I reminded of the title of Karl Popper’s famous book when I read about current political developments. In America, both parties are increasingly hostile to an open society. According to Jon Hartley, things look much better north of the border:
Poilievre’s conservative economic-policy platform — largely built on zoning reform to promote housing affordability and on occupational-licensing reform to get skilled immigrants to work — have handed his party a significant lead in the polls. . . .
Poilievre’s conservative plan directly confronts the tight local and provincial land-use regulations. These regulations prevent new housing construction in many Canadian cities, and that in turn spawns skyrocketing housing prices, making it nearly impossible — especially for younger voters — to own a home. . .
As a result of Poilievre’s plan to withhold federal infrastructure funds from municipalities that don’t hit housing supply-growth targets that cheapen housing, young voters, an almost universally progressive demographic, have been miraculously galvanized to support the Canadian conservatives. . . .
Poilievre is also winning votes from legal Canadian immigrants by proposing occupational-licensing reforms that help such immigrants use skills previously honed in their home country that can’t be used in Canada because of onerous laws. For instance, Poilievre has proposed a “Blue Seal Test” for 20,000 Canadian immigrant doctors (many of whom currently drive for rideshare) to allow these doctors to practice in Canada, contingent on their passing a medical exam.
In the US, substantial portions of both political parties are opposed to “YIMBY” measures to boost housing construction. While some individual proposals are flawed, it’s telling that opponents tend to avoid offering alternatives. For many, a lack of new housing in their area is a feature, not a bug.
Canada’s conservatives are also far more supportive of free trade than either political party in the US. They are also supportive of Canada’s immigration policy, which admits about 500,000 immigrants per year. And that’s in a country of only 40 million, vs. 330 million in the US.
Many of the open society issues do not fit neatly on the left-right axis. It’s heartening to see Canada’s conservatives embrace this general approach, so different from what we see in the US.
PS. Speaking of Canada, this Bloomberg article caught my eye:
Legal Cocaine Is Coming, This Canadian Startup Predicts
Safe Supply Streaming begins trading on Canadian exchange
Company to push for legal drugs, invest in addiction clinics
READER COMMENTS
steve
Nov 18 2023 at 4:02pm
Hard to find details on the Blue Seal thing. There really is a lot of variation in the quality of foreign medical training. It’s hard to conceive of a single test that would adequately test the relevant knowledge and physical skills needed for all specialties. Seems like the kind of thing a professional bureaucrat would dream up.
Steve
Scott Sumner
Nov 19 2023 at 12:01am
“It’s hard to conceive of a single test that would adequately test the relevant knowledge”
The market?
Dylan
Nov 19 2023 at 9:28am
In Canadian healthcare?
Scott Sumner
Nov 19 2023 at 12:13pm
That’s the problem.
steve
Nov 19 2023 at 2:00pm
The market is a pretty incomplete answer. If you are suggesting just letting them practice and then see if they fail that has, I hope, obvious problems. How many bad outcomes do we accept before we dont let them practice? (I think what really happens is that insurance companies wont pay them, they cant get malpractice insurance and few would be willing to hire them. A much better alternative would be to have them work in a supervised apprentice program for a while.)
Steve
Scott Sumner
Nov 21 2023 at 3:29pm
“I think what really happens is that insurance companies wont pay them, they cant get malpractice insurance and few would be willing to hire them. ”
So are you agreeing with me?
MarkW
Nov 18 2023 at 8:04pm
There really is a lot of variation in the quality of foreign medical training. It’s hard to conceive of a single test that would adequately test the relevant knowledge and physical skills needed for all specialties.
I know personally of a foreign MD who came to the US to do a fellowship (advanced training in a specialty). When he finished it, he decided wanted to stay and practice in the U.S. so he had to do a U.S. residency (basic training) alongside a bunch of newly minted Med school grads. He was lucky to be able to get a residency slot at all (and in doing so, pushed somebody else out of a slot that year). What we’re doing now is insane (unless your goal is to limit the supply of MDs and drive up salaries).
steve
Nov 19 2023 at 2:40pm
I have been doing this for a long time. I know FMGs who were total failures once they got into a US program even after they had done complete training in their home countries. I have FMGs working for me who are outstanding docs. The reality is that medical training is highly variable across the world. I think ware too careful with people from countries who have consistently good programs. So if a Canadian doc comes here (or vice versa) I dont see the need for more training. However, for most any 3rd world country and most others I think we need some period of supervised work to make sure they are competent and have adequate language skills.
The market component you could add in would be to allow training programs to decide the amount of time they need to assess people. Take India and China for example. People who train at their best programs are pretty good. People who train at their weakest programs pretty bad. Let programs decide if they want to have shorter assessment periods for people from better programs.
About 20%-25% of US docs are foreign trained. Language skills do cause issues. So there is some percentage at which I think departments dont function as well. There is a lot of unmet demand so you would need to bring in a ton more FMGs before you see salaries drop. Next, the money that docs control far outweighs their salaries so total health care spending will be massively increased. If you do knock down pay then the FMGs will be less likely to come.
Steve
MarkW
Nov 19 2023 at 6:07pm
So if a Canadian doc comes here (or vice versa) I dont see the need for more training.
Agreed. We should have both pharmaceutical and medical professional licensing reciprocity with Canada, the UK, the EU, Australia, and Japan at least.
john hare
Nov 20 2023 at 4:11am
Next, the money that docs control far outweighs their salaries so total health care spending will be massively increased. If you do knock down pay then the FMGs will be less likely to come.
These are some critical issues. Virtually everyone knows of visits in which the bills seem to bear little resemblance to the care received. If the doctors were getting paid the amount billed, they would be making tens of millions of dollars a year for their work. The ones I know personally do well, but not that well.
I have a favorite walk in clinic that is $150.00 pay in advance with cash. Minor stuff obviously with extras for x-rays and such. I know of people spending many multiples with insurance at the ER for similar issues.
Peter
Nov 18 2023 at 11:51pm
Mark,
You are missing that until quite recently, and I think still in one or two states, you didn’t need a formal education to be a medical doctor nor even residency, you only had to pass the licensing exam. This was allowed as a way to ensure rural doctors who raised their kids as doctors for generations could practice given at the practitioner level they were just as competent as the degree milled doctors. It also provided an avenue, which is relevant here, for foreign doctors to get licensed.
The fact we now require unnecessary schooling is the root problem and it’s an easy fix.
Jeff
Nov 19 2023 at 1:58am
It was as it should be—I see no good reason why educational tests for licensure should be treated any differently than religious tests. Professional schools should enjoy success in the marketplace to the extent that their courses are useful in preparing candidates for challenging exams that are equally open to all comers.
steve
Nov 19 2023 at 2:11pm
What you are talking about is a GP, general practitioner. They are pretty much non-existent now as there isnt much of a role for them. Might as well use a nurse practitioner.
Steve
Thomas L Hutcheson
Nov 19 2023 at 11:36am
Certainly the Canadian Conservative reforms are good, but “open society usually applies to things like free speech, xenophobia, religious/ethnic tolerance not pareto optimal economics.
And come on! Land use and merit based immigration reform is a much bigger (or less tiny 🙂 issue among D’s than R’s. I’d even say that about trade issues, although there bot are soo bad that tiny degrees of less badness are pretty irrelevant.
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