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 3: The invisible mind

David Reisman

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


Liberal democracy is thee and me. Great books, great Leviathans and the doctor who knows best must defer to real-world men and women who have a preference to reveal. Their evidence is selective and their reasoning suspect. Their probabilities become their predictions and the fortuitous their facts. Real-world men and women are a handful. Muddle-headed, frustrating and opinionated, thee and me want the law of gravity to be repealed, the care budget to be doubled and wonder drugs to be delivered as of right. Thee and me are the reason why our leaders need long holidays and become old before their time. Ordinary people are a handful. In a liberal democracy, however, they are also the suprema lex: ‘Although it may be accepted that where public funds are involved we ought not to use a fool’s valuation in deciding upon their allocation, if … society is comprised soley [sic] of fools, then the valuation of these fools is the correct one to use’ (Mooney, 1977: 126–7). The fellow traveller on the Clapham omnibus knows best. That is the bedrock absolute that liberal individualism came into being to protect. The democratic order requires a good knowledge of what real-world men and women really want. That is just the problem. The contents of people’s minds are not directly observable. There is no sophisticated polygraph that can measure the relevant brainwaves. There is no Clapham omnibus in which all is said and done.

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