Politics, coercion and power: An analysis of economic failure in healthcare systems

Abstract

This study examines notions of government and market failure in British healthcare by tracking and analysing the changing views of opinion formers. Presenting original data that highlights the attitudes of today's opinion formers towards populist notions in health economics it provides a unique insight into the limits and boundaries of contemporary debate. Significantly, the research concludes that swathes of elite opinion no longer support the National Health Service (NHS) in its traditional nationalised guise. While opinion formers instead now believe in a much greater plurality of public and private healthcare today's elite not only question the idea of state healthcare but they also remain sceptical of a purist libertarian market. Indeed, in noting that healthcare has always attracted the interventionist attentions of those with state power, the study questions in fundamental ways the meaning of such terms as 'market' and 'private sector'. In highlighting the timeless propensity for medical and health professionals to seek legislative favour, it argues that the world has never actually seen anything resembling a real market in the bio-medical paradigm and its forbears. Healthcare has always been a deeply corporatist venture run in association with a range of mystical, military, religious, or purely political statist elites. The study begins with an historical overview of healthcare from the military hospitals of the Roman period, through the religiosity of the Middle Ages, the mutuality of the nineteenth century, the statism of the National Health Service and the recent rise of public private partnerships. Examining such concepts as monopoly, consumer ignorance, moral hazard and externality, it also analyses notions of public versus private goods in the context of today's healthcare.