I think this is a fabulous idea and this kind of sensible approach to regulation could be applied in many different areas, increasing personal freedom without excessively increasing risk and third-party costs. For example, in finance, maybe the default could be that only fixed rate mortgages can be sold, but if you take and pass a rigorous exam and indemnify the government from any claims if you end up losing your house, then you can be sold an adjustable rate or interest-only mortgage. Maybe you could have default speed limits as we do now, but if you take an exam +/- agree to telemetry in your vehicle, you can go faster than the speed limits as long as it’s safe.

Particularly for my low-income patients who end up coming into the ER for a refill (or a complication of having ran out of their meds), I’ll often write a 3 month supply and 3 refills, so giving them one year of access to their meds without needing a doctor. I still strongly encourage them to get a primary doctor and see that doctor in order to get help with their medical conditions, but the idea that we should effectively coerce patients into seeing a doctor by withholding life-saving medications (“it’s for their own good!!!”) seems grossly unethical to me, and doesn’t take into account the problems poorer people have in getting good affordable healthcare. But I’m pretty sure my position is an outlier among emergency medicine docs.