THE NORMATIVE CONSTITUTION OF PROFESSIONAL POWER

This article concerns the manner in which we think and talk about powe r in health care policy and regulation, and the political and social p ractices allied with that discourse. I assert that in health care poli cy and practice we speak of and live within the era of countervailing power. In this language and practice power is a force exercised by one actor to enforce its will against another actor against whom power is exerted. I contend that this language inculcates an individual and so cial passivity in which citizens rely upon various types of representa tives to constitute health care for them in a manner in which they do not and cannot participate. However, this language of power and the po litical and social practice with which it is associated is merely a co ntingent, historical product. I claim that an alternative discourse of power is possible, in which power consists of the social interactions in which all of us mutually participate but no one of us can control. Power in this sense is participatory by nature, and because no one is in control, it makes no sense to relegate tasks to specialized, nonpa rticipatory domains. This alternative discourse of power, therefore, m ight call forth participatory practices in health care and a concomita nt diminution of specialization and expansion of the public sphere. Th e result would be to blur the lines separating politics from everyday interaction, politics from economy, professionals from patients, and i nsurers from insureds. Participation would mean much more than casting a vote or writing a check but would also include the mutual sharing o f time and energy in the tasks that need to be done: long-term and sho rt-term care, practices of prevention, caring for the chronically ill, and monitoring bureaucratic and professional activities.