ok, I just put in “mexico dental tourism” into Google and came back with 143K hits including explanations of how much cheaper all things dental are down there. Of course, if you have to actually go to Mexico and you are not in California/Texas, that costs quite a bit of money for transportation, which rules out the more low key procedures (which, incidentally, are the most routine and least risky). It does, however, indicate that if the legal restrictions on foreign (let’s say Mexican) dentists were removed/ignored, the prices would have declined accordingly and/or the operator would have reaped a decent profit.
Maybe this stuff is not on par with drugs in profitability, but hey, criminal syndicates have been known to run all sorts of businesses. I would imagine that for them there is no big marginal cost to opening and milking a new business, as long as they have already invested into successfully seizing and continually defending the turf, which is a fixed cost.
Nevertheless, I guess the post above about illegal dentists in Miami sheds light on this. So it does exist in some quantity, just maybe not as widespread as it could be and possibly with not enough gang support if they end up busted.
Illegal drugs are big logistics operations requiring a lot of personnel to smuggle them and distribute them. Although drug trading can happen through independent intermediaries, each agent wants a big cut. There is a large efficiency of scale to have one organization push through the various parts of the operation and treat the participants as employees rather than entrepreneurs.
I just don’t see the parallels for medicine. And tools and prescriptions can be bought online.
I wonder why that is. Is there not enough comparison-shopping between dentists to push down prices, are our dental schools too strict and put out too few graduates, or is the ADA some sort of union/cartel artificially deflating the numbers of dentists or encouraging them to collude on price? Where is the market failure?
Well, if you’re talking about it legally, then it’s not necessarily true that the influx of immigrant dentists would lower everyone’s costs. One of the huge, huge contributing factors is the price American medical professionals have to pay for malpractice insurance. It’s cheap in Mexico, because the tort lawyers haven’t screwed up things quite yet. The cost of doing business is also a lot less in most parts of Mexico compared to most parts of the United States. What you pay your hygeinists, receptionists, insurance specialist, and landlord are typically much cheaper than in the States. That adds up. And unless you’re stuck on a government health plan, most dentistry is a cash business. Even if you have employer-provided insurance, you still pay out of pocket and then get reimbursed, in most cases. Removing this insurance layer saves a substantial amount.
I find the OP’s hypothetical to be based on some bizarre assumptions, not the least of which is that there is money to be made in providing healthcare to the poor.
As others have mentioned, there is already a huge organized crime presence in the healthcare field, although it usually centers around insurance and medicare fraud.
But the whole inquiry is kind of like asking why pizza delivery guys don’t expand into driveway paving.
It’s been a while since I’ve read the book, but I believe the quote you are referring to is speaking more about the lack of economic incentives for low-level street dealers. They tend to make very little considering they put their lives in great danger. However, I think the authors ignored the other (non-economic) incentives that are in play.
Here’s the paper, in PDF. My quote is speaking about both gang behavior and individual choice to join the gang. They don’t ignore the other non-economic incentives. In fact, they specifically state they exist:
“Certainly, economic considerations play an important role in the decisions of members and the activities of the gang. However, we fiŽnd that social/nonpecuniary factors are likely to play an important role as well.”
I’m sure the most fundamental reason something like this doesn’t occur is there’s much more money to be made in running guns and drugs and committing other crimes.
From what I’ve read (maybe grossly distorted accounts) of the Italian Mafia, maybe it would do something like that (offering the poor medical care) as a way to get the local population on its side (kind of like John Gotti Sr’s popular & illegal neighborhood fireworks & block party for the Fourth of July.) But not so much as a money-making venture as a populist political move.
As well as what Balthisar mentioned, it’s also a matter of “McDonald dollars vs US dollars” and of what will the market in each location support.
If I make 30K Simoleons in Picaville, where the average salary is 10K with prices to match, I’m rich. If I make 60K Simoleons in Rasoville, where the average salary is 100K with prices to match, I’m scramping at home… but going on vacation to Picaville will make me look like a Rotschild to the locals.
Drug cartels have pilots, Coastguard personnel, local government, State officials, DEA agents, and who knows whom else on the payroll.
Why not doctors? Does the drug mule pilot make his living off of legitimate travel fees? Does the drug boat captain pay his crew with legitimate money?
Drug cartels, and gangs, seek to take their share, or all, of a communities money. What better way to take money from those that are not under the influence of drugs? Forced health care. If you think a drug cartel or even a legitimate gang can’t afford to pay a shady doctor more that they would make legitimately, think again.
Then add the “you and your family at gunpoint” factor, and we can all see how there can be numerous highly qualified, or at least qualified, doctors under their control.
