… is from page 105 of Michael Cooper’s 1974 article “The Economics of Need: The Experience of the British Health Service, ” as quoted on page 33 of the soon-to-be-published 2021 35th anniversary edition of Steven Rhoads’s 1985 book, The Economist’s View of the World: And the Quest for Well-Being :
The conception of sickness as an unambiguous and absolute state led to the false hope that unmet need could be abolished. In practice, sickness has been found to be a relative state capable of almost infinite interpretations by both potential patients and the medical profession.
DBx: This important insight is quoted in Rhoads’s chapter titled “Marginalism” (a summary version of which is available free-of-charge here ). To understand marginalism is to understand that no particular benefit is a supreme good greater quantities of which are worth acquiring regardless of cost. Acquiring additional units of (say) reduced risk of exposure to some pathogen might be worthwhile, given the cost of the acquisition, if little such risk-reduction has yet been acquired. But there comes a point at which the benefit, though real, of additional risk-reduction becomes less than the cost of achieving that benefit.
When failure to understand this reality results in the elevation of any particular benefit into a goal regarded as always supreme above all – as a benefit to be pursued, regardless of cost, until the maximum possible amount of this benefit has been secured – the result is much worse than economic inefficiency; it is derangement .
Further, an understanding of marginalism reveals the deep confusion of those persons who make such claims as “health care should be affordable to all.” Sounds lovely. But what counts as health care? If we classify as “health care” only aspirin, bandages, and first-aid items, then in modern America health care is already (and has been for some time) affordable to all. But given our level of prosperity health care in modern America surely also includes access to, consultation with, and treatment by, trained physicians as needed, as well as treatment in hospitals as needed.
Ah, but when are such treatments “needed”? If health care were as naturally abundant as breathable air, there would be no additional quantum of health care that would not be worth acquiring if such acquisition provided even the slightest benefit. But health care is not and never will be so abundant as breathable air. And so there will always be some additional units of health care that, while acquisition of these units would indeed further improve health, are not worth acquiring. Providing every person afflicted with the seasonal flu with a month-long stay in his or own exclusive floor of a hospital whose every staff member, including office clerks and janitors, is a graduate of a world-class medical school would no doubt provide some health benefit, currently unachieved, to each person with the seasonal flu. But our level of prosperity isn’t yet close to prompting us to regard such medical treatment as “needed.”
It’s easy to see that there comes some level of medical treatment that no sane person today would classify as “needed.” Yet the deeper point is that determination of what levels and kinds of health care are “needed” is not a technical problem. It is a problem not to be determined by physicians, health-care ‘experts,’ government panels, or MD-sporting Washington Post columnists. The ‘correct’ level of health care not only differs from person to person (if for no reason other than that different persons have different preferences for risk), but is ultimately determined by economic considerations – that is, by trade-offs, by the value of what is sacrificed in order to obtain any level of health care.