SCIENTISM AND ECONOMISM IN THE REGULATION OF HEALTH-CARE

As health care costs continue their apparently relentless rise, it see ms to be universally perceived that the United States and western Euro pe are gripped by a cost crisis. To resolve the apparent crisis, U.S. and western European governments and third-party payers are turning in creasingly to a new positivist discipline, called health services rese arch, for which neoclassical health economics is the dominant discours e. However this discipline may actually reinforce the strength of biom edical positivism and the concomitant technological imperative. Like b iomedicine, health services research is technologically driven, depend ent on ''advances'' that generate more comprehensive and therefore mor e ''accurate'' data. Accordingly, just as biomedicine causes health ca re workers and patients to depend on technologies for diagnosis and tr eatment, health services research instills in the body politic depende nce on technocratically conceived solutions for political problems. Mo reover, because biomedicine and health services research share positiv ist epistemic and methodological premises, both objectify the subjects they study, abstract those subjects from context, and thereby ignore the cultural dimensions of the problems at hand. Rather than inculcate an ethic and practice in which medicine focuses on the meaning of ill ness for a life, a cultural phenomenon, this form of positivism streng thens the tendency to reject meaning in favor of the causes and course of disease and the abstracted probability of its occurrence. Accordin gly health services research and the forms of regulation with which it is allied threaten to overwhelm the medical humanities movement. Furt hermore this scientism precludes the institutionalization of political forums in which we can deliberate on the meaning of medicine, health, and death in our lives.