Healthy, Wealthy, or Wise? Issues in American Health Care Policy

By Charles T. Stewart Jr. | Go to book overview

third-party payments reduces the role of quality rationing by price, so everyone wants the best.

Americans, many of them, believe that they are entitled to the best health care. But this is impossible; only a few can get the best. Suppose we all agree that the Smith-Jones Clinic is the best. Then ten times as many customers demand access as the clinic can handle. What to do? The clinic could raise its prices sky-high, eliminating most customers. This is rationing by price, which we reject. Or it could pick those it thinks have most to benefit (perhaps excluding anyone over age sixty-five) or pick blindly by lottery. It is still rationing, but not by price. Or it could expand its capacity tenfold. Then its quality would have to fall, it would no longer be considered the best, and other clinics would be faced with the problem of rationing excessive demand. Not everyone can get above-average anything.

Why do beneficaries always want more than any viable system can deliver? First, of course, they are unaware of their costs, or if aware, the cost to them of additional services may approach zero. Second, there are exaggerated expectations of what medical care can deliver, largely induced by the medical care establishment. Third, there is the change in what many people consider acceptable states of health and well-being; ours has become a hypochondriac society, in part because of the enhanced ability to deliver effective services and propaganda to that effect, in part because of rising incomes and an increased ability to pay for health care. Fourth, we have experienced a correlated shift in self-concepts from the Calvinistic, tough image of the past to a self-indulgent, tender image of the present, and a related change from a concept of health and sickness as natural outcomes of personal behavior, mental attitude, and uncontrollable events to one of medical interventionism, victimology, and extroversion of responsibility. Related to this change toward a narcissistic self-image is an increase in risk aversion and a demand for a fail-safe, risk-free life and an extreme reluctance to accept death as inevitable, a pathological fear of death. The demand for fail-safe cures is part of the explanation not only for the large increase in malpractice suits but for the preposterous awards recommended by juries.


Notes
1.
David Reisman, Market and Health ( New York: St. Martin's Press, 1993), 25.
2.
Don Kenkel, "Consumer Health Information and Demand for Medical Care," Review of Economics and Statistics 72 ( November 1990): 587-95.
3.
Milford Rouse, Inaugural Address as President of the AMA, Journal of the American Medical Association 258 ( July 17, 1967): 87-89.
4.
A. J. Culyer and Adam Wagstaff, "Equity and Equality in Health and Health Care," Journal of Health Economics 12 ( 1993): 431-57.

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Healthy, Wealthy, or Wise? Issues in American Health Care Policy
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Notes viii
  • 1 - Determinants of Health 1
  • Notes 6
  • 2 - Why Are Costs Out of Control? 7
  • Notes 27
  • 3 - Must Living Standards Decline? 28
  • Notes 38
  • 4 - Health Insurance Raises Demand and Supply 40
  • Notes 49
  • 5 - The Excess of Physicians and Services 51
  • Notes 77
  • 6 - The Medicalization of Health 82
  • Notes 97
  • 7 - Mental Illness 99
  • Notes 119
  • 8 - The Excessive Demand for Medical Care 123
  • Notes 136
  • 9 - Research and Technology 138
  • Notes 161
  • 10 - The Physician as Agent 164
  • Notes 179
  • 11 - Prevention: Environmental and Behavioral Modification 181
  • Notes 210
  • 12 - The Demedicalization of Health Care 213
  • Notes 222
  • 13 - What to Do? 223
  • Notes 250
  • Index 253
  • About the Author 263
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