Sophistry in American medicine? Platonic reflections on expertise, influence and the public’s health in the democratic context

Abstract

Without question, the American medical craft—the physicians, clinicians and healthcare organisations that comprise the American healthcare sector—provides immense value to patients and contributes expertise on matters relevant to the public’s health. However, several conspicuous realities about healthcare in America should give the reader pause. Most problematic are the comparative measures of access to care, quality of care, life expectancy, racial health disparity and cost, all of which demonstrate how many Americans experience relatively lower value public health than other Western liberal democratic states. Since the early 1900s, American medical craft behaviour contributed to suboptimal social investment in public health, successfully influencing greater medical investment and higher healthcare expenditure relative to social welfare investments. Today, American policymakers seek the ‘holy grail’, a mythical panacea that purports to restrict spending and improve care quality and value, leading the USA to chase ‘technocratic solutions to political problems’. This paper explores the claim that the USA is hampered by suboptimal public health decision making. Public health decision making has been historically impacted by the overextended reach of medical craft expertise—technê in Platonic terms of art—as permitted by the American democratic political system. American policymakers must not forget that the debate over technê, epistêmê, sophistry and who should have authority in public affairs is not new. Rather, it is an ancient debate, and now as then, the ancient arguments remain relevant in a democratic context. For particularly helpful insight, one ought to look no further than the lessons of Plato’s dialogues. Platonic lessons on expertise and decision making can enlighten our understanding of modern public health decision making, specifically regarding the appropriation, allocation and distribution of health-related resources in the state.