Medicine and the Market: Equity v. Choice
Daniel Callahan, Director of International Programs, The Hastings Center and author of Medicine and the Market: Equity v. Choice
Willis B. Goldbeck, Consulting Director, Global Public Health Policy and Government Affairs, UCB
Jeanne Lambrew, Senior Fellow, Center for American Progress
Susan Lee, Vice President for Economic Policy, Center for American Progress
Improvements in American health care cannot be made without addressing the fundamental assumptions that underpin our ideas about what health means. That conclusion was the product of a spirited panel discussion on the role of market forces in American health care, hosted on Thursday by the Progressive Bioethics Initiative at the Center for American Progress (CAP).
Panelist Daniel Callahan, Director of International Programs for the Hastings Center, led off the discussion by talking about his new book Medicine and the Market: Equity v. Choice, coauthored with Angela Wasunna. Joining him on the panel were Willis Goldbeck, consulting director for Global Public Health Policy and Government Affairs at UCB, and Jeanne Lambrew, Senior Fellow at CAP. Susan Lee, CAP Vice President for Economic Policy, moderated.
Callahan, whose book took a comparative look at different health care systems from around the world, found that the best systems had “universal health care with carefully introduced and carefully tested market practices.” Key to his understanding is moving past the false choice between markets and government involvement. A better way of framing the issue, according to Callahan, is to view market forces as a set of tools to achieve overall social goals. Under that conceptual model, the value of particular market forces can be tested against a higher standard of equitable access to quality health care.
Callahan pointed out that in many European countries, where universal care is held as a fundamental social value, health care systems are clearly effective. He listed lower costs, higher life expectancies, broad popular support, and quality of care at least equal to the U.S. as the advantages of a comprehensive, universal approach to health care.
By contrast, according to Goldbeck, “The U.S. does not have a system of health anything.” Goldbeck characterized the U.S. approach as a “medical care and repair model” that is fragmented and disjointed. Medical care, meaning specific responses to specific conditions, is emphasized at the expense of health, a broader concept incorporating prevention and overall well-being. Shifting the public discourse to that broader concept could facilitate progress on some substantial fundamental health issues facing the country. For example, distinguishing medical necessity from medical enhancement would enable us to draw some lines around what types of treatments the health system should and should not promote.
All panelists observed that America’s market-influenced emphasis on constantly improving medical technology — called the “infinity model” because it assumes no limit to useful medical progress — has raised the costs of health care across the board. While health care has improved as a result of technology, Callahan said, “The greater the improvement, the more we spend.” An increasingly expensive medical industry raises serious questions about equality of access and long-term sustainability. The basic issue is whether advancing high tech medicine is the best way to allocate limited health care resources that might be better spent on prevention or basic treatment.
Settling the questions will not be an easy task, according to Goldbeck. “We don’t know how to define basic health care,” he said, because we expect basic care to include coverage for every medical contingency. The panelists agreed that if the expectations of the health care system are going to change, the fundamental assumptions of health policy must also change. Lambrew, for one, is optimistic about the possibility for a positive shift. Pointing to growing calls for health coverage from businesses and encouraging developments on the state level, she said that the time for universal health care as a meaningful political issue “might be sooner than you think.”
Note: All video provided in QuickTime (MPEG-4) format.
