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Access to medicines

Markets are highly efficient mechanisms for ensuring that outcomes track people’s different preferences. This is illustrated by the first story, which suggests how markets can achieve a miraculously apt match-up of people to vacations or, more generally, commodities. Markets can be similarly efficient in achieving an apt match-up of people to jobs. But markets can be problematic, too, as the second story suggests. Channary rents out her body for a few dollars, often suffering violence and abuse. She will be HIV positive in a few years and, unable to afford advanced AIDS medicine, she will die in her early twenties. The tourist will enjoy quality medical care in his home country and will have quite a few extra years beyond his parents’ life expectancy. Though fifty years older than Channary, he will outlive her by a decade. Some see no moral problem here. They may judge that, when Channary is renting out her body, she is choosing her most preferred option. If she lacked this opportunity, she would be worse off. And if she rents out her body while knowing the risks, then why should others have to bail her out later when, like so many girls before her, she gets sick? But consider the situation, seven years after their encounter, when he gets his coronary bypass while Channary is losing her battle with AIDS. The cost of his surgery is 200 times that of an annual supply of the antiretrovirals she needs. It is wonderful, of course, that he can be given more healthy years of life. But is it right that she is left to waste away, and to die at 23? There are two related points here. Looking to the future, we might ask whether the market-produced outcome tracks what matters. At $150 per year (Rimmer, 2008), Channary cannot afford the antiretrovirals she needs to survive. Does her access to this medicine really matter less than all the other things on which such an amount, or more, is actually spent? Is an extra year of life for her really less important than my jet ski rental or my dinner at the revolving restaurant? Looking to the past, we should question the economic distribution that conditions decisions and market allocations. Channary indeed prefers to rent out her body seeing her younger siblings cry for food and her mother from despair. But how come she is trapped in such an awful set of options? She was born into a poor family in a country that had suffered decades of devastation. Cambodia was drawn into the Vietnam War, which ended in 1975 with a victory for Pol Pot and the Khmer Rouge. Having killed about one-fifth of the population in four years, they were ousted by Vietnamese forces in 1979, but, with support from China, the US, the UK and the UN, the Khmer Rouge continued to wage a devastating civil war that left Channary’s family in perpetual destitution. None of this can be viewed as her responsibility. It is hard to find fault even with her parents, who worked hard all their lives to get by. They did have five children, to be sure, but with high infant mortality and the lack of social security for old age, one can hardly fault them for that. And they could not have foreseen, of course, her father’s early death from typhoid fever. A market system can put poverty to good uses. It is a good thing that those who, for whatever reason, tend to use resources poorly should become poorer as a result and thus get fewer resources to waste. This is good because more scarce resources will then be controlled by people using them well. And it is good also because, under such a system, people have incentives to improve their performance. But these thoughts must be balanced against two other considerations. The penalty should not be hugely disproportionate. The man who wasted heating oil last year, and the woman who overspent her credit card—let the market constrain them to cut back their spending. But this should not lead to their freezing or starving to death or