Health Care Vouchers & the Rhetoric of Equity

A new medical conservatism has emerged from the health care politics of the last decade. In both style and content, this movement bears little resemblance to the old politics practiced for so many years by the American Medical Association (AMA). The spokesmen of that earlier era tended to be uniformly strident, uncompromising, and fiercely ideological in their defense of the status quo. By contrast, the proponents of the new conservatism are consistently moderate, conciliatory, and pragmatic. Since most of them are university-based scholars rather than physicians, their writing tends to lack that element of intense and often hysterical self-interest that characterized their predecessors' style. The content of their proposals reflects this spirit of reasonableness and accommodation to the modem world. For example, they unabashedly proclaim the need for National Health Insurance (NHI), in one form or other; they criticize fee-for-services in favor of prepaid group practices; and they even chide the medical profession for preaching a flinty capitalism while enjoying the fruits of a cushy monopoly. As sociologist Paul Starr wryly notes, the socialized medicine of one era has become the corporate reform of the next.1