The Flexner Report’s Stranglehold on Health Care
Congressman Ron Paul recently gave a speech on the House floor covering the topic of health care. In it he brought up the Flexner Report, an item that few individuals have even heard about that is worthy of much more attention than it currently receives.
“A lot of problems were created in 20th century as a consequence the Flexner Report (1910), which was financed by the Carnegie Foundation and strongly supported by the AMA. Many medical schools were closed and the number of doctors was drastically reduced.” – Ron Paul; September 24, 2009
The seeds of the Flexner Report were planted in 1908 when the Carnegie Foundation for the Advancement of Teaching commissioned Abraham Flexner, a high school principle, to research and report on medical schools in the U.S. Flexner himself was not involved in the medical industry, but after being asked to take on the report he researched and grew fond of the medical systems in England, France, and Germany.
In the report, which was officially published in 1910, Flexner called homeopathic schools “a striking demonstration of the incompatibility of science and dogma.” What’s curious is that Flexner points out that between 1900 and 1909 homeopathic schools decreased from 22 to 15 and students within the schools decreased from 1,909 to 1,009. Flexner uses these figures to conclude that “the rise of legal standard must inevitably affect homeopathic practitioners.” In short, even with the marketplace whittling out the unproductive and unsustainable homeopathic colleges (or any colleges, for that matter) that Flexner clearly did not appreciate, he still advocated increased government intervention to further clear out homeopathic schools.
Flexner believed the problems in medicine were primarily because there were too many doctors and medical colleges. “The country needs fewer and better doctors; and…the way to get them better is to produce fewer.” The flaws of Flexner’s arguments and his general report is that he may indeed have made some noticable observations, but he did not consider the economic consequences of increased government intervention, a centralized medical system in the hands of the American Medical Assossiation (AMA), and the impact of fewer doctors and medical schools.
Basic economic common sense tells us that when you forcibly remove one product without subsequently lowering demand, you will increase the price of that product. Less supply without less demand means higher prices. The homeopathic schools that Flexner so strongly criticized may have lacked in some areas of educational standards compared to more traditional health schools, but they provided a key element of competition for allopathic medicine and an essential choice for individuals who needed health care.
Basic economics also tells us that weak products and services are bound to fail to the competition due to inefficiency and poor judgment. As I previously mentioned, Flexner’s own research displayed that homeopathic schools were struggling to stay open and maintain steady attendance. Their services had difficulty competing in some cases, and those schools (or services) disappeared or were in the process of failing.
The publishing of the Flexner Report in 1910 led to many educational reforms. Among Flexner’s final proposals included extending years spent in health education (two years in undergraduate collegiate studies and four years in medical school), increasing the caliber of medical schools to universities, expanding government involvement in medicine, decreasing total graduates to 3,500 from 4,500, and bringing the total amount of medical schools in the U.S. from 150 to roughly 31. In short, Flexner proposed a medical system driven not by the free market and individuals, but a manipulated system molded by some of the wealthiest men and foundations in the world. In fact, the Rockefeller Foundation donated large sums of money to schools who followed the model recommended by the Flexner Report.
One of the unfortunate impacts the Flexner Report had on medical education was the shut-down of many schools geared toward disadvantaged rural areas, African-Americans, and women. Because of mandated school time regulated by the AMA and state governments, only those wealthy enough to afford at least six years of college had a chance at becoming a licensed doctor. This essentially limited the market for prospective doctors to wealthy white males. (All but two African-American medical colleges were closed.)
The flaw with the Flexner Report is the same flaw that has brought us to today’s broken medical system. When a product is forcefully limited to be provided by a certain central group (in this case the AMA), it will reduce choice and competition. Choice and competition in a free marketplace are what drive businesses to become more efficient and productive, which provides the greatest possible benefits to individuals who are able to freely buy and sell in the market. A strong, sustainable system built for individuals cannot come from a manipulative central source, it must come from the demands and choices of the people whom it is intended to help.
Government regulatory standards do not necessarily serve the individual as many people believe. In the case of medical care, the Flexner Report recognized many flaws with education that the free market was already weeding out on its own. Rather than allow people and communities to make their own choices with doctors, medicine, and education, it was all placed in the hands of the AMA and state governments, thus limiting the supply. This resulted in less doctors, more expensive education, and decreased access to medical care.
A central system concentrates power into the hands of a select few individuals, groups, and organizations who have the means to control that respective market. A free market divides that power among individuals who have the ability to make their own decisions themselves and through their communities.
Concentrated control, as proposed and implemented in the Flexner Report, is the direct cause of the majority of problems with health care today. The solution does not lie with more government intervention and centralized power, but rather with increased individual freedom. The answer is not centralized power in government, but centralized power within ourselves.