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 12: Inequality and health

David Reisman


The White Paper of 1944 that led to the creation of the British National Health Service (NHS) on 5 July 1948 took equality in health to mean equal access for equal need. It built on the historic Beveridge Report of 1942 which had declared war on the ‘five giant evils of Want, Disease, Ignorance, Squalor and Idleness’ (His Majesty’s Stationery Office, 1942: para. 456). It committed itself to the generation and perpetuation of a common entitlement. It made clear precisely what levelling as levelling up would have to mean: The Government … want to ensure that in the future every man and woman and child can rely on getting … the best medical and other facilities available; that their getting these shall not depend on whether they can pay for them, or on any other factor irrelevant to the real need. (Ministry of Health, 1944: 5) The objective was to be the universalisation of the best. Allocation was to be driven not by the profit motive and the ability to pay but by an equal citizen’s right to the most appropriate treatment as prescribed by the best available professional. Like was to be treated as like. Medical services were to be distributed on the basis of medical need alone. Filthy lucre would not be permitted to jump the queue. Explicitly, it was to be the equalisation of the inputs. Implicitly, it was to be the equalisation of the outcomes as well. In the end there would be a national health status.

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