Random Events, Conditions, Disorders, Diseases: Part II

Posted on February 29, 2012


I finished Part I of this post making two claims.  The first claim was that the labels given the circumstances of patients can affect the patients’ perceptions of themselves. The second was that those labels can affect the treatment offered to the patients. In addition to those two claims, I asked two questions. One of the questions was, “Is health care a public or private good?”

To those of you who are saying, “That’s a trick question,” I will admit that it is definitely a trick question. The trick spins on two pivotal points. The first pivotal point is how one understands the word “good.” If one takes it as meaning “benefit,” health care can and should provide a private benefit to individuals. I believe individuals should have the opportunity to enjoy their lives completely. If individuals are healthy, they are enabled to contribute as much as they can to society. The more individuals benefit society, the more society benefits.

I know the second pivotal point making this a trick question will get me in trouble with many readers, because I am going to bring the discipline of economics into the mix. Some of you are already asking, “How can you put a monetary value on a human life?”

Before I sink too deeply into this quicksand, I will tell everyone that I value everyone’s life, just as John Donne wrote in his essay, Meditation XVII,

“No man is an island, entire of itself…never send to know for whom the bell tolls, it tolls for thee.”  If one person dies or is incapacitated, that takes away a little piece of me. Most people are more familiar with Donne’s essay translated into a poem that Ernest Hemingway used in the flyleaf of his novel, “For Whom the Bell Tolls.” In this sense, health care is of social benefit.

Although many political careers have been lost or almost lost trying to traverse this quicksand blog, I’m not a politician and I believe that I must begin wading through the quicksand. Health care, just like everything else in today’s world, has expenses related to it. Expenses and money bring the discipline of economics into the fray. Economics defines a social good as a benefit with two properties.

The first property is known as “non-rivalry.” This refers to a good that all can enjoy in common in the sense that each individual’s consumption of such a good leads to no subtraction from any other individual’s consumption of that good. Health care on the surface may appear to be a non-rivalry good. However, on closer inspection it is not hard to become convinced that there is not an inexhaustible supply of doctors’ time, hospital space or medications.

The second property is known as “non-excludability,” that is, it is impossible to exclude any individuals from consuming the good. For health care, it is easy to see that certain individuals can be excluded.

Since health care fails both the non-rivalry and non–excludability tests, health care can’t be classified as a social good. Does that make it a private good? The major problem with labeling health care a private good is that the overwhelming majority of individuals can’t afford the cost of treatments associated with health care.

In addition, even if all the individuals who need a certain type of health care were to pool their resources, they couldn’t possibly pay for the research and development necessary to further the fight against their condition, disorder or disease. R & D for health care must be considered something beyond the communal efforts of those directly affected. R & D requires a social effort.  In Part III of this post, I will highlight a number of those R & D efforts as well as some communal efforts that attempt to help patients and their caregivers cope with their day-to-day problems.