Choice, Equality and Cost
Chapter 4: Inputs and outcomes
A cow eating grass in a meadow is not the same as a nourishing beefsteak that drives away the flu. A doctor watching television in a bar is not the same as a robed crusader who whips out a tumour. The doctor, like the cow, is an input. The flu, like the tumour, is an outcome. The input is the means. The output is the end. They are not the same. Eggs are not omelettes and wards are not cures. Still, however, there is a human propensity to treat the parts as valued contributors to the well-being of the whole. Health care leads the field in eagerness and optimism. In few other areas of social life is there a greater willingness to take spend as a proxy for success. It may be wishful thinking to assume that more means more but it is nonetheless a near-universal heuristic. Most people treat the sirloins and the surgeons as a sacred cow. Most people oppose cuts in care because economies at the margin will infect our fellow citizens with sneezes and coughs. The link, however ill-specified, has the force of a shared conviction. It is a non-rational representation that must be treated with respect. This chapter is concerned with the principal inputs which are commonly believed to make us well. They are discussed in five sections: ‘Medical care’, ‘Care beyond medicine’, ‘Jurisprudence and legislation’, ‘Prosperity and progress’ and ‘Increments and totals’.
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