If illegal drugs flow like water, imagine how legal drugs might flow, given the rampant theft and and divergence of legitimate drugs in the US.
From a drug/gang lords perspective, why let an illegal alien take advantage of a US healthcare fund, when I can make a few bucks, and force them to do it?
Not everyone wants to get high, but everyone needs to be taken care of physically. Those that control the everyday lives of the people in their territory will surely control their healthcare, their food supplies, their safety, and their futures.
I’m genuinely surprised that the OP’s question didn’t raise more eyebrows.
*Not everyone wants to get high, but everyone needs to be taken care of physically. *
The emergency room is “free” if you dont mind bad credit. Its 100% free if you use a fake name and SSN. Lots of people know this trick. So in extreme circumstances there’s absolutely no incentive to see a gang doctor.
Regular care in poor neighborhoods isnt very expensive. 40 or 50 per visit, sample medicines, and lot of poorer people qualify for state assisted healthcare.
The thing about getting high is that you really have no choice when youre addicted. You can only get the stuff illegally, thus the gangs supply it. You can get healthcare legally and sometimes very cheaply.
Fair point, but I think giving lip service to non-economic incentives, then stating their behavior is still irrational isn’t fair. Either way, Venkatesh’s book doesn’t, if memory serves, seem to cling to that argument too strongly.
But this never happens. You can’t keep someone under your control all the time, and they’ll go to the cops.
The reason gangs are able to keep their low-level dealers under control is that the low level people can’t go to the cops, because they’re criminals. This is why prostititutes don’t go to the cops when they get beat up by a customer or their pimp, because they don’t want to attract the attention of the cops. If a massage therapist got beat up by their agent, or by a customer, they’d go to the cops right away.
So a legitimate doctor could be coerced into providing emergency services at the point of a gun–once. Then he goes to the cops.
Independent drug dealers and buyers can’t. And so organized crime provides those sorts of services–higher ups members resolve disputes between lower level members because the cops and courts can’t be involved.
And we have to look at the sorts of crimes that lend themselves to organization, and those that don’t. You don’t see organized gangs of muggers, because mugging is a one-man operation. You point a gun at someone and get their wallet, and run away. You don’t need any backup. But compare that to auto theft. Sure, it only takes one kid to steal a car. But what does he do with the car after that? He has to take it to a garage where it can be chopped, or resold, or whatever it is that they do with stolen cars. And so car thieves have to be more organized than muggers, because a solo car thief can’t make any money, he has to sell his stolen car to another criminal.
Certain types of drugs work the same way. Cocaine and heroin have to be imported. So you could run a one-man drug dealing operation, but where do you get your supply of crack? You have to get your crack from an importer, someone with the organization to ship cocaine from Columbia.
It seems to me that running an unlicensed health care facility falls more on the independent side than the organized side. Sure, you need a network of customers, and you need some way to get medical supplies. But you could just have someone buy antibiotics legally in Mexico, and mail them over.
For really bad stuff, your customers are going to the emergency room. So you’re mostly treating chronic “weak and dizzy all over” type of stuff. So you mix in a lot of traditional medicine, some bedside manner, a few grey-market drugs purchased in Mexico, and you’re golden. Not much need for organization. And hence, not much organized crime involvement.
wwwait! Who said anything about “at gunpoint”? What gunpoint? I am not saying that the gang is supposed to do racketeering of doctors, or force them cut prices or work for free or any such evil thing. I am saying that the gang would HIRE doctors/dentists, for a good salary (by Mexican standards, at least), to work illegally in America. That is, if you can work legally in America, you do that. And if you cannot, with the help of the “club of legitimate businessmen” you can work in a Latino community and have the reasonable expectation that your customers will not try to sue you for malpractice or report you to authorities (because if they do, the gang will punish them).
But you don’t have to rely on the threat of retaliation from your homies to keep the patients in line.
These are going to be poor immigrants, right? They aren’t going to sue. They’re going to keep their heads down. If they don’t like your work, they’ll just go to another quack doctor. That’s the point of operating among the immigrant community, right? Among people who don’t speak english, who don’t trust the cops or the legal system, both because that’s the way things work in their home country, and because they don’t want to be hassled by La Migra.
Think about it from the point of view of the unlicensed health care provider. Is your big worry getting sued by your patients? No, because the whole business is off the books.
If the only thing stopping angry patients from reporting you to the AMA is the threat of retaliation from a gang, well, I doubt you’re going to stay in business long anyway. Because nobody is going to patronize your unlicensed clinic if you’re that hated. You’re relying on the goodwill of the community to protect you, and they have goodwill towards you because you provide services that they can’t afford from the licensed health care system. And your customer can report a shady business to the cops anonymously, and then what good is your mob connection?