Medical Protectionism

One of my co-workers broke his glasses yesterday. He couldn't get them replaced immediately because of a Washington state law (I don't know whether Oregon has a similar law) that you cannot buy eyeglasses without a recent prescription. He hadn't been to an optometrist in a long time, and didn't have one.

Hearing of the law when he went to a glasses-in-an-hour place, he wanted to see an optometrist immediately, but it was late and none were still open.

His situation affords me the opportunity to complain about two kinds of anti-consumer government interference in the health care market: Prescription and licensing requirements.

No one should be legally required to have a prescription to purchase eyeglasses, period. As an advocate of freedom I'll go further and claim that no prescription should be legally required in any circumstance whatever; I fully support the right of individuals to self-medicate. Prescription requirements are a form of rent-seeking by the health care industry — you have to have an appointment to get one, so they make money.

Prescription requirements will no doubt be defended on "safety" grounds, but the case of eyeglasses is transparent (heh) enough to expose the lie. It's easy to evaluate whether your corrective lenses are doing their job. If you can't see well, you'll know it, and a legal requirement adds nothing to your own motivation to have clear vision.

My co-worker had to find an old pair of glasses to wear. Those old lenses are less effective and leave him with worse vision. The legal requirement to have a prescription has made him less safe by delaying his purchase of new glasses. What was the reason for that requirement, again?

He has no medical need to see an optometrist. Only an artificial legal need to see one. He already knew his prescription; why should he have to pay someone to tell him something he already knows?

And yet, despite his willingness to nonsensically see an optometrist immediately, he couldn't. Their office wasn't open. They don't have customer-friendly hours because they don't have enough competition … because of state licensing requirements, another form of rent-seeking.

The "safety" argument is more convincing at first blush for licensing than for prescriptions, but it's still wrong. You're supposed to imagine irresponsible quacks peddling bogus medicines, but again especially in the case of vision correction the consumer is completely capable of evaluating the quality. A bad optometrist will lose customers to better ones. Even when the quality of care is difficult for customers to evaluate, private rating agencies could clearly substitute for state licensing, and then anyone who insisted on having an "approved" doctor could simply select one from their list.

The only advantage of state licensing over private rating is that licenses are administered by the state, and the state makes it illegal for anyone who doesn't have a license to practice. State power is used to artificially reduce competition, thereby increasing the incomes of the smaller number of practitioners. They tell you it's for safety, but it's really protectionism.

If optometrists had to compete more aggressively, some would succeed by offering customer-friendly hours, such as the late evening hours my co-worker needed. Licensing is anti-consumer — and anti-safety as well, because again this delays my co-worker's purchase of new glasses!

Prescription and licensing laws should be abolished. They increase costs, inconvenience consumers, and are antithetical to the free market.

Interestingly, Warren wrote a similar story a few days ago. From his comments I learned that, unsurprisingly, you can buy vision correction products in Taiwan without a prescription.

P.S., since my co-worker asked, my last pair of glasses (bought at Binyon's) cost $234: frames $72 and each lens $81. My lenses are very strong and I also sprang for the premium coatings after being bothered by lots of scratches on my previous pair. My price was after a large discount that I have no reason to believe they don't automatically give to everyone.