Rebecca Haw Allensworth is a David Daniels Allen professor of law at Vanderbilt Law school. She is the author of The Licensing Racket: How We Decide Who Is Allowed to Work and Why It Goes Wrong.
In this week’s conversation, Yascha Mounk and Rebecca Haw Allensworth discuss why one in five American workers need a professional license, how licensing boards create modern guild systems that exclude immigrants and limit mobility, and whether these requirements actually protect consumers or just insiders.
This transcript has been condensed and lightly edited for clarity.
Yascha Mounk: When people think about professional licensing boards and the need to get a license in order to practice a profession, they probably think of doctors and lawyers, perhaps a couple of other professions. That is something of a misapprehension. There is a much greater number of professions, and a much greater share of the workforce than one might imagine, that are actually subject to these kinds of licensing requirements in the United States.
Rebecca Haw Allensworth: That’s right. My research shows that about one in five American workers has to have a professional license, which I define as a state-granted permission to do your work, obtained after some significant investment in education or a test. We’re not talking about taking a CPR course over a weekend to become a coach. We’re talking about going to a year’s worth of school to cut hair, for example.
Even with that kind of narrow definition of professional licensing, we’re talking about tens of millions of American workers—more people than are in unions in the United States, way more than are subject to the minimum wage. I say professional licensing is basically the most important regulatory institution we have.
Mounk: Fascinating. Tell us some more of these examples. What are some of the more absurd examples of professions where you need to have this extensive training, this extensive regulatory process, in order to be admitted into—let’s call it what it is—a guild?
Allensworth: The most ridiculous one is actually one that we’re very familiar with, which is the hair profession. To become a barber, you have to have more hours of instruction than are in law school. You have to take a full year, nine to five, to do your education. You have to put ten to twenty thousand dollars down, sometimes put it on your credit card, live with a family member, not earning any money—and all that just to cut hair.
The licenses for barbering and cosmetology are sort of brother and sister professions and are very similar. Then there are the ones that you don’t think of as being licensed—that aren’t licensed maybe in every state. Until recently in my state, you had to have a license to install alarm systems, even just ones that you bought at Costco.
Mounk: We’re not talking about a concert hall or anything like that. We’re talking about putting up a couple of extra alarm systems in your private residence, and you need to have a license for that.
Allensworth: The kind of thing that you would be perfectly allowed to do in your own residence. If you install one for your neighbor one time, you’re in violation of the licensing law.
Mounk: For pay or even if you do it as a favor?
Allensworth: Most of these are not to do with pay. Most of them cover even doing it for free, which is still considered to be providing the service. Of course, if you’re not doing it for pay, maybe the board will try to go easier on you. But as my research shows, sometimes the investigative and prosecutorial staff want to go easy, but the licensing board doesn’t even let them. So usually there’s no carve-out for doing it for free.
Mounk: What’s interesting here, thinking of this in comparative perspective, is that some of these professions are probably licensed everywhere, with differences in the precise details of how that happens. One interesting thing is what the Anglo-Saxon jurisdictions do, where they tend to have private bodies with some kind of official standing. It’s not directly a state institution that licenses lawyers, for example, whereas in Germany or France it would probably be a state-run institution that does that.
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For something like a barber, a lot of the continent would have a kind of apprenticeship system, which is a very different thing. Perhaps that shouldn’t be necessary either, and it might not be as permissive as it should be, but you’re getting on-the-job experience and earning some limited amount of money while you’re doing it. What we’re talking about in terms of barbers here is going to barber school for a year, paying tuition, not actually on the job, not earning. What does that look like?
Allensworth: In a lot of these cases, you’re still cutting hair and earning money for the school. So you’re actually in some ways paying the school twice: the tuition, and also the income they get from the people coming in to get their hair cut. It is different from an apprenticeship system. In America we have a few apprentice-based professions—tattoo artists, at least in my state, are apprentice-based.
But I would also note that even where you’re nominally making money on the way to your training, it can be really burdensome. An example in the United States is therapists. Therapists graduate from their degree program, usually a master’s, sometimes a bachelor’s degree. They take their exam and then have a provisional license that isn’t a real license. They have to do hundreds, sometimes thousands of hours of supervised therapy during which they’re making very little money, paying high fees to their supervisor who isn’t really doing a lot of work. This can be so daunting that we’ve learned almost half of people who go through the requisite education to become a therapist don’t go on to get their license. It’s just too much of an effort to go through that effectively-apprenticeship program.
