ABSTRACT
This chapter critically examines the problematic conceptual and normative foundations of mainstream health economics in the context of the COVID-19 pandemic. Around the globe, this tradition has informed the development of both measures and policies relating to health and healthcare. For its proponents, this status reflects the utility of health economics as an objective ‘toolkit’: one that applies mainstream precepts to comprehend the value of medical procedures and treatments through generating a particular type of evidence of their potential consequences. We critically reflect on this account by noting problems in the ‘three pillars’ of conventional health economics and in its ‘toolkit’ approach. In doing so, we survey the mainstream analysis of infectious disease, emphasizing the individualism at its center. We contend that the ‘toolkit’ narrative of health economics masks its underlying value structure. All economics is value-laden, and health economics is no exception. Accordingly, we trace the value structure underlying the latter to its utilitarian orientation. Standard health economics equates agents’ behavior with Homo Economicus, which centers on selfishness and atomistic individualism. This is based on ‘I’ language, whereas many health issues necessarily invoke ‘we’ language, with a range of associated ethical implications. Reflecting on these limitations, we contend that mainstream health economics is frequently inadequate in its examination of health and healthcare issues, such as that presented by the COVID-19 pandemic. In developing this critical reflection, we present the basis of an alternative approach emphasizing the importance of language in informing analysis. Our aim is to highlight the need for a broader basis for investigating health and illness: recognizing that the economy constitutes one element of a wider healthcare system that is constitutive of the provisioning processes through which societies produce and reproduce.
