Is Equality the Right Public Policy Goal?

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines research on health disparities in the United States:

Researchers Erika Cheng and David Kindig found that life expectancy varies from county to county by as much as ten years or more…

In [another] study, the country was divided into race-county units, and the researchers found that the life expectancy of one subgroup of black males, which the authors identified as high-risk urban black males, was more than 20 years shorter than Asian females’ life expectancy.

The brief then asks:

What are the policy implications? The brief discusses what policies can be put in place to ameliorate preventable disparities…

But this runs counter to the normal approach that has dominated health policy research for some time, which is also the economic approach: That is to ask how many additional years of life are produced by spending a dollar on various policy alternatives. The economist’s answer is: we should spend money on various programs until the extra years of life gained per dollar spent are the same across all policy options. When that happens, we are maximizing the years of life gained for a given budget. Alternatively we are minimizing the cost of the extra life expectancy we produce.

If we maximize years of life saved per dollar of expenditure, we may not get more equality. We may get more inequality. I think I can say with some confidence that we definitely would not get absolute equality.

Comments (12)

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  1. August says:

    Also, why does equality inside a country matter more than equality across borders?

    • Baker says:

      Because people have bought into the idea of nationalism. I’m not a fan

    • Cabaret says:

      Can’t people see the suffering that national boundaries cause?

    • Dalton says:

      Don’t get confused. As this article points out, equality should be the goal.

      However the region for “maximize years of life saved per dollar of expenditure” should be international.

    • Elin says:

      Everybody knows that the marginal benefit of a dollar spent is higher in low income areas.

    • Fred says:

      Following any type of value paradigm where equality is paramount stagnates growth and progression, because people can’t progress past others.

    • Gavin says:

      Growing our healthcare system out of this disaster should be our priority. Equality in rights is important, equality in ability is impossible.

      • John Fembup says:

        Bu-bu-bu-but it’s my RIGHT to be equal in ability.

        See, it’s all in what “rights” include.

        Obama ‘frinstance says everyone has a right to health care. I suspect he thinks it’s fine to confiscate the labor of physicians by underpaying them.

        James Madison ‘frinstance said everyone had a right to free speech. But it doesn’t cost me anything when you exercise that right. Unless, that is, you’re telling me to “stick ‘em up”.

        So there seems to be something fundamentally different about James Madison’ definition of rights and Barack Obama’s definition.

        But, hey, Obama is the Constitutional perfesser.

  2. Studebaker says:

    Liberal public health wonks love to cogitate on areas such as inequities in life expectancy by race and social status. Oddly enough, the inequities are not primarily due to lack of recourses or discrimination. Most of the differences in life expectancy are due to perverse lifestyle behaviors. People at higher income and social status maintain a healthier lifestyle. As a result, public health advocates want additional spending on health literacy and education for the poor. They also want additional spending to mitigate the poor outcomes of the detrimental behavior.

  3. Perry says:

    Are people with health insurance healthier because of they have health insurance, or because they live a healthier lifestyle?
    I think it’s important to realize as Studebaker pointed out, much of this percieved inequality is not due specifically to health care or lack thereof, it’s due to poor lifestyle choices. In that regard, money is better spent on education which does not require high dollar medical services, or even medical insurance for that matter.

    • Nigel says:

      I guess i’ll be the guy that brings in the genetics question…what if some people are just genetically healthier than others?