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 14: Equalising medical care

David Reisman


There is more to good health than formal care. Marked inequalities in health statusare caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples’ lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. (World Health Organization, 2008: 1) The social gradient is always multidimensional. It is often unjust. The structural conditions of daily life and not the formal care inputs alone must all be thrown into the melting pot if a more equal society is to be forged. A holistic approach is required that does not economise on the homes and the jobs. There is more to good health than uncaring economics, biased politics and medical solutions that are not enough to equalise the life-chances in illness and death. The health divide ‘appears to have little to do with differences in health care systems. For example, the mortality differentials for the United States, which favors market-based health care (at least for the non-elderly), and Austria, where the government provides universal health care, are virtually identical’ (Cutler et al., 2011b: 124).

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