i. Approaching the problems

How can we resolve the kind of dilemmas expressed in these headlines?

Asking people what they think

This is the approach Ann Bowling of the King's Fund Centre took. She set out to discover what 'ordinary people' thought should be the health service priorities by conducting a detailed survey of the residents of a part of London. Below are some responses taken from the survey.

• "I think life saving treatments for children are most important. We've had our time now"
• "If a child is really unable to survive it really does seem a bit naive to plough a lot of money into it"
• "If people don't lead healthy lives why should the health authority waste money on making them aware"
• "The most important thing is to cure people who have life threatening illness and then help people to lead a good life"
• "Instead of curing it prevent it. There's no guarantee that you can cure someone so it is better to prevent illness"
• "Care of the dying is most important - why should people suffer?"

Many economists would argue that the problem with these responses is that they mix up opinions and value judgements with facts. Economists believe that it is important to distinguish questions of fact from value judgements and opinions.

Fact or opinion?

A statement such as "Specialist in heart-lung transplants resigns from the NHS in protest at lack of funding" is a positive statement: it can be shown to be true or false and is not dependent upon the value system of the observer. In contrast, "Health care is a basic right and should be provided free" is a normative statement. It cannot be proved true or false: our view of it depends on our value system. One of the things which makes the debate over the provision of health care difficult to resolve is that positive and normative issues are very much intertwined. Sorting out fact from opinion is a first step but it does not explain why there are not enough beds in hospitals or why people might be refused treatment. To analyse this we need to explore the idea of scarcity.