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 13: Narrowing the gap

David Reisman


The World Health Organization regards the ‘highest attainable standard of health’ as a ‘fundamental right’. It can never be just to violate a ‘fundamental right’. A ‘fundamental right’ cannot be reduced to a market tradeable. A ‘fundamental right’ is more than wants and interests, competition and efficiency. The aim is not simply to equalise the standard but, specifically, to universalise the best. That is why the desired equalisation cannot be achieved by selectively refusing treatment to candidates with above-average health status or by deliberately cross-infecting patients with above-average access to specialists and drugs. Envy and malice can easily shunt the car of levelling on to the siding that leads to Schadenfreude and then on to Birkenau. The focus on the human essence keeps the car on the path of reason. To level down rather than to level up would be an inequitable violation of core personhood that is an inalienable possession of the healthy and not just of the unwell. To be equally healthy means to be equal and to be healthy. It does not mean that Peter can be robbed of life-years in order to bring him closer to Paul. To do this would be morally on a par with cosmetic surgery to reduce beautiful Jolene to the point score of average Ethel that was explored by L.P. Hartley in his Brave New World of Facial Justice.

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