On the Concept of a Socialist Health System: A Question of Marxist Epistemology

Abstract

This paper concerns the best approach to the concept of a socialist health system. It first criticizes a narrow empiricism, which reduces the subject to a phenomenalistic study of existing health systems in socialist countries, paying insufficient attention to historical contexts and developments and to the worldwide evolution of socialist ideas. Such a rightist empiricism, separating practice from theory, is then contrasted with a leftist idealism, which separates theory from practice. The latter approach entails abstract models of an ideal socialist health system with many characteristics, without specifying which are the necessary and sufficient ones for applying the global designation “socialist.” This leads to epistemological confusion and a deterministic view of the relation of the social formation to the health system, which is in fact complex. A socialist health system is best seen as an aspect of socialist theory rather than as an actual social entity. Viewed this way, it can act as a continuing guide to social practice and be enriched by that practice. Taking an appropriate class standpoint, socialist health theory should relate to social factors in the causation of disease and in the capacity of peoples to undertake health-related activities and to the social control of health care services and related industries.