Mounk: On the plus side, it’s a good income scheme for people who are qualified therapists, because they have all these aspiring therapists to supervise.
It’s fascinating. I wonder what the shape of the picture is. What percentage of all therapy provided in the United States is being delivered by aspiring therapists? Probably not that high, but it’s fascinating.
Let’s start perhaps with more standard professions and then work our way down to some of the ones where we’re more surprised. Even in the professions where we might agree that licensing is necessary, there are real problems with this system. Take doctors, take lawyers. Broadly speaking, I agree that we do need licenses for them. But part of what that allows is for these bodies to regulate how many lawyers and particularly doctors there are. One of the reasons why medical care is so expensive in the United States, and particularly one of the reasons why the United States actually has a strikingly low number of physicians per capita in international perspective, is that there are extremely onerous requirements for qualifying as a doctor. It’s very hard to found new medical schools in the United States, and incredibly hard to get into medical school. There’s a need for more doctors, but it’s incredibly hard for even big existing universities that don’t have medical schools to get medical schools approved, in part because the boards licensing physicians have a self-interest in keeping the number of physicians down, because that’s what keeps salaries up.
Allensworth: The role of state licensing boards, which is mostly the focus of my research and the book, in approving new graduate seats in programs is actually pretty limited. The bigger problem really is residencies, and that goes to other regulatory systems, including the AMA, that are very similar to the licensing system—it’s just not really what I wrote about.
What I would say is that they work hand in hand. The AMA and these other licensing systems are keeping down the number of American graduating physicians, while the boards are making sure that foreign medical grads can’t get their license and that no exceptions will be made, no loosening up of practice requirements that might, for example, allow nurse practitioners to do some things that doctors might otherwise do.
They’re similar problems, but a little bit different, because it’s not the state medical boards that are determining what the approved schools or residencies are. But they all have the same mentality, and they are all, at bottom, organized by doctors. The boards are on the back end making sure that nobody does an international end run around what the AMA and other regulators have done.
Mounk: This is a problem that turns up again in lower-level professions as well. You’d think that part of the better outcomes of integrating immigrants in the United States compared to Europe is that America is more flexible: you can show up and on your first day drive Uber, and relatively quickly enter some other kind of profession. So it was surprising to learn how big the obstacles are even in many relatively blue-collar, working-class, middle-class professions. You can have been a hairdresser for 30 years in your country of origin, arrive in the United States, and in many states you can’t go and be a barber the next day.
Allensworth: There’s some reciprocity between states, but even that is pretty limited. As for international reciprocity in a profession like hair, there’s not much at all. Most countries don’t require the hundreds, sometimes thousands of hours that we require of a profession like cutting hair. It really tends to impact the lower-income professions, professions that would be good places for somebody who’s just starting out in the United States. Maybe they don’t speak English particularly well, so they’re going to go into a service-based profession where they don’t have to speak the language so well. Beauty would be a good example. We’ve seen time and time again licensing boards taking steps to keep those people out.
Some people think that licensing is progressive because if you have a license, you tend to have higher income and better working conditions, and that’s true even in the lower-income professions. But it’s actually regressive because within those communities, within those groups, it gives advantages to the ones that already have those advantages.
Mounk: I hadn’t even thought about the problem of reciprocity in this context. I’m obviously aware of it for lawyers, where some state boards have mutual reciprocity but a lot don’t, and that really limits the mobility of lawyers across state lines. I did not think that would be true of barbers: that if you are a barber in Tennessee, you may not be able to move to Michigan without having to retrain for a year or something like that.
Mobility in the United States has really gone down—people move a lot less now than they did 50 years ago, which goes a little against the intuition people have about those kinds of trends, but which is well documented. I wonder whether those kinds of rigid licensing requirements play a real role in that. If you’re a barber making a lower-middle-class income in one state and for whatever life reasons you need to move to a different state, you may be constrained from doing that because you’d have to give up your profession or go back to school for a year.
Allensworth: The reciprocity issue is a big problem with the lower-income professions too, and it’s especially problematic when you don’t have a lot of infrastructure behind you to help you figure all this out. If I’m a physician and I work for a health group at the border of Tennessee, North Carolina, and Georgia, my employer is going to handle all of that for me. I’ll have some assistant who’s responsible for figuring out all the continuing education I need to do every year, renewing my license—I’m not really going to see any of that. That’s an economic waste that gets passed on to patients and consumers, so it’s not great. But professionally, it doesn’t impact me as much.
