Terry Fowler

The Political System of Health Care

Our current health care system is seen to be in crisis, mainly because no one seems to be able to able to afford it.  Lack of affordability is the symptom, not the cause of the crisis.  Nevertheless, we continue to assume that spending more money on health services will contribute to our health.  The activities of the medical establishment have in fact little relation to our overall health (Thomas McKeown, The Role of Medicine: Dream, Mirage, or Nemesis? (Princeton Univ. Press, 1979)).  Infant mortality in New York, where $3000 per person is spent on medical care annually, is 10.8; in Shanghai they spend $38 per person, and infant mortality is 9.9. (John Robbins, Reclaiming Our Health (H.J. Kramer, Tiburon CA, 1996,1998))

Most of our health can be explained by a good diet, proper exercise, lack of substance abuse, and healthy social relationships.  Why, then, is there such a crisis?  The answer is partly scientific, partly political.

The methods used by modern medicine can be traced back to the scientific revolution of the 17th century in England and France.  The worldview proclaimed by the new science was that Nature was mechanical and could be explained, predicted, and indeed controlled by humans, once sufficient knowledge had been acquired.  This worldview extended to seeing the body as nothing more than an extremely complicated machine.  When a person was sick, he or she could be cured by replacing a screw, oiling a hinge, or sometimes removing a part. Information about specific functions or parts of the body became essential to diagnosing and treating illnesses.  Just as in other areas of science, doctors became specialists – experts whose detailed knowledge entitled them first to unusual respect, and then to authority.

Indeed, the health care system in the 21st century is hierarchical in the extreme.  Anyone who has been to a hospital has seen doctors sweeping through their rounds with herds of interns, ministered to by nurses.  Even though nurses often know as much or more about the patients, their status is clearly inferior.  Somewhere below them are the cleaning staff, patients, and other helpers.  Asserting one’s self as a patient can be a sobering experience, because as a patient one is assumed to know nothing about the proper procedures to follow for a full recovery.  Clinics and doctors’ offices are generally miniature replicas of this scenario, although obviously there are exceptions.  The medical professions regulate themselves, to be sure, but there is a hierarchy within professional associations as well, and heterodoxy is not easily tolerated.

Beyond this structure, there are drug companies who thrive on secretive research to produce the pill for particular illnesses, because as sole producer of that pill, large profits may be realized.  Severe penalties are applied by governments to any company that makes the same pill and sells it for less.  Manufacturers of expensive x-ray equipment, dialysis machines, and diagnostic aids such as MRIs all funnel into the centralized management and procurement systems of hospitals (which are growing larger and larger).

There is a close relationship between a theory of healing that sees the body as a machine and the authoritarianism of the health system.  First of all, if you are a machine, you can’t tell what’s wrong with yourself.  You have to be told by an expert using a fancy machine whether you are well or not.  Even healthy young women who are pregnant and feeling fine can get a shiver of fear if an ultrasound turns up something suspicious.  We have learned to rely on others to tell us how we feel. (Duden, History Beneath the Skin)

“Authoritarian Science and the Sickness Industry,” Green Horizon Quarterly, Winter 2005, 13-16