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Leftist Propaganda on Health Care

March 11, 2009

This morning I was listening to Amy Goodman’s excellent show, Democracy Now. They were talking about the latest proposal for nationalized health care, called “single payer” health. The idea is that the state is the single payer for everyone’s health care.

I’m all for nationalized health care—America is (stupidly) the only post-industrial nation not to make this move yet—but something said by one of the people on the show was frustrating to me.

I’m paraphrasing, since I was driving at the time and couldn’t write it down, but one woman said something like this: “medical decisions should be based on human life rather than on money.”

Now, this sounds great, but it is really naive. Foucault talked about this issue one of his interviews:

I do not see, and nobody can explain to me, how technically it would be possible to satisfy all the needs of health along the infinite line on which they develop. And even though I do not know what would limit them, it would be impossible in any case to let expenditures grow under this rubric at the pace of recent years. [my emphasis]

Later, the interviewer asks who will decide the limits placed on health care, and Foucault answers:

Such choices are being made at every instant, even if left unsaid. They are made according to the logic of a certain rationality which certain discourses are made to justify.

The question I pose is to know whether a “strategy of health”—this problematic of choice—must remain mute. Here we touch upon a paradox: this strategy is acceptable, in the current state of things, insofar as it is left unsaid. If it is explicit, even in the form of a more or less acceptable rationality, it becomes morally intolerable. Take the example of dialysis: how many patients are undergoing dialysis, how many others are unable to benefit from it? Suppose we expose the choices that culminated in this sort of inequality of treatment—this would bring to light scandalous rules!  It is hear that a certain rationality itself becomes a scandal.

It have no solution to propose. But I believe that it is futile to cover our eyes—we must try to go to the bottom of things and to face up to them. [emphasis mine]

This seems right to me. It is naive and foolish to think that cost-benefit decisions don’t have to be made or shouldn’t be made.

I guess my question is this: is it nevertheless appropriate to utilize superficial claims like “don’t make medical decisions based on money” if you’re trying to rally support for the cause, or is it ultimately counter-productive insofar as it reproduces the invisibility of the real mechanisms behind medical decisions?

2 Comments leave one →
  1. Alderson Warm-Fork permalink
    September 7, 2009 4:38 pm

    (I know this is a few months ago, I searched your blog for ‘Foucault’ and came upon it)

    Maybe what the quoted claim is trying to get at is more like “medical decisions should be based on human life rather than on profit”, i.e. the rationing mechanism should be about efficient use of resources in producing ‘human life’ (and presumably well-being), rather than doing that only as a means to generate profits for capitalists? And just expressed very badly?

  2. missivesfrommarx permalink*
    September 7, 2009 9:06 pm

    Your suggestion is spot on: we SHOULD think in terms of efficient uses of resources for producing well-being rather than generating profits. But what I think was said on the radio was something that mystified human life as “priceless.” That’s a good rhetorical tool, I suppose, but you can’t build a policy around it.

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