9/08/2009

Is Health Care a Commodity?

As the left and right blast each other concerning health care, a major question remains unanswered.

Clarke E. Cochran, Ph.D., Professor of Political Science at the Department of Health Organization Management at Texas Tech University, will deliver an address entitled "Seeking Justice: The Imperiled Promise of Healthcare Reform" at The Center for Public Justice's 15th annual Kuyper Lecture on October 22 in Washington, D.C.

10 years ago, before all the heated town hall meetings and all the left- and right-wing media pundits started spouting off on this, he addressed health care reform at a presentation given at Calvin College.

In this address, Cochran raised this critical question: Should we view Health Care as a commodity?
"Different spheres of society appropriately employ different bases of distribution. College professors aim to assign grades on the basis of merit or achievement. The same principle is used for prizes in an athletic competition. Parents distribute slices of cake at a child's birthday party according to strict equality, lest fights break out. Numerical equality governs votes in a democratic society. Cameras, blue jeans, automobiles, pencils, and diamond rings are distributed according to the logic of the market.

Need is the proper principle for distributing health care because health is necessary for a community's proper functioning. Good health facilitates social interaction and economic enterprise. Medical care is one of the principal means to preserve and restore physical, mental, and emotional functioning. Therefore, all societies (except the United States) that value health and that have the financial and technical means to develop modern systems of medical care recognize that health care for all citizens is a matter of public justice.

The prime competitor of need as a distributive principle is the market. Commitment to laissez-faire capitalism promotes a vision of the market as the single metaphor for life. Yet the market, however appropriate for the distribution of commodities, depends on an individualistic perspective foreign to commitment to the common good. It treats health care as a commodity like cameras, cars, pencils, and blue jeans. Those without financial resources receive inferior care or no care at all. The American tendency to make health care a market commodity produces very high quality technical care, but at the highest cost and worst access in the modern world."

The flip-side of the argument is this: A market-driven system properly places responsibility on the shoulders of the consumer, rather than on an impersonal bureaucratic entity. Markets produce the best product at the best cost because producers must respond to the demands of consumers. Our health care system must honor the image of God in each human being, meaning that we must care for the needs of each human being while we also honor the dignity of each human being by not robbing them of personal responsibility. Cochran talks about this as well (we’ll look at this in a few days).

So, before we can get into the nitty-gritty of policy, a foundational question needs to be addressed: Should we view Health Care as a commodity?

7 comments:

Michael Kruse said...

Interesting stuff.

For further thought. Food is a basic need. Yet we don't have a centralized bureaucracy organized to provide everyone with food. The market, supplemented with aid, does this quite well.

Does need for something equal the right to have it provided by the government? If so, then we quickly drift toward totalitarianism.

Rather, I think our rights are in the form of not being blocked from meeting our needs. Government can see that it has a vested interest in helping us meet our needs. But the responsibility of meeting needs is with individuals and their communities.

I'm curious to see where your discussion goes.

Byron Harvey said...

At the risk of being redundant from a previous post, it seems to me that the good professor blames the market for our high-cost/poor-access situation, when in fact we have a quasi-market situation when it comes to health care. I, along with Michael, will find this discussion interesting; it seems to me that we have to fight to keep certain aspects of health care in the "commodity" arena--if I can afford to get the surgery, I ought not be prevented from getting it--while at the same time addressing the legitimate concerns that exists re cost and access. We ought, to use an analogy, to find ways to allow everybody to drive at least a Neon, without restricting the right of people who want (and can afford) a Maserati to own one.

If it's not a commodity, what would we label it, a "right"? And that gets itchy, for reasons Michael enumerates...

Bob Robinson said...

Michael,
Exactly my thoughts, re: food and shelter (see my comment to Pam at the previous post, where I said, "Health Care is a 'right' as much as food and shelter are 'rights.' However, few would agree to giving over to the federal government the responsibility for feeding and sheltering every American. That being said, the government does indeed have the responsibility of monitoring and regulating the food and housing industries so that the inevitable inequities and injustices of unfettered capitalism do not harm the common good.")

Bob Robinson said...

Byron,
What makes me "itch" is when we determine as a society that certain health care is Maserati Care, only for the elite who can afford it, and other health care is Neon Health Care, for those unfortunate enough not to have high paying jobs or affluent inheritances.

In a just society, should certain people have access to top-tier "Maserati" health care while others only have access to second-class "Neon" health care?

The term "social apartheid" comes to mind here, defined as "de facto segregation on the basis of class or economic status."

Byron Harvey said...

Yes, in a just society, that should exactly be the case, if you understand my definitions; I will use "Neon" to suggest "better than what currently exists, adequate, at the very least". I will use "Maserati" to suggest that if somebody has the financial means to get some particular surgery/treatment he may deem beneficial, it should not be up to the government to restrict that choice, and doctors ought not be bound as to what they can and cannot do. If 95-year-old grandpa has the financial resources and wants the bypass surgery, no "just" system can deny him that--and I fear that's where Obamacare may take us.

In a just society, the government doesn't tell me what I can spend my money on (generally speaking, of course; I'm not advocating for child prostitution, for instance). Now, that doesn't by any stretch of the imagination mean that all choices are morally equal, that it's perfectly moral and right to lavish myself with wretched excess while people starve--but it is to say that if I have the money to spend, it's only "just" that government not restrict my right to spend it as I please--and if that means some exotic surgery or a 4th house in the Bahamas, then the government ought not restrict those things, however much you and I might find those choices distasteful, materialistic, etc.

By all means, let's do what we can to lift up the poor, be it in healthcare, employment, what-have-you, clearing every path for those who are willing to work to better themselves, etc. Let's strive to have a better healthcare system for all. But let's not fall into the mistaken thinking that we need to tear down those at the top in order to lift up those at the bottom.

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