Introduction

Throughout the 1960s Titmuss engaged in an acrimonious dispute with the Institute of Economic Affairs over the market's role in healthcare provision. More positively, this ultimately resulted in one of his most significant works, and last major book published in his lifetime, The Gift Relationship. Here, as well as dealing with the mechanics of the acquisition and use of blood for medical purposes, Titmuss sought to articulate, as advertised on the cover of the first edition, his ‘social philosophy’. For Titmuss, the contrast between the British and American methods of securing blood was marked. The former rested on voluntary donations, and for proponents of altruism in welfare this situation was truly exemplary. Donors gave their time freely, donated their blood at no charge, and could not know who might receive their donation – an instance of the kindness of strangers. Voluntary workers, too, were an important part of a system which existed within a necessary framework of universal healthcare provision. In America, blood was often sold by impoverished donors to for-profit blood banks, arguably laying blood supplies open to contamination, and to potential shortages. The British system was thus both morally superior and more efficient. As we saw in Chapter 24, The Gift Relationship had an impact on American opinion and policy, something returned to below when considering the book's reception.

Early skirmishes

In spring 1963, Titmuss's ‘Ethics and Economics of Medical Care’ appeared in the first edition of the journal Medical Care. Titmuss was involved in this publication's creation, a member of its editorial board, and had participated in its inaugural press conference, agreeing to say ‘a few words from the “social” point of view. He clearly saw Medical Care as a suitable outlet for his ideas on healthcare and the market, a feeling which was reciprocated. The editor, Dr Abraham Marcus, told him that he was ‘very glad indeed that you are going to write on the subject’. In his article, Titmuss noted the introduction of Britain’s ‘free-on-demand health service’ in 1948, something which was not ‘in its essential principles a novel event’, given historical precedents. However, in the work of economists associated with, especially, the IEA and the American Medical Association, the NHS was now regarded as ‘a unique aberration’.