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 17: State, market and cost

David Reisman


Laws shape choices. Natural law gravitates to the market equilibrium as if guided by an invisible hand. It is one law but it is not the only law. This chapter is about the balance between automaticity and plan when the invisible hand has demonstrably failed to contain the cost. Section 17.1, ‘An internal market’, is about the compromise solution of quasi-markets within a State-owned system. Section 17.2, ‘Controls’, discusses the role of ceilings and licences when free enterprise is thought unable to stop the rise. Section 17.3, ‘Liberalisation’, is about deregulation. Some observers have contended that decentralisation is an untapped resource that can put all the clocks right. Section 17.3 says that nothing in the world can put all the clocks right. There is no pill for every ill, but some pills can cure some of the ills some of the time. Section 17.3 asks if the return of autonomy from the whole to the part is such a pill. The previous chapter explained that large tasks require large organisations. Complete physical, mental and social well-being is a large task. A national health service is a large organisation. Monoliths have economies and monopolies contain costs. Under Stalin, Russian railways ran on time. It would have been a waste to lay duplicate tracks side by side so long as these railways satisfied the Russians’ reasonable expectations. Are duplicate beds any different? Prima facie it is an argument for a unified network.

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