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Robert McMaster

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Robert McMaster

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Robert McMaster

Standard health economics is an applied field of neoclassical economics. It has three central characteristics: first, it conceives health care interactions in terms of market exchange, albeit these exchanges frequently demonstrate “market failure”; second, it embraces homo oeconomicus: the value of actions rests solely on their outcomes, and following from this, third, health economics attempts to construct cardinal utility measures as a means of evaluation. Each of these characteristics, jointly and separately, has been subject to extensive criticisms. This chapter concentrates on one area of criticism that has not received the attention that it, arguably, merits. The standard approach usually overlooks the importance of “care” and “caring” in the provision of health and medical care. Care is challenging to define – it is instinctive, can be manifest as a range of particular activities, may be associated with a role, and therefore reflects obligations, duties and virtuous behaviour, among other properties. The standard approach cannot capture these features in its reductionist and restrictive framework. This results in the potential for an extensive misallocation of resources in the provisioning of caring services. The chapter advocates a reformed health economics founded on a concept of care – as opposed to market exchange – that properly treats the patient as a person.

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Robert McMaster

The simple answer is ‘Yes’. Care is too important to ignore. Without care, none of us would be around. Feminist economist Julie Nelson (2016, p. 12) argues: ‘The place of care in the economy is everywhere’. Yet the broad corpus of economics, including some heterodox approaches (with the exception of feminist economics) seems to overlook, or under-appreciate this basic fact. Economic accounts featuring care frequently conceptualise it in terms of usually unpaid, heavily gendered activities. Indeed, the separation of the production sphere from the domestic lends to the impression that the site of caring – the domestic sphere – is not really an economic activity. The traditional method of calculating national income further buttresses this fault line. In short, extensive areas of economic activities are largely ignored by much of economics. Arguably, Post Keynesianism is not exempt from such criticism. Whilst elements of Post Keynesianism acknowledge the economy as a system of social provisioning (for example, Lee 2009), to date there has been little in the way of developing the notion, especially concerning the importance of care. In her address to The General Theory and Victoria Chick at 80 (GTVC) conference at University College London in July 2016, Vicky emphasised how Keynes thought that economic growth could/should not be infinite. Chick (2018) maintains that there are signs of a transformation in our economic system that may render economic growth, as we know it, as exhausted or unattainable (see also Chick and Freeman, Chapter 12, this volume). She highlights how in The General Theory, Keynes argued that the marginal efficiency of capital would continuously decline to equal the prevailing interest rate such that investment and saving would be zero. In making this argument, Keynes (and Chick) align to a more Classical tradition of the stationary state. Keynes appears close to John Stuart Mill in considering that a non-growth era could represent a different or high-order opportunity in human development. More recently, the issue of de-emphasising growth has risen in prominence with concerns over climate change. For example, in Prosperity Without Growth, Tim Jackson (2007) discusses Keynesianism and a ‘new green deal’. Others, such as Mariana Mazzucato (2015) and Yanis Varoufakis (2017) support a ‘new deal’, which rejects austerity economics and advocates a universal basic income, and the right to a clean environment, inter alia, as means of fostering human flourishing and combating forces of inequality.

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Robert McMaster