I saw a case of a barber who was trying to move from Michigan to Tennessee and couldn’t get his license because Tennessee insisted on an English-language exam. He couldn’t pass it because he was not a fluent English speaker, but he had been cutting hair for many years, including in the military, and he had a license in Michigan—which he had obtained using an interpreter to help him understand the language. That was just a no-go. He didn’t have an employer or sophisticated people trying to help him through the process.
Mounk: I said earlier, in a slightly glib way, that these are really just guilds. This is the way that guilds have historically worked: it was incredibly hard to get in, and the point of making it incredibly hard to get in was to provide members with insider status, to make sure they wouldn’t have too much competition, wouldn’t have to change their methods too much, and could keep their salaries up. Is that the right analogy? Do you think this is basically a modern reenactment of the medieval guild system, or is that a misnomer? Obviously many guilds had hereditary elements that the new ones don’t, so there are going to be some important distinctions. But is that a helpful way of thinking about both the incentives at stake and the negative externalities, or not?
Allensworth: It is a helpful comparison and I think it’s apt, as long as we understand it as an analogy—it’s not a perfect one-to-one. As you pointed out, there are some differences. But some of the important things to keep in mind is that it is an inside-versus-outside mentality, and the psychology is very similar. I didn’t hear members of the profession or people on the board talking a lot about money and their bottom line, although I did sometimes. More often I heard them talking about identity and prestige, the importance of their work, and how not just anybody can do it. I think that is a major holdover from the guild perspective, where it really was about belonging. It was hereditary, but the same idea: we are in this group, we are in this family, this is what we do. Many of the benefits to members are very similar: higher earnings, less competition. It’s hard to get in, and once you’re in you’re kind of made. So I do think it’s a useful analogy.
Mounk: Part of the problem is that outsiders have a very hard time getting in. Medieval guilds often required you to be born into the right family—that’s not the case today, but there are these cumbersome barriers: you have to go to barber school for a year, which may be economically prohibitive, or go through years of supervised therapy, and many people drop off at that point.
The other idea, of course, is that you protect the insiders. In the medieval guild, if you’re the son of somebody who’s in the guild, you may not have any particular talent at that trade, but you’re going to be grandfathered in. You argue that there’s a kind of equivalent of that today as well, in the sense that even as these licensing boards make it incredibly hard for outsiders to get in, once you are in, you’re kind of set—often whatever you do.
Allensworth: That’s right. This was the most shocking part of my research, at least to me. I went into it with the idea that there’s going to be a lot of red tape, much of it unnecessary. I’m an antitrust professor, so I was looking at this through the lens of competition: they’re going to want to keep competition down, profits up. If you think about it that way, maybe when it comes to discipline, when a doctor or a lawyer does something wrong, you’d think they’ll be really hard on them, because kicking them out means one less professional to compete against. I saw the opposite. The self-regulation at the heart of these licensing boards resulted in second, third, fifth chances for practitioners who were just really incompetent and unsafe. That was harder for me to understand.
Mounk: Give us some examples, because from the book you’re not talking about somebody who gave a bad haircut once, or even had a safety violation once that is more concerning but was a one-off. You’re talking about people with a sustained pattern of blatantly illegal or blatantly immoral behavior.
Allensworth: I have so many examples it’s hard to pick one, but I’ll give a couple that illustrate it well. One is a real repeat offender. There was a doctor who was found to have a lot of marijuana in his home for sale, along with a bunch of drugs that he had clearly taken home from the hospital, either for recreation or because he was addicted to them. He took a state charge for it, pled no contest, and went on probation with a license. This is also a pattern I saw where the criminal system acts first, even though you would think the threshold for licensing action is lower—it’s easier to get a state conviction than to have real action on your license.
The board, in response to this state criminal charge, put him on probation and mandated that he go to addiction treatment, as he was evidently addicted to benzodiazepines. While on probation and without the authority to prescribe opioids, which he had lost in that action, he found an end run: he had pre-signed scripts from a buddy, which he used to sell prescriptions for opioid use disorder medication and benzodiazepines out of his car for around three hundred dollars apiece. Totally illegal.
Mounk: Out of his car. God forbid a foreigner who’s arrived in the United States cut somebody’s hair, or your friendly neighbor help you install an alarm system—but giving people opioids or serious medications out of a car is totally fine with a licensed physician.
