By David Reisman (auth.)
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In a meaningful sense, this is 'political income', and it must be reckoned as a part of the total rewards of office. 2o Such a constraint of conviction will have important implications for the health care sector. An advocate of privatisation who is also an opponent of deficits will call for cuts in national health spending in response to macroeconomic exigency. A proponent of integration who is also a spokesperson for the hard-to-reach will demand female doctors for housebound Asian housewives.
There is no way to say for certain. There is no way to say for certain if the autonomous pressure of the practitioner with the vested interest constitutes a serious challenge to the effective functioning of the market for health. What is more certain is the bounded nature of the producers' power: 'If suppliers can influence demand, there must exist limits on their ability to do so. '23 The doubts expressed by Auster and Oaxaca concerning the ability of the medical professionals Galbraith-like to shift the demand function into any position of the suppliers' own choosing are valid and logical.
It is legitimated in an analogous manner in the case of clinical freedom where the public, consulted, takes the view that the doctor knows best. Ignorance and expertise being so unequally distributed, the public might reason, the community cannot do better than to rely on its trained professionals with their service ethic to act the gatekeeper with respect to the what, the when and, most difficult of all, the for whom. Such a confidence in the wisdom of the practitioner was expressed by the White Paper of 1944 even as it proposed the introduction of the National Health Service: 'The practice of medicine is an individual and personal art, impatient of regimentation.
Market and Health by David Reisman (auth.)