It's not at all uncommon to go to the doc knowing exactly what he's going to do, exactly what he's going to say, and exactly what prescription he'll give you, why waste all that fucking time and money just so the guy in the white coat can tell me what I already know?

I want to go to a doctor when I don't know what's wrong with me, not when I do.

  1. Access to prescription drugs which are not safe.
  2. Access to specialized equipment.
  3. Access to highly skilled people to do something you can't do safely.  

PS: If it's really safe for you and society then you can buy it over the counter. Do you really think it's a good idea to change this?

Yes. If a drug is not safe for the user, it should come with a warning about the risks involved. Choosing whether or not to accept those risks to get the potential benefits of a drug is up to the individual.

I'm more open to the idea of gatekeepers for drugs that can harm others. Antibiotics are the obvious example. Sure, require a prescription for antibiotics, but first let's get them out of animal feed.

Why? Seriously, all drugs should be OTC because it simply shouldn't be the governments job to protect me from myself. The government should have no say about what I choose or choose not to put in my own body. I can go to the store and pick up enough alcohol to drink myself to death in a matter of hours and that's OK, but pills require special treatment and protection? Bullshit.

Drugs should be clearly labeled with warnings, side effects, all pertinent information a person needs to make a decision. The only exceptions would be things like antibiotics because there's a valid reason to restrict their use and it benefits everyone to do so.

Doctors can still tell me what drug I should take, and in what dose, but they shouldn't be at all involved in my obtaining those drugs. If I go buy a bunch of morphine and overdose and kill myself, well... that's called natural selection, and it's a good thing. If you're really concerned about making sure people are informed, mandate that the pharmacist brief people of the issues.

The very notion of prescription drugs is just absurd really, we've just gotten so accustomed to the nanny state that we don't notice just how absurd it is. Many family doctors are little more than state approved drug dealers these days. Patients know what they want, they know what to say to get them, and doctors are more than happy to write them, so long as their pockets are lined with regular and mostly unnecessary checkups to do nothing more than refill a prescription.

Yes, many drugs are very dangerous and an overdose could easily kill you, guess what, so will an overdose of gasoline. So will an overdose of water, or diet pills, or hundreds of other OTC stuff. Things shouldn't be illegal because they're dangerous if you misuse them, that's not freedom.

> 2. Access to specialized equipment. > 3. Access to highly skilled people to do something you can't do safely.

Which are valid reasons to actually go see a doctor. I can't cat scan myself or operate on myself.

It takes a fucking lot of training to have any clue what's safe to take in what dosage once you start mixing a few drugs. Put all that stuff out on the shelf and tens of thousands of people will die every year. But hey, if you still think that's a good idea feel free to convince other people.

You're ignoring my central point, I didn't say it wouldn't be dangerous, I said it's not the governments job to protect a person from himself. People would learn fairly quickly that it's stupid to just buy a bunch of stuff and mix it, and as I said, doctors and pharmacists can still inform people of what they should take and what not to mix stuff with.

Our current system artificially makes doctors into an extremely overly paid government sanctioned artificially limited monopoly. This keeps the price of health care artificially high, it's a protection racket using people's own health against them to forcefully take their money. Being a doctor should be a way to help people, not a way to become a millionaire. People should be enabled to treat themselves, doctors should be a choice we have, not a requirement forced upon us by the law.

The fact is people already self medicate, that's how it's always been and that's how it'll always be, but they shouldn't have to go to Mexico, Canada, or their local drug dealer to get what they want, they should be able to just go to their local pharmacy.

It is the government’s job to protect people.

Mixing the drugs people take for fun, with drugs people take for their heath is a straw man argument.

Total heath care costs in this country have little to do with how doctors prescribe drugs. Changing how that works on a fundimental level is a high risk change for little payoff.

No it isn't, I don't have to go renew my license every third time I fill my tank. If long term prescription came with unlimited refills that didn't require more trips to the doc, I wouldn't be complaining.

> It is the government’s job to protect people.

From other people, and from outside invaders. Situations where there is a victim. It is not the governments job to protect me from myself, I cannot be my own victim. Well, this is how it should be in a free country, something we clearly aren't anymore.

> Mixing the drugs people take for fun, with drugs people take for their heath is a straw man argument.

