Wednesday, January 05, 2005

Can "Society" Afford so many Cell phones?

Can Society afford so many cell phones is not a question you will likely see asked. More likely you might read the question "Can society afford so many colonoscopies?", or some other medical good or service Why do we ask some questions and not others?. Concern about cost and cost benefits analysis (CBA) are common now in medical publications.
CBAs are typically cast in terms of the cost to "society". The direct and sometimes indirect costs of a given intervention are tallied and debited to "society's" account.
Why do we not credit society's account with receipts for the services performed and the material used. One man's costs is another's revenue. Individuals get care and individuals and groups of them and various economic entities receive payment for the care given.
"Society" is not some third payer in the game. Society is not some super entity. Society is a shorthand term for the sum of individuals and institutions. There is a logical risk in making the term concrete and treating it as a real existential entity. Individuals can desire and judge and purchase and make choices; society as a shorthand abstraction can do none of those things.
Why are costs decried in this particular area of economic activity? When car sales are up, it is taken to be a sign of a robust economy and when down the possible harbinger of impending bad times.
Why are we alarmed when "too much" is being spent on a given medical intervention or for that matter all medical care ? Why is buying iPods good and buying flu shots not?
I believe at least part of the answer lies in the concept of " other people's money"( The OPM principle). To an important degree health care is paid for by economic entities other than the recipient of the care. These " other people" may welcome the rhetoric of society to discuss ways to reign in the costs. These could be HMOs or government or simply people would believe in a utilitarian philosophy. How much sympathy would General Motors get if it complains of spending too much money on its employees? Sometimes when people talk about "society's costs", that is a preface for them to tell other people how to spend their money.


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2:56 PM  

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