Government Intervention in the Health Care Market

Government Intervention in the Health Care Market Naif Almutairi a) As an economic adviser to the Health Minister, how would you respond to the following question raised by a member of parliament? It is more of a basic human right to have access to food than to health care. Why do governments intervene more directly in markets for health care compared to markets for food? Introduction In the western political tradition, basic human rights are universal: all rights are necessary in order to make up the fundamental requirements of a human being (Donnelly, 2013). However, in practice, human rights are hierarchical. As Montgomery (2002:373) declares, peoples actual experiences with human rights reveal which ones are the most prevalent in their daily lives, and thus provide a possible basis for estimating their relative importance and for adopting appropriate policies. Different cultural groups and nationalities have different experiences of human rights (Donnelly, 2013). For example, people from high income countries such as Britain have few experiences of the right to food, yet frequent (and even inevitable) needs for the right to health care (Macklem, 2015). As a result, it can be argued that while food is more of a basic right to life (i.e. without food one cannot live) than the right to have access to health care, the latter is far more applicable to the delivery of human rights in the social, economic and political context of early twenty first century Britain. This essay will examine the problem of basic rights in greater detail, looking in particular at the reasons why the government tends to intervene more directly in health care markets than markets for food. As will become apparent, in order to understand the issue, it is essential to consider the unique nature of the health care marketplace, and the underlying need for government regulation that this necessarily entails. Government Intervention in the Health Care Market In order to understand why governments intervene more frequently and directly in health care markets, it is essential in the first instance to consider the nature and the function of the marketplace. For most commodities (including food), the market performs a simple function that permits buyers and sellers to exchange a good or service for a fee (Harvey, 2011). Free markets therefore allow the price of the good or service to be determined by: (1) supply and demand; and (2) resources available (Harvey, 2011). Prices for food products are agreed by both the buyer and the seller with supply and demand dictating the pattern of the interchange between the consumer and the producer (Donaldson Gerard, 2005). Viewed from this perspective, in a free market place (i.e. a marketplace that is characterised by an absence of government intervention) consumers are sovereign (Taylor Mankiw, 2014). Consumers are thus free to make choices and producers respond in kind (Taylor Mankiw, 2014). However, the health care market is fundamentally different from food and other commodities that are bought and sold in the marketplace (Klein, 2005). Two points in particular are apparent. Firstly, when a consumer becomes seriously ill and needs to enter the health care marketplace, the costs of goods and services are likely to be extremely high (Donaldson Gerard, 2005). For example, for the vast majority of consumers, the costs of complex surgery will far exceed what the customer is able to afford. Thus, consumers in the health care market place are not sovereign economic actors as they are in food markets where hunger is alleviated according to what kind of food the consumer can afford (Wiseman Jan, 2011). Secondly, unlike consumers of food, health care consumers cannot predict when they will become sick or what their future health care needs might be (Donaldson Gerard, 2005). Therefore, consumption in the health care market is not determined by choice but, rather, by uncertaint y (Wiseman Jan, 2011). As a consequence, in the health care market, most transactions occur between insurers and health care providers rather than between the consumer and the commodity producer (Guinness Wiseman, 2011). This, in turn, ensures that transactions which occur in the health care market place are influenced by complex processes of risk management, information asymmetry resulting from consumer ignorance and negative externalities (i.e. where health care exacts a cost to all consumers regardless of whether or not they are purchasing any products) (Guinness Wiseman, 2011). Consequently, in the health care market, prices are not determined by supply and demand; rather, prices are determined by interactions between insurers and suppliers, and health care providers (Taylor Mankiw, 2014). Furthermore, unlike in other commodity markets, the price of health care is not affected by the quantity or availability of resources: when the consumer