[lit-ideas] Market Pricing for Health Care
- From: "John McCreery" <john.mccreery@xxxxxxxxx>
- To: ANTHRO-L@xxxxxxxxxxxxxxxxxxxx, Lit-Ideas <Lit-Ideas@xxxxxxxxxxxxx>
- Date: Thu, 10 Jan 2008 14:00:35 +0900
First, allow me to 'fess up. This piece was written in response to a debate
on DemsAbroad, the Yahoo! Group list for members of Democrats Abroad. Since
the issue affects us all, however….
I have been following with interest the debate over the desirability of
having the market determine prices for health services. To deepen the debate
a bit, allow me to introduce two thoughts.
The first is from George Soros, who in The Open Society remarks that, while
the market is undoubtedly the greatest wealth-generating mechanism in human
history, it is driven entirely by private greed. Thus, there is nothing in
it to ensure the provision of public goods (things like justice, education,
healthcare) that should be distributed equally.
The second is from Robert Kuttner, who in Everything for Sale: The Virtues
and Limits of Markets observes that the distinction between private and
public goods is rooted in the fact that private goods offer a genuine
choice, individual consumers can take them or leave them. From soft drinks
in a vending machine to real estate or hedge funds, freedom of choice does,
in fact, drive the competition that market fundamentalists venerate. In
contrast, public goods are what are more usually called necessities.
In the case at hand, a patient has no control over what the doctor
prescribes. In acute, life-threatening situations, the patient is, moreover,
in no condition to make rational decisions. When life-and-death, not Coke or
DeBeers, are at stake, the basic assumptions of free-market pricing
collapse. Decision-making passes to others, who, if driven more by private
profit than goodness and mercy may delay or prevent treatment, resulting in
patient death. A case in point is that of the young woman whose parents
joined the Edwards campaign after Cigna's twice delaying her application for
a kidney transfer resulted in her dying.
It is clear, moreover, that a free market in medical services results in the
same distribution of services as any consumer market, e.g., automobiles,
where some may never be able to afford a car or may have to make do with a
second-hand lemon while others can cruise around in a Lexus or even a
Bugatti. And, as incomes become increasingly polarized, the quality of
service available to those at the lower end of the income scale tends to
deteriorate, while those at the upper end of the scale continue to enjoy
"the world's best medical care," as, indeed, they enjoy the world's best of
everything.
The tricky and, thus, political issue here is where to set the boundary
between public and private goods. It is, thus, not surprising that critics
of national healthcare systems frequently point to elective surgery as a
source of dissatisfaction. If the choice is between a life-saving kidney
transplant and a nose job, it seems clear. But what, for example, of the
knee surgery my mother had done. She was in her seventies. She experienced
severe and disabling pain that affected her quality of life. It was not,
however, life-threatening. Should she have been pushed to the head of the
line because her insurance paid for the surgery instead of, for example, the
child of a poor family whose lack of treatment would hamper her education
and opportunities for future employment? My mother was my mother. But for
me, at least, this is still a tough call. A single-payer system that covered
both my mother and the kid? I'd be happy to pay higher taxes for that.
--
John McCreery
The Word Works, Ltd., Yokohama, JAPAN
Tel. +81-45-314-9324
http://www.wordworks.jp/
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