Public health insurance under a nonbenevolent state.
This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.
Département des Sciences Administratives, Université du Québec en Outaouais, C.P. 1250, Succursale Hull, Gatineau, Québec J8X 3X7, Canada. pierre.lemieux@uqo.ca
Pierre
P
Lemieux
D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006078:Government Programs / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006291:Health Policy / Q000191:economics; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009313:National Health Programs / Q000458:organization & administration* / Q000639:trends; D018855:Single-Payer System / Q000458:organization & administration*