Criticism Number 6
Samuel uses a model built on paradigms developed outside health care and seeks to induce governments to impose it on health care systems across the world on the basis that because it works elsewhere it must work in health care too. As such it exhibits all of the worst features of an ideological based system of reform. This is not the way to introduce change and doing it in this way is fraught with danger.
The market has imposed its practices and thinking on health care in the face of logic and evidence. Financial success has been proof enough. Given the opportunity it will do exactly the same in Australia and any other country, which liberalises health care.
CLICK HERE -- for more information about the cognitive, social and political processes involved in desirable change and the way in which the market has imposed the changes which serve its purposes but disadvantage citizens. The processes adopted by Samuel impose solutions on others and do not support socially generated changes within postmodern paradigms.
I am concerned about the nature of Samuel's proposals, particularly the ultimate objectives. I am concerned about the intended and unintended consequences of achieving those objectives, and of the processes used to accomplish them.
Samuel's ideas of "internal consistency" tightly "articulated" from the outset can only be achieved by using a single paradigm and ignoring all other insights, including those which emerge as the system is introduced. It provides "greater certainty for private sector players". This effectively downgrades community interest and input. Professional insights are discredited. It exhibits undesirable features that can only impede effective and beneficial social change.
It promotes integration in a market-based system. That has been one of the major problems in the US system. It has facilitated fraud, unethical relationships with the medical profession, and the manipulation of vulnerable people for profit.
Any sensible plan for change must be incremental and based on carefully evaluated steps. Ideally it should start from something which is known to work in health care and develop this to meet the changing situation. It should be examined from multiple points of view. There should be wide input. Broad rather than narrow objectives should be synthesised from these. Small carefully evaluated steps are required. Economic considerations are important when deciding on how to most effectively spend the available money. Evidence and unanticipated outcomes must be sought and carefully examined. It should commence and be continually centred on the actual experience of the situations that are to be reformed. It is important that this should not be a marketing exercise - a "Yes Minister" process for selling corporate or political ideology.
These processes must be shielded from pressures generated by self-interest. I doubt the market's ability to do this. This www site shows that the health care market has not done so.
CLICK HERE -- to proceed to the next criticism - Number 7
CLICK HERE -- to proceed to the next section of Samuel's speech.