It's always a bit risky to critique a Nobel Laureate but here goes....


There's no doubt that the work of Amartya Sen has enriched the human race. His studies of famine, as an example, have led to a general realisation that in the modern era they're not a result of insufficient food, they're a result of insufficient ability to purchase food that is extant (or to attract food from outside the area to the one of earth). The solution is therefore not to ship corn or wheat, but to ship money and simply give it to people. That this idea has so penetrated even the US government sufficiently that both the Bush and Obama Administrations have attempted to change the method of US famine relief in the face of the usual vested interests is evidence of quite how powerful the point is. However, this does not mean that Professor Sen is correct in all things. And this piece on universal health care shows us this:

The usual reason given for not attempting to provide universal healthcare in a country is poverty. The United States, which can certainly afford to provide healthcare at quite a high level for all Americans, is exceptional in terms of the popularity of the view that any kind of public establishment of universal healthcare must somehow involve unacceptable intrusions into private life. There is considerable political complexity in the resistance to UHC in the US, often led by medical business and fed by ideologues who want “the government to be out of our lives”, and also in the systematic cultivation of a deep suspicion of any kind of national health service, as is standard in Europe (“socialised medicine” is now a term of horror in the US).

The problem with this is that the US does have universal health care. What it does not have is universal health care insurance. And that's a vital distinction. We do not think that the US health care financing system is something that anyone should really be desiring to imitate. We most certainly don't suggest that the NHS, or any other of the European health care systems, should be rebuilt upon the American model. But it is the financing of the system, not the actual treatment, health care delivery, system that is the undesirable thing to copy.

Rock up to any emergency room in the US and you will be treated regardless of capacity to pay. Every county runs a health care system for the indigent and those otherwise unable to pay. Medicaid provides treatment to the poor. Everyone, but everyone, in the US has access to medical treatment. What they do not have access to is treatment without the possibility of having to pay for it out of pocket: and pay for it after the treatment has been given of course.

The importance of this distinction is that Sen is discussing how other countries, ones which don't in fact have universal health care, might move to having such. Great, excellent, a subject well worth discussing. It's also true that we wouldn't go around recommending the US system to those poor countries which currently don't have universal healthcare. But if we don't distinguish between healthcare and the method of financing access to it then we're going to get horribly confused as we try to design the appropriate systems.