Scientism and economism in the regulation of health care

Abstract

As health care costs continue their apparently relentless rise, it seems to be universally perceived that the United States and western Europe are gripped by a cost crisis. To resolve the apparent crisis, U.S. and western European governments and third-party payers are turning increasingly to a new positivist discipline, called health services research, for which neoclassical health economics is the dominant discourse. However this discipline may actually reinforce the strength of biomedical positivism and the concomitant technological imperative. Like biomedicine, health services research is technologically driven, dependent on "advances" that generate more comprehensive and therefore more "accurate" data. Accordingly, just as biomedicine causes health care workers and patients to depend on technologies for diagnosis and treatment, health services research instills in the body politic dependence on technocratically conceived solutions for political problems. Moreover, because biomedicine and health services research share positivist epistemic and methodological premises, both objectify the subjects they study, abstract those subjects from context, and thereby ignore the cultural dimensions of the problems at hand. Rather than inculcate an ethic and practice in which medicine focuses on the meaning of illness for a life, a cultural phenomenon, this form of positivism strengthens the tendency to reject meaning in favor of the causes and course of disease and the abstracted probability of its occurrence. Accordingly health services research and the forms of regulation with which it is allied threaten to overwhelm the medical humanities movement. Furthermore this scientism precludes the institutionalization of political forums in which we can deliberate on the meaning of medicine, health, and death in our lives.