Allensworth: Keep in mind he’s on probation with the board. This is his second chance, and this is what he does with it. This is not just a violation of the licensing law—it’s a federal crime. He can’t plead no contest to federal charges; he’s going to have to do some time. In the face of this, the licensing board gives him another chance, and that chance looks an awful lot like the first: more supervision, more probation, please don’t do it again. He then finds another scheme, this time selling fraudulent COVID tests door to door. It’s a second opinion on COVID: if you have a positive test, he’ll sign a doctor’s note saying you don’t.
Mounk: Presumably, in order to be able to travel or do whatever.
Allensworth: Yes, travel—and this was high COVID, pre-vaccine, back when a positive test had real consequences. This is somebody who has manifestly no respect for the licensing board, no sense that it’s a real regulatory body. He’s kind of right: nothing really happened to him until he was finally sentenced to prison on the federal charges.
That’s one example, and he was a real operator—he found an angle on everything. But at the end of the day, I’m not sure he really hurt people. I also saw doctors who really hurt people get second chances. There was an OB-GYN who sexually abused eleven of his patients, traded sex for drugs with them, used drugs on the job, had extensive malpractice associated with his OB-GYN practice, ten peer reviews at the hospital, one stillborn baby. He got his license back. As far as I know, he still has one.
Mounk: A lot of the dynamics we’re talking about could be explained by Econ 101, or perhaps Econ 102. You have a club, that club is going to try to maximize benefits for its members, and it’s going to try to restrict access because if everybody can get in, the benefits for each member are going to be diluted. That explains why you make it really hard for an immigrant from Ghana or from Kyrgyzstan to become a hairdresser, and it explains why you want to maintain this licensing regime. Probably some of the people involved in the profession are also the ones running the barber schools, which explains why you want extensive requirements. All of that makes sense.
But on the discipline side, as you’re saying, there’s actually an economic incentive to throw people out of the profession. You might also think there’s a reputation management incentive to do so, since bad actors reflect badly on everybody. On the other hand, it makes sense that once you’re one of us, we’re going to protect you no matter what. You see that in other contexts, like police unions: once you’re a member of the club, the solidarity is unconditional. So how counterintuitive is this from a theoretical perspective? What does it tell us about what’s driving this behavior and how we should think about it?
Allensworth: This is harder to understand than the other side of things, the too-much-red-tape observations. You could tell an economic story, and I think the economic story is present when it comes to the associations. These associations are groups of professionals whose whole reason for existing is to protect and promote the members of the profession. This is not really supposed to be a public protection function. They want what’s best for doctors and lawyers, and what’s best for doctors and lawyers is having the most benefit of the doubt when they’re accused of something, having the most due process.
The reason why those more economic incentives work at the board level has more to do with psychology and sociology than economics. The associations provide the boards, which are made up of everyday working professionals who are not deeply expert in their field beyond what they are clinically competent to do, with narratives all about second chances and forgiveness. It’s also, ironically, about access to care and access to justice in the legal profession. If you take this guy out of circulation—and this was an important consideration in the OB-GYN case—he worked in inner-city Memphis, he worked with TennCare patients, which is the state’s Medicaid program. If you take him out of circulation, that’s a bunch of women who aren’t going to have any care. These narratives pull at the heartstrings of board members, and they also reinforce a sense of professional identity: don’t let someone else tell you what our profession is; we are the only ones competent to say what this profession is. So a little bit of psychology and a little bit of sociology, with some nudging from the associations.
The last point is that this was especially problematic in medicine, and I think it’s because doctors care a lot about making people better. They’re likely to see problems as attributable to sickness. Most of these physicians had struggles with substance use disorder, and so there was this temptation to see the whole problem as treatable, as fixable, even when they had really betrayed the trust of their patients.
Mounk: It would be interesting to dive into this case a little further. Given some of the things I know about the medical profession, including some of the behavior of the American Medical Association in recent years and some of the broader cultural trends among highly educated, affluent Americans, I wonder to what degree there’s also just ideology involved. The thinking that you can’t blame people for any form of addiction—which in itself I agree with—even when it leads them to act in highly dangerous and unprofessional ways. The argument that he’s treating a lot of women in poor inner-city communities is fair enough if he’s treating them well, but evidently he was not treating them well. This seems to me frankly like a bunch of identity politics and other forms of slightly credulous progressive ideas making it hard to exercise judgment in that context. Would that be fair to say about this case, which you know much better than I do, or do you think that’s not part of what’s going on?
