Health Policy

Health Policy

Choice, Equality and Cost

David Reisman

This lucid and comprehensive book explores the ways in which the State, the market and the citizen can collaborate to satisfy people’s health care needs. It argues that health care is not a commodity like any other. It asks if its unique properties mean that there is a role for social regulation and political management. Apples and oranges can be left to the buyers and the sellers. Health care may require an input from the consensus, the experts, the insurers, the politicians and the bureaucrats as well. David Reisman makes a fresh contribution to the debate. He argues that the three policy issues that are of primary importance are choice, equality and cost.

Chapter 1: Introduction

David Reisman

Subjects: politics and public policy, public administration and management, social policy and sociology, health policy and economics

Extract

Health policy is collective action. It is action undertaken by a group of people because doing nothing does not bring about the kind of society in which they wish to live. Richard Titmuss said it all: ‘Social policy is about social purposes and choices between them’ (Titmuss, 1974: 131). Social policy has ‘no meaning at all if it is considered to be neutral in terms of values’ (Titmuss, 1974: 27). Ideology is on the x-axis. Belief is on the y-axis. Stranded in between, there is thee and me. That is how health policy is made in a liberal democracy that is built upon economic exchange but upon the common identity as well. Richard Titmuss had public policy in his blood. Adam Smith did not. Adam Smith was in favour of pecuniary self-interest, rational choice and the invisible hand of supply and demand. The consumer and the shopper, he said, could be relied upon to produce the well-being of nations. The discrete individual knows where the shoe pinches. The gain-seeking salesman knows whom he has to satisfy in order to live well: ‘By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good’ (Smith, 1961 [1776]: I, 448). Adam Smith looked to goal-orientated exchange to maximise people’s well-being, self-perceived.