3. Cost-control ensures not our health but a rationalized guarantee of the medical system's income. The central issue is how to extend the system while lowering or stabilizing the price.
4. Consumer participation co-opts potentially disruptive citizens by providing participation in medicine as a substitute for political action that might affect the critical determinants of physiological il l health.
5. Ethical 'reform' could limit medical hegemony by concluding that such issues as abortion and life extension are not medical prerogatives. However, medical professionals have co-opted theologians and clergy by expanding their trade and becoming the guiding counselors for appropriate decisions regarding these problems. 1
6. 'Preventive' medical care systems can make every person a client each day of his life. Medicalized prevention tells us that we need the medical system precisely because we do not perceive a need.
Each reform, therefore, represents a new opportunity for the medical system to expand its influence, scale and control. I t is no wonder that the reform efforts are often generated by medical interests. Indeed, should the American people come to believe that health is basically a political affair and abandon the medicalized reform efforts, the medical system would deflate like a great balloon pricked by the common sense of citizens. The system needs the hot air of reform i f i t is to continue to inflate.
The System's Political Functions
Despite the utility of reform as an essential process to promote the growth of medicine, i t would be totally inaccurate to suggest that medical reform is basically a self-serving mechanism of the medical industry. Its 'nonmedical', political effects are now its most important function. Indeed, the reason the 'health care crisis' is so nonconsumable is that we cannot afford to digest i t because its functions are so critical to the maintenance of the status quo. The political functions of the system are numerous:
First, in any economy that becomes capital-intensive, means of distributing income are needed in order to create new markets and to forestall disruptive unemployment. 'Service' systems rationalize alternative means of income distribution. The expansion of the medical system is, in most modernized societies, a primary means of providing income and markets disguised as help.
Second, expanding medical systems require the manufacture of need. As each new need is created, citizens have an increased sense of deficiency and dependence. Indeed, an essential function of professional medical training is to increase the capacity of the trainee to define his or her neighbor as deficient while reducing the capacity of the neighbor to cope.
Third, as physiological health remains stable or diminishes while medical resources increase, political energies are increasingly consumed in the effort to reform the medical system. Next to inflation and recession, 'health' insurance is still the major domestic issue on the U.S. political agenda. The consumption of politics through medical reform is a central function of the 'crisis'. New Ecologist No. 4 July/Aug 1978
Fourth, in many countries current research demonstrates that increasing numbers of people use the medical system for reasons that doctors say are not physiologically based. In the U.S., well over half the 'patients' are classified by doctors as not having physiological problems. When doctors are asked why these people visit them, they identify a series of cultural, social and economic problems. Therefore, their medical 'care' is, by the doctor's own definition, a placebo for that action that could address the cultural, social, economic and political causes of the malady.
Fifth, the growth of medical hegemony provides the training ground for popular acceptance of expertise. As public belief in the need for medically defined service expands, the people act less as citizens. They are more accurately defined as clients. Clients are people who believe that they are going to be better because someone else knows better. In the U.S. this training in 'clientage' contributed to support for the Vietnam war. Having been trained by professional servicers to believe in professional expertise, American clients waged war by putting their faith in 'systems analysts', 'international relations experts' and 'management authorities'. They were given prescriptions for the problem coded in terms of body counts, minilistening devices, herbicides and missions. Prepared for professional dependence, they accepted the diagnosis and prescription of a new breed of war-making professionals.
Sixth, the growth-oriented medical system trains people to accept inequity as the price of progress. Indeed, issues of equity and justice can be most effectively co-opted by the belief that the next professionaltechnological breakthrough will bring health to everyone i f we will only invest our resources in professional 'help'. This 'research and development' argument has been a magnificent mechanism to ensure regressive use of efficacious medical resources while preparing people to accept the generalized proposition that inequity is the price of progress.
Seventh, the most important political role of a growth-oriented medical system is its capacity to obliterate any remnant cultural sense of the limits of a technological society. Communicating its commitment to the death of death, the medical system, by its growth, affirms a world view that places ultimate value in development, exploitation and conquest. In a society that is decaying because of the unlimited growth of technology and technique, medicine's primary political function is to obscure the cause of our dying.
Reasserting the Possibility of Politics
Viewed in these terms, the essential function of medicine is the medicalization of politics through the propagation of a therapeutic ideology. This ideology, stripped of its mystifying symbols, is a simple triadic credo: (1) The basic problem is you, (2) the resolution of your problem is my professional control, and (3) my control is your help. The essence of the medical ideology is its capacity to hide control behind the magic cloak of therapeutic help. The power of this mystification is so great that the therapeutic ideology is being