Abstract
In the past years, Zed Books press house has distinguished itself for a series of publications particularly critical of current neoliberal economy; publications of which The Health of Nations is a significant example. Mooney reflects upon present problems and future developments of contemporary World’s health care system. By highlighting ‘the enormous difference between the rich and the poor’ (p. 3) in four case-studies (the USA, the UK, Australia and South Africa), the book finds a possible solution to the current social inequality and global emergencies, such as global warming, in a‘communitarian’shift in health care policy.
Following Harvey (2005), the book is an open critique of neoliberal economics and ethics that pervade current health care policy-making. Neoliberal thinking is based on an assumption that a free(d) market can reach a socially optimum equilibrium with regard to production and distribution of services. Thus, also in health-care, state intervention is considered as only able to worsen the efficiency reached by market(pp. 69–70). In the past decades, Mooney notes,national governments and international institutions have followed these principles (pp. 44–55) resulting in a powerful individualist and subjectivist turn into policy-making and dismantling post-WWII social programmes. Despite original hopes, 40 years of neoliberal politics have globally resulted in individualization of society, weakening of social solidarity, commodification and medicalization of health care, and eventually the development of an unequal and inefficient health care system. The social price of this transformation is paid mostly by the poor.
By describing the making of the neoliberal health care system, Mooney brings to the fore the political dimension that underpins it. In a plain and clear language, he shows the fundamental role played by pharmaceutical industries, medical associations, mining and other manufacturing enterprises in affecting policy-making. Conversely, people appear marginalized, even ignored, in the current decision-making process.
One of the key questions at stake throughout the volume is the identity of the beneficiaries of the present health care system. The book suggests they are corporate or political lobbies rather than people. Mooney points out that the way to bring back people to the centre of health care ‘is threefold: first, to get acceptance of the need for a debate about who exercises power over resource allocation in health care, and about who should exercise power at what levels; second, thereby to gain greater recognition that the issue is one of political economy; and third, to seek to influence the nature, funding, principles and priorities in this sector by shifting power to the citizenry’ (p. 132). This threefold intellectual and political turn corresponds to moving from a health care system focused only on the individual well-being, to a new one interested in the well-being of the entire society – here considered to be following Durkheim, more than the sum of its individual parts (cf. p. 124) – and rooted in the ideals of social efficiency and social equity (cf. 133). In the intentions of the author, such a reform represents a factual strategy to eliminate poverty, strengthen equality and democracy and reinforce the sense of community and belonging (p. 144).
The book can be read within a broad and long-lasting debate about the social impact of neoliberalism, and Mooney’s communitarian project is an original element of a thread of research aimed at formulating a new political economy based on the well-being of the people. The book is particular effective in opening the ‘black box’ of current health care politics, and highlighting the systemic problems that affect it. In particular, in the case of development studies, Mooney’s is a lucid analysis of contemporary global bio-politics and the role that international institutions, national governments and private enterprises play.
While neoliberal politics is seen as generating and reinforcing global inequality, empowering citizens, that is to reinforce democracy, may be an answer to the worst deficiencies of present health care system. While Mooney links this process to a communitarian turn in policy-making, however, the cultural, social, and geographical extension, composition and organization of the communities at the basis of the author’s proposal are not clear. Unfortunately, the reference to a local contextualization of these fundamental aspects of a community (cf. p. 126) does not solve completely the conundrum.
Moreover, in Mooney’s argument, the effectiveness of a communitarian-oriented reform of health care system appears to lie in an assumed discrepancy of understanding of politics between current (neoliberal) ruling elites and the (non-neoliberal) broader body of citizens. On this basis the transfer of power from ruling elites to the body of citizens would result in a radical shift in understanding – and hopefully practicing – of politics. However this transfer may not be so effective when the neoliberal ideals are shared throughout society: a particular case in point is continental Europe.In this context, I would argue,a transfer of power risks creating a new health care system that presents the same systemic deficiencies of the current one. Unfortunately, Mooney does not investigate the case of European states, such as Italy, where neoliberal-oriented reforms of health care system have been enforced with a strong popular consensus in the past twenty years.
Although these questions are left open, because of its overall clarity and straightforwardness, the volume is particularly advisable as an introductory reading for students and researchers who are approaching the theme of health care. In particular, academic readers as well as the general public can find a thought-provoking reading in Mooney’s investigation and description of the tangle of interests that underpin the health care system. The communitarian thesis, then, represents a valuable exercise in the urgent task of rethinking present politics and democracy.