What are the essential elements of the health care crisis? I would say increasing costs, relative poor outcome per unit of cost, lack of access to care due to lack of insurance coverage and health care disparities, together with unequal standards of care. All of these issues are related to the way health care resources are allocated. We have not resolved as a society how those resources should be allocated or on which factors, moral, political or economic, should the decision be based. In the United States our health care system is highly fragmented, and each of these factors is involved to different degrees in guiding the decisions in different segments of the system. In countries which have a unified social insurance program, it would be easier to identify the principles by which the distribution and level of social welfare benefits are governed.
A governmental budget is a political, social, economic and moral document. What would we appreciate of those factors in an analysis of the federal budget? And even more challenging, what would we learn of an assessment of the budget-making process? I think here one might invoke the proscription of knowing how a piece of legislation or a sausage is made. Someone said that politics is the authoritative allocation of scarce resources. While I thought that was the purview of economics, it suggests that control over resources is governed by the exercise of political power. This notion brings us to consider the current issue under discussion in Washington and the media, the so-called “Grand Bargain/Fiscal Cliff” debate over the reduction of budget deficits.Read More