Over the years I have had to confront the arguments that "we are different", that "these things could not happen here" and that "our regulations would prevent this". I have pointed out that these arguments are not logical and we are not superhuman. Our regulators have been inexperienced and inept.
We are now confronted by the nursing home scandal, the scan scam, and a host of other socially distasteful practices as the market has sought to tighten its hold on sport, the media and every other facet of our lives. That things like this would occur was predictable and was predicted. True believers were deaf.
The argument that our market is intrinsically
different to that in the USA and that US corporate ideas and
practices will not dominate must be accepted as an illusion.
Any argument for a competitive healthcare marketplace must confront and examine the health care marketplaces which already exist. The only place where a "health care marketplace" in the true sense of the word has developed and operated over a sufficient length of time for its full impact to be realised is the USA.(30 years). They have also had ample opportunity to adjust to problems. In other countries the marketplace has been limited, peripheral, tightly controlled or very modified and restricted.
New marketplace models, like that proposed by Samuel in his speech to the World Bank claim to be different and to have addressed the problems of failed market systems. It is therefore important to carefully analyse failed systems to see where they have failed, the extent of their failure, and why they have failed. Are the failures due to the underlying paradigms of understanding, the philosophy and practices of the market or are they a consequence of inappropriate pressures from alternate systems.
Samuel identifies failures in professional
ethics and belief systems and he is very critical of professionalism.
I examine some
aspects of professionalism in the
same way on another www page. Both paradigms need to be evaluated in
their historical context
The USA has been selling their market system to the world for a number of years. US companies are the most active in establishing international divisions and are enthusiastic about the opportunities offered in international markets. US groups have established advisory services to other countries and US businessmen have set themselves up as international health care consultants. They claim credibility and discredit their critics by marketing their activities as "reform". Ron Williams in his book "Remission Impossible" published in 1992 indicated that these megacorps would not enter our market unless they could conduct businesses their way and structure the system for their purposes. Marketplace advocates plan to open our "health care market" to them - as do those promoting globalisation as an economic rather than a social process.
The US Coalition for Service Industries (CSI)
is promoting the inclusion of health care in international
trade agreements. It is pressing for
"liberalisation" of health care and the US government has identified
with their mission. It is pressing this in international trade talks.
The CSI justifies this on the basis of the vast profit opportunities
for US companies in the international arena. It views the local
regulatory structures which protect patients as obstructions to be
liberalised. In Australia two US multinational corporations have
fallen foul of our obstructions - the probity provisions which
protect our citizens, and which our government has already dismantled
in aged care.
US corporations become particularly active
when they face pressure from fraud
investigations. They are able to
cushion problems in the local marketplace by expanding overseas and
relying on their international operations to tide them over.
Australia has been at the receiving end on three occasions.
However strongly theorists deny that they are promoting the US system the reality is that what we will get is US ideas, US managers and US companies. We need only look at what has happened in other countries to date. Australian business is already heavily colonised by US managers. Managers of local hospitals have brought in US managers to give them advice. No advocate of a market system in health care can credibly maintain his position unless he fully confronts what has happened in health care in the USA. Marketplace advocates like Samuel and Wooldridge do not do so. This www site describes the US system in detail. It also describes the way in which US health care principles and practices have been introduced into other countries.