The Political Economy of Healthcare, an exemplary example
This projected special issue of Régulation Review is intended to contribute to the development of a political economy of healthcare. Such an approach does not simply offer a specific way of analysing the questions raised by the healthcare sector. It is also indispensable for any serious consideration of the specific features of healthcare. How, for example, can problems of economic policy in the healthcare field reasonably be analysed if we confine ourselves to a technical analysis composed of the disembodied, dehumanised theoretical models used and abused by mainstream economics? This fantasy version of scientific methods based on the cult of the so-called exact sciences excludes any exchanges with the other social sciences. Indeed, economics is part of these other social sciences, and this is particularly the case for the economics of healthcare because healthcare is, to use Marcel Mauss’s term, a ‘total social fact’. It weaves together various legal, economic, social and even religious dimensions with the organisation of the healthcare system to arrive at society’s fundamental social pact.
- 1 . The adjective patient made its entry into French around 1120 and into English in the mid 14th cen (...)
In the healthcare sector as in others, ready-made, easy-to-use theories have completely separated mainstream healthcare economics from the subject it claims to study. Indeed, the field of healthcare underscores the fact that human beings can suffer and that they are often particularly helpless in the face of illness, much less death. What do these patients have in common with the perfectly rational agent so dear to standard theory?1 Someone who is ill hardly fits the profile of the ideal consumer as conceived by orthodox analysis, or that of the individuals imagined by the theory of insurance, according to which they are better off spending their Sunday in the hospital emergency service because it is free.
The primordial importance of healthcare forces us to recognise that it is not a product like any other, one which could be relegated to the status of a commodity like any private good in the name of promoting the supposedly universal principle of competition. It is also clear that issues of justice (or injustice) are particularly crucial when they touch on the provision and delivery of healthcare. In this area more than others, it is difficult to side-step this ethical rigour.
However, what is involved here is not simply a condemnation of the mainstream toolkit as applied to healthcare. It is also necessary to show that the healthcare sector is an indicator of the deficiencies of the standard economic analysis. There are many other areas where the impasses of mainstream thought are perfectly obvious but healthcare offers a particularly stimulating sounding board.
Another reason healthcare constitutes an exemplary example is the fact that it sums up a large part of the evolution of social policies, including, in France for example, the carry-over of unrestricted pension plans, the individualisation of social protection and the transfer of the management of public funds for social benefits to non-governmental players. The hospital, which used to be the symbol of France’s republican social pact, is now a laboratory for theories of competition and the doxa maintaining that the same rules should be applied to public and private sectors. The study of healthcare ‘reform’ demonstrates that a theory of change must be structured around the triptych ideas/interests/ institutions. Ideas, standards and conventions give institutions life and meaning. They are part of historical trajectories and recurring power struggles (in particular between medical liberalism and the concern of social reformers for the socialisation of expenditures), but also political alliances made between certain social groups at the patient’s expense, in every sense of the term.
In addition, healthcare offers a classic example because it lies at the heart of the evolution of capitalism. Indeed, the hypothesis that healthcare is to modern capitalism what the automobile was to Fordism cannot be brushed aside. A growing share of production and consumption now bears on healthcare, along with education and leisure activities. This new accumulation regime has been called ‘anthropogenetic’ because it is aimed at replacing the human being by human work. The spread of this model imposes an increase in healthcare spending, which in turn calls for funding. Because healthcare spending cannot just be private, public budgets have to increase, and this constitutes a challenge to commodification. From this standpoint, considering healthcare as a simple cost to be reduced is an absurd strategy.
This special issue of Régulation Review is thus intended to show how the healthcare system is emblematic of the evolutions of capitalism. The importance of healthcare goes beyond strictly sector-based issues. This is what makes it an exemplary example.
The present call for contributions is associated with the quarterly seminar on the political economy of healthcare (SEPOSA), held at the Centre for Economic Research and Its Applications (CEPREMAP). Articles can bear on different aspects of the healthcare system, such as private-practice medicine, the pharmaceutical industry or health insurance.
Submissions should exceed 10,000 words (including notes, references, appendices, tables and figures). Publication guidelines may be consulted here.
Submission deadline: 15 December 2013.
1 . The adjective patient made its entry into French around 1120 and into English in the mid 14th century. In both cases, it was applied to the individual ‘enduring without complaint’. It then came to be used as a noun, designating the sick person in relation to the doctor. The patient is thus defined by opposition to the agent, a relationship which, taken in the economic sense, is not without consequences.Haut de page