ABSTRACT
This chapter examines the emergence of health care rationing as an issue of public debate. In particular, it seeks to show how such a debate offers a false promise of democratic policy making that seems to accord with aspects of Habermas’ ideal speech situation. We argue that attempts to gain public agreement and involvement regarding the principles underpinning decisions about resource allocation in health care do not meet the criteria for undistorted communication and therefore reflect underlying power relationships and indeed may replicate them. More importantly, we would argue, debates concerning criteria for rationing do not necessarily represent a positive way forward for empowering the general population but, rather, could represent a colonization of lifeworld values that have to date resisted such rationalization. We conclude that most attempts to create socially acceptable criteria for the rationing of health care services are doomed to replicate system-world priorities because of the way that they are set up. We further argue that in attempting to place health policy on a rational footing insufficient attention has been given to the processes and interests created by the operation of ideology in class societies.
