In This Review

Medicine and the Market: Equity Versus Choice
Medicine and the Market: Equity Versus Choice
By Daniel Callahan, Angela A. Wasunna
John Hopkins University Press, 2006, 334 pp
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Health care is the top public concern in the United States and many other countries. Two of the most vexing problems of health policy are how to balance coverage and quality of care against constantly rising costs and how best to finance those costs. This useful book reviews and evaluates the role of market forces in resolving these problems. It is necessarily a cross-country study, with a detailed focus on the United States and Canada and informative discussions of the health-care systems in Europe and many developing countries. (Japan is oddly omitted.) Reliance on market forces is greatest in the United States, but nonetheless nearly half of U.S. health-care funding is public -- indeed, in per capita dollar terms, much more than in many "socialist" countries, such as the United Kingdom and France. Health-care costs have continued to rise virtually everywhere, and the evidence indicating that market forces -- which have been increasingly introduced since the 1980s -- can restrain these increases is at best ambiguous and uncertain and more honestly highly doubtful. The arguments put forward by the pharmaceutical firms to justify high prices for drugs -- which are hard to evaluate without more information than the industry is willing to reveal -- come in for especially skeptical scrutiny.