Health, by what means and at what price?

Summary The economists' perspective on the health debate is reductive. But as reductive as it is, this point of view is also inevitable. In health care, as elsewhere, our societies have to make choices that are usually described as economic. The question of the proper allocation of resources among the various health needs is therefore "inescapable". Arbitrating between these needs is as difficult as it is inevitable. One may wonder about the deep-seated reasons for the introduction and growth of a competition issue in areas where it was perhaps not initially present. We are no longer in subsistence societies. We are in societies in which the number of goods and services that are provided has multiplied considerably. This situation exacerbates the difficulties of any planning. The "central" intervention to decide what should be is increasingly difficult: how to decide from above what is good for a given person, in a world where this person makes complex arbitrations between the items of his consumption. Of course, this diversity of possible choices is unequally accessible according to income. But we live in a world of multiplied goods, many of which belong to what used to be called the superfluous and not the necessary. The legitimacy of decentralized mechanisms is growing, and with it the taboo on the profit motive is weakening. This is true, albeit in a mitigated way, for the health sector, not only because part of the care is what is sometimes called comfort, but because progress is accompanied by an increase in the goods made available, such as treatments, and an increasing indeterminacy of the register of the necessary. Three texts open this book, the second in a cycle on health: by Roger Guesnerie, L'inévitable regard économique . by Pierre-Yves Geoffard, La santé et ses " marchés " . by Julian Le Grand, La question du choix dans les systèmes de santé : illusion ou solution ? In the "Counterpoints" section, Claudine Attias-Donfut, Marie-Odile Bertella Geffroy, Jean-Louis Bourlanges, Jean-Marc Ferry, Maurice Godelier, Joseph Maïla, and Serge Marti debate the proposed analyses. In the postface, Roger Guesnerie reviews the proposals, questions and criticisms to which they gave rise.