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 18: Conclusion

David Reisman


There are no easy answers. This book has shown that health policy is a labyrinth of tangles. Each of them is a crossroads. Not one of them is the gold standard. Not one of them is universally right or eternally wrong. The choice is unambiguous. It all depends. An obsession with single answers, like the quest for ‘complete physical, mental and social well-being’, is an uncompromising El Dorado that brings out the fanatic and the megalomaniac in us all. Titmuss (n.d.) was right to warn that there is ‘something unhealthy about the perfection of the absolute’. The truth will be a mix of different perceptions and a multiplicity of conflicting viewpoints. There is no algorithm that can predict the sines and cosines of fair-minded exchange of opinion. Agreement is all. Without give and take it would be Hobbes all the way to the Apocalypse. There is no panacea that will resolve for all time the tension between individual and society, consumption and investment, duty and preference, authority and exchange, community and liberty, Richard Titmuss and Adam Smith. Health policy is an ‘and’ and a compromise like all the rest. That is just the point: ‘The most important concept in political economy is the and. The most important asset in the study of the mixed economy is an open mind’ (Reisman, 2005: 14). All students of health policy must adapt their tools not just to the ‘is’-ness but to the ‘and’-ness which is all around.

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