Rediscovering Comte de Saint-Simon: From Aristocracy to Meritocracy, a Journey to Inclusion

Abstract

A born aristocrat, Saint-Simon converted to meritocracy, advocating a technocratic concept where economy was managed by technical masters whose leadership was based on merits and who were neither entitled nor elected but fitted to navigate the organizational change. We introduce a health-care efficiency assessment model construed on the elements of Saint-Simon’s utopistic theory. Social morality and technological optimism are analyzed to conscript arts of doctrinal ends with arts of productivity. A debate between the technocratic and market-based health care rests on a transcendent, yet anthropocentric criteria: value, valence, and expectancy. Based on a comparative effectiveness analysis of health-care value and expectancy, the German, Spanish, and Japanese health-care systems appear to be closer to the technocratic model due to the principal of social solidarity and uniform evaluation standard that define the schedule of charges for services and their relative point value to one another. Germany, Spain, and Japan spend less on per capita health needs than the USA; however, in those countries life expectancy is higher than that in the USA. The American health-care system utilizes more MRI exams and the physician’s EMR response is lower. In a cross section, maternal, neonatal, and perinatal mortality rates are higher in the USA compared to those in Germany (relative risk (RR) = 4.0; 2.0; 2.6 correspondingly), Spain (RR = 7.0; 1.5; 8.0), and Japan (RR = 4.7; 4.0; 24.0).