Health Care and Cost, in McArdle's* comments

But who is doing your biding? When you go to work, you get paid so you do the 'bidding' of the employer. So, as in the example I give below, if a surgeon could certify that an assistant could do an operation, then presumably the surgeon can do it for less because he could be doing something else. If the state rules that he cannot, then the state is raising your costs. Or is it when the state mandates a 'maximum wage' for a pharmaceutical or a procedure that it is doing our bidding. A part of our cost structure is mandated basically quality controls which may or may not be excessive but they certainly are costs. Could states do those differently, thus lower costs while still allowing people to own their labor, selling it at a market price, and be doing your bidding?

It wouldn't be hard to cut spending by 30%. You could allow PA's or NPs to do surgeries if a board certified surgeon said they had done that surgery successfully 15 times (under their 'supervision') for instance. But you run into an interlocking set of desired quality controls and cost factors. Former president Clinton's statement that abortion should be 'safe, legal, and rare' is something of an allusion to that. It wasn't that people couldn't get abortions but the quality control was poor.

*Link http://www.thedailybeast.com/articles/2013/02/04/the-technocratic-dilemma.html