CORPORATE PRACTICES

In confronting individual corporations I had written accounts of the conduct and culture of several of them. Tenet/NME, Columbia/HCA, Mayne Nickless, Sun Healthcare, Revesco, the WTO, the World Bank etc.

My plans to write a critical analysis of what was happening and create an understandable context were frustrated by the flow of events and the need to respond to the governments actions, the advent of groups like Healtheon and Revesco, and the attempt by US corporations to impose their system of health care by using the World Trade Organisation (WTO)

I was precipitated into writing these pages by Graham Samuel's speech to the World Bank. This highly theoretical economic model exhibited all the worst features of ideological blindness. Not only did it not make any sense outside his narrow economic paradigm but it simply ignored a vast body of knowledge about the way the health care market actually operated and the consequences for the people it should have served. Instead of confronting evidence he either denied it or pretended it did not exist.

I responded with a wordy criticism attacking this model and exploring each of his claims in detail relating it to what had happened in the marketplace. In doing so I wrote many of the pages in this section of the www site. His speech is consequently the focus of many of the pages.

I have now reworked my criticism of Samuel's abstract model making it more pointed and setting it against the actual experience of "consumers" in the marketplace. I have used the original text as the basis for a number of pages and linked these to the criticism. There were also a number of other more analytic pages I had written earlier in this section. Some of the pages arising from my criticism of Samuel's speech fit into other sections and are found elsewhere on this site.

The end result has been a series of often overlapping pages dealing with different facets of the marketplace model. Several pages touch on related themes. I have responded to criticisms of professionalism by acknowledging some of the problems and analysing the reasons for them. A number of pages touch on the roles of professionals. Others examine what Samuel calls "consumers".

Many of the pages in this section address in one way or another what Samuel calls "starting points". These are the fundamental apparently self evident understandings around which people build their ideas of the world and how to behave in it - their norms and values. We can call them meaning systems, frames of interpretation or paradigms. In other pages on this www site I have explored the importance of starting points and paradigms in determining how we are likely to behave. I have related this to

• context - the situation in which we find ourselves, and to
• identity - who we are in the sense that "I am the person who has done this"

I have looked at the way people behave when they are faced with conflicts between paradigms, and also when they are under pressure to adopt paradigms which are discordant with the contexts in which they find themselves.

For the purpose of analysis I have identified two key paradigms and set them against one another.

The market paradigm:- I have identified the market paradigm as primarily about self, personal advancement and the rights of individuals. Its mode of operation is competition. It is the place where we buy and sell goods, where we generate the wealth which allows us live well and be a caring cooperative community. Its success depends on being distrustful.

The community paradigm:- I have set against this a community and Samaritan paradigm. This is primarily about responsibility to others, empathy, humanity, belonging. Its primary mode of operation is cooperation. This is the world we all live in when we relate to others and attend to the well-being and needs of the community and of our fellow humans. Its success depends on trust. Its understanding of civilisation is very different to that of the market place. The health of the community and Samaritan paradigm is intimately related to the idea of a "civil society". In her Boyer lectures Eva Cox argued for a civil society. A civil society cannot exist in the marketplace, but the market is an essential servant and a prerequisite for a civil society.

There are clearly activities and contexts which lie in the market domain and others which lie in the community's domain. Health and aged care are clearly in the latter.

Most of the pages in this section explore the application of these two paradigms and their starting points to issues surrounding health and aged care.

Language is developed in response to the situations in which we find ourselves and the paradigms we develop in that context. Each change in context and understanding calls for an expansion and redefinition of language. This takes a long time. To begin with we are stuck with what already exists.

The discourse of the last century has been between the right and the left - capitalism and socialism. Language and understandings have followed. The market model of health care represents the extreme right. In criticising it I use the language of the left. This exposes me to labeling as being socialist or even red. This is far from the truth.

Criticising the market:- If I was a businessman and some idiot from the far left proposed turning the marketplace into a commune or collective where the product of all effort was shared among all of society I would be very indignant. I would use the language and the rhetoric of the right to attack and discredit him. I would show that this had already been tried in Russia and had not worked. This would be perfectly appropriate.

At the same time its is perfectly legitimate for the community and its other structures including health care to be critical of market practices. Point out that it is overemphasising greed by the use of incentives, that it is endangering the environment and the health of citizens, that it is taking unfair and unjust advantage of the vulnerable, that its marketing is deceptive and so on. We can complain that its overemphasis on competititiveness is having an adverse impact on society as a whole.

We would expect the market to take note and address the problems. Like other structures in society it has an overall responsibility to benefit the community. The medical profession and environmentalists would lend a hand and offer helpful suggestions. They would not take over the marketplace and set it up as a clinic.

Criticising health care:- As a doctor and a citizen, I am faced with a series of idiots from the far right who propose turning health care into a marketplace where vulnerable citizens are traded for the personal profit of individuals. I use the language and the rhetoric of the left to attack and discredit them. I show that this has already been tried in the USA and has not worked. This action seems appropriate.

It is perfectly legitimate for the community and the market as part of that community to point out that the health care system has not been financially responsible and that it is wasting scarce resources. It is not serving the community as well as it should. The market and economists can lend a hand and offer helpful suggestions. It is not legitimate or socially responsible for economists to take over health care and turn it into a market.

What I am criticising then is not belief systems. They are integral to our lives. We cannot do anything without frames of understanding by which we recognise and interpret the world around us. Because we live our lives in different contexts (business, farming, medicine, the army) we seem to live in different worlds. Understandings will come from the "worlds" individuals live in. Any understandings from another "world" will be carefully set against our "world" to be sure that they make sense in our world.

What I am criticising is extremism. The idea that some idea which one group uses in their world is a universal truth. That it applies to all other worlds and that all other worlds must be forced to comply with it because it will benefit them. There is nothing as right and convincing as belief. Fact and logic become irrelevant.

Extremism of one sort or another has been the curse of the 20th century. It is the debris of the 20th century which threatens to litter the 21 st with another series of dysfunctional social crises which make the world less livable.

What is behind my arguments and my thoughts for the future (in this instance health care) is that starting points and paradigms are no more than tools for the job. We need to examine what we are trying to accomplish and what issues it raises. We can then choose the paradigm or set of paradigms which seem most appropriate. We can objectively examine and confront conflicts created by paradigms and take steps to understand and address them.

Central to this is the idea that as a society we should detach identity from grand ideas and all encompassing beliefs. We should ground our lives and our identities in the different contexts in which we live. It also means learning to live with different paradigms, understanding how they work, selecting those we need and openly addressing conflicts between paradigms.

All this is immensely difficult in a world which thrives on uncertainty, and generates productivity by fostering insecurity. It is difficult in a world rendered distrustful by a dominant marketplace ideology. In such a world individuals grasp at all encompassing ideas as a lifeline to pull them to solid ground. It is extremely difficult in a world where individuals are bombarded with marketing that is filled with unstated ideological presuppositions. It is compounded by politicians who secure power by promoting simplistic overarching ideas based on a particular ideology.

As indicated earlier this section consists of a large number of pages analysing and criticising. The content was written at different times and in response to different developments in health care and the marketplace.

The next page contains a list of the material with a short summary indicating the content. Many of these pages can be accessed from the criticism of Samuel's speech, where the order follows Samuel's argument's.

CLICK HERE -- to go to the summaries of these pages