Goldstein Evan V
Med Humanit. 2019 Mar;45(1):45-51. doi: 10.1136/medhum-2018-011469. Epub 2018 Jul 14.
Without question, the American medical craft-the physicians, clinicians and healthcare organisations that comprise the American healthcare sector-provides immense value to patients and contributes expertise on matters relevant to the public's health. However, several conspicuous realities about healthcare in America should give the reader pause. Most problematic are the comparative measures of access to care, quality of care, life expectancy, racial health disparity and cost, all of which demonstrate how many Americans experience relatively lower value public health than other Western liberal democratic states. Since the early 1900s, American medical craft behaviour contributed to suboptimal social investment in public health, successfully influencing greater medical investment and higher healthcare expenditure relative to social welfare investments. Today, American policymakers seek the 'holy grail', a mythical panacea that purports to restrict spending and improve care quality and value, leading the USA to chase 'technocratic solutions to political problems'. This paper explores the claim that the USA is hampered by suboptimal public health decision making. Public health decision making has been historically impacted by the overextended reach of medical craft expertise-technê in Platonic terms of art-as permitted by the American democratic political system. American policymakers must not forget that the debate over technê, epistêmê, sophistry and who should have authority in public affairs is not new. Rather, it is an ancient debate, and now as then, the ancient arguments remain relevant in a democratic context. For particularly helpful insight, one ought to look no further than the lessons of Plato's dialogues. Platonic lessons on expertise and decision making can enlighten our understanding of modern public health decision making, specifically regarding the appropriation, allocation and distribution of health-related resources in the state.
毫无疑问，美国的医疗行业——包括医生、临床医生和医疗保健组织在内的美国医疗保健部门——为患者提供了巨大价值，并在与公众健康相关的事务上贡献了专业知识。然而，美国医疗保健领域的几个显著现实应该让读者有所思考。最成问题的是在医疗服务可及性、医疗质量、预期寿命、种族健康差距和成本方面的比较指标，所有这些都表明，与其他西方自由民主国家相比，有多少美国人享受到的公共卫生价值相对较低。自20世纪初以来，美国医疗行业的行为导致了对公共卫生的次优社会投资，成功地影响了相对于社会福利投资而言更多的医疗投资和更高的医疗保健支出。如今，美国政策制定者在寻求“圣杯”，一种据称能限制支出并提高医疗质量和价值的神奇万灵药，这使得美国在追求“用技术官僚的解决方案来解决政治问题”。本文探讨了美国因公共卫生决策欠佳而受到阻碍这一观点。从历史上看，公共卫生决策受到医疗行业专业知识（用柏拉图的艺术术语来说就是技艺）过度延伸的影响，这是美国民主政治制度所允许的。美国政策制定者不应忘记，关于技艺、知识、诡辩以及谁应该在公共事务中拥有权威的争论并非新鲜事。相反，这是一场古老的争论，而且现在和当时一样，这些古老的论点在民主背景下仍然具有相关性。为了获得特别有益的见解，人们只需看看柏拉图对话录中的教训即可。柏拉图关于专业知识和决策的教训可以启发我们对现代公共卫生决策的理解，特别是关于国家卫生相关资源的拨款、分配和分发方面。
