здравоохранение и рынок

Журнал New Republic опубликовал офигительнейшую статью против маркетизации здравоохранения (к сожалению, статья доступна только подписчикам). Вот оттуда показательный отрывок:

In 1963, a seminal analysis of the medical care system as a market was published in the American Economic Review by the distinguished economist Kenneth J. Arrow. He argued that the medical care system was set apart from other markets by several special characteristics, including these: a demand for service that was irregular and unpredictable, and was often associated with what he called an "assault on personal integrity" (because it tended to arise from serious illness or injury); a supply of services that did not simply respond to the desires of buyers, but was mainly shaped by the professional judgment of physicians about the medical needs of patients (Arrow pointed out that doctors differ from vendors of most other services because they are expected to place a primary concern for the patient's welfare above considerations of profit); a limitation on the entry of providers into the market, resulting from the high costs, the restrictions, and the exacting standards of medical education and professional licensure; a relative insensitivity to prices; and a near absence of price competition.

But perhaps the most important of Arrow's insights was the recognition of what he called the "uncertainty" inherent in medical services. By this he meant the great asymmetry of information between provider and buyer concerning the need for, and the probable consequences of, a medical service or a course of medical action. Since patients usually know little about the technical aspects of medicine and are often sick and frightened, they cannot independently choose their own medical services the way that consumers choose most services in the usual market. As a result, patients must trust physicians to choose what services they need, not just to provide the services. To protect the interests of patients in such circumstances, Arrow contended, society has had to rely on non-market mechanisms (such as professional educational requirements and state licensure) rather than on the discipline of the market and the choices of informed buyers.

Of course, another conclusion could have been drawn from Arrow's analysis (though he apparently did not draw it). It is that medical care is not really a "market" at all in the classical economic sense, and therefore that the basic theories of economics are not relevant to the discussion of the first principles of health care. But our society assumes that market economics applies to virtually all human activity involving the exchange of goods or services for money, and this dogma is rarely questioned. Most economists would acknowledge that medical care is an imperfect or idiosyncratic market, but still they believe that it is a market, and that it should therefore obey economic predictions.

Человек, который утверждает, что здравоохранение это «такой же бизнес, как и любой другой», а посему и там должно неукоснительно следовать законам свободного рынка, либо (а) циничная и бессердечная сволочь, либо (б) болван с напрочь промытыми мозгами. Второй вариант встречается намного чаще, чем первый. Потому что тот, кто долдонит «больше конкуренции, меньше регуляции» и т.д., не вникая при этом в суть проблемы, сродни какому-нибудь Свидетелю Иеговы, который ходит по домам и раздаёт людям всякие идиотские религиозные брошюрки, монотонно при этом повторяя, "Jesus will come and solve all our problems".

А иногда мне кажется, что либертарианство это такая завуалированная форма евгеники -- в условиях свободного рынка, слабые и больные вымрут нафиг, а оставшиеся «эффективные собственники» будут расой сверхчеловеков.

Update: а вот ещё одна статья против маркетизации здравоохранения, на этот раз в Slate.