MidwivesCertified nurse4,000Lay6,000Total10,000Medical doctorsPrimary care195,300Nonprimary care391,700Total587,000Naturopathic doctors1,000Nurse practitioners21,000Source: Data on acupuncturists, homeopathy, N.D.s (1992),chiropractors, D.O.s (1993) and massage therapists (1994) fromOffice of Alternative Medicine, NIH, Alternative Medicine:Expanding Medical Horizons, NIH publication no. 94-066(Washington: Government Printing Office, December 1994); datafor M.D.s (1992) from Martin Gonzalez, SocioeconomicCharacteristics of Medical Practice 1994 (Chicago: AMA, 1994);data for midwives (1995) from Diana Korte, "Midwives on Trial,"Mothering, (Fall 1995); and data for N.P.s (1991) from Mullan etal., p. 145.(a) The estimated 3,000 health care practitioners who are li- censed to use homeopathy include acupuncturists,chiropractors, dentists, naturopaths, nurse practitioners, osteopaths, physicians, physician assistants, and veterinarians.Office of Alternative Medicine, National Institute of Health, p. 82.United States are privately funded; none are state owned. By contrast, 76 of the 126 medical schools are stateowned.At a time when government is looking for ways to reduce health spending, it should examine closely the supply side of health care reform. Some experts have raised concerns about an oversupply of highly trained specialists who relyheavily on government funding for training, while at the same time licensure laws and federal reimbursementregulations restrict nonphysician providers from entering the health care marketplace. An overview of the currentsupply of selected health care providers is presented in Table 1.Any serious reform of the U.S. health care system must address the medical monopoly. Barriers to entry into the healthcare marketplace are partially responsible for high health costs and lack of access to primary and preventive healthcare.
Individual Choice and Freedom to Contract
Professional licensure laws and other regulatory restrictions impose significant barriers to Americans' freedom of choice in health care. Clark Havighurst, the William Neal Reynolds Professor of Law at Duke University, has pointedout, "Professional licensure laws have long made the provision of most personal health services the exclusive provinceof physicians. Obviously, such regulation limits consumers' options by forcing them to use highly trained, expensivepersonnel when other types might serve quite well."Yet the freedom to contract--the right of individuals to decide with whom and for what services they will dispose of their earnings--is one of the fundamental rights of man. As Chief Justice John Marshall said in Ogden v. Saunders,"Individuals do not derive from government their right to contract, but bring that right with them into society . . .[e]very man retains [the right] to . . . dispose of [his] property according to his own judgment." Indeed, legalphilosophers and ethicists, such as Roger Pilon, Richard Epstein, and Stephen Mecado, convincingly argue that the