The caring commodity : transformations in the exchange character of medicine in New Zealand (1840-1985) : a thesis presented to the Dept. of Geography, Massey University in complete fulfilment of the requirements for the degree of Master of Arts

Retrospective analysis of actions and interactions connected with health care makes evident their place as constituted and constitutive components of capitalist social relations. The contextually constrained activity of individuals to achieve certain ends has contributed to the production of outcomes which appear to be beyond individual control and which shape the social world. In explaining the main transformations in the character of medical services since the early days of European settlement emphasis is placed upon the multiple and differentiated emergence of various structures of relationships between, principally, doctors and patients, doctors and doctors, and those who, at various stages, have attempted to intervene in those relations. Over the period 1840-1985, medical practice has been transformed from a service provided on a user-pays basis, to one of collective provision, and back towards the "private" sector. In the six decades after 1840 medicine and the State became enmeshed. Some moves towards the State provision of health care services occurred. The period 1900-35 saw the supporters of both free enterprise and socialistic medicine inexorably drawn towards advocacy of some grand scheme of collective care, the character of which was extensively debated from 1935 until 1942. The outcome brought "free" provision of most medical care to those in need and also served the long term interests of capital. Since then, health care has been returning to the market. In part, the broad sweep from, and back to, commodity relations has arisen from actions to "solve" problems of health care provision and use. The solutions arrived at, however, have been compromises between conflicting demands. Although at times "solutions" may have facilitated the more humane allocation of medical services, the general tendency is for them to reproduce capitalist social relations

Reviving egalitarianism in the Global Transformation: Building occupational security

The world is in the midst of a Global Transformation, reflecting the painful creation of a global market society. Globalization was the disembedded phase, in which inequalities and insecurities multiplied as national systems of regulation, social protection and redistribution were dismantled or broke down. This reflected the collapse of labourism and systems of industrial citizenship, and an end to the building of national welfare states as the development objective. The outcomes were unsustainable. But what should be the counter-movement by which the global economic system will be re-embedded in society? This article suggests that a new approach to social and economic security is required, one that places work and occupation at the centre of life rather than labour, and one in which universal basic economic security is the primary development objective. In order to move in that direction, this article advocates the use of five policy decision principles by which all policies and institutional changes should be evaluated. It concludes by sketching a progressive strategy oriented to occupational citizenship, giving equal respect to liberty, equality and fraternity, or social solidarity. The world is in the midst of a Global Transformation, reflecting the painful creation of a global market society. Globalization was the disembedded phase, in which inequalities and insecurities multiplied as national systems of regulation, social protection and redistribution were dismantled or broke down. This reflected the collapse of labourism and systems of industrial citizenship, and an end to the building of national welfare states as the development objective. The outcomes were unsustainable. But what should be the counter-movement by which the global economic system will be re-embedded in society? This article suggests that a new approach to social and economic security is required, one that places work and occupation at the centre of life rather than labour, and one in which universal basic economic security is the primary development objective. In order to move in that direction, this article advocates the use of five policy decision principles by which all policies and institutional changes should be evaluated. It concludes by sketching a progressive strategy oriented to occupational citizenship, giving equal respect to liberty, equality and fraternity, or social solidarity

The difference that tenure makes

This paper argues that housing tenures cannot be reduced to either production relations or consumption relations. Instead, they need to be understood as modes of housing distribution, and as having complex and dynamic relations with social classes. Building on a critique of both the productionist and the consumptionist literature, as well as of formalist accounts of the relations between tenure and class, the paper attempts to lay the foundations for a new theory of housing tenure. In order to do this, a new theory of class is articulated, which is then used to throw new light on the nature of class-tenure relations

Comparing workfare regimes: similarities, differences, and exceptions

This paper examines the spread of punitive welfare reforms aimed at enforcing work and discouraging unemployment, what we call ‘workfarism’. While comparative institutionalist theories predict that these policies should be confined to countries with ‘liberal’ political economies such as the US and UK, elements of workfarism have appeared in other countries with more generous welfare states, including Germany. Drawing on secondary literature and our field research, we describe and compare workfarist policy shifts in Germany, Great Britain, and France. Our comparison highlights two important but neglected factors: the use of markets in public administration and the central power of the state

Reconstructing data : evidence-Based Medicine and Evidence-Based Public Health in context

The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on «sound facts». The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of «de-professionalization») and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health)

Reconstructing data : evidence-Based Medicine and Evidence-Based Public Health in context

The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on «sound facts». The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of «de-professionalization») and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health)

Is There an Opportunity to Establish the Social-Capitalism in the Post Socialist Transition?

Recently Claus Offe has put the question that concerns the fate of the European model of social capitalism: Can the model of social capitalism survive the European integration in the context of certain contemporary tendencies? Offe has presupposed that the mentioned model is challenged by the processes of globalization and the integration of the post socialist countries into the European Union. The working hypothesis of the article is that there is an opportunity to provide a coherent answer to this question. The article consists of two parts. In the first part the author starts with the Polanyis socio-economic theory and emphasises the importance of this approach for the analysing of the tendencies of capitalism in Western Europe and in the post socialist countries. The author argues that with the Polanyis theory we are able to explicate the forms of the embedded liberalism in Western Europe after 1945 and the orientation of non-embedded neo-liberalism and the functioning of the workfare state after the crisis of the Keynesian welfare state. Despite the tendencies of the globalisation projected by neo-liberalism, the central element of the social capitalism, namely, the welfare state, remains with the dimensions of the continuity. In the next part the author points out that there is an asymmetrical structure between the Western-Europe and non-Western part of Europe concerning the socialisation of capitalism. The neoliberalisation in accordance with the model of the transfer of ideal-type of capitalism is more strongly implemented in the countries of transition. In addition, the mentioned theoretical approach provides opportunities to explain the failures of implementing of neo-liberalism in the post socialist countries. On the basis of the endorsing of the socio-economic aspects we can adress the issue pointed out by Offe.Karl Polanyi, Transition, Social capitalism, Welfare state

From Resource to Burden: Rescaling Solidarity with Strangers in the Single Market

'Organised solidarity' of a mediated legal form constitutes the backbone of the modern welfare state built on solidarity between strangers. The interplay between the single market and the national social systems is key in defining who owes what to whom under the 'transnationalised' European solidarity. Free movement rights have increased the 'entanglement' of national social systems' revenue and expenditure sides, considered to jeopardise their steering capacity. As a corollary to free movement, transnational solidarity does not take place beyond or between national welfare states, but rather within: as solidarity with strangers. Here transnational solidarity is applied by way of a sociological framework to trace the evolutionary path of free movement of persons as it fluctuates between 'commodification' and 'decommodification'. Against that backdrop, this article reviews whether a paradigm shift is currently promoted as to the question where solidarity with strangers begins and ends

"Making work pay" : from justifications to implementations

The aim of this paper is to discuss the relevance of «making work pay» policies from within. We first discuss the various justifications of the motto and then connect them to the existing variety of implementation experiences in Europe. We compare the classical organization of arguments behind the motto "making work pay" to an hourglass, the diversity of national institutions regarding work and social protection being one of its top parts ; work incentives constitute the narrow part ; lastly, the variety of implementations corresponds to its other wide end. We show that this unifying reasoning is not relevant and propose a model which corresponds to a more complex logic : the diversity of national institutions and implementations being matched by a set of different and conflicting objectives regarding work, whose dynamic dimension is gaining more and more importance. The policy debate should then be summed up by another motto : «Making transitions pay».Social protection, labour market policies, work incentives.