Allensworth: The identity politics part of that particular case does map onto this. There was a lot of what you said in the first half—the idea that people can’t be held responsible for their addiction and their sickness—that was definitely present. But if anything, it was sort of the opposite when it came to the second problem. The inner-city, dominantly Black population that are his victims aren’t really the kinds of people the board sees itself as there to protect. The board’s mentality is really more oriented toward the mainstream patient who has commercial insurance and goes to a well-regarded hospital. That’s the world in which the licensing board members operate. In a lot of ways, I think they were throwing the less privileged patients under the bus with this decision.
Mounk: I certainly agree that they were substantively throwing those patients under the bus. But the way you framed it earlier was that he’s providing care to these inner-city communities and we can’t deprive them of that care. That sounds to me like a confused argument driven by a sense of: who are we to tell these women what doctor to go to, and who are we to deprive this community of the lovely doctor who has scores of malpractice suits against him?
Allensworth: The irony, of course, is that they don’t have a choice. The farther you go down the echelons of medical care, and for that matter legal care—because this problem is not unique to medicine, it exists in law too—the less choice you have about your provider. That’s why I think a lot of troubled physicians and lawyers end up serving the underserved: if they have a troubled, checkered history, patients and clients either aren’t going to know that, or if they do know it, they’re not going to have much of a choice. That was another thing that was really surprising in my research that I don’t think a lot of people are talking about: the caste system we’ve created through the disciplinary system, where we take people who are very problematic to begin with and shunt them towards the most needy patients, clients, and customers who don’t have a choice, including working in prisons and, in the legal world, representing immigrants and indigenous people.
Mounk: I’m trying to think through what the devil’s advocate argument for the licensing regime would be here. Presumably some of this sorting would happen in any case. If you had no licensing regime at all, doctors and lawyers with a particularly good reputation would be hired by the best hospital systems, and those with a very bad reputation would end up providing services that others don’t want to provide because they’re less lucrative—and the same in the legal profession. The argument for the licensing system, even if it isn’t doing this perfectly, is that it at least provides some protection even for the least privileged segments of the population, and that in the absence of licensing you would get that effect more strongly rather than less strongly.
Allensworth: That’s true, but there’s a real irony to the structure of that argument. On the one hand, you’re saying we need licensing to protect the people who don’t know what they’re getting—which is true of a lot of professional services—or who don’t have a choice, which is also true of a lot of people who consume those services.
Mounk: If we had no legal licensing, the problem isn’t that when Bank of America needs to hire lawyers, they’re going to hire frauds. Bank of America is going to be a big and sophisticated enough organization to figure out which lawyers are good and reputable. The problem is if Joe Schmoe, or an underprivileged Joe Schmoe, is in desperate need of a lawyer, they might end up with a real huckster.
Allensworth: When we’re talking about raising barriers to entry and the red tape issue, we care a lot about quality and protecting people. We do that by creating all these barriers to entry and making the population of providers smaller and smaller, which isn’t necessarily good for the public because it makes those services more expensive, harder to get, more rare, harder to access in rural areas. But for the people who are able to get them, they’re going to be above a threshold. Except that then when it comes to discipline, you totally abandon that threshold, and abandon what seems to me like the most plausible justification for the licensing system in the first place.
Mounk: Which is to make sure that the doctor who clearly has a substance use issue, who’s clearly not acting in the interest of patients, who has a score of well-founded malpractice suits, doesn’t get to keep treating patients.
Allensworth: Let me give you another example. Let’s say you could make one rule that said nurse practitioners can work up to the scope of their practice—they can do a bunch of things that they can’t do in some states, including Tennessee, without physician supervision. You’re going to expand access to care for potentially a million people through one rule. Then later in the afternoon, you can see a disciplinary case for one doctor who, that we know of, has killed five patients by prescribing them so many opioids that they overdosed and died, not to mention the hundreds of others he did this to. You keep that one doctor in play for access to care. It just doesn’t add up. You can do so much more for the access to care problem on the rule side than you can on discipline.
Mounk: This is perhaps not directly about licensing boards, but it’s part of a wider system where we’ve delegated a lot of self-governance to members of a profession. My example, which went viral when I wrote about it, is that I went kayaking on the Connecticut River a good number of years ago and ended up losing my glasses when the kayak turned over. I needed to get new glasses, and it was so difficult. There aren’t a lot of opticians around there, and it takes a while to get an optical test. Everywhere in Europe, you can just walk into a store and say, make me glasses with this prescription. Either a store employee uses the same machines an optician would use to test the strength of your eyes, or you just tell them your last glasses were this strength and they make them. In the United States, you can’t do that.