Drugs are drugs, and what you call recreational drugs many of its users would absolutely say they take for their health, both mental and physical. It's not a strawman, you just don't like it. The fact is how the drug is classified is irrelevant to the issue of who owns my body and gets to say what does or doesn't go into it?

> Total heath care costs in this country have little to do with how doctors prescribe drugs.

It's one of many factors, I didn't say it was the biggest.

> Changing how that works on a fundamental level is a high risk change for little payoff.

Gaining the freedom to control your own body and not have a government decide for you is not a little payoff, freedom is worth any price.

For example, Iran does not have an epidemic of dying women due to OTC birth control.

I have no doubt that you and many of your colleagues are compassionate and well intentioned. But you also pay dues to an organization that has a political lobbying arm. This is of course, entirely understandable. Washington has a ton of power, power which can be used to steam roll you. Thus you support an organization that has a goal of looking out for your interests in Washington. It does so quite well. Too well, in fact. As a result of AMA lobbying, America has far fewer doctors than most other developed countries. The result is higher prices for consumers, and no evidence of better care. See: http://blogs.law.harvard.edu/philg/2009/04/05/the-futility-o... Again, I don't blame the doctors, I blame the design of the political system that creates constant factional fighting over the resources of the country, with some factions getting screwed and others doing the screwing. ( Oh Madison, how wrong you were ... )

Part of the way the restrictions of new doctors work is by restricting medical schools. This of course drives up the price of medical schools, sending doctors into massive debt. Frankly, there is no reason that doctors need four years of college on top of four years of college on top of four years of high school. I'm sure the whole thing could be compressed into eight years, as other countries have done.

For new doctors, loosening the barriers to entry would be a Pareto optimum improvement. Salaries would fall, but so would the costs of schooling. Overall the public would benefit without harming new doctors.

But existing doctors would get screwed, as you point out. To be fair, any reducing of the barriers to entry should include compensation for current doctors.

Every time a politician sneezes someone get screwed. You can't compensate everyone.

Really? I have read that the increases in the mean wage of doctors have outpaced or at least tracked medical inflation at least since Bush took office. Given that doctor salaries are a major component of health care costs, there aren't too many ways that that can not have anything to do with our national health costs.

In general, doctors in the US make close to twice as much as doctors in other rich countries, while enduring similar costs of living. Doctor salaries definitely aren't the whole picture--we also spend almost twice as much per patient on prescription drugs along with twice as much on bureaucratic overhead.

Drug costs:

The NSF funds a near majority of the drug research that is done in the US (and this doesn't include much of their basic biology research even when it later proves crucial for drugs), and meanwhile drug companies spend close to 50% of their budgets on sales and marketing. Of the research that they do carry out, a large portion of it is on developing clone drugs to get around other drug companies' patents. Some portion of their research budgets also go into things which in a sane world I could have categorized under marketing and sales without drawing comment: stuff like cures for baldness.

Overhead: I don't know a lot of details about why the bureaucratic overhead is so much higher; I've heard some handwaving on lawyer costs involved in eeking out payments from estates during medical bankruptcy, the costs of dealing with multiple insurers, etc., but I haven't seen any hard numbers itemizing these things. I do know that malpractice isn't a significant part of it: around the time Bush came into office touting his catch-all solution to the problem of rising health care costs--malpractice reform--the ratio of malpractice judgments in dollars to national health care spending was around 0.60%. I don't know if that included settlements, but there is a pretty decent upper bound on what settlements/judgments could have been in total: the ratio of the amount spent by doctors on malpractice insurance premiums vs. national healthcare spending was 1%.

But, I can't go discuss a problem with my pharmacist then buy a generic. And, I would be surprised to hear I can go directly to a specialist, even if I pay cash instead going through insurance. Just saying, it's difficult.

They can, actually. All of the more common antibiotics are marketed for use in fish tanks and can be bought with no prescription from aquarium stores or ordered from Amazon. Looking up the markings on the pills shows them to be exactly the same pills you'd get from a pharmacy with a prescription.

Of course, you should have a pretty good idea of what sort of bacterium you're infected with before you take antibiotics. If you live with two people who are diagnosed with strep throat, and your tonsils swell up a day later, you probably don't need a culture to tell what you have. Don't abuse antibiotics.