Health Care, the Price System and the Conflict Between Access to Care and Cost-Containment

Stephen Paschall

Journal of Economic Issues, 2009, vol. 43, issue 2, 403-412

Abstract: Health policy in the United States struggles with apparently conflicting purposes: (1) access to health care and (2) cost-containment. The failures of policy to resolve this apparent conflict have produced inequities in the health system and the perverse outcomes of high costs and poor access. The failures of policy are associated with the third-party payment system that has become a "rationing transaction" in John R. Commons' hierarchy of transactions. The dominion of private interests over the payment system elevates the financial interests of insurers over the interests of patients. Commons' approach to "reasonable value" as a means of resolving conflicts of interest through a process that engages all participants in the going concern suggests a strengthened role for the public sector in the payment system to achieve the public purposes of the health system.

Date: 2009
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DOI: 10.2753/JEI0021-3624430213

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