In the 1970s, about 10 percent of American workers required licenses to perform their jobs legally. By 2015, that proportion had more than doubled to 22 percent. There is widespread agreement among economists and an increasing awareness among politicians that there is no public-interest justification for many restrictions of the freedom to work. Indeed, both the Obama and Trump administrations have encouraged states to scale back onerous licensing regulations.
Almost all the policy discussion focuses on the unreasonable burdens regulations place on workers, who in many cases should be able to offer their services without getting anyone else’s permission. I now have personal reasons to believe that the debate over credentialism should pay more attention to the costs incurred by consumers.
I have had two major back operations and have substantial osteoarthritis elsewhere. Over time, I have been treated for these problems by a wide range of health professionals. A few years ago I was only 70 percent recovered from an operation for a new knee. My surgeon had discharged me, and work with a good physical therapist still left me unable to get the aerobic exercise that my cardiologist said I needed.
With low expectations, I turned to a personal trainer at the Boar’s Head Sports Club in Charlottesville. I had noticed that in addition to giving advice about the fitness machines, one trainer—let’s call her Joy—was doing hands-on work with many of her clients.
After a few sessions with Joy, my knee function dramatically improved, and I could exercise comfortably. Then Joy turned to problems with my lower back, and later to my wife’s hip and shoulder problems. We both experienced a dramatic reduction in pain in every case.
But Joy has recently been told that she can no longer work hands-on with her clients. A physical therapist and a massage therapist had complained to management that her practice lacked the appropriate license. Joy had never had a client complain, and she was willing to serve only those who signed waivers; but the lawyers were consulted, and unduly frightened managers at the sports club determined that, stretching aside, Joy would do no more touching.
Here’s why that doesn’t make sense. In her two decades of work, Joy has developed expertise in myofascial release—a deep-tissue massage technique in which the practitioner applies firm pressure to the client’s body with hands and even elbows to reach deeper layers of muscles and fascia. According to a large Consumer Reports survey, deep-tissue massage is more helpful to those suffering osteoarthritis pain than chiropractic treatments, acupuncture, over-the-counter medication, and several kinds of supplements and is nearly as helpful as prescription medication.
Massage therapy is the closest thing to an official home for myofascial-release therapy. If Joy wants to pay $12,000 and take 750 hours of instruction at a massage-therapy school, she can become a certified massage practitioner. But myofascial-release therapy is not a prominent practice among massage therapists. At the local massage school, only the last 12 hours of the 750 are devoted to myofascial release.
So massage-therapy school would be of little use to Joy, who already has a master’s degree in exercise physiology. In earning that degree, she took semester-length courses on anatomy and physiology at the University of Virginia medical complex. Most massage instructors, much less graduates of massage schools, cannot match this learning base.
In fact, massage therapy does not have an established learning base, and no single school could teach the various modalities. A glossary lists 22 kinds of massage that begin with the letter A and 30 that begin with the letter B! I haven’t counted how many begin with the other 24 letters, but it is clear that possession of a massage-therapy license does not tell a potential client much of anything.
An enormous number of people in manifold occupations seek to improve human health and well-being without medication, injections, or surgical incisions. It’s mad to stop them from doing so. Let licensed massage therapists brag about their credentials on their office walls and on the Web, but let the unlicensed also practice bodywork—as couples have done for millennia.
We consumers can tell who makes the pain go away. And through word of mouth, those practitioners who make the pain go away will eventually prosper.
Joy can make my pain go away. The government won’t let her do it.
Recently retired, Steven E. Rhoads taught public policy at the University of Virginia for over 40 years.
