27 Mar

Health Care Reform: the role of social theory

Posted By Politybooks

First posted 8th December 2009

December sees the publication of two second editions: Patrick Baert & Filipe Carreira da Silva’s Social Theory in the Twentieth Century and Beyond, and Elaine Denny & Sarah Earle’s Sociology for Nurses. In the first of this month’s posts focussing on health-related issues, Filipe Carreira da Silva (Research Fellow at the University of Lisbon) writes about what social theory has to offer debates about health care institutions and reform.

High in Obama’s agenda in his first year in office is the reform of the US health care system, one of the developed world’s most dysfunctional health care systems. Yet, the challenge of providing universal and general health care without overburdening national budgets is far from being a uniquely American issue. In the UK, for example, the debate over the efficiency and economic sustainability of the NHS is almost as old as the NHS itself. The same is true in dozens of other countries around the world. It is no wonder then that efforts to reform health care systems are being scrutinized by the media as never before. Heated debates over the best solutions are receiving today almost daily media coverage. Many voices can be heard in these debates, from those who still advocate a free market “one-fits-all” kind of solution to those who mourn the demise of the postwar welfare state and urge for its rebirth.

Social scientists, I believe, can have their voice heard in this public debate as well. Consider social theorists. There are those (such as the “new institutionalists” in the areas of rational choice, historical, and sociological institutionalism) whose work deals with the origins and consequences of social and political institutions. National health care systems are one such type of institution. It is important to enlarge the public understanding of what is at stake by showing, for instance, the long-term, structural resilience of social institutions: once created, it can be exceedingly difficult to change (let alone get rid of them) because of the costs associated with such change even though their current performance is a far cry from the initial expectations that had led to their creation decades earlier.

Another aspect that social theory can illuminate is the consequences of economic globalization (for example, the work of Manuel Castells, Saskia Sassen and Richard Sennett), particularly for the postwar welfare state. This particular political institutional configuration was created within a specific period of modernity in which nation-states, social classes and national citizens were neatly conceived as both socioeconomic and political realities and social scientific objects of study. This sort of methodological nationalist bias was first criticized in the 1970s and has come under serious scrutiny in recent years following the economic globalization of the 1990s. As modernity shifts and is reinterpreted in different ways in different civilizations so its institutional forms (the nation-state and its institutional apparatus, scientific disciplines, etc.) have been changing, differentiating and dedifferentiating too. It follows that discussions on health care reform can only benefit from a better understanding of social institutions as concrete embodiments of national responses to the question of what it is to be modern. Social theory has shown the extent to which this is a question that admits of multiple answers and, as such, can help broaden the scope of possibilities in public debates over institutional reform.

Several other social-theoretical insights could be pointed out. Take the control over the bodies of citizens that the institutions of the state possess: from mental institutions to genetic engineering research, and from prisons to the public surveillance of our cities, the modern state’s politics of control are very much a defining feature of our “brave new world” (see, for example, the biopolitics of Michel Foucault). Or consider the way socioeconomic inequalities are reproduced by institutions created to eliminate them (see, for example, the work of Pierre Bourdieu). Even more than health care systems, public school systems have been exhaustively studied from this perspective in one of sociology’s most passionate yet inglorious civic battles of the second half of the twentieth century.

Social theorists rarely see themselves as part of an institutional sub-unit in the social sciences. But I guess we all agree that, despite our differences (or because of them), what we have to say about a real-world problem like health care reform puts things into perspective in a way that can vastly enrich public debates. The pen can indeed be a mighty sword.

The second edition of Filipe and Patrick Baert’s Social Theory in the Twentieth Century and Beyond is released this week, providing an easy-to-read but provocative account of the key figures and classic schools central to the development of social theory, as well as the cutting-edge developments in social theory today.