It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner but their regard to their own interest. We address ourselves not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages.
(Adam Smith, The Wealth of Nations)
The private market . . . narrows the choices for all men—whatever freedom it may bestow, for a time, on some men to live as they like. It is the responsibility of the state, acting sometimes through the processes we call 'social policy', to reduce or eliminate or control the forces of market coercions which place men in situations in which they have less freedom or little freedom to make moral choices, and to behave altruistically if they so will.
(Richard Titmuss, The Gift Relationship)
Should we leave the education of our children to the professionals on the grounds that teacher knows best? When ill, should we be patient and simply trust the doctor to make us well again? Should we have the right to choose the hospital where our illness is to be treated, or to choose the school where our children are educated? Or would such choice lead to destructive competition between schools and hospitals, competition that would damage not only the people making the choices but also those who work within those institutions and indeed the wider social interest? Would greater patient or parental power undermine professional and other forms of altruistic motivation? More generally, would empowering the users of public services destroy the so-called public service ethos, and would society be both materially and morally impoverished as a result?
Resolving these questions for public services such as health care or education is of crucial importance. But similar issues arise elsewhere in that collection of public policies often termed the welfare state, including those that more directly concern our personal incomes and expenditures. Should government compel us to save more in order to pay for our pensions? Should we be required to take out insurance against the possibility that we might need long-term care?