is sick they have no option but to purchase the product that can make them better (Wiseman, 2011). As a result, stripped of the power and influence of sovereign consumers, the health care market is fundamentally distorted. Where, in an ideal market, consumers act as a check upon the power of the producers, in a health care market suppliers and producers are predominant (Donaldson Gerard, 2005). Consequently, left to its own devices, the health care market would be subject to endemic failure characterised by problems of distribution, resource inequalities and an absence of price controls (Walshe Smith, 2011). It is for this reason that the government tends to intervene more directly in the health care market than in the food market. Government intervention in the health care market is required to regulate the marketplace, establish the parameters for prices, and allocate and fund scarce resources (Mills, 2011). Without government intervention, the public costs of consumption would exceed the private costs of production (Mills, 2011). Conclusion The Member of Parliament who raised the question has failed to grasp two important points. Firstly, although, from a theoretical vantage point, rights are universal, in practice rights are characterised by hierarchy. In Britain, the right to health care is of more practical value than the right to food. Secondly, because consumers are not sovereign, the health care market is susceptible to market failure. Although the existence of market failure and/or market inequalities is not in itself a reason for government intervention, the extent of the distortions and pervasive incentives that arise in health care renders government intervention in the funding and regulation of the health care market an economic necessity. b) What do you think should be the objectives of a health care system? How would you finance and organise the system to achieve this? Introduction At the dawn of the twenty first century, health care is arguably the most contested area of public policy with the legitimacy of governments depending in large part upon the ability to meet the health needs of ageing populations in times of deep economic uncertainty (Buse et al, 2012). The centrality afforded to health care therefore demands that policy-makers have clear objectives and goals so as to set attainable long and short-term agendas for public health care delivery. This essay will examine the issue of objectives in greater detail, looking in particular at the goals of health care in the contemporary era. In addition, the essay will consider the ways in which the state should finance and organise the system in order to meet its objectives. Over the course of the essay, it will be necessary to discuss problems such as raising funds, paying doctors and financing hospitals and other front-line services. The Objectives of the Health Care System The core objective of any health care system should be two-fold. On the one hand, a health care system should endeavour to improve the health and wellbeing of all of the people who use the system regardless of wealth (Mahon, 2011). On the other hand, a health care system should look to reduce the economic burden of disease upon the state (Robinson, 2011). However, these two objectives cannot be achieved in isolation. For example, aiming to improve the wealth of the population demands that the health care system improves access to primary health care (Mahon, 2011). Likewise, reducing the burden of disease demands that health care systems improve the cost effectiveness of health services, and recruit the best medical professionals available to deliver health care (Donaldson Gerard, 2005). Therefore, the core objectives of the health care system are undermined by an unresolved tension between social and economic goals: where social goals outline the primacy of equity, economic objectiv es underscore the importance of efficiency; likewise where social goals consider quantity, economic objectives emphasise quality (Maynard, 2005). As a result, the objectives of the health care system are determined by the nature of the institutional mix between public and private health care providers (Maynard, 2005). Financing and Organising the Health Care System to Achieve Objectives In order to examine how to finance and organise a health care system, it is essential to contemplate the question of opportunity cost. As Donaldson and Gerard (2005) attest, the principle of opportunity cost is constructed upon the premise that purchasing one item inevitably involves a trade-off against another. For example, a health care manager who decides to invest in a particular treatment cannot do so for a different treatment. Thus, the true cost of the allocation of scarce resources is the inability to pay for other resources that the health system requires (Wiseman, 2011). Therefore, opportunity costs suggests that there is always a trade-off between equity