Williams presents a commonsensical way of assessing health policy. A society’s health policy is rational to the extent that health care is given to those who need it and irrational to the extent that it is not. (He ties this to egalitarian politics, which is an interesting, but separable point.)
Williams’s account of how health care should be distributed makes no use of economic ideas. One thing I would like to accomplish is to show just what economic ideas can add. That will put one of our Ps together with our E, if you will.
Jon articulated one idea from economics, paraphrasing Prof. Leikens, in saying that there are no such things as needs, only things that people are willing to pay a lot to get. If so, there’s not much point in distinguishing between goods distributed according to need and goods according to merit.
That may be true for a certain kind of economic analysis. If you want to analyze how people behave and how goods are allocated through exchanges, there isn’t much point to distinguishing goods that people need from other goods. Everything that people want is the same in kind, they differ in degree, measured by how much people are willing to pay for them.
But we aren’t interested only in describing how people behave and how goods are allocated through exchanges. We assess behavior and allocations in various ways. One question we ask is whether a society meets its members’ needs. If not, the rules governing its exchanges should be altered, if possible, to better achieve this result. Or, at least, that’s what I think.
I think this is a flaw in Williams’s article: it treats goods distributed according to merit as scarce but not goods distributed according to need. As I said, I sort of see why he might have done this. In a wealthy society, most needs can easily be met. Food, shelter, and clothing aren’t so scarce that we can’t easily guarantee that everyone has enough to cover their needs.
But health care seems not to be like this. You can always use more.
As Jennifer pointed out, when I say things like this, I run into a little trouble. That’s because I also say things like “we are treated too much and get more health care than we need or is even good for us.” That pretty clearly implies that there is an upper limit to the amount of care that one needs.
There must be a subtle way to reconcile the two points. There is a lot of care that we don’t need, but sometimes get. But there is always some kind of care that we do (or might) need, but might not get.