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 10: Equity and equality

David Reisman


Equity means fairness. It means that the entitlements are as they ought to be. It means that each member of society is getting his or her just deserts. Fairness can refer to the beginning. Ex ante each contestant is known to enjoy the appropriate opportunities when the starting-gun goes off. Fairness can refer to the race. In-period each runner is seen to experience the same treatment within the accepted guidelines of the rules. Fairness, finally, can refer to the finish. Ex post each player is believed to have been accorded the prize that they deserve. No one is getting less than they deserve. No one is getting more. Fairness is a moral absolute. It is a correct procedure or an equilibrium outcome. In that sense it is different from equality, which is merely a statement of fact. Jill is precisely as tall as Jack. John is precisely as fat as Bill. There is no suggestion that they ought to be the standard size. Equality is measuring up. That is all. This chapter is concerned with fairness. Yet it is concerned with sameness as well. The reason is that, rightly or wrongly, equity is often the moral principle that is invoked to make equality a desired objective and not just a dispassionate yardstick. Many people attach normative significance to a levelling of interpersonal distance. Many people say that in core areas of social life it is proper for the disparities to be kept within manageable limits.

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