Health, Politics & Political Thought

The Social Contract within American Medicine

Photo: “Social Contract and American Healthcare” by Alexis Doss
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Purpose: As an intern for a respected lobbying firm in Washington D.C., I had the tremendous honor of attending many congressional meetings on Capitol Hill. I attended one in particular that explored whether the government or the physcician/provider should have input in health-related decisions that affect the patient. I believe in little to no government participation, given that physicians are the preeminent stakeholders that best understand the elements that contribute to disease and health than any other healthcare actor. This brief will prepare for further economic analysis of how political philosophy can certainly impact health policy and healthcare regulation. I hope to utilize this perspective as a foundation for further interpretations and economic evaluations of sustainable health policy. This post demonstrates my ability to associate political philosophy with healthcare policy.

The understanding of a social contract is arguably the most pivotal aspect of the health care system in the United
States. Unlike other nations in the Western hemisphere, the United States has implemented a more dispersed model of health care procedure; that is, pluralism in the medical profession is revered, specialization and up-to-date technology are highly valued, and emphasis on tertiary care services is greatly preferred. Patients would not accept these specificities if they weren’t openly engaged in and approved of a social contract with the health care system and, more specifically, the physician in practice. 

Social contract theory is a moral and politically philosophical idea rooted within the “state of nature” paradigm of political theory. It is, essentially, the notion that demonstrates the reasoning in which (perceived) rational individuals decide to voluntarily consent to renounce their natural freedom to obtain the benefits of order and accordance. The individual gives up her rights to the state for a myriad of reasons, such as for security, safety, and protection.

This relationship between the state and the individual is analogous to the relationship between the physician and the patient. The physician/patient social contract is an agreement between two parties: one party, the patient, relinquishes her right(s) to acquire medical training and expertise and entrust her physical, social, and mental wellbeing to her physician; the other party, the physician, must provide adequate care to enhance the health conditions of the patient and ultimately prevent death. Principally, “professional sovereignty” of physicians is granted for the betterment of patient health outcomes.

Our interactions, transactions, correspondence, and procedural endeavors rely on the agreement set forth by the patient and the physician. If the relationship is not established, the success of the health care system would inevitably be non-existent. The providing of medical and health care to those in need embodies a certain level of
professionalism. Within the context of American medicine, the physician/patient relationship is the “medical” version of social contract theory, for “in return for the privilege of autonomy, physicians bear the responsibility for acting as the patient’s agent, and the profession must regulate itself to preserve the public trust” (Bodenheimer and Grumbach, p. 57).

Bibliography

Bodenheimer, T., & Grumbach, K. (2016). How Health Care Is Organized – 1: Primary, Secondary, and Tertiary Care. In Understanding Health Policy: A Clinical Approach (pp. 45-59). Place of publication not identified: McGraw Hill Education.

Earning Patient Trust Crucial to Health Care Reform. (2017, April 27).
Retrieved February 05, 2019, from
https://deloitte.wsj.com/cio/2015/04/27/earning-patient-trust-crucial-to-healthcare-reform/

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