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 9: Equality and Health

David Reisman


The White Paper of 1944 that led to the creation of the British National Health Service on 5 July 1948 took equality in health to mean equal access for equal need. It built on the historic Beveridge Report of 1942 which had declared war on the ‘five giant evils of Want, Disease, Ignorance, Squalor and Idleness’ (His Majesty’s Stationery Office, 1942: para. 456). The White Paper said precisely what it understood by the commitment to levelling up: ‘The Government … want to ensure that in the future every man and woman and child can rely on getting … the best medical and other facilities available; that their getting these shall not depend on whether they can pay for them, or on any other factor irrelevant to the real need’ (Ministry of Health, 1944: 5). The aim was the generalisation of a common standard. It was to be the universalisation of the best possible entitlement. Like was to be treated as like. Resource allocation was not to be driven by profit maximisation and the ability to pay. All citizens were to be given what their doctors defined to be medically appropriate. The inference was that the equality of inputs would feed through into an equality of outcomes. In the end a national health status, like a national language, would emerge as the badge of a citizenship shared. The common culture would extend to the common health culture. Professional or manual, rich or poor, the children of Shakespeare, England and St George would have...

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