Some conclusions about the threat posed to the Australian system by Columbia/HCA, concerns about the application of marketplace forces in health care and concerns about the fundamental contradictions in economic rationalist theory

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Columbia/HCA Update

The attempt by Columbia/HCA to enter Australia not only presents an immediate problem and a threat. It also opens up wider issues at progressively more fundamental levels. It raises major questions about the direction which health care is taking in Australia. It raises issues about the application of current political theories to healthcare and other humanitarian endeavours. At the deepest level it challenges the validity of these theories, the ideas on which they are based and their applicability.

1. At an immediate level there are serious concerns about the practices of the company Columbia/HCA which is attempting to enter Australia. The concerns relate not only to whether it has indulged in criminal conduct but whether its commercial conduct indicates that it is a good and desirable citizen. Is it the sort of person we should welcome in Australia? Further than this we must ask whether its philosophy and approach to medicine is appropriate for the medical arena and in particular whether it is appropriate for the medical arena in Australia. Is it a fit and proper person to hold hospital licences within the meaning of Australian regulations?

2. A theoretical framework has been developed to handle the dysfunctional conduct of large corporations as revealed in healthcare. This draws on a psychological concept of open and closed minds, a psychiatric concept of successful sociopathy and the sociological concept of social control. It is suggested that there is a balance between these. When social control is impaired by forces in society then dysfunctional closed minded behaviour and sociopathic conduct are not controlled or directed.

3. The movement towards large corporations results in a loss of social control. Globalisation and the adoption of an economic rationalist ideology which sees corporatisation and management as universally applicable to all forms of human activity compound the problems of social control. These paradigms do not pay service to the values which society uses to control deviant conduct. Traditional systems based on these values are seen as archaic and in need of cultural reform. This is accomplished using "change and quality" arguments which have little relevance to the systems targeted. These corporate forces come into direct and irreconcilable conflict with societal values in the provision of health care. The limitations of economic rationalism are exposed to those still able to look.

4. It is suggested that economic rationalism and managerial prescriptions based on economic rationalist theory are not universally applicable to all forms of human activity.

5. It is suggested that at the deepest level there are fundamental flaws in economic rationalist theory and in the way in which managers apply it. This is because it is based on economics without a proper understanding of human cognition and the nexus between the individual, culture and society. Process and abstraction become more important than reality which is subjugated to a theory which cannot be challenged. As a consequence it is alienating and causes a loss of morale. It capitalises on self interest and destroys the values which bind the individual to society, so making it work. It is neither rational nor economic within any wider frame of interpretation. This is well illustrated by its application in humanitarian endeavours, particularly the care of the sick. The USA is an excellent example and Australia is not far behind.

In 1967 Peter Berger the US sociologist, stressed the dangers in thinking of the structures of society "as entities existing in and of themselves, detached from human activity and production". ¹⁵⁵ The economy is one such structure. It is only a part of society and is interdependent with other structures. It is a product of human activity and is maintained by individuals behaving humanly. There is a danger in viewing these structures as static and separate. Berger indicates that "understanding ought always to be humanizing, that is, ought to refer back the imposing configurations of social structure to the living human beings who have created them." The problem with economic rationalism is that it fails to do so. It exists only within the framework of one structure in society, and does not address society as a whole. Proponents do not confront it within this context or within the context of structures which they seek to 'reform'. Berger continues "Society, then, is a product of man, rooted in the phenomenon of externalization, which in turn is grounded in the very biological constitution of man." It is here that the basic flaws in economic rationalist concepts and their consequences are revealed, and an understanding of their alienating effect becomes apparent.

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Central Map ..... Initial Map ..... USA Map ..... Australian Map ..... International Map ..... Corporate Practices Map..... (to print)

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Path
Home Page .... US Corporate Page .... Access to Columbia/HCA

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Overview 1 (1997) ... Overview 2 (2000) ...Overview 3 (2003) ... Patients ... I told you ... Licenses

Columbia/HCA submission pages
Background--The USA--Australia--Business Practices--Mayne--Conclusion--References

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Last modified October 1998 J.M. Wynne
checked August 2003