Medicine and the Market

Equity v. Choice

Daniel Callahan and Angela A. Wasunna

Publication Year: 2006

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world—from Canada and the United States to Western Europe, Latin America, and many African and Asian countries—they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide.

Published by: The Johns Hopkins University Press

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Acknowledgments

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pp. ix-x

If it takes a village to raise a child, as the saying goes, it takes almost that large a group to help someone write a book on medicine and the market. The topic is large, contentious, and international in scope. We were helped enormously by many people. We will begin with our research assistants—Mary McDonough, Juniper Lesnik, Rebecca Birnbaum, Michael Khair—and the staff ...

Introduction. Of Money, the Market, and Medicine

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pp. 1-15

All of us seek health, the well-functioning of our mind and body, just as all of us recoil from pain and suffering. Yet the pursuit of health and the avoidance of suffering are a never-ending struggle. We are beset by a body programmed to decay and decline and by an external world that manages to bring harm to us from the outside, whether from accidents, plagues, viruses, deadly bacteria, or ...

1. From Adam Smith to HMOs: The Origins of Medicine and the Market

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pp. 16-51

Consider two classic texts, one from the fifth century BC, the other from the eighteenth century AD. In his Republic, Plato writes that ‘‘the physician, as such, studies only the patient’s interest, not his own . . . The business of the physician, in the strict sense, is not to make money for himself, but to exercise his power over the patients’ body . . . All that he says and does will be done ...

2. A Tale of Two Cultures: Canada and the United States

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pp. 52-86

Who wants to live next to a giant, even if for the most part a friendly one who speaks your language, offers you movies, TV sitcoms, automobiles, and, to top it off, a huge market for your exports? But that same giant brings with it a culture capable of swamping yours. It has a history of hostility to government, an individualism that at times seems opposed to the very idea of human ...

3. The Endurance of Solidarity: Universal Health Care in Western Europe and Elsewhere

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pp. 87-116

One country, the United States, has never proclaimed a principle of affordable health care for all. Another country, Canada, was late getting there. Yet a large number of other countries have been there for a long time, riding out wars, depressions, political upheavals, and, in recent decades, the beckoning embrace of the market. The nations of Western Europe have been the heartland ...

4. The Market in Developing Countries: An Ongoing Experiment

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pp. 117-162

Our attention so far has been focused on medicine and the market in affluent, developed countries. Whether market- or government-oriented in their health care systems, however, it can surely be said that money talks. Economic wealth and security together guarantee a decent long life for most of those who have them, however health care is organized. The poor and developing countries of the world have no such benefits. ...

5. The Market Wild Card: Pharmaceuticals

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pp. 163-202

The provision of drugs and other technologies, but particularly drugs, is the market wild card in health care systems. Like the joker in some card games, it can be assigned any value—high or low—depending on how one wants to play it. Some countries want to assign it the highest possible value, notably the ...

6. The Value of the Market: What Does the Evidence Show?

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pp. 203-246

Arguments about the market and health care seem interminable, lasting many decades now, seemingly resistant to any decisive outcome, much less consensus. Why is that? Is it possible that the evidence on the market’s value is ambiguous, open to various divergent interpretations? Or that it is confusingly ...

7. The Future of the Market in Health Care: Undercurrents from the Past, Riptides from the Future

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pp. 247-274

Most people want decent health care to be readily available at an affordable price. When they hurt, they want a doctor to look at them, a nurse to care for them, drugs they can afford, and a hospital to take them in if they need medically necessary surgery or complex care. Increasingly in developed countries, ...

Notes

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pp. 275-310

Index

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pp. 311-320

E-ISBN-13: 9780801888816
E-ISBN-10: 0801888816
Print-ISBN-13: 9780801883392
Print-ISBN-10: 0801883393

Page Count: 334
Publication Year: 2006