On the Relationship Between Medicine and Social Security Systems

Abstract

A serious uneasiness exists in the relationship of doctors, patients, and social systems. In our opinion, this uneasiness arises from the fact that the social system itself functions according to rules other than those of the medical system. Social rules are essentially of the ethical order, illness being part of a system of exchanges which, since it gives the right to certain social benefits, becomes “currency.” In this regard, each party must observe a very particular morality: the subject should, just like any other salesman, sell his “sickness merchandise,” the buyer (the social system) must assure itself of the “good quality of the products.” An eminently paradoxical relationship in regard to the medical model, since one must often prove that one cannot get better in order to be treated well. This complicates the task of the doctor, insofar as it is then a question, for him, of ensuring himself of the “honesty” of the patient rather than of understanding him, making a diagnosis, and prescribing therapy. Each of the participants, the doctor, the social insurance, and the patient, remains convinced of his own good will and of the ill will of one or the other party according to a very well known schema. All are really in good faith but do not understand each other. This sort of conflict seems to us to derive essentially from a logical confusion caused by the amalgam of ethical references and irreconciliable methodologies in the present state of administrative and legal provisions.