I assume you are speaking strictly about popular sense in the U.S. And I
doubt this statement is even true here, rather you are speaking about,
excuse the expression, inside the beltway consensus. When I go to a
meeting like the International Health Economics Association, it is only
among the U.S. contigent (and to a lesser extent U.S. trained technocrats
from dependent countries with AID or IMF/World Bank jobs), who feel it
necessary that social criteria for making health resources allocation
decisions must flow directly from "neoclassical foundations of welfare
economics." There are lots of other creative, and empirically based
approaches being advances that try to combine some meaningful mix of
objective individual well-being, equity under fixed budget constraints and
some measure of social preference that would emerge under a democratic
process. No one claims to have the final answer and there is a lot of
controversy and debate but the point is; no one except the U.S. NC find any
reason that all discussion of social allocation must be bound to the NC
paradigm and, in fact, there have been several keynote addresses at these
conference expressing bitter resentment that the U.S. NC types want to
impose this orthodoxy on the rest of the world. Also on interest is that
much of the work presented by the non-US world at these meetings is actually
about ongoing work in making health care sector allocation decisions while
most of the U.S. work is about either about high abstract models of health
care Industrial Organization, mostly concluding that a minimum of regulation
(and even cooperation) is best [from orthodox NCs] or documenting the
pathology of the U.S. healthcare market in actual operation [the rest of
us].
I served as the "unofficial" U.S. expert on an OECD panel trying to evaluate
how health systems deal with breast cancer across different country systems.
"Unofficial," because it basically impossible to identify any U.S.
government agency that can officially represent the U.S. on planning or
policy in regard to national health care allocation. The head of the OECD
study expressed great frustration to me about this and I had to explain to
him that the idea of official government health care planning in the U.S.
was not an acceptable idea. Afterall, if such a concept were acknowledged,
what would be the fate of the "magic of market place." Most Penner's are
aware of the fate of healtcare reform under the Clinton's (I hasten to say -
I think the Clinton's proposal, itself, was fatally flawed and
unprincipled). But even much milder attempts to provide non-market
technical guidance to how health care is organized and delivered have been
bitterly opposed and defeated. For example, after some successful
experience in restricting the over-dissemination of expensive and redundant
capital equipment, most Certificate of Need regulations have been repealed.
The Agency for Healthcare Research and Quality (AHRQ, formerly known as
AHCPR) was once suppose to issue objective, science-based clinical
guidelines. After it did so on the treatment of lower back pain that
indicated that surgical treatment is almost never indicated, the orthopeadic
surgeons managed to lobby Congress to abolish the agency. The agency was
"saved" but it's ability to issue meaningful guidelines was essentially
eliminated. The slogan of the surgeons was along the lines of "don't let
government bureaucrats mess around with the free choice of the medical
market place."
This is a digression, but the point is that when you tell this kind of story
to European or Canadians they stare back at you in disbelief. They can't
fathom the degree of anarchy that is allowed for something as important as
people's health. [Don't get me wrong, I am not saying that these other
societies have achieved social-democratic paradise status, but I think we in
the U.S. often forget how much social chaos we allow even by comparison to
these mildly reformist societies.] Then they hear the "top" U.S. academic
health economists basically apologizing for this state of affairs by saying
it resembles a highly simplified model that supposedly replicated so kind of
optimality, arbitrarily defined by some crypto-facist theoretician half or
century or more ago.
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]
Sent: Friday, August 17, 2001 4:55 PM
To: [EMAIL PROTECTED]
Subject: [PEN-L:16017] Reducing Risk (was Re Re . . . DeLong)
mbs: to Martin, The only special thing is the lack of any
popular sense of an alternative answer.
to Carrol: properly defined, defending the working class
is the common good, though it's not as easy to define
"primarily black & female working people" properly in
this vein. Not impossible, but not easy.
In re: sabotage, my impression is that this modus
operandi has become standard for whichever party is
not in the White House: do whatever to sabotage the
other guys, albeit to no productive end.
mbs
Ditto, But what is so special and correct about any given neoclassical
solution to this question?
Max Sawicky wrote:
>
> That's interesting as far as matching policies to
> popular preferences, but does it tell me
> how to vote if I'm dedicated to the common good?
>
If I weren't tired and didn't have errands to run, I'd try to give a
substantive commentary here, but I am tired and must run, so I'll state
a dogma that I think could be defended undogmatically.
Progressive politicians ought not to honor the common good; they ought
(by fair means or foul) defend the interests of working people,
primarily black & female working people. They ought also (though this is
actually redundant) do all in their power to sabotage the work of the
Defense Dept., the State Dept. and the Attorney General.
Carrol