I called for a lifting of those restrictions, the article went very viral, and I was denounced for spreading misinformation by the president of the American Optometric Association or some such body. This is exactly the kind of insider dealing at work. The people making the rules about when you can produce glasses are the ones whose livelihood depends on giving people eye exams all day long, and they will find arguments, however spurious, for why that is absolutely medically necessary, when very few other industrialized countries consider it necessary under the same circumstances.
What’s the cost of that? The cost is the marginal person who struggles to pay for glasses for themselves or their child, who delays taking their child to the optician when they can’t see the blackboard properly, who has to wear the same pair of glasses even as they’re falling apart and their prescription has deteriorated—because that extra cost of the eye exam is the barrier that stops them. It has a really direct negative impact. It’s good, if you can afford it, to go to the eye doctor every now and again and get your eyes checked, and opticians absolutely provide a valuable service. But to make it mandatory in this way is just out of all proportion to the trade-off.
In general, I think it’s a very positive feature of Anglo-Saxon societies that there are private bodies with a real ethos of self-governance, as an alternative to having everything directed by the state. But on balance, would it be more rational to have a state institution make those decisions, one that is less directly beholden to the interests of the profession? The disadvantage of the way this is set up in the United States, the United Kingdom, and most Anglo-Saxon jurisdictions is that you create a direct conflict of interest: the people making decisions about who gets admitted to a profession, and about things like what is required to prescribe glasses, are always members of a profession with a very obvious conflict of interest.
Allensworth: The whole book is really about this problem of conflicts of interest, of handing it over to the professionals to regulate themselves. We have to go back to the medical profession to see how this happened. Medicine was the first profession to really professionalize in the way I’ve identified, where they said: this is our profession, only we know what’s safe, what’s good, what’s real medicine, and so we are going to decide who’s in and who’s out. The key move was to then get the state to say that you can’t practice medicine at all without their say-so. Every profession has basically followed this model of self-regulation, using the state to back it up. Much as it may make sense that medicine is only fully understood by doctors, that does not change the fact that there’s a huge conflict of interest between what’s good for the public and what’s good for doctors. You need guardrails, you need government involvement to make sure this kind of self-regulation doesn’t go too far. Moreover, it doesn’t make sense to reproduce the medical model all the way down to every profession, including alarm system installers, where that kind of expertise doesn’t really play in.
Let me give you an example of another area we all care about deeply, especially as parents: childcare. Childcare encompasses everything from the neighborhood kid babysitting all the way up to the fanciest pre-K in New York City. There are no laws saying you can’t babysit, no laws requiring certain qualifications, even though this is a very safety-sensitive activity. We do let the private market work itself out as far as what kinds of regulation you opt into and pay for. We also have mandatory regulation for childcare centers, but it’s not licensing—we don’t make you go to school for a year and pass an exam. It’s more about background checks, CPR certification, a few safety rules. This is what I would want to see for something like eyeglasses: a system where people may opt into a more expensive, more comprehensive option, while others can just get their kid glasses even if it’s not a hundred percent perfect. We have evidence from other countries that a much less onerous system works basically fine.
Now imagine you’re a legislator, this is a big deal for you, and you want to pass a bill getting rid of the licensing regime for opticians. They are going to make it such a headache for you. They’re going to come up with every possible example of some child who did or didn’t die of cancer because they did or didn’t get an exam from someone trained to recognize it. There’ll be nobody on the other side.
Mounk: What the president of the American Optometric Association was saying is that she wants Americans to be able to catch dangerous eye diseases, tumors, or other conditions that are sometimes discovered during a mandatory eye exam. I take that seriously—if you have the means to go get a professional eye exam, absolutely do that. But she wasn’t talking about all of the people who die in traffic accidents, or who don’t learn to read in school, because they can’t see properly—because glasses are far more expensive here than in any other country, and they haven’t been able to afford the glasses or contacts they need to go about their daily lives.
Allensworth: This is a common argument I hear about hair professionals too—that they can recognize diseases of the scalp, and I’m sure that’s true. That’s partly why I bring up the childcare example. There are lots of cases where somebody who is good at childcare could intervene in a way that would be really helpful for a child, or fail to intervene in a way that doesn’t turn out well. It’s something we all care a lot about, but it’s a problem we solve in a different way.
In the rest of this conversation, Yascha and Rebecca discuss how to develop a professional licensing system that works and why the opioid crisis revealed the weaknesses of licensing. This part of the conversation is reserved for paying subscribers…
