17 - How Should We Design Access to a Healthcare System?

Summary

Healthcare is a wonderful, tragic case of the limits of individual capacity in making consumer choices. Often health and medical decisions are so complicated, so expensive, and have consequences so far in the future that it is practically impossible for ordinary individuals to make informed choices about their medical priorities. Given this, it is a natural reach for expert help (i.e., doctors), and the hand of government regulation (in the form of national insurance schemes). Here, Gersel, Souleles, and Thaning look at two national healthcare systems (Switzerland and the United States) that make use of market-based and for-profit mechanisms to provide healthcare. The crucial difference between them is that the United States remains wedded to the idea that individuals can and should make their own informed choices about their care (see pp. 32–36). In contrast, Switzerland has put a hard limit on what can reasonably be expected of individual choice in healthcare provision and has enacted a number of mandatory regulatory guardrails. It should come as no surprise, at this point in the case book, that citizens are taken better care off in the system that actually recognizes limits to individual consumptive behavior in healthcare, rather than sticking to the presumption of the hyper-intelligent Homo-economicus. It turns out we can in this case predict what people need, better than they themselves can through their purchases in an open market (see pp. 38–44).