Steven Taylor has published a string of posts on healthcare and healthcare reform over at OTB (here, here, and here) that, frankly, has me rather baffled. In comments Dr. Taylor writes:
Part of the question is whether good public health, to use Dave’s phrase, is a public good or simply an individualized commodity like an TV.
to which I responded that healthcare doesn’t fit the definition of a public good.
Public good is a term of art in economics. A good is something that can be bought or sold. A public good is a good that is non-rivalrous (meaning you and I can consume it at the same time; one of us consuming it doesn’t preclude the other from consuming it, too) and non-excludable (meaning that I have no way of preventing your consuming it). An example of a public good would be nuclear deterrence.
To my mind my response was completely non-controversial, no more controversial than correcting somebody when he or she refers to a Phillips screwdriver as a thingummy or, perhaps more accurately, calls a star screwdriver a Phillips screwdriver. I would think it’s just ignorance and, after the distinction has been made clear, the speaker would know. They’re different things; they’re intended for different things. The purpose of language is sharing ideas. In order to do that you’ve got to agree on meanings. Without such agreement there is no communcation.
However, the subject has spawned quite a bit of discussion.
So, let’s consider healthcare, private goods, and rights.
Although there are segments of our healthcare system that are public goods, e.g. sanitary sewers—clearly non-rivalrous, arguably non-excludable, and certainly only delivering its beneficial public health effects when their use is compulsory—in general healthcare is a private good. When you consume a dose of erythromycin I cannot consume that dose; if there is only one dose available some allocation mechanism must determine which of us gets it. That is by definition a private good.
However, the healthcare private good has beneficial side effects (the economics term of art for these is positive externalities) that cause everybody to benefit. When the poor are sick their diseases may spread to the rich. Ultimately, that is why public health departments came to be.
Can a private good be a right? I suppose it depends on what you mean by a right. If you assert healthcare as a right, do you mean a right like freedom of the press? That has never been construed as a mandate for the federal government to buy printing presses for everybody. Or do you mean something different?
If by a right you mean something that must be provided and paid for by somebody regardless of your ability to pay, we already have that, at least in the case of emergency care. Hospital emergency rooms are required by law to accept people in urgent need of care regardless of their ability to pay.
I don’t believe, however, that’s what people mean when they say a right to healthcare. What is meant? That’s not a rhetorical question; I genuinely want to know. If healthcare is a right (according to your definition), on what basis could you deny healthcare to someone? Note that if you can never deny healthcare to anyone under any circumstances at the limit case there either can be no such thing as property rights or there can be no rights of self-determination for healthcare providers.
Because healthcare, generally, is rivalrous and excludable some sort of allocation mechanism is necessary. The mechanism can be the market, it can be healthcare providers, or it can be some third party, e.g. the government.
I think that allocating healthcare resources via market reforms is likely to have adverse public health consequnces. If the allocation is to be done by physicians we must adopt some sort of capitation system coupled with a single payer strategy and total healthcare spending must be capped. If the allocation is to be done by a third party, we’ve also got to cap healthcare spending.
However, when healthcare spending is rising at 5% a year, the non-healthcare economy is rising at 2-3% per year, and the majority of healthcare is paid for via tax dollars it’s rather obvious that the situation is unsustainable.