Health Care and Public Policy
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Health Care and Public Policy

David Reisman

Health Care and Public Policy is a comprehensive and intelligible cross-disciplinary account of the objectives of health care policy (medical, social, economic) and of the policy-tools that government can employ (cost–benefit analysis, entry barriers, competition) in order to ensure that scarce resources are not wasted nor needy social groups deprived of basic and affordable care.
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Chapter 3: Needs and Wants

David Reisman


Consumer sovereignty means that the shopper is the best judge of his own interest. Liberal democracy means that the citizen and not the dictator determines the mix that will be supplied. The markets and the voters speak with a single voice in support of factoring down and of bottom-up precisely because only the patient can say where it hurts: ‘Underlying most arguments against the free market is a lack of belief in freedom itself’ (Friedman, 1962: 15). The freedom to choose is the freedom to translate wants into facts. Needs, however, are a different matter. Wants are perceptions: a person who is mentally ill is not mentally ill if he says he is sane. Needs are absolutes: ‘Whales were not fishes merely because people thought they were for centuries’ (Daniels, 1985: 29–30). Wants are fleeting: they are whims that can be disregarded without irreparable damage to the bedrock essence. Needs are imperatives. They carry the implication ‘that the entity asserted to be needed is actually necessary’. They convey the message that ‘this needed entity ought to be received’ (Culyer, 2005: 227). Wants are preferences: the consumer alone knows if his marginal utility is just worth the marginal expense. Needs are structures: ‘Fiddlers need fiddles; photographers need cameras’ (Braybrooke, 1987: 33). Needs are objective: the benefit has an identity of its own that has form and substance even when it is not seen, felt or heard. Wants are subjective: the assessment, all in the individual’s mind, vanishes when the ostrich...

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