Is Healthcare a Public Good?
Dr. Jeoffrey Gordon, a family practice physician writes a guest editorial today at the above linked blog, KevinMD:
My response to Dr. Gordon:
You make your argument well. However your argument, like all arguments rests on a certain set of assumptions. One of these assumptions is that the concept of “public good” is obvious and well defined. I would argue that the definition of public good is artificial and the distinction between public and private goods is hazy.
For instance, depending on a society’s level of technological sophistication food production and distribution could be considered a public good. One could imagine a society in which food production and distribution would meet criteria 1,2 and 3 of the above definition: requiring enormous resources, high up front cost and characterized by “externalities.” Surely you benefit If your neighbor is well nourished and then becomes a productive member of society- perhaps by developing a trade which then benefits you by streamlining your labor. But the majority of food distribution and production today (at least in the U.S.) is done through private means. And on a per calorie basis, historical costs of food (adjusted for inflation) continue a steady (if bumpy) march downward.
Does this imply that based on man’s particular place in history and techological sophistication a “public good” can at times morph into a private good? Or does the distinction always hold up? To the extent that the above argument rests on this rather malleable definition of public good, it is shaky.
In addition, some of the examples that Dr. Gordon implements to buttress his position directly contradict his argument. The internet is not publicly owned or distributed. It is, in fact a great example of the power of entrepreneurs in a free market to rapidly innovate and bring extraordinary wealth and opportunities to the population at large.
There is one thing that makes healthcare truly a unique good and it is not that it is a “public” good. It is the expectations of the doctor and patient. There is an implied covenant implicit to the doctor patient relationship- and codified in the Hippocratic oath- that at every interaction the patient/consumer receive the highest level of care.
The question then becomes: what is the highest level of care? And does it always equate with the most expensive care?