and efficiency (Maynard, 2005). This has been particularly prevalent in the NHS where certain areas of the health care system (for instance, coronary disease) have been prioritised over others (for example, mental health) (Ham, 2009). Financing and organising the health care system therefore demands that public health agen cies incorporate the private sector into models of economic development (Balduzzi, 2011). Public-private partnerships (PPPs) have already become a staple feature of health care economics (Klein, 2005). PPPs allow the state to shunt the responsibility for financing the building, operation and design of hospitals and other clinical and non-clinical services to private sector contractors in the guise of Special Purpose Vehicles (SPVs) (Broadbent Laughlin, 2005). Although PPPs have been criticised for increasing the risk of financing health services back onto the public sector, the merging of public sector interests with private sector imperatives represents an ideal means of alleviating the economic burden of funding health care from the state (Klein, 2005). In particular, institutional diversity is able to address the problem of opportunity cost when there is only the one health care provider (Broadbent Laughlin, 2005). PPPs should thus remain a central means of financing and organising health care services. In addition, in order to raise funds, public health care providers should look to fuse taxation with income from patient charges (Donaldson, 2011). Moreover, significant funds can be raised from public health providers treating private patients. For example, NHS Foundation Trusts (FTs) have seen income from private patients increase by 16 per cent in the past two years, totalling  £395.9 million in 2014-15 (Health Investor, 2015). Private sector initiatives can also be used to help to pay for the expertise that is required to deliver quality health services (Donaldson, 2011). Research undertaken by Donaldson (2011), for example, suggests that doctors respond positively to financial incentives (i.e. remuneration per consultation or per operation). Although financial incentives have been criticised for leading to over-recommend of health services, there is little evidence that this is an inevitable by-product of market-based remuneration (Donaldson, 2011). Contractual performance-rel ated pay where wages are linked to market economies would therefore represent the most viable means of paying for and retaining the best medical staff in order to deliver the objectives of the health care system (Tofts, 2011). Conclusion The objectives of the health care system are both economic and social. On the one hand, a health care system should endeavour to improve the health and wellbeing of the population through improving access to care. On the other hand, a health care system should aim to reduce the burden of disease by improving the quality of health care provision. However, the problem of opportunity cost suggests that there is always a trade-off between efficiency and equity. It is therefore proposed that health care systems are financed and organised according to a public-private model. This, in turn, would help to build hospitals and other front-line services, pay doctors and raise funds for the allocation of resources. In the final analysis, quantity and quality can only be established by locating alternative means of financing and organising the health care system.  Ãƒâ€šÃ‚   References Balduzzi, P. (2011) Models of public-private partnerships for the provision of goods, in, Journal of Economics and Politics, 23(2): 271-296 Broadbent, J. and Laughlin, R. (2005) The development of contracting in the context of infrastructure investment in the UK: the case of the Private Finance Initiative in the National Health Service, in, International Public Management Journal, 6(2): 173-197 Buse, K., Mays, N. and Walt, G. (2012) Making Health Policy: Second Edition Maidenhead: The Open University Press Donaldson, C. and Gerard, K. (2005) Economics of Health care Financing: The Visible Hand: Second Edition London: Palgrave Macmillan Donaldson, C. (2011) Credit Crunch Health Care: How Economics Can Save Our Publicly-Funded Health Care Systems Bristol: Policy Press Donnelly, J. (2013) Universal Human Rights in Theory and Practice: Third Edition New York: Cornell University Press Guinness, L. and Wiseman, V. (2011) Health care markets and efficiency, in, Guinness, L. and Wiseman, V. (Eds.) Introduction to Health Economics: Second Edition Maidenhead: The Open University Press, pp.117-132 Ham, C. (2009) Health Policy in Britain: Sixth Edition London: Palgrave Macmillan Harvey, D. (2011) The Enigma of Capital and the Crises of Capitalism London: Profile Health Investor (2015) NHS private pay income up 14% in two years. In Health Investor [online], available at, http://www.healthinvestor.co.uk/ShowArticle.aspx?ID=4259 (first accessed 24.10.15) Klein, R. (2005) The public-private mix in the UK, in, Maynard, A. (Ed.) The Public-Private Mix for Health Oxford: The Nuffield Trust, pp.43-62 Macklem, P. (2015) The Sovereignty of Human Rights Oxford: Oxford University Press Mahon, A. (2011) Health and wellbeing: the wider context for health care management, in, Walshe, K. and Smith, J. (Eds.) Healthcare Management: Second Edition Maidenhead: The Open University Press, pp.96-119 Maynard, A. (2005) Enduring problems in health care delivery, in, Maynard, A. (Ed.) The Public-Private Mix for Health Oxford: The Nuffield Trust, pp.293-310 Mills, A. (2011) Health systems in low and middle income countries, in, Glied, S. and Smith, P.C. (Eds.) The Oxford Handbook of Health Economics Oxford: Oxford University Press, pp.30-57 Montgomery, J.D. (2002) Is there a hierarchy of human rights? in Journal of Human Rights, 1(3): 373-385 Robinson, S. (2011) Financing health care: funding systems and health care costs, in, Walshe, K. and Smith, J. (Eds.) Healthcare Management: Second Edition Maidenhead: The Open University Press, pp.37-64 Taylor, M.P. and Mankiw, G. (2014) Economics: Third Edition London: Pearson Tofts, A. (2011) Managing resources, in, Walshe, K. and Smith, J. (Eds.) Healthcare Management: Second Edition Maidenhead: The Open University Press, pp.399-417 Walshe, K. and Smith, J. (2011) Introduction: the current and future challenges of healthcare management, in, Walshe, K. and Smith, J. (Eds.) Healthcare Management: Second Edition Maidenhead: The Open University Press, pp.1-12 Wiseman, V. (2011) Key concepts in health economics, in, Guinness, L. and Wiseman, V. (Eds.) Introduction to Health Economics: Second Edition Maidenhead: The Open University Press, pp.7-29 Wiseman, V. and Jan, S. (2011) A simple model of demand, in, Guinness, L. and Wiseman, V. (Eds.) Introduction to Health Economics: Second Edition Maidenhead: The Open University Press, pp.37-54

Mini Dialectic Journal

This old lore I had forgotten; else I was not here. In the first scene, we see Teiresias brought in front of Oedipus to talk about the prophecy. He knows the true identity of the King, but feels like it is a burden for him to know it at all. He knows that it wouldn’t profit him to know the truth about Oedipus and the prophecy. He regrets being there, and wished that if he could have just forgotten it, then he won’t have to be in that place. As a prophet, Teiresias felt compelled to tell the truth though he knows that it won’t benefit him. He got dragged in the situation that’s why it’s really is burdensome for him. Ode 1 – CHORUS: Sore perplexed am I by the words of the master seer. Are they true, are they false? I know not and bridle my tongue for fear, Fluttered with vague surmise; nor present nor future is clear. Quarrel of ancient date or in days still near know I none Twixt the Labdacidan house and our ruler, Polybus' son. Proof is there none: how then can I challenge our King's good name, How in a blood-feud join for an untracked deed of shame? In this part, the chorus is somewhat doubting Teiresias and is siding with Oedipus. They’re saying that what the old prophet’s words were confusing, and because of this ambiguity, there is a hint of doubt in the prophecy. They dare not challenge the integrity of the good King Oedipus, as there is not much proof in what the prophet is saying. Because of this, none of them really knows what lies ahead in the future. Scene 2 – CREON: Were not his wits and vision all astray, when upon me he fixed this monstrous charge? When Oedipus and Teiresias argued, it unfolded to the King that someone would dethrone him, and it was Creon. Creon, brazened, stood up to question his King’s assumptions. He reasoned out that the prophet may be out of his mind when he said such things to Oedipus, which he shouldn’t believe much of what he says. Ode 2 – CHORUS: My lot be still to lead   The life of innocence and fly Irreverence in word or deed,   To follow still those laws ordained on high Whose birthplace is the bright ethereal sky No mortal birth they own, Olympus their progenitor alone: Ne'er shall they slumber in oblivion cold, The god in them is strong and grows not old. Still, Oedipus is devoid of the truth. He consults the gods, yet none of them seems to hear his woes and prayers. As a King who knows nothing about himself, he feels fear, anger and pity for himself. All he wanted to know was who his true parents are, but how will he now about it, if there’s know hope left for him to find the truth. Scene 3 – JOCASTA: My greetings to thee, stranger; thy fair words Deserve a like response. But tell me why Thou comest—what thy need or what thy news. Jocasta receives a visitor, who came to tell them that Polybus, Oedipus’ father has died. She thought that because of this, Oedipus was freed of the prophecy, only to find out that Polybus was really not the King’s father. Jocasta thought it was great news at first, only to find out that it would be a nail in the coffin for them. The visitor finally confirmed that Polybus and Merope were not Oedipus’ real parents. Ode 3 – CHORUS: Child, who bare thee, nymph or goddess? sure thy sure was more than man, Haply the hill-roamer Pan. Of did Loxias beget thee, for he haunts the upland wold; Or Cyllene's lord, or Bacchus, dweller on the hilltops cold? Did some Heliconian Oread give him thee, a new-born joy? Nymphs with whom he love to toy? At this part, the chorus questions that the real parents of Kind Oedipus, as the King himself doesn’t know anything about it. All that has unfolded to him that moment was realizations that he grew up knowing nothing about his own self, and as the truths became known, slowly he understands that there is a possibility that the prophecy about him has already been fulfilled. Scene 4 – OEDIPUS: Ah me! Ah me! All brought to pass, all true! O light, may I behold thee nevermore! I stand a wretch, in birth, in wedlock cursed, A parricide, incestuously, triply cursed! This part is the bitter realization that it was really him who’s mentioned in the prophecy, as confirmed by the shepherd. He killed his own father, and married his own mother Jocasta. He wasn’t able to bear all the bitter realizations in the end, despite all his greatness as a king. He was still a human being, weak at heart. Ode 4 – CHORUS: O heavy hand of fate! Who now more desolate, Whose tale more sad than thine, whose lot more dire? This is the summary of emotions felt in the story. Oedipus feels nothing but sadness, as his life has been full of lies. As he discovers the truth about himself, he learns that the prophecy has been true. He is the murderer of his father and had an incestuous relationship with his mother. Nothing could be worst that what he experienced. Exodos – OEDIPUS: Dark, dark! The horror of darkness, like a shroud, Wraps me and bears me on through mist and cloud. Ah me, ah me! What spasms athwart me shoot, What pangs of agonizing memory? After knowing the truth bout his life, Oedipus blinded himself, and has exiled himself away from the city. The haunting memory of his past would always be with him, that’s why he could not bear live in the light. Works Cited: â€Å"Sophocles' Oedipus the King†.   2000. April 1 2008. . Segal, Charles. Oedipus Tyrannus: Tragic Heroism and the Limits of Knowledge. 2nd ed. New York: Oxford University Publishing, 2001. SparkNotes. â€Å"Oedipus Plays†.   2006. April 1 2008. . —. â€Å"Oedipus the King†.   2006. April 1 2008. .   

What Happened to the Mayan Civilization

Week 2 Assignment 1 Michael McCue HUM111 World Cultures I Dr. Andrew N Allphin 16 October 2012 †¢No one can say for certain what happened to the Mayan people, but theories abound and include varied possible alternatives to explain the abrupt and mysterious disappearance of the Mayan civilization. Many historians have questioned â€Å"how† or â€Å"why† the Mayan civilization disappeared after the 10th century; however there is no definitive answer to this question.One possible theory is the Mayan’s civilization grew to such an extent that they deforested so much of the region that it had significant climate changes, thereby forcing the Mayan people to immigrate to other regions (Server, 2004), this theory has some scientific background, and scientists have used satellites to study the topsoil of Central America. They found that right before the civilization collapse, the sediment had changed from tree pollen to weed pollen, suggesting there were no more tree s in the area.The result of a treeless environment is the erosion of fertile topsoil, warmer climate, and a possible reduction of precipitation. Since the Mayans depended on water reservoirs from precipitation, this would have had a detrimental effect. Another theory surrounding the disappearance of the Mayan people is consistent droughts that took place preceding the tenth century and the reduction of civilization through various wars caused the Mayan civilization to dwindle down to virtual extinction.While both theories sound relevant, scientific data is also consistent to what is happening the region of Central and South American and the deforestation of the rain forest. Perhaps history is only repeating itself. References Medina-Elizalde, M. & Rohling, E. J. (2012). Collapse of Classic Maya Civilization Related to Modest Reduction in Precipitation. Science 24 February 2012, Vol. 335 no. 6071 pp. 956-959. DOI:10. 1126/science. 1216629 Sever, T. (2004). The Rise and Fall of the Ma yan Empire. [email  protected] Headline News. Retrieved from http://science. nasa. gov/science-news/science-at-nasa/2004/15nov_maya/[pic][pic]

The Spoils System Definition and Summary

The Spoils System was the name given to the practice of hiring and firing federal workers when presidential administrations changed in the 19th century. It is also known as the patronage system. The practice began during the administration of President Andrew Jackson, who took office in March 1829. Jackson supporters portrayed it as a necessary and overdue effort at reforming the federal government. Jacksons political opponents had a very different interpretation, as they considered his method to be a corrupt use of political patronage. And the term Spoils System was intended to be a derogatory nickname. The phrase came from a speech by Senator William L. Marcy of New York. While defending the actions of the Jackson administration in a speech in the U.S. Senate, Marcy famously said, to the victor belong the spoils. Intended as a Reform Under Jackson When Andrew Jackson took office in March 1829, after the bruising election of 1828, he was determined to change the way the federal government operated. And, as might be expected, he ran into considerable opposition. Jackson was by nature very suspicious of his political opponents. As he took office he was still quite angry at his predecessor, John Quincy Adams. The way Jackson saw things, the federal government was full of people who were opposed to him. When Jackson felt that some of his initiatives were being blocked, he became incensed. His solution was to come up with an official program to remove people from federal jobs and replace them with employees considered loyal to his administration. Other administrations going back to that of George Washington had hired loyalists, of course, but under Jackson, the purging of people thought to be political opponents became official policy. To Jackson and his supporters, it was a welcome change. Stories were circulated claiming that elderly men who were no longer able to perform their jobs were still filling positions to which they had been appointed by George Washington nearly 40 years earlier. Spoils System Denounced as Corruption Jacksons policy of replacing federal employees was bitterly denounced by his political opponents. But they were essentially powerless to fight against it. Jacksons political ally (and future president) Martin Van Buren was at times credited with having created the new policy, as his New York political machine, known as the Albany Regency, had operated in a similar fashion. Published reports in the 19th century claimed that Jacksons policy accounted for nearly 700 government officers losing their jobs in 1829, the first year of his presidency. In July 1829, a newspaper report claiming the mass firings of federal employees actually affected the economy of the city of Washington, with merchants unable to sell goods. That may have been exaggerated, but there is no doubt that Jacksons policy was controversial. In January 1832 Jacksons perennial enemy, Henry Clay, became involved. He assailed Senator Marcy of New York in a Senate debate, accusing the loyal Jacksonian of bringing corrupt practices from the New York political machine to Washington. In his exasperated retort to Clay, Marcy defended the Albany Regency, declaring: They see nothing wrong in the rule that to the victor belong the spoils. The phrase was widely quoted, and it became notorious. Jacksons opponents cited it often as an example of blatant corruption that rewarded political supporters with federal jobs. Spoils System Reformed in 1880s Presidents who took office after Jackson all followed the practice of doling out federal jobs to political supporters. There are many stories, for instance, of President Abraham Lincoln, at the height of the Civil War, being endlessly annoyed by officer-seekers who would come to the White House to plead for jobs. The Spoils System was criticized for decades, but what ultimately led to its reform was a shockingly violent act  in the summer of 1881, the shooting of President James Garfield by a disappointed and deranged office seeker. Bettmann/Getty Images   Garfield died on September 19, 1881, 11 weeks after being shot by Charles Guiteau at a Washington, D.C. train station. The shooting of President Garfield helped inspire the Pendleton Civil Service Reform Act, which created civil servants, federal workers who were not hired or fired as a result of politics. The Man Who Coined the Phrase Senator Marcy of New York, whose retort to Henry Clay gave the Spoils System its name, was unfairly vilified, according to his political supporters. Marcy did not intend his comment to be an arrogant defense of corrupt practices, which is how it has often been portrayed. Incidentally, Marcy had been a hero in the War of 1812  and served as governor of New York for 12 years after briefly serving in the U.S. Senate. He later served as the secretary of war under President James K. Polk. Marcy later helped negotiate the Gadsden Purchase while serving as secretary of state under President Franklin Pierce. Mount Marcy, the highest point in New York State, is named for him. Yet, despite a long and distinguished government career, William Marcy is best remembered for inadvertently giving the Spoils System its notorious name.