Health Policy
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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.
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Chapter 7: The public

David Reisman


There is individualism: it maintains that the patient alone can recognise a healthy mind in a healthy body. There is professionalism: it insists that the doctor must have clinical freedom since the clinician alone can identify a need. Then there is social-ism. Social-ists believe that the patient and the doctor are only cells in an organism, atoms in a structure. The patient and the doctor are only parts. The truth is the whole. Social-ists situate the I in the context of the We. They believe that the embedding collectivity is an entity sui generis. They believe that the social cake is qualitatively different from the discrete ingredients that mix and meld. Social-ists argue that the internalised norms, the shared mores and the common conventions add up to mutual constraint by agreement and consensus: ‘We may say that what is moral is everything that is a source of solidarity, everything that forces man to take account of other people’ (Durkheim, 1984 [1893]: 331). The mapped coordinates emancipate the unrooted and the homeless from meaningless egotism and anomic detachment. It is their function to integrate the rudderless self in meaningful interdependence with its teammates and its fellows. They are, Durkheim says, the sine qua non if the Hobbesian bellum is to be kept at bay: ‘Cause all social life to vanish, and moral life would vanish at the same time, having no object to cling to’ (Durkheim, 1984 [1893]: 331).

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