ABSTRACT
Health care systems pay too much attention to the ‘medical model.’ A more moderate approach seeks greater democracy in health care in order to enhance citizenship and reduce dependence. There are a series of standard diagnoses, and these can be predicted from the training and institutional positions of the people making the diagnoses. Economists are interested in efficient allocation of resources. Welfare calculators recognize that the ‘problem’ with insurance is the point of insurance: both insurance and health service systems were created precisely because people did not want to face tradeoffs at the point of service. Spending for either local health care systems or compulsory sickness funds affect the ability of the national government to raise revenues for other purposes. Internal market reforms offer finance ministries a chance to appropriate both the usual economic and public health arguments about the inefficiencies of the medical model, and use those to justify lower funding.
