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p 53 The Medicalization of Life
"...some critics recommend enlightened cost consciousness on the part of consumers; (55) . . .
. . others, not trusting the self-control of laymen, recommend mechanisms to heighten the cost consciousness of producers.(56)"
Physicians, they argue, would prescribe more responsibly and less wantonly if they were paid (as are general practitioners in Britain) on a 'capitation' basis that provided a fixed amount for the maintenance of their clients rather than a fee for service.
But like all other such remedies, capitation enlarges the iatrogenic fascination with the health supply.
People forgo their own lives to get as much treatment as they can.
In England the National Health Service has tried, albeit unsuccessfully, to ensure that cost inflation will be less plagued by conspicuous flimflam.(57)
The national Health Service Act of 1946 established access to healthcare resources for all those in need as a human right.
The need was assumed to be finite and quantifiable, the ballot box the best place to decide the total budget for health, and doctors the only ones able to determine the resources that would satisfy the need of each patient.
But need as assessed by medical practitioners has proved to be just as extensive in England as anywhere else.
The fundamental hope for the success of the English health-care system lay in the belief in the ability of the English to ration supply."
55) John and Sylvia Jewkes, Value for Money in Medicine (Oxford: Blackwell, 1963, pp. 30-7, argue: 'It may be that, as electorates become more sophisticated, they will recognize they have in fact to pay for free services'; also that relatively cheap prevention through more healthy everyday habits is more effective than purchase of repairs.
56) Fuchs, in Who Shall Live?, chap. 3, argues for institutional licensing as a substitute for the licensing of individuals. Under such a system, medical-care institutions would be licenses by the state and would then be free to hire and use personnel as each saw fit. This system would deploy resources more efficiently and proved more upward job mobility. But the physician's control over care produced and delivered by others would be weakened.
57) For a bibliography on socialized medicine in Britain, consult Freidson, Profession of Medicine, p. 34 n.9"
A Veritable Dictatorship by Sylvie Simon (Healing, an Illegal Practice) with preface by Mtr Philippe Autrive