Human physical life is trifoldly organized into nerve/sense system, rhythmical/circulatory system and metabolic/limb system. Health is the harmonious working-together of these quite different (physiological and morphological) functions within the body. 1 Disease, on the other hand, is the loss of a cohesive independence of these three systems, and what was appropriate in one area has now become the source of infirmity in another. Thus, the whole person suffers. Even before the actual clinical diagnosis can be made, illness must be viewed as the usurping of the whole by the part.
That the social body-that is, human communal life in its entirety-can be similarly diseased-that is, disordered functionally-is a fact insufficiently recognized today. While in the past human beings were more instinctively related to one another socially, since the 16th Century this is no longer possible, given the steady breakdown in religious authority, the legitimate cry everywhere for thoroughly democratic state institutions and the incredible pervasiveness of modern economic activity. Just as there is no centralization in the individual human organism, that each function contributes equally to the specific whole, so, too, in the healthy social-body three quite distinct activities must be similarly organized. The crucial difference is that in the trifold social-body these separate members must be consciously elaborated: 1) an independently articulated cultural/spiritual life which allows for the free unfolding of human capacities; 2) totally open democratic state-institutions reflecting absolute equality; 3) purely associative economic activity that meets the needs of all consumers.
The current debate as to the rising costs of medical care in this country has obscured a more fundamental issue: How is medicine socialized? That is: How is it to be wholesomely membered into the social organism so that it may neither obtrude, nor be obtruded upon, by forces inimical to its own inherent nature? As the present monolithic state-structure is gradually superseded by a threefold articulation, economic forces will continue to imperil both civil right’s relations and cultural freedom. Perhaps the greatest danger here lies in the blurring of the distinction between actual economic activity per se and the whole field (including labor!) of human rights, but this is closely followed by the annexing of culture, to which medicine belongs, into the state or into the economy. Culture, which is a function of the free unfolding of personal abilities, is not subject to a vote; nor must it become dependent on the variable needs of commodity exchange. A complete and thorough separation must thus exist between what constitutes genuine economic interests, public rights and independent cultural activity, and a healthy, organic sense for these differences will have to develop in order to avoid the real threat of a corporatized state and of an economically vitiated cultural life.
A threefold articulation of the social-body has nothing to do with utopianism. It simply states the reality that everywhere today human beings meet one another in three quite different social spheres. The importance, however, is to clearly understand within which sphere these meetings occur. Each meeting has its own milieu, its own unique context, and it is this context that accordingly characterizes the kinds of meetings that there occur. Like art, religion, education, and science itself, medicine is first and foremost a cultural/spiritual activity, and belongs to that realm where real autonomy must prevail. Furthermore, it is an activity of one individual on behalf of another. There may be other hygenic and/or eugenic aspects, but the pristine moment, as it were, is always individually based. Therefore, how medicine is funded is subsidiary to who provides the care in the first place.
Since the beginning of this century, the practice of medicine has become (re-)restricted by law. The simple proposition of this essay is that state medical licensing laws are a social anachronism and a cultural abuse of the law, and that the deregulation of medicine vis-a-vis state licensing is pre-eminently a healthy expediency founded on the very nature of the activity itself and its relation to the other members of the social organism. Besides providing better care and protection to the consumer, medicine-singular-would then become pluralized -the professions of medicine-thus allowing for the development of real complementarity. 2 And with more choice, the actual cost to the consumer would drop precipitously (which today is by no means a completely subsidiary benefit). As will be argued, the escalating costs, malpractice litigation and institutionalized fraud are directly, if paradoxically, linked to state licensing laws.
“Render unto Caesar” has meaning within one sphere only, the political-right’s sphere. Medicine, on the other hand, to be socially salubrious, must not become subsumed within Caesar’s realm, but must be set free both politically and economically to pursue its high and only mission: to restore the sick to health.
The specious, paternalistic argument for licensing laws as ‘consumer protection’ is not borne out by history nor by practice. Anyone troubling to research this history (see below) will find that these laws were enacted not so much to protect the so-called consumer as to protect a specific profession from outside competition. In fact, it is invariably the practitioners, and not the public, who clamor most for regulatory legislation. The usual, self-serving contention is that the public is too credulous, too ill-informed and distracted to make an intelligent choice on its own behalf. It is time to overcome this prejudice for the simple fact is that, besides the personal tragedy in believing government can protect an individual from an unreasonable judgement, consumers are already sufficiently protected by the judiciary in every case that can be named. That state medical licensing boards are used to discipline incompetent physicians is, at best, only partly true. Equally relevant are the innumerable times these same medical boards are used, acting by way of the police power of the state, to suppress ‘alternative physicians’, squelch legitimate, innovative research, intimidate homebirth midwives, attack the anti-vaccination movement, and generally limit free choice.
“The whole trend of the evolutionary force of modern mankind is in the direction of this threefolding of the social organism. As long as the social life could be guided in all its essentials by the instinctive forces at work…there was no urgent tendency towards this definite membering into three functions. Basically, there were always these three, but in a still dim, unconscious social life they worked together as one. Our modern age demands of man that he now place himself consciously into the social organism.”