Thursday, July 6, 2006
Program: 12:30 PM to 2:00 PM
Lunch served at 12:00 PM
Admission is free
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Daniel Callahan was the co-founder of The Hastings Center as well as the Director and President from 1969 to 1996. He is presently Director of its International Programs, a Senior Lecturer at the Harvard Medical School, and Senior Scholar for Institute of Politics and Policy Studies at Yale University. He is also an Honorary Faculty Member at Charles University Medical School, Prague, Czech Republic. Dr. Callahan received his Ph.D. in philosophy from Harvard, his M.A. from Georgetown University, and his B.A. from Yale. He is an elected member of the Institute of Medicine, National Academy of Sciences; a former member of both the Director’s Advisory Committee, Centers for Disease Control, and the Advisory Council, Office of Scientific Integrity, U.S. Department of Health and Human Services. He won the 1996 Freedom and Scientific Responsibility Award of the American Association for the Advancement of Science. Dr. Callahan is the author or editor of 39 books. They include the forthcoming Medicine and the Market: Equity v. Choice (Johns Hopkins University Press, 2006); What Price Better Health? Hazards of the Research Imperative (University of California Press, 2003); False Hopes (Simon & Schuster, 1998); The Troubled Dream of Life: In Search of a Peaceful Death (Simon & Schuster, 1993); What Kind of Life: The Limits of Medical Progress (Simon & Schuster, 1990); Setting Limits: Medical Goals in an Aging Society (1987); The Tyranny of Survival (1973); Abortion: Law, Choice and Morality (1970); Ethics in Hard Times (1982); and, with his wife, Sidney, Abortion: Understanding Differences (1984). He has contributed articles to Daedalus, Harper’s, The Atlantic, the New England Journal of Medicine, the Journal of the American Medical Association, The New Republic , and other journals.
Willis B. Goldbeck, is the Consulting Director of the Global Public Health Policy and Government Affairs for UCB. He serves as an advisor for the Pfizer MRSA Leadership Initiative and Infectious Disease Program, the European Union Foundation for the Improvement of Living and Working Conditions, and is an appointed member to CChange, the National Dialogue on Cancer. As the former Chairman of the Institute for Alternative Futures and the former CEO of The Health Project, Goldbeck continues to serve on the boards of both institutions. Goldbeck is the Founder and past-President of the Washington Business Group on Health (now known as the National Business Group on Health), a non-profit organization dedicated to representing large employers’ perspective on national health policy issues and providing practical solutions to its members’ most important health care problems. He was also the director of the EU CARE Telematics program and has served on the boards of the National Mental Health Association, American Health Planning Association, National Parents and Teachers Association, National Rehabilitation Hospital and the Washington Hospital Center. He has served as an advisor to the European Regional Director of the WHO and as a consultant to the Belgian Ministry of Health, White House National Health Information Infrastructure Project, Monsanto, Schering-Plough, Lucent Technologies, Pharmacia and the United Health Group.
Jeanne Lambrew is a Senior Fellow at the Center for American Progress and an associate professor at George Washington University, where she teaches health policy and conducts policy-relevant research on the uninsured, Medicaid, Medicare, and long-term care. Lambrew worked on health policy at the White House from 1997 through 2001, as the program associate director for health at the Office of Management and Budget (OMB) and as the senior health analyst at the National Economic Council. In these roles, she helped coordinate health policy development, evaluated legislative proposals, and conducted and managed analyses and cost estimates with OMB, the Department of Health and Human Services, the Treasury Department, the Labor Department and other relevant agencies. She was the White House lead on drafting and implementing the Children’s Health Insurance Program and helped develop the president’s Medicare reform plan, the initiative on long-term care, and other health care proposals. She also worked at the Department of Health and Human Services during the 1993-1994 health reform efforts, and coordinated analyses of budget proposals in 1995. Prior to serving at the White House, Lambrew was an assistant professor of public policy at Georgetown University (1996). She received her masters and Ph.D. from the Department of Health Policy, School of Public Health at the University of North Carolina at Chapel Hill and bachelor’s degree from Amherst College.
Susan Lee is the Vice President for Economic Policy at the Center for American Progress. Prior to joining the Center, Sue spent over five years at McKinsey & Company, where she worked with a broad range of clients in the health care and nonprofit sectors and gained expertise across a variety of strategy and management issues. Her experiences have included developing a set of Medicaid reform options for a governor, shaping a major foundation’s investment strategy in K-12 education, and working with leaders of England’s National Health Service to reform regulation of the hospital system. During law school, Sue worked with Attorney General Janet Reno as well as at the law firm of Covington & Burling. She conducted research with both professor Elizabeth Warren on health care affordability and professor Derek Bok on opportunity in America. Additionally, she taught legal research and writing to first-year law students. Sue received her undergraduate degree from Harvard College and her law degree from Harvard Law School, and she is a member of the New York Bar.