The Philosophy of Universal Health Care

Greg Mankiw's piece in yesterday's New York Times poses a tough question concerning universal health care. To wit, how does a society decide who's to receive the benefits of a limited resource? Or to put it another way, for someone who needs an extra bit of an expensive life-prolonging treatment, what's the mechanism by which we're to say, enough is enough?

It's a tough question, to be sure. Here's an excerpt:

The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it. That soft-hearted aspiration, however, runs into the hardheaded reality that state-of-the-art health care is increasingly expensive. At some point, someone in the system has to say there are some things we will not pay for. The big question is, who? The government? Insurance companies? Or consumers themselves? And should the answer necessarily be the same for everyone?

Update: The following link mirrors the argument Mankiw makes about technology comprising the biggest cost factor in U.S. health care. Bloomberg features this comparative analysis between the Canadian and U.S. health care systems and says that a portion in the differences in cost -- much lower in Canada -- can be attributed to the use of technology. Read on:

Technology partly explains the cost discrepancy between the two nations. There are 67 percent more coronary-bypass procedures in the U.S. than in Canada and 18 percent more Caesarean sections, OECD data show. In 2006, the U.S. had more than four times the number of magnetic resonance imaging units - - 26.5 for every million residents compared with 6.2 for every million in Canada -- making Americans three times more likely than Canadians to get a scan, according to the OECD. ...

“The real difference has been their ability to control technology costs,” said Anderson, who directed reviews of health systems for the World Bank and developed U.S. Medicare payment guidelines for the Health and Human Services Department. “The only thing the U.S. is consistently No. 1 in when it comes to international comparisons with Canada and other OECD countries is cost.”

Less technology and, according to a 2007 report from the World Health Organization, 20 percent fewer doctors in Canada than in the U.S. have led to longer lines north of the border. In 2008, 20 percent of chronically ill Canadians surveyed by the Commonwealth Fund reported waiting three months or more to see a specialist. Five percent of Americans polled said they had to wait that long.