Observations Atlantic crossing

Faith based health policy: the urge to privatise

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39237.433843.59 (Published 07 June 2007) Cite this as: BMJ 2007;334:1193
  1. Uwe E Reinhardt, James Madison professor of political economy
  1. Princeton University, Princeton, New Jersey
  1. reinhard{at}princeton.edu

    Who owns health systems matters less than that the various enterprises operate on a level playing field

    Privatising publicly owned and operated enterprises in health systems has become a new fashion in health policy around the world. The movement is based on the credo (and a pure credo it is) that the management of anything by investor owned, private enterprise is by that very fact more efficient than management of the same activity by publicly owned enterprise. Like most credos—such as the belief in the Virgin Birth—this one lacks robust empirical support; but it matters little. The believers march on undaunted and have been successful in spreading the faith.

    One illustration is the firm belief of President Bush and his supporters in Congress that the long term fiscal sustainability of the hitherto government run Medicare programme for elderly people in the United States can be assured only by entrusting that programme to private health insurance plans. On the basis of that credo, they wrote into the Medicare Modernization Act of 2003 a provision under which US tax payers must now pay private health plans an average …

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