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Market-Based Reforms in Health Care are Both Practical and Morally Sound

Published online by Cambridge University Press:  01 January 2021

James Stacey Taylor
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Extract

Markets have long had a whiff of sulphur about them. Plato condemned innkeepers, whose pursuit of profit he believed led them to take advantage of their customers, Aristotle believed that the pursuit of profit was indicative of moral debasement, and Cicero held that retailers are typically dishonest as this was the only path to gain. And even those who are more favorably disposed towards markets in general are frequently inclined to be suspicious of markets in medical goods and services. For example, Margaret Thatcher (to take someone far removed — in many respects! — from Plato, Aristotle, and Cicero) supported the legal prohibition of markets in kidneys despite being arguably the most pro-market Prime Minister the United Kingdom saw in the 20th century.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 40 , Issue 3 , Fall 2012 , pp. 537 - 546
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

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References

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“Private property” can describe various bundles of rights; this exegesis glosses over the various permutations that are possible as they are not directly germane to the discussion at hand.Google Scholar
Two points are worth noting here. First, to say that private property rights exist against a general background of coercion is not to claim that they can only exist “in the shadow of the State.” It is possible that private enforcement agencies could be used to protect property rights, and hence such rights are possible even in an anarchist society. Second, note that it has not been claimed that “systems of private property must exist against a general background of coercion…” – only that they (contingently) do. It is possible that a society with private property could exist none of whose members are ever motivated to transgress the property rights of others. In such a case private property could exist without the threat of coercion in the background. As such, Debra Satz is simply wrong to claim that “true laissez-faire is not even logically possible” (for it clearly is), although it might not be practically possible given the conditions of the real world.Satz, D., Why Some Things Should Not Be For Sale (New York: Oxford University Press, 2010): At 27.CrossRefGoogle Scholar
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Although from Section I it is clear that a purely State-based approach to providing health care would be less effective than either a market-based system or a mixed system with both State and market involvement, it is not clear where the chips would fall in this discussion when the latter two approaches are compared. It might be, for example, that a mixed system in which the persons who would not otherwise have access to health care receive this from the State with this being funded by minimally intrusive system of taxation would be better from the point of view of one who values autonomy than a purely market-based system. Or, again, it might not. This decision could only be made after both empirical research has been done on the effects of each approach on persons' health, and serious conceptual work has been done on the how these effects translate into effects on person's autonomy. Moreover, one would also have to decide whether or not it would be legitimate to trade of some persons' autonomy to secure an enhancement in that of others – and even whether this question is conceptually coherent.Google Scholar
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Indeed, since the commercial provision of health care is more practical than its State-based alternative, as was argued in Section I, if one is truly concerned with achieving the ends of medicine, then one should support a market-based system for providing health care, not oppose this.Google Scholar
“Motive” is here being used in its Millian sense.Google Scholar
Kant, I., Groundwork of the Metaphysics of Morals, trans.Patton, H. J. (New York: Harper Torchbooks): At 397. See also Taylor, J. S., “Market Incentives and Health Care Reform,” Journal of Medicine and Philosophy 33, no. 5 (2008): 498–514, at 507–508.Google Scholar