Best-Laid Plans: Health Care's Problems and Prospects

Is health care like the BC Ferry Service or Ontario Hydro? Lawrie McFarlane and Carlos Prado argue that health care is being treated as though it were just another public utility and that the present crisis in medicare has developed precisely because of this approach. In The Best-Laid Plans they contend that what health care needs is less centralized management and the restoration of empowerment to both patients and care-givers. Contrary to recent attempts to reform health care, which have been based on the assumption that all health care needs is better management, McFarlane and Prado contend that what separates health care from other public services is the complex relationships between the service providers (doctors, nurses, physiotherapists, etc.) and their clients (patients), and the tendency for these relationships to evolve in unpredictable ways. Using Michael Foucault's "genealogical" and "ethical" analyses to explain the unpredictable nature of interactions in a high stakes, emotionally loaded environment, the authors demonstrate how planning, administration, delivery, and reform of a basic public service have gone wrong.