Mostly empty words – what the discourse of “choice” in health care does

Abstract

This paper has two purposes: one is to analyse how the policy of freedom of choice emerged and was formed in the Swedish health care discourse; the second is related to how free choice influences the discourse in health care and how subjects are formed within the field, i.e. what the language of choice in health care does. The research strategy is inspired by a combined theoretical framework borrowed from Michel Foucault's concepts of "discursive formation" and "subjectivization" completed with Judith Butler's concept of performativity. The language of "freedom of choice" calls to mind the rhetoric of promises, i.e. that the patient should be free and responsible, in his or her relation to health care. Since patients seem to be insufficiently informed and supported about the actual benefits of possibilities and limitations associated with the severely restricted reform of free choice, the statements concerning opportunities to make personal health decisions will lose their significance. The advocacy of discourses of freedom of choice seems therefore mostly like empty words, as they are producing weak patients instead of free and empowered people. As the reform was initiated in the beginning of 2000 it is rather fresh. The paper produces insights into the rhetoric of political promises and the limitations of the reform dealing with freedom of choice in health care.