, microbiology,
physics, pharmacology, physiology, and chemistry; subjects that
you were expected to know. There were also complex machines to learn
inside-out, because you had to be able to fix them yourself if they
broke down.

This
was during the forging of a new profession, brought about by emerging
technology. The doctors and the technicians were determined to find
better ways to keep people alive after surgery or trauma, so the
era of life-support machines was born. The technicians took their
responsibility seriously and they did not make entry into their
world easy. People who just wanted a job could look elsewhere.

Of
course, there are parasites in any business, no matter how much
you try to get rid of them. When you have a national organization
that supposedly represents thousands of people in a business, you
necessarily have people running it. At first those people still
worked in hospitals and ran the organization on the side, but the
membership kept growing and the dues piled up and one day there
was just too much work to be done at the office. The bureaucrats
arrived.

Other
things happened. Medicare refused to recognize the profession and
all the Blues followed suit, which created a big reimbursement problem
for hospitals. Hospital administration gradually became a profession
too and adopted the model of organization from the government and
the old rust-belt industries, the top-down pyramid, which required
a department head who had to attend meetings instead of treating
patients. Ambitious young doctors saw opportunity knocking and began
to write research papers and textbooks on the new technology. Medical
centers started formal in-house education programs. Voices were
raised here and there demanding that we become genuine, validated,
professionals, just like the doctors and the nurses, by asking the
state to license us too.

I
objected to that, naturally, and the national organization duly
published my objection in their journal. I predicted that licensure
would destroy the quality and the integrity of the practitioners
and thus would destroy the credibility of the profession itself.
This was not well received, particularly by those individuals who
resented the threat of ostracism for inadequate work and the onerous
difficulty of acquiring that piece of paper the way we had been
doing it. They wanted schools. They wanted teachers who would be
reasonable and understanding. They could get what they wanted if
the state required graduation from a school to qualify for a license.
From big empires do little empires grow.

I
have heard it said that professional licensure came into existence
at the insistence of professionals themselves who wished to restrict
access to their field, the idea being to raise the price by limiting
the supply for a given demand. I wonder, though, how much the cry
for licensure was driven by simpler motives like envy, jealousy,
and fear, like the motives behind the anti-trust lawsuit against
Microsoft? I mean, if a person could demonstrate exceptional expertise
in a field and contribute to innovation in that field, would it
really matter to similar professionals if that person is licensed?
I don't think so.

I
would like to be able to say to my young and hopeful colleagues,
once more, "I don't care where you learned it, just tell me
how you would use the Henderson-Hasselbach equation in this situation,"
instead of depending on the license they acquired by graduating
from a program and taking a multiple-choice test, thus satisfying
the requirements of the state licensing board.

The
structure of the licensure process in our society sits on a foundation
that presumes there is some state authority that knows more than
anybody else, that knows best who is qualified and who is not qualified
to do something, without any guarantees. The fact that this authority
is a person who merely collects and files documents demanded by
a checklist prepared by a committee is totally ignored. None of
these people are accountable in a malpractice lawsuit, for example,
because they issued a license to somebody who was totally incompetent
to do the licensed job, but who was fully competent to supply the
required documents. Documents don't do surgery. I think we'd all
be better off if we left the certifying of medical professionals
to insurance underwriters who have a financial stake in being right.
Insurance could guarantee to the consumer that the practitioner
is educated and competent, the state cannot.

So
let's consider licensing software engineers. Immediately one realizes
that if Mr. Bill Gates had been forced to get a license first, the
world would most likely not have a Microsoft Corporation today.
We read about thousands of young people who renounce the tedium
of higher education for the excitement of writing software, which
they learned to do on their own, and creating their own Internet
companies. Some succeed, some fail. I can just see some bureaucrat
focusing myopically on the failures and saying, we ought to make
it easier for them, their self-esteem depends on it, and I know
how to give them all equal opportunity: license them! Make them
all the same!

I
do hope that I haven't given somebody an agenda in that paragraph,
but here's another idea, the government could license writers too.
Didn't the Soviet Union do something like that?. This wouldn't be
censorship, mind you, that would be unconstitutional, but no writer
could be published who was not licensed, a wholly different matter.
I wonder what committee would set the standards? Ah, the New York
Times! I wonder about the rules a writer would have to obey? Education
requirements, tests, continuing education, fees to be paid? A whole
new bureaucracy devoted to ignoring complaints? And all paid for
by the victims, just like the DMV and the state licensing boards.

Elegant
idea, and many a politician would pant to dream of it, but it wouldn't
work, for the same reason that licensing cats doesn't work. Not
all people are as independent, stubborn, stuck up, wily, and disobedient
as cats, but writers come pretty close, especially libertarian writers.

In
the end, if we could just let go of our precious and profound co-dependent
faith in the omniscience and omnipotence of the state, once reserved
in our civilization for God alone, we might see that licensing professions
is the codification of mediocrity. The most able and the least able
are granted equality by the state, and the devil take the hindmost,
who are us, the consumers. We pay for it. The license? Abolish it.

April
21, 2001

Robert
Klassen is a medical technician and writer. Here’s
his web site.

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