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Who Shall Live? Health, Economics, and Social Choice (Expanded Edition)
In this classic book, Professor Victor Fuchs draws on his deep understanding of the strengths and limitations of economics and his intimate knowledge of health care institutions to help readers understand the problems every nation faces in trying to allocate health resources efficiently and equitably. Six complementary papers dealing with national health insurance, poverty and health, and other policy issues, including his 1996 presidential address to the American Economic Association, accompany the original 1974 text.Health professionals, policy makers, social scientists, students and concerned citizens will all benefit from this highly readable, authoritative, and nuanced discussion of the difficult choices that lie ahead.
296 pages, Paperback
First published March 31, 1975
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Displaying 1 - 11 of 11 reviews
May 9, 2025
Actually exceptional. One of those books that tickles your mind and changes your career trajectory.
October 17, 2016
Health economics classic.
Traditionally, the family (combined with religion) was the mechanism for insuring against the consequences of disease and disability and the locus of the production of care. With industrialization and urbanization, the provision of insurance and of care tended to move out of the family and into the market, the observed increase in medical's care share of total economic activity is thus nothing more than an accounting illusion.
However, medical insurance didn't stay into the market, but increasingly became a function of the state. Every time the state assumed an additional function, the need for close family ties became weaker. It has often been alleged that intra-family dependency relationships are inhibiting and destructive to individual fulfillment. However, whether a dependency relationship with the state will prove less burdensome remains to be seen. Plus there is also the question whether the efficient provision of impersonal caring is feasible.
Another essential question is how the cost of health care should be shared? Two conflicting answers, casualty insurance vs social insurance model. Which one is more conductive to an efficient health care system is primarily an empirical question (interwoven with value judgements) that cannot be answered a priori. Which approach is more just is primarily a value question (individual vs collective responsibility). Hopefully the genetics revolution may further shift(consolidate) public sentiment toward the social insurance model.
Technological chance in medicine must be tamed but not destroyed, as it is the most important force behind the escalation of health care expenditures. Needed is a new technology assessment, mapping not only efficacy and safety, but also encompassing considerations of quality of life, patient preferences, and especially the evaluation of costs and benefits.
Finally, we must learn to cope with an aging society. The amount of health care that the elderly can consume is limited only by the imagination and ingenuity of scientist, physicians, et al Ultimately we must teach people how to die (major challenge as most people haven't even mastered the art of living) Otherwise things will get messy, with mounting financial and ethical pressures, whereby the right to death with dignity will be transformed into an expectation and eventually an obligation.
Traditionally, the family (combined with religion) was the mechanism for insuring against the consequences of disease and disability and the locus of the production of care. With industrialization and urbanization, the provision of insurance and of care tended to move out of the family and into the market, the observed increase in medical's care share of total economic activity is thus nothing more than an accounting illusion.
However, medical insurance didn't stay into the market, but increasingly became a function of the state. Every time the state assumed an additional function, the need for close family ties became weaker. It has often been alleged that intra-family dependency relationships are inhibiting and destructive to individual fulfillment. However, whether a dependency relationship with the state will prove less burdensome remains to be seen. Plus there is also the question whether the efficient provision of impersonal caring is feasible.
Another essential question is how the cost of health care should be shared? Two conflicting answers, casualty insurance vs social insurance model. Which one is more conductive to an efficient health care system is primarily an empirical question (interwoven with value judgements) that cannot be answered a priori. Which approach is more just is primarily a value question (individual vs collective responsibility). Hopefully the genetics revolution may further shift(consolidate) public sentiment toward the social insurance model.
Technological chance in medicine must be tamed but not destroyed, as it is the most important force behind the escalation of health care expenditures. Needed is a new technology assessment, mapping not only efficacy and safety, but also encompassing considerations of quality of life, patient preferences, and especially the evaluation of costs and benefits.
Finally, we must learn to cope with an aging society. The amount of health care that the elderly can consume is limited only by the imagination and ingenuity of scientist, physicians, et al Ultimately we must teach people how to die (major challenge as most people haven't even mastered the art of living) Otherwise things will get messy, with mounting financial and ethical pressures, whereby the right to death with dignity will be transformed into an expectation and eventually an obligation.
July 17, 2022
I read the 2nd expanded edition, first published in 2011.
It is disheartening how little has changed since the first version book was first published. Almost everything author discusses is even more relevant almost 50 years later.
It is incisive and comprehensive.
The only disappointment is that the data has not been updated since 1995 or so.
While I support the universal voucher program suggested, my question to Dr. Fuchs and his collaborators is how to deal with all those administrators in doctors' offices, CMS and so forth who will be put out of their jobs.
It is disheartening how little has changed since the first version book was first published. Almost everything author discusses is even more relevant almost 50 years later.
It is incisive and comprehensive.
The only disappointment is that the data has not been updated since 1995 or so.
While I support the universal voucher program suggested, my question to Dr. Fuchs and his collaborators is how to deal with all those administrators in doctors' offices, CMS and so forth who will be put out of their jobs.
June 19, 2008
I came across this book in a used bookstore a number of years ago and picked it up. It first came out in the early 1970s and is one of the most cogent explanations of how health systems work and what is wrong with the US health system that I can think of. Just amazing that someone could see this so clearly and write it up so well, over thirty years ago and we're still in this mess.
January 2, 2021
Very informative book on the health care system of the US and health economics. Dr. Fuch's book provides a delineation on the pros and cons of universal health care and what could be done to achieve it. Nevertheless, a large portion of the work seems to be a hard sale on universal coverage.
December 5, 2023
Read 3rd Edition
Echoing former reviews— it is disappointing that little has changed when it comes to healthcare accessibility
Echoing former reviews— it is disappointing that little has changed when it comes to healthcare accessibility
July 7, 2012
Caveat: only read Intro and Chapter 1 as an assignment. I have to say, for a fairly old book, the themes brought up in these sections are still strikingly relevant. Namely, Fuchs spells out the health care dilemma in economic terms and challenges the romantic notion of "health care as a right." Regardless of where you fall in the political spectrum, this is required reading for health care professionals, IMHO.
September 28, 2015
This is an outstanding book on the multidimensional nature of choices made in health policy, and the inherent tradeoffs and opportunity costs involved in decisions to interfere with the healthcare market. Far too many policymakers fail to consider the complexity of healthcare in their decisions and take, as Fuchs labels it, a 'monotechnic' approach to the issues. This book is a "must read" for anyone who wants to be a serious student of health policy and economics.
August 3, 2011
I read this in college -- when managed care was just starting to make national inroads. The book examines the challenges in allocating health care resources efficiently and equitably. The book was first published in 1974 (the edition I read). The book has since been updated although if you read the original version, Fuchs' arguments are just as pertinent now as in 1974.
February 16, 2014
Read the 1975 edition in college. We are still wrestling with the same problems in health care and his analysis of each of the 'players' is still relevant - patients, physicians, hospitals, insurance companies, social policy makers, etc.
February 6, 2008
Not an easy read but very interesting. I really liked it.
Displaying 1 - 11 of 11 reviews