The Politics of Medicine

When medical care is made free and health resources are allocated through the political system, certain inevitable consequences are expected. First, because health care that is rationed by waiting is less valuable, voters will prefer to spend less on it than they would have spent if care were purchased with money. Second, despite the stated desire to create equal access to care, geographical inequalities are inevitable if voters in different areas have different preferences. Third, inequalities by income and education are inevitable if higher-income, higher-educated voters prefer more health-care spending to other forms of government largesse. In addition, the same skills that make some people more successful competing in the private market place also tend to make them more successful when competing for goods in nonmarket settings. Fourth, because the healthy outnumber the sick and for other reasons, there will be enormous political pressure to over-provide to the healthy and under-provide to the sick. Fifth, because of concentrated interests, the provider side of the market will have a more powerful influence over resource allocation than the patient side of the market. Finally, those in the best position to change the system and remove its defects (the wealthy and the powerful) are among those who benefit the most from its continued existence.