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10 Citizens and Consumers Americans widely believe and are frequently told by political leaders that “we’ve got the best health care system in the world.”2 How good a country’s healthcare system is can be determined, in part, by the health of the population. To measure a country’s health, the World Health Organization (WHO) developed an indicator of “healthy life expectancy,” which identifies the number of years that a child born now could expect to live in good health. e measure takes into account total life expectancy as well as expected years of illness. e healthy life expectancy of Americans ranks the United States 22nd out of 23 industrialized countries. Only the Czech Republic has a lower healthy life expectancy.3 Other factors, such as the data accumulated in recent years on the large number of Americans who die each year because of medical mistakes4 and the fact that well over 40 million U.S. citizens are without health insurance at any given time, also contribute to the doubts about how well the current healthcare system serves the American public. e American healthcare system is by far the most expensive. e per capita healthcare expenditures in 2004 are estimated to Collectively, we are . . . demanding to know whether a treatment is more effective and safer and more cost-effective than alternative choices when used in typical patients over a period of years.1 144 Marketing to the Public be over $6,100, more than twice as much as other industrialized countries. “Even taking into account our higher per person gross domestic product, the United States spends 42 percent more on health care per person than would be expected, given spending on health care in other OECD nations.”5 It appears that many other countries are achieving better results and doing it at a lower price. In the words of Donald Barlett and James Steele, “Americans pay for a Hummer but get a Ford Escort.”6 ere are, of course, many areas of excellence in the U.S. healthcare system and many Americans receive excellent healthcare . But the system as a whole can definitely be improved. e presidential claim that we have the best healthcare system, quoted above, was followed by the statement that “we need to keep it that way.”7 Acknowledging that the system is not as good as it can be or should be is the starting point for seeking ways of improving present methods of providing that care, just as the claim that the system is the best can lead to protecting things the way they are. Many factors affect the nature and quality of healthcare practices , including the methods of marketing healthcare products. In marketing prescription drugs, pharmaceutical companies have an obvious responsibility to the individual patients or consumers who use these drugs. e responsibility to the public, however, is not just to these individuals. Since marketing practices have the potential, even the likelihood, of having an impact on the nature, quality, and cost of healthcare generally, we also need to consider the implications of marketing practices for the system as a whole. We, the public, are citizens as well as consumers. In Mark Sagoff’s words, “We act as consumers to get what we want for ourselves . We act as citizens to achieve what we think right or best for the community.”8 In acting as citizens, individuals work together with others for what they perceive to be the common good. is sometimes requires subordinating individual self-interests to the good of the community. ough a simplistic model of economic behavior suggests that individuals are only interested in their own personal and family financial self-interests, their participation in the community makes it clear that life is not so one-dimensional. Individuals often make decisions about their own consumer in- 145 Citizens and Consumers terests in a manner that reflects their concern for the well-being of the community as a whole, not just a concern for themselves. When individuals make decisions to buy higher-priced organically grown food, for example, they may do so because of a concern about the impact of “conventionally grown” food on their own health or they may be seeking to support a more environmentally sound model of agriculture. e growing interest in “socially responsible investment” indicates that many people want their money to support the kinds of businesses that they believe are socially beneficial at the same time that this money brings them a reasonable